A Study of early experience with the use of buccal mucosa for substitution urethroplasty.

INTRODUCTION : The long term results of internal urethrotomy are poor. It requires repeated procedures followed up with repeated dilatation. The use of flaps or grafts is mandatory in a patient with long segments of stricturous urethra. Onlay buccal mucosa grafting is a recent addition to armamentarium. Onlay grafts are placed either on the dorsal or ventral aspect of urethra. Other commonly used tissues for urethroplasty include 1. Penile skin, 2. Posterior auricular skin, 3. Bladder mucosa, 4. Buccal mucosa. The new technique of dorsal onlay graft urethroplasty described by Barbagli in 1995 has been greeted with great amount of enthusiasm through the world. The reported success rate was around 93-96% with a follow up of 20-35months. In this study, we have attempted to extend the use of the buccal mucosal graft procedure for management of long anterior urethral strictures including pan urethral strictures. Suprechko, in 1886, was the first to describe the use buccal mucosal graft. Before the era of antibiotics, the post-operative results with this graft were poor. In 1980, Duckett reported using the buccal mucosal graft in epispadias repair. Barbagli proposed the dorsal placement of buccal mucosal graft and evaluated the post-operative complications of buccal mucosal grafting. AIM OF STUDY : To evaluate the efficacy and early results of buccal mucosa graft in stricture of urethra. MATERIALS AND METHODS : Inclusion - 1. Strictures >2cm involving anterior urethra. 2. Patient with comorbidity (DM/HT) were also included. Exclusion - 1. Severe oral cavity infection, 2. Mucosal ulceration, 3. Mucosal fibrosis, 4. Mucosal white or red patches severe perineal pathology. The pre-operative work up included, General physical examination, Examination of urethra for any mass, Glans penis examination, Perineum examination for peri urethral inflammation/any fistula, Dental opinion for oral cavity to rule out any oral pathology. Pre-operative variable includes age of the patient, duration of symptoms, pre-operative uroflowmetry and previous cystoscopy findings. Past history of previous urological surgery and dilatation were also recorded. CONCLUSION : Dorsal onlay is the preferred form of graft placement. Buccal mucosal graft is the ideal substitute for urethra, especially in medium length urethral stricture. Buccal mucosa graft has good graft properties for graft survival. Oral cavity donor site had no significant complications. Failure rate was 15.38%, so dorsal on lay buccal mucosal urethroplasty is ideal for urethral strictures. Longer follow up is need (keeping attrition over a period of time for substitution urethroplasty in mind before coming to definite conclusion)