Augmentation, Buccal Mucosal Graft, Long Anterior, Penile Skin, Urethral Stricture, Urethroplasty
Conditions
Brief summary
The aim of this study is to analyze the outcomes of dorsal onlay buccal mucosal graft (BMG) and penile skin graft (PSG) urethroplasty in the management of long segment bulbar urethral stricture.
Detailed description
Penile urethral reconstruction proves to be a continuous challenge as no perfect technique is considered for all patients with this problem. Among all the methods used for treatment of urethral stricture, the substitution urethroplasty with tissue transfer using either flap or graft is the gold standard treatment option for long segment urethral strictures. In 1993, McAninch described a circular fasciocutaneous flap for the management of penile urethral stricture up to 15 cm that showed excellent cosmetic and functional outcomes due to this being a hairless, flexible flap with a rich vascular supply. Buccal mucosal graft (BMG) was rediscovered and popularized in 1992 by Burger et al., then El-Kassaby et al. in 1993 published a series using buccal mucosal graft to repair anterior urethral stricture. Buccal mucosal graft became an ideal urethral substitute due to easy harvesting, hairlessness and compatibility in a wet environment.
Interventions
PROCEDUREBuccal Mucosal Graft (BMG) Urethroplasty
Urethroplasty using a buccal mucosal graft harvested from the inner cheek. The graft is dorsally onlaid to reconstruct the strictured urethral segment. The procedure is conducted under spinal or general anesthesia.
PROCEDUREPenile Skin Graft (PSG) Urethroplasty
Urethroplasty using a penile skin graft harvested from the ventral surface of the penis. The graft is applied dorsally after excision of the fibrotic urethral segment. The surgery is performed under spinal or general anesthesia.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
MALE
Age
18 Months to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with long segment anterior urethral stricture that was defined as a stricture with a length of more than 1 cm with spongiofibrosis. * Patients with previous failed urethral dilatation or direct vision internal urethrotomy (DVIU)
Exclusion criteria
* Patients with lichen sclerosus * Patients with history of hypospadias repair * Patients with recurrent urethral stricture after failed previous urethroplasty
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Surgical Success Rate | 9 months postoperatively | Success is defined as satisfactory urinary stream with no need for further intervention (such as dilatation or DVIU) and no evidence of stricture on retrograde urethrogram during follow-up. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Length of Urethral Stricture | Intraoperatively | Length of Urethral Stricture will be measured to compare the characteristics of strictures managed by each graft technique. |
| Postoperative Complications | 9 months postoperatively | Complications such as infection, bleeding, graft failure, and fistula formation following surgery will be recorded. |
| International Prostate Symptom Score (IPSS) | 9 months postoperatively | Evaluation of changes in urinary symptoms using International Prostate Symptom Score (IPSS) to assess functional outcome and patient comfort after urethroplasty will be assessed. |
Countries
Egypt
Contacts
Primary ContactMohamed I Elmaadawy, MD
Outcome results
None listed