Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Urology

Introduction and objectives: Anterior urethral stricture is a challenging disease. Multiplicity of surgical techniques denotes that none is ideal. Very few prospective randomized studies are available to compare different techniques. Our aim is to compare the use of buccal mucosal graft (BMG) versus local penile skin flaps (LPF) in patients with complex anterior urethral strictures. Methods: A total of 34 adult patients with complex anterior urethral stricture were included. A complex anterior urethral stricture was defined as a stricture length of >2 cm and/or previous failed procedures, including urethral dilatation, direct visual internal urethrotomy (DVIU) and urethroplasty. We randomised patients to undergo either buccal mucosa dorsal onlay graft or ventral onlay local penile skin flap urethroplasty. Successful treatment outcome was defined as no further treatment of the urethral stricture required after urethroplasty and peak flow rate >15 ml/s. We compared operative time, estimated blood loss, complications, and recurrence rates in both groups. Results: Mean follow up was 22.3 months in BMG group vs 18.9 months in LPF group. Median stricture length (40 mm in BMG group Vs. 50 mm in LPF group) was not statistically different between the two groups. Mean operative time was 185.9 min and 190.6 min in BMG group and LPF group respectively. Estimated blood loss was significantly higher in LPF group, (median 400 ml and 300 ml in LPF and BMG group respectively, p=0.003). Regarding complications, two patients (11.8%) in each group developed wound infection, one patient (5.9%) in LPF group had urinary fistula, and one patient (5.9%) presented by ventral chordee post operatively. In BMG group, only one patient (5.9%) developed mild limitation of mouth opening. The success rates in the buccal mucosal (88.2%) and penile flap (88.2%) groups were similar

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