Buccal mucosal graft in repeat urethroplasty.

Introduction: Our aim was to evaluate the efficacy of a tubed buccal mucosal graft in repeat urethroplasty for patients with urethral stricture and failed previous operations.

Materials And Methods: Ten patients (aged 12 to 47 years) with urethral stricture were entered into the study. All had a history of failed previous urethroplasties, and 5 had failed internal urethrotomies, too. Repeat urethroplasties were performed by excising the fibrous tissue around the stricture; buccal mucosa was then harvested from the inner cheek, made into graft tubing, and interposed into the defect. The patients were followed at 1, 6, and 12 months.

Results: The procedure was technically successful in all the patients. The mean operative time was 150 minutes. The stricture sites were in the posterior urethra in 8 and the anterior urethra in 2 patients. The mean urethral defect length was 4.9 cm. The primary etiology was pelvic fracture in 7 patients. Strictures recurred postoperatively in 3 patients, all of whom had a urethral defect longer than 5 cm, and 2 of whom had more than 1 previous failed urethroplasties (compared with 1 out of 7 in the successful cases). Urinary flow rate increased significantly (from 0 to 10.4 +/- 7.33 mL/s) postoperatively (P = .018). Longer strictures produced significantly poorer graft urethroplasty outcomes (P = .001).

Conclusion: Urethroplasty with buccal mucosal grafts is tough, resilient, easy to harvest, and leaves no scar. It appears to be an optimal substitute for anterior and posterior urethral strictures longer than 3 cm.