Urethral strictures were very difficult to manage, some treatment modalities of urethral strictures were fraught with more patient’s morbidity and rate of recurrence of the stricture. However, an enormously useful tool for the armamentarium of Reconstructive Urologist was buccal mucosal urethroplasty. Mostly it was preferred buccal mucosa grafts because of its outstanding short and long-term results, low post-operative barrier rate, and relative ease of use. And utilize it for mostly bulbar urethral stricture repairs and some of the pendulous urethral stricture repairs, generally in union with a first-stage Johanson repair.
The buccal substitution urethroplasty is usually performed with a 2 team approach: one team will harvests the buccal mucosal graft and the other team will performs the perineal dissection.
PROCEDURE:
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A two-team approach was used with the patient under general anaesthesia and nasotracheal intubation, the diseased urethra is exposed by incision, depending on the site of stricture.
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For pendulous urethral strictures a circumcoronal incision is used, whereas for more proximal strictures a midline perineal incision is used. The spongiosum is detached dorsally from the corpora and a urethrotomy is made exactly at the 12 o’clock position.
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In patients with related with meatal or fossa navicularis strictures, the stricturotomy is prolonged to the meatus. Then a dorsal meatotomy is and linked along with dorsal stricturotomy on the pendulous urethra.
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Buccal mucosa is harvested from the cheeks or lower lip, depending upon the length of the stricture, and quilted to the corpora with interrupted 5–0 polyglactin sutures, and subsequently sutured to the cut edges of the urethra with continuous sutures.
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For meatal reconstruction, the distal most BMG is fixed with interrupted 5–0 polyglactin sutures to the dorsally cut margins of the meatus.
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The two-stage procedure includes urethral opening, complete excision of the fibrotic tissue and BMG on laying in the first stage. The urethra is reconstructed in the 2nd stages 4–6 months after the first.
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The patient is discharged 3–5 days after surgery with an indwelling urethral and a suprapubic catheter. Catheters are removed 3 weeks later, after micturating cystourethrography. The follow-up was by medical history, uroflowmetry and urethral calibration for 3-month intervals at the first year and consequently every 6 months; contrast medium studies were taken as and when required. Failure was defined as the recurrence of obstructive symptoms and/or failure to calibrate with a 16 F Foley catheter.
