Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Urology Reports
Published in: Current Urology Reports 8/2014

01-08-2014 | Urosurgery (A Stenzl, Section Editor)

Graft Surgery in Extensive Urethral Stricture Disease

Author: Miroslav L. Djordjevic

Published in: Current Urology Reports | Issue 8/2014

Login to get access

Abstract

Surgical treatment of long urethral stricture disease remains one of the most challenging problems in urology. In recent years there has been continuous discussion with regard to the etiology, location, length, and management of extensive urethral stricture disease. Various tissues such as genital and extragenital skin, buccal mucosa, lingual mucosa, small intestinal submucosa, and bladder mucosa have been proposed for urethral reconstruction. The most frequent questions pertain to the optimal technique for urethroplasty and the optimal graft for substitution urethroplasty, as judged by both patient satisfaction and outcome success. We review the recent literature with respect to any new information on graft urethroplasty for extensive urethral stricture.
Literature
1.
Lumen N, Hoebeke P, Willemsen P, et al. Etiology of urethral stricture disease in the 21st century. J Urol. 2009;182:983–7.PubMedCrossRef
2.
Mangera A, Patterson JM, Chapple CR. A systematic review of graft augmentation urethroplasty techniques for the treatment of anterior urethral strictures. Eur Urol. 2011;59:797–814.PubMedCrossRef
3.
Greenwell TJ, Castle C, Andrich DE, et al. Repeat urethrostomy and dilation for the treatment of urethral stricture and neither clinically effective nor cost-effective. J Urol. 2004;172:275–7.PubMedCrossRef
4.
Buckley JC, Heyns C, Gilling P, Carney J. Dilation, internal urethrotomy, and stenting of male anterior urethral strictures. Urology. 2014;83:S18–22.PubMedCrossRef
5.
Tian Y, Wazir R, Yue X, Wang K, Li H. Prevention of stricture recurrence following urethral endoscopic management: what do we have? J Endourol. 2014;28:502–508.
6.
Lubahn JD, Zhao LC, Scott JF, Hudak SJ, Chee J, Terlecki R, et al. Poor quality of life in patients with urethral stricture treated with intermittent self-dilation. J Urol. 2014;191:143–7.PubMedCentralPubMedCrossRef
7.
Mangera A, Chapple C. Management of anterior urethral stricture: an evidence-based approach. Curr Opin Urol. 2010;20:453–8.PubMedCrossRef
8.
Santucci R, Eisenberg L. Urethrotomy has a much lower success rate than previously reported. J Urol. 2010;183:1859–62.PubMedCrossRef
9.
Breyer BN, McAninch JW, Whitson JM, et al. Multivariate analysis of risk factors for long-term urethroplasty outcome. J Urol. 2010;183:613–7.PubMedCrossRef
10.
Hampson LA, McAninch JW, Breyer BN. Male urethral strictures and their management. Nat Rev Urol. 2014;11:43–50.PubMedCrossRef
11.
Palminteri E, Brandes SB, Djordjevic ML. Urethral reconstruction in lichen sclerosus. Curr Opin Urol. 2012;22:478–83.PubMedCrossRef
12.•
Riechardt S, Dahlem R, Fisch M. Urethral ‘cripples’: two stage procedures. Curr Opin Urol. 2012;22:484–6. The good review of all aspects related to urethral cripple cases and recommendations for repair.PubMedCrossRef
13.
Barbagli G, Perovic S, Djinovic R, et al. Retrospective descriptive analysis of 1,176 patients with failed hypospadias repair. J Urol. 2010;183:207–11.PubMedCrossRef
14.
Barbagli G, De Angelis M, Palminteri E, et al. Failed hypospadias repair presenting in adults. Eur Urol. 2006;49:887–94.PubMedCrossRef
15.
16.
Barbagli G, Guazzoni G, Lazzeri M. One-stage bulbar urethroplasty: retrospective analysis of the results in 375 patients. Eur Urol. 2008;53:828–33.PubMedCrossRef
17.
Dubey D, Vijjan V, Kapoor R, et al. Dorsal onlay buccal mucosa versus penile skin flap urethroplasty for anterior urethral stricture: result from a randomized prospective trial. J Urol. 2007;178:2466–9.PubMedCrossRef
18.
Barbagli G, Morgia G, Lazzeri M. Dorsal onlay skin graft bulbar urethroplasty: long –term follow-up. Eur Urol. 2008;53:628–33.PubMedCrossRef
19.
Kinkead TM, Borzi PA, Duffy PG, Ransley PG. Long-term follow-up of bladder mucosa graft for male urethral reconstruction. J Urol. 1994;151:1056–8.PubMed
20.
Jordan GH. Scrotal and perineal flaps for anterior urethral reconstruction. Urol Clin N Am. 2002;29:411–6.CrossRef
21.
Xu YM, Qiao Y, Sa YL, et al. Urethral reconstruction using colonic mucosa graft for complex stricture. J Urol. 2009;182:1040–3.PubMedCrossRef
22.
Dubey D, Sehgal A, Srivastava A, et al. Buccal mucosal urethroplasty for balanitis erotica obliterans related urethral strictures: the outcome of 1 and 2-stage techniques. J Urol. 2005;173:463–6.PubMedCrossRef
23.
Simonato A, Gregori A, Lissiani A, et al. The tongue as an alternative donor site for graft urethroplasty: a pilot study. J Urol. 2006;175:589–92.PubMedCrossRef
24.
Simonato A, Gregori A, Ambruosi C, et al. Lingual mucosal graft urethroplasty for anterior urethral reconstruction. Eur Urol. 2008;54:79–85.PubMedCrossRef
25.
Barbagli G, De Angelis M, Romano G, et al. The use of lingual mucosal graft in adult anterior urethroplasty: surgical steps and short-term outcome. Eur Urol. 2008;54:671–6.PubMedCrossRef
26.
Song LJ, Xu YM, Lazzeri M, Barbagli G. Lingual mucosa grafts for urethroplasty: a review. BJU Int. 2009;104:1052–6.PubMedCrossRef
27.
Sharma AK, Chandrashekar R, Keshavamurthy R, et al. Lingual versus buccal mucosa graft urethroplasty for anterior urethral stricture: a prospective comparative analysis. Int J Urol. 2013;20:1199–203.PubMedCrossRef
28.
Dublin N, Stewart LH. Oral complications after buccal mucosa harvest for urethroplasty. BJU Int. 2004;94:867–9.PubMedCrossRef
29.
Markiewicz MR, De Santis JL, Margarone JE, et al. Morbidity associated with oral mucosa harvest for urological reconstruction: an overview. J Oral Maxillofac Surg. 2008;66:739–44.PubMedCrossRef
30.•
Rourke K, McKinny S, St. Martin B. Effect of wound closure on buccal mucosal graft harvest site morbidity: result of a randomized prospective trial. Urology. 2012;79:443–7. Randomized study about morbidity after harvesting of buccal mucosa graft.PubMedCrossRef
31.
Barbagli G, Fossati N, Sansalone S, et al. Prediction of early and late complication after oral mucosal graft harvesting: multivariable analysis from a cohort of 553 consecutive patients. J Urol. 2014;191:688–693.
32.
Meeks JJ, Erickson BA, Fetchev P, et al. Urethroplasty with abdominal skin grafts for long segment urethral stricture. J Urol. 2010;183:1880–4.PubMedCrossRef
33.
Lee YT, Cho TW, Jeong HS, et al. Reconfigured sigmoid colon neourethra: substitution of refractory posterior urethral stricture. Urology. 2005;65:157–9.PubMedCrossRef
34.
Mundy AR, Andrich DE. Entero-urethroplasty for the salvage of bulbo-membranous stricture disease or trauma. BJU Int. 2010;105:1716–20.PubMedCrossRef
35.
Xu YM, Fu Q, Sa YL, et al. Outcome of small intestinal submucosa graft for repair of anterior urethral strictures. Int J Urol. 2013;20:622–9.PubMedCrossRef
36.
Palminteri E, Berdondini E, Colombo F, et al. Small intestinal submucosa (SIS) graft urethroplasty: short-term results. Eur Urol. 2007;51:1695–701.PubMedCrossRef
37.
Palminteri E, Berdondini E, Fusco F, et al. Long-term results of small intestinal submucosa graft in bulbar urethral reconstruction. Urology. 2012;79:695–701.PubMedCrossRef
38.•
Mangera A, Chapple CR. Tissue engineering in urethral reconstruction-an update. Asian J Androl. 2013;15:89–92. The current literature review on the different ways of tissue engineering in urethral reconstruction.PubMedCentralPubMedCrossRef
39.
Li C, Xu YM, Liu ZS, Li HB. Urethral reconstruction with tissue engineering and RNA interference techniques in rabbits. Urology. 2013;81:1075–80.PubMedCrossRef
40.
41.
Asopa HS, Garg M, Singhal GG, et al. Dorsal free graft urethroplasty for urethral stricture by ventral sagittal urethrostomy approach. Urology. 2001;58:657–9.PubMedCrossRef
42.
Hayes MC, Malone PS. The use of a dorsal buccal mucosal graft with urethral plate incision (Snodgrass) for hypospadias salvage. BJU Int. 1999;83:508–9.PubMedCrossRef
43.
Singh PB, Das SK. Kumar, et al. Dorsal onlay lingual mucosal graft urethroplasty: comparison of two techniques. Int J Urol. 2008;15:1002–5.PubMedCrossRef
44.
Pisapati VLNM, Paturi S, Bethu S, et al. Dorsal buccal mucosal graft urethroplasty for anterior urethral stricture by Asopa technique. Eur Urol. 2009;56:201–6.PubMedCrossRef
45.
Aldaqadossi H, El Gamal S, El-Nadey M, et al. Dorsal onlay (Barbagli technique) versus dorsal inlay (Asopa technique) buccal mucosal graft urethroplasty for anterior urethral stricture: a prospective randomized study. Int J Urol. 2014;21:185–8.PubMedCrossRef
46.
Barbagli G, Selli C, di Cello V, Mottola A. A one-stage dorsal free-graft urethroplasty for bulbar urethral strictures. Br J Urol. 1996;78:929–32.PubMedCrossRef
47.
Riechardt S, Pfalzgraf D, Dahlem R, Fisch M. Surgery illustrated-focus on details: dorsal buccal mucosal inlay for penile urethroplasty. BJU Int. 2009;103:1444–7.PubMedCrossRef
48.•
Pfalzgraf D, Kluth L, Isbarn H, et al. The Barbagli technique: 3-year experience with a modified approach. BJU Int. 2013;1:132–6. Good comparative study between results of original Barbagli technique and author’s modification.CrossRef
49.
50.
Xu YM, Feng C, Sa YL, et al. Outcome of 1-stage urethroplasty using oral mucosal grafts for the treatment of urethral strictures associated with genital lichen sclerosus. Urology. 2014;83:232–6.PubMedCrossRef
51.
Hudak SJ, Lubahn JD, Kulkarni S, Morey AF. Single-stage reconstruction of complex anterior urethral stricture using overlapping dorsal and ventral buccal mucosal graft. BJU Int. 2012;110:592–6.PubMedCrossRef
52.
53.
Kulkarni S, Barbagli G, Sansalone S, Lazzeri M. One-sided anterior urethroplasty: a new dorsal onlay graft technique. BJU Int. 2009;104:1150–5.PubMedCrossRef
54.
55.•
Lee YJ, Kim SW. Current management of urethral stricture. Korean J Urol. 2013;54:561–9. Excellent review of current techniques for urethral stricture disease.PubMedCentralPubMedCrossRef
56.
Barbagli G, Sansalone S, Romano G, Lazzeri M. Bulbar urethroplasty: transecting vs. nontransecting techniques. Curr Opin Urol. 2012;22:474–7.PubMedCrossRef
57.
Al-Qudah HS, Santucci RA. Buccal mucosa onlay urethroplasty versus anastomotic urethroplasty for short urethral strictures: which is better? J Urol. 2006;175:103 (abstract 313).
58.
Erickson BA, Granieri MA, Meeks JJ, et al. Prospective analysis of erectile dysfunction after anterior urethroplasty: incidence and recovery of function. J Urol. 2010;183:657–61.PubMedCrossRef
59.•
Palminteri E, Berdondini E, De Nunzio C, et al. The impact of ventral oral graft bulbar urethroplasty on sexual life. Urology. 2013;81:891–8. This paper highlights the most important facts about sexual life after bulbar urethral stricture reconstruction.PubMedCrossRef
60.
Andrich DE, Leach CJ, Mundy A. The Barbagli procedure gives the best results for patch urethroplasty of the bulbar urethra. BJU Int. 2001;88:385–9.PubMedCrossRef
61.
Barbagli G, Palminteri E, Guazzoni G, et al. Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique? J Urol. 2005;174:955–8.PubMedCrossRef
62.
Figler BD, Malaeb BS, Dy GW, et al. Impact of graft position on failure of single-stage bulbar urethroplasties with buccal mucosa graft. Urology. 2013;82:1166–70.PubMedCrossRef
63.•
Chen ML, Odom BD, Johnson LJ, Santucci RA. Combining ventral buccal mucosa graft onlay and dorsal full thickness skin graft inlay decreases failure rates in long bulbar strictures (>6 cm). Urology. 2013;81:899–903. This paper describes novel technique with combining of skin and buccal mucosa grafts.PubMedCrossRef
64.
Barbagli G, Montorsi F, Guazzoni G, et al. Ventral oral mucosal onlay graft urethroplasty in nontraumatic bulbar urethral strictures: surgical technique and multivariable analysis of results in 214 patients. Eur Urol. 2013;64:440–7.PubMedCrossRef
65.
Gill NA, Hameed A. Management of hypospadias cripples with two-staged Bracka’s technique. J Plast Reconstr Aesthet Surg. 2011;64:91–6.PubMedCrossRef
66.
Djordjevic ML, Kojovic V, Bizic MR, et al. “Hanging” of the buccal mucosal graft for urethral stricture repair after failed hypospadias. J Urol. 2011;185:2479–82.PubMedCrossRef
67.
Johanson B. The reconstruction in stenosis of the male urethra. Z Urol. 1953;46:361–75.PubMed
68.
Schreiter F. Mesh-graft urethroplasty: our experience with a new procedure. Eur Urol. 1984;10:338–44.PubMed
Metadata
Title
Graft Surgery in Extensive Urethral Stricture Disease
Author
Miroslav L. Djordjevic
Publication date
01-08-2014
Publisher
Springer US
Published in
Current Urology Reports / Issue 8/2014
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-014-0424-3

Other articles of this Issue 8/2014

Current Urology Reports 8/2014 Go to the issue

Female Urology (K Kobashi, Section Editor)

Management of Recurrent Stress Incontinence Following a Sling

Pediatric Urology (M Castellan and R Gosalbez, Section Editors)

Botulinum Toxin A’s Expanding Role in the Management of Pediatric Lower Urinary Tract Dysfunction

Pediatric Urology (M. Castellan and R. Gosalbez, Section Editors)

The Use of Autologous Buccal Mucosa Grafts in Vaginal Reconstruction

Female Urology (K Kobashi, Section Editor)

Challenges and Future Prospects for Tissue Engineering in Female Pelvic Medicine and Reconstructive Surgery

Pediatric Urology (M Castellan and R Gosalbez, Section Editors)

Prenatal Hydronephrosis: Postnatal Evaluation and Management

Pediatric Urology (M Castellan and R Gosalbez, Section Editors)

Renal Transplantation in Augmented Bladders