Role of dorsal on lay buccal mucosal graft urethro-plasty for long anterior urethral strictures.

Ponraj, C (2006) Role of dorsal on lay buccal mucosal graft urethro-plasty for long anterior urethral strictures. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION : The long-term results of internal urethrotomy are poor; either requiring repeated dila tation or repeated urethrotomies. Conventional staged urethroplasty does not produce consistent results. The use of flaps or grafts is mandatory in patients with longer and complex strictures. On lay graft is an recent addition to the armamentarium. On lay graft is done either dorsally or ventrally. Various tissues like penile skin, posterior auricular skin, bladder mucosa and buccal mucosa are used. Since 1995-96 Barbagli described a new dorsal on lay graft urethroplasty. It has been greeted wit h fair amount of enthusiasm throughout the world. Success rate of this procedure has been 92-95% for a period of 19 to 36 months. We have attempted to extend the use of the procedure for long anterior urethral strictures including pan-urethral strictures using buccal mucosal graft. AIM OF THE STUDY : To evaluate the efficacy of dorsal on lay buccal mucosal graft urethroplasty in treating long anterior urethral strictures. MATERIALS AND METHODS : It is a prospective study from August 2003 to September 2005. A total of 13 patients were enrolled in the study. Inclusion Criteria: 1 .Strictures > 2.5cm in length (Long anterior urethral strictures). 2. Patients requiring repeated internal urethrotomy or dilatations. Exclusion Criteria: 1. Periurethral phlegmon, 2. Urethrocutaneous fistula, 3. Associated with chronic renal failure, 4. Scarred perineum. The preoperative workup included careful general physical examination, palpation of the anterior urethra for any mass; glans penis inspected for signs of urethral meatal stenosis or balanitis xerotica obliterans. The perineum was inspected and examined for the presence of fistulas or periurethral inflammation. Dental surgeon’s opinion was obtained regarding the hygiene of the oral cavity and to rule out any buccal mucosal pathology. CONCLUSION : Buccal mucosal graft has good graft properties for graft survival with minimal donor site morbidity. Dorsal onlay graft is the preferred form of graft placement. Buccal mucosal graft is an ideal substitute for urethra in treating medium length bulbar urethral strictures. Because of less failure rate 11.11% single stage dorsal on lay buccal mucosal graft urethroplasty may be offered as an alternative to staged urethroplasty in case of long urethral strictures.

Item Type: Thesis (Masters)
Uncontrolled Keywords: dorsal ; lay buccal mucosal graft ; urethro-plasty ; long anterior urethral strictures.
Subjects: MEDICAL > Urology
Depositing User: Kambaraman B
Date Deposited: 09 Aug 2017 02:10
Last Modified: 09 Aug 2017 02:10
URI: http://repository-tnmgrmu.ac.in/id/eprint/2560

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