Dorsal buccal mucosal graft (BMG) urethroplasty has recently gained its popularity as a substitute for urethral reconstruction for both strictures and complex hypospadias.
-
Operation was done under general anesthesia with nasotracheal intubation and the patient are lay in exaggerated lithotomy position.
-
Operation was performed by two team approach. One team occupied in urethral procedure, and other team is engaged in harvest of the buccal mucosa. Through a midline perineal incision, the bulbocavernosus muscle was divided exposing the corpus spongiosum of the anterior urethra.
-
Then the bulbar urethra was easily dissected from corpora cavernosa. By invaginating the penis, the penile urethra was likewise dissected up to the coronal sulcus. Then the strictured part of the urethra was recognized.
-
The other team then harvested the buccal mucosal graft of required length, from the internal cheek area underneath the Stensen’s duct without injuring it. Usually, 6-cm. long graft can simply be harvested from the inner cheek.
-
If the essential graft length is more than 6 cm, then the cut line is prolonged along the lower lip up to the centerline to get the further length of buccal mucosa. In this method, buccal mucosal graft up to 10-12 cm of length and can easily be harvested.
-
Lignocaine (2%) with adrenaline (1:200000) was injected into the edges of the desired graft length before harvesting to get better hemostasis. Stay sutures are located into the corners and the graft is harvested.
-
Graft donor site is blocked with continuous, 3-0 chromic catgut sutures to accomplish good hemostasis. The graft is then defatted and tailored to its proper size.
-
The dissected urethra was rotated 180o. The dorsal surface of the strictured segment was exposed and opened vertically extending the incision for about 1 cm both proximally and distally into the normal urethral lumen.
-
The proximal and distal urethral lumina of the urethra were calibrated. The graft was sutured, splayed and quilted over the corpora cavernosa using few 5-0 polyglactin quilting sutures for reinforcement with good support and minimizing the dead space.
-
The left border of the urethral mucosa was sutured to the graft by using 4-0 polyglactin interrupted stitches. A 16F pure silicone Foley catheter was introduced through the urethra into urinary bladder.
-
Then the urethra was rotated back to its normal location and the right margin of the urethral mucosa was sutured equally to the remaining margin of the buccal mucosal graft. At the last step of the method, the graft is totally covered by the urethra.
-
Suprapubic catheter is usually not used if at all the patient is already presented with it. The patient should use antibiotics until the catheter is removed.
