Urinary and sexual outcomes of dorsal plus ventral double graft bulbar urethroplasty
Enzo Palminteri et Al.
Annual EAU Congress 2009
Center for Reconstructive Urethral and Genitalia Surgery, Arezzo, Italy
Introduction & Objectives
We report our experience with dorsal plus ventral double graft (DVDG) urethroplasty for bulbar urethral strictures.
Materials & Methods
We reviewed the records of 39 men, mean age 37.6 yr, with bulbar strictures underwent patch urethroplasty using a DVDG of buccal mucosa (BM) between 2002 and 2008. The urethra was opened ventrally in the midline over the stricture; the exposed dorsal urethra was incised in the midline: the margins of the incised dorsal urethra were dissected from the tunica and an elliptical raw area was created where the first graft was placed dorsal inlay. Subsequently, the urethra was augmented by the ventral onlay second graft that was anastomosed to the lateral margins of the urethral plate. Finally, the spongiosum was closed over the graft. Erectile function questionnaires were completed than 1 year postoperatively. Successful outcome was defined as normal voiding without need for any postoperative procedure and no deterioration of sexual function compared to preoperative status. Results of prior studies using the same erectile function questionnaires after various types of urethroplasty were then compared to those of our series.
Mean follow up was 40.2 months and all follow-ups were more than 2 years. Average stricture length was 3.2 cm (range 1.5 to 8). Of 39 cases 34 (87.2 %) were successful and 5 (12.8 %) failures with recurrence of the stricture. No patients referred erectile problems and all were satisfied about sexual life.
In tight bulbar strictures the dorsal and ventral double BM graft provides a reliable solution to achieve an adequate urethral lumen by preserving the urethral plate and to avoid postoperative erectile complaints: medium-term results are encouraging.