Expanded use of a dorsal onlay augmented anastomotic urethroplasty with buccal mucosa for long segment bulbar urethral strictures: analysis of outcomes and complications.

Objective: To evaluate the results of a dorsal onlay augmented anastomosis using buccal mucosa to reconstruct long segment bulbar urethral strictures. The ideal treatment of long segment bulbar urethral strictures remains controversial. Urethroplasty with tissue transfer is typically required, but the optimal technique is unknown.
Materials and Methods: A prospective cohort of 163 patients with complete follow-up data underwent dorsal onlay augmented anastomosis using buccal mucosa for long segment bulbar urethral strictures from November 2003 to March 2011. All patients underwent preoperative urethrography and cystoscopy. The follow-up protocol consisted of cystoscopy and subjective symptom assessment at 6 months and symptom assessment at 12 months, with repeat cystoscopy, if indicated. Annual symptom assessments were performed thereafter as required. Stricture recurrence was defined as a segment <16F on cystoscopy or the presence of intractable voiding symptoms. The secondary outcome measure was the incidence of postoperative complications using a nonvalidated questionnaire. Fisher's exact test was used to evaluate the patency and complication rates between patient age and stricture length.
Results: The median follow-up period was 31.0 months (range 6-91). Of the 163 patients, 157 (96.9%) had no evidence of stricture recurrence. Postoperative complications included postvoid dribbling (41.7%; 68 of 163), urinary tract infection (3.7%; 6 of 163), erectile dysfunction (3.1%; 5 of 163), orchalgia (10.4%; 17 of 163), and donor site morbidity (4.3%; 7 of 163). Age was not associated with recurrence, but stricture length ≥5 cm was associated with a lower patency rate (P = .010).
Conclusion: Dorsal onlay augmented anastomosis using buccal mucosa demonstrated a 96.9% patency rate in our single-center prospective study and should be considered for reconstruction of long segment bulbar urethral strictures, especially with a focal segment of obliteration. Strictures ≥5 cm are prone to recurrence but are still amenable to dorsal onlay augmented anastomosis using buccal mucosa.
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