Dorsal Buccal Mucosal Graft Urethroplasty for Anterior Urethral Stricture by Asopa Technique

• Published in: European urology 2009-07, Vol.56 (1), p.201-206
• Main Authors: Pisapati, V.L.N. Murthy, Paturi, Srimannarayana, Bethu, Suresh, Jada, Srikanth, Chilumu, Ramreddy, Devraj, Rahul, Reddy, Bhargava, Sriramoju, Vidyasagar
• Format: Article
• Language: English
• Subjects: Adult; Follow-Up Studies; Humans; Male; Middle Aged; Mouth Mucosa - transplantation; Prospective Studies; Reconstructive Surgical Procedures - methods; Recurrence; Urethral Stricture - diagnosis; Urethral Stricture - surgery; Urology; Young Adult
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2008.06.002

Abstract Background Buccal mucosal graft (BMG) substitution urethroplasty has become popular in the management of intractable anterior urethral strictures with good results. Excellent long-term results have been reported by both dorsal and ventral onlay techniques. Asopa reported a successful technique for dorsal placement of BMG in long anterior urethral strictures through a ventral sagittal approach. Objective To evaluate prospectively the results and advantages of dorsal BMG urethroplasty for recurrent anterior urethral strictures by a ventral sagittal urethrotomy approach (Asopa technique). Design, setting, and participants From December 2002 to December 2007, a total of 58 men underwent dorsal BMG urethroplasty by a ventral sagittal urethrotomy approach for recurrent urethral strictures. Forty-five of these patients with a follow-up period of 12–60 mo were prospectively evaluated, and the results were analysed. Intervention The urethra was split twice at the site of the stricture both ventrally and dorsally without mobilising it from its bed, and the buccal mucosal graft was secured in the dorsal urethral defect. The urethra was then retubularised in one stage. Results and limitations The overall results were good (87%), with a mean follow-up period of 42 mo. Seven patients developed minor wound infection, and five patients developed fistulae. There were six recurrences (6:45, 13%) during the follow-up period of 12–60 mo. Two patients with a panurethral stricture and four with bulbar or penobulbar strictures developed recurrences and were managed by optical urethrotomy and self-dilatation. The medium-term results were as good as those reported with the dorsal urethrotomy approach. Long-term results from this and other series are awaited. More randomised trials and meta-analyses are needed to establish this technique as a procedure of choice in future. Conclusions The ventral sagittal urethrotomy approach is easier to perform than the dorsal urethrotomy approach, has good results, and is especially useful in long anterior urethral strictures.