K.H.YEE1, M.ENG1, I.EARDLEY2, WD.LAU1
Khoo Teck Puat Hospital1, St James’s University Hospital2
Anterior urethral stricture disease is a relatively common condition affecting men. Worldwide, there is a preponderance of endoscopic treatment of urethral strictures compared to urethroplasty, despite the superior outcomes of the latter procedure. Substitution urethroplasty using buccal mucosal graft (BMG) has become standard of care in the management of a variety of anterior urethral strictures not amenable to endoscopic treatment or excision and primary anastomosis (EPA). In this case series, we report our technique and outcomes of substitution urethroplasty of the bulbar urethra following subspecialty fellowship training in reconstructive urology.
Four patients presented with bulbar urethral strictures and underwent substitution urethroplasty during an 8-month period from December 2019 to July 2020.
Two cases appeared suitable for EPA, but intraoperative evaluation demonstrated a longer spongiofibrosis segment than indicated on pre-op urethrograms, hence augmented anastomotic urethroplasty was performed. There was 1 case of a long-segment bulbar stricture, and 1 case where bulbar stricture was associated with urethrocutaneous fistula. All the cases healed over 3 weeks without immediate or early complications. One patient (25%) had a residual penile urethral stricture that represented panurethral disease.
Substitution urethroplasty using BMG is a technique that should be in the armamentarium of all reconstructive urologists. This technique is transferable through appropriate fellowship training with promising patient outcomes. Reconstructive urology subspecialty training should be encouraged to increase the number of urologists who possess the expertise to offer this procedure to eligible patients.