Postauricular skin as an alternative to oral mucosa for anterior onlay graft urethroplasty: a preliminary experience in patients with oral mucosa changes.

Objectives: To investigate the feasibility, tolerability, safety, and efficacy of using the postauricular skin graft as substitute material for anterior urethroplasty. We first reported a preliminary experience in a selected group of patients in whom the oral mucosa and genital skin were both not usable.

Methods: We retrospectively reviewed the charts of 35 patients, average age of 34 years (range, 20-64 years), who underwent urethroplasty using postauricular skin grafts for anterior urethral strictures. Stricture etiology was lichen sclerosus in 12 (35%) cases, unknown in 10 (29%), trauma in 8 (22%), and infection in 5 (14%). Of 35 strictures, 15 (43%) were classified as panurethral, 12 (34%) were in the penile urethra, and 8 (23%) in the bulbar urethra. As measured by preoperative urethrography stricture, length varies from 3-15 cm (mean stricture length, 8.9 cm). Posterior auricular skin was harvested by one team and urethral reconstruction (bulbar, penile or pan-urethral) by the other team.

Results: Mean operative time was 190 minutes (range, 120-300 minutes). Of 35 cases, 31 (89%) were treatment successes and 4 (11%) were failures. Five patients had developed wound infections, which were treated properly as per culture sensitivity report. No patient developed diverticulum, fistula, sacculation formation, or protrusion of the graft at external meatus.

Conclusions: In circumcised patients with submucosal fibrosis involving the cheek oral mucosa, postauricular skin is a good substitute material for urethral reconstruction, and also in patients with lichen sclerosus stricture diseases.