Management of partial or complete traumatic urethral disruption of the anterior urethra poses a challenge. Buccal mucosal grafts(BMG) are the gold standard for substitution urethroplasty. Here, we evaluate the efficacy and complications arising from one-stage BMG with dorsal onlay augmented anastomotic technique for traumatic anterior urethral stricture, examine early surveillance urethroscopy and long-term outcomes among urethroplasty patients.

From January 2015 to July 2022, male patients with anterior urethral stricture ≥ 2 cm were retrospectively analyzed. All patients underwent one-stage buccal mucosal grafts dorsal onlay anastomotic technique by a single surgeon. Preoperative suprapubic catheterization was initially carried out in all patients. Their ages ranged from 18 to 63 years (mean of 42.5 years). Post-operative evaluations including uroflowmetry and early surveillance findings with using a flexible 16.5 Fr cystoscope. The primary outcome was the stricture free survival rate, defined as no stricture recurrence.

A total of 12 patients with pinhole or blind end anterior urethral stricture were included. The stricture site was bulbar in 4, pendulous in 7 and pan-urethral in 1; the mean (range) stricture length was 4.3 (2-6) cm. The mean follow-up period was 15 months (range 4-24). The median maximum urination rate was 4.5 ml/s. Following the anterior urethroplasty, we examine the stricture site with using flexible cystosocpe in every 2 weeks and all the patients still had annular stricture in post-operative first month. Two patients had complications with previous buccal mucosa flap grew well but the size shrinkage, then one patient re-do BMG urethroplasty in post-operative first month, another patient re-do in post-operative 3rd month.

In our cohort, the post-operative annular stricture could be reconstructed by using the solid sound in every month. The stricture free survival rate was 80% (8/10) after solid sound reconstruction for 12 months. We believe that the repeated sessions of direct visual internal urethrotomy in our study likely caused the expansion or lengthening of the stenosis, thereby increasing the required amount of graft and hindering adequate perfusion of the corporeal bed of the graft. However, none of our re-stenosis patients in this study exhibited complete fibrosis.

Early flexible cystoscopic visualization of the urethroplasty site is a feasible and reliable examination for following post-operative status. Even in difficult cases with traumatic urethral pinhole or blind end anterior urethral stricture, the results of one-stage buccal mucosal grafts urethroplasty with the combined solid sound reconstruction demonstrate a decrease in the frequency of recurrence of urethral stricture.

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Osman NI, Chapple CR. Is Urethrotomy as Good as Urethroplasty in Men with Recurrent Bulbar Urethral Strictures? Eur Urol. 2020 Oct;78(4):581-582.