Female buccal mucosa graft urethroplasty: a new modified ventral onlay “AZ” technique

• Published in: International Urogynecology Journal Vol. 31; no. 12; pp. 2543 - 2550
• Main Authors: Ozlulerden, Yusuf, Celen, Sinan, Zumrutbas, Ali Ersin, Aybek, Zafer
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-12-2020; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Bladder; Catheters; Female; Gynecology; Humans; Infections; Intubation; Medicine; Medicine & Public Health; Middle Aged; Mouth Mucosa; Original Article; Pain; Patients; Plastic Surgery Procedures; Skin & tissue grafts; Surgery; Sutures; Treatment Outcome; Urethra - surgery; Urethral Stricture - surgery; Urine; Urogenital system; Urologic Surgical Procedures, Male; Urology; Vagina; Buccal mucosa; Female; Stricture; Urethra; Urethral stricture; Urethroplasty
• ISSN: 0937-3462; 1433-3023; 1433-3023
• DOI: 10.1007/s00192-020-04354-w

Introduction and hypothesis
To present the surgical details and the outcomes of our modified ventral onlay buccal mucosal graft (BMG) urethroplasty technique in female patients with urethral strictures.
Methods
We included the first seven female patients who had BMG urethroplasty between January 2015 and April 2019 and had at least 6 months of follow-up. Patient age, stricture length, comorbidities, number of previous treatments, pre- and postoperative uroflowmetry data, and post-void residual volumes were recorded.
Results
The mean patient age was 56.7 (44–80) years. The mean stricture length was 3.1 (2–4) cm. The mean postoperative follow-up time was 23 (7–48) months. The preoperative mean maximal flow rate (Qmax) was 5.1 (3.2–9.5) ml/s and post-void residual urine volume (PVR) was 84.4 (37–158) ml. At the 3rd month after surgery, mean Qmax was 31.8 (24.7–36.2) ml/s, and PVR volume was 7.1 (0–16) ml. Three patients had the postoperative 2-year follow-up, and 12th and 24th month mean Qmax values were 28 (23.6–33.2) ml/s and 28.5 (24.1–31.1) ml/s, respectively. The mean operation time was 63.8 (55–113) min. We did not observe any infection, vaginal erosion, urinary incontinence, or oral discomfort due to graft harvesting postoperatively.
Conclusion
Female urethroplasty provides high cure rates and should be performed in case of recurrent FUS. The early and medium-term results of our modified new technique indicated that it might be used as a simple alternative to current techniques. In all of our patients, it significantly increased the flow rate and reduced PVR without any significant complications.