Presentation Authors: RAJIV KORE*, KOLHAPUR, India
Introduction: In a near obliterated segment of a urethral stricture placing two grafts on both dorsal and ventral aspect of urethra is an acceptable modality of treatment (Double face grafting). There are two ways to do this i.e. 1. Dorsal approach 2. Ventral approach. We compared these approaches in a cohort of patients requiring this procedure.
Methods: A total of 50 patients treated from February 2013 to January 2017 were retrospectively evaluated. Pre-operative assessment was done by symptom score, uroflowmetry, post void residue, urethrogram and cystoscopy. Near obliterative segment was defined if the lumen was < 6F. In the dorsal approach urethra was rotated dorsally; urethrotomy was done over the stricture; obliterated segment was marked, diseased mucosa along with underlying fibrosis was excised; the healthy bed thus created on the dorsum of spongiosa was grafted with a tailored buccal mucosal graft (BMG). The procedure was completed with dorsal onlay grafting. In ventral approach a ventral urethrotomy was done over the stricture. After entering the lumen incision was taken on the dorsal wall of urethra. The edges were mobilized. Appropriate size BMG was placed as an inlay. The procedure was completed by a standard ventral onlay.Catheter was kept for 3 to 4 weeks. _x000D_
Follow-up was done at 3, 6 months and yearly thereafter by symptom score, uroflowmetry. If required urethrogram and / or cysto-urethroscopy was done.
Results: Out of the total 50 patients, 30 were treated with dorsal approach(Group A) and 20 with ventral approach (Group B). The cases were matched in age, etiology and morbidity profile. Mean age was 34 years (range 27 to 52). Overall follow up was 25 months (range 16-54). Average length of stricture was 4.6 cm (range 3.1 to 8.3). Length of the obliterated segment was 2.5 cm (range 1.1 to 3.2). Success rate was 90 % in group A and 88 % in group B. Complication rate was 5 % in group A and 7 % in group B. Complications noted were wound infection, donor site pain. Main disadvantage of ventral approach was in very narrow or completely obliterated cases where the urethral strip was too narrow for the double grafting. Therefore dorsal approach was preferred in these cases.
Conclusions: Double face grafting of near obliterated segment of non-traumatic urethral stricture creates desired circumference. Dorsal and ventral approaches are equal in outcome measures and complications. However dorsal approach is more versatile in its application in extremely narrow or completely obliterated segment.