LINGUAL MUCOSAL GRAFT URETHROPLASTY FOR SHORT ANTERIOR URETHRAL STRICTURES: A PROSPECTIVE STUDY
Mohamed El Sayed Metwally, Ahmed F. Abdelrahim, Sabri M. Khaled
Urology Department, Al-Azhar Faculty of Medicine, Cairo, Egypt
Objective: The aim of this study was objective and subjective evaluation of lingual mucosa graft (LMG) urethroplasty in repair of anterior urethral stricture as regard surgical outcome, donor site morbidity, and complications. Patients and methods: Prospective interventional study that included 40 male patients with anterior urethral strictures of various etiologies. These patients underwent LMG urethroplasty between May 2015 and November 2018. The mean length of the stricture was 3.56 ± 0.50 cm and the site of the harvest graft was the ventrolateral mucosal lining of the tongue. Single stage dorsal onlay lingual mucosal graft urethroplasty was done in 38 patients while two staged urethroplasty was done in 2 patients. At the 3rd postoperative week all patients underwent full clinical assessment including oral morbidity, removal of urethral catheter after retrograde pericatheter urethrogram. Any extravasation was managed by extending the period of catheterization. Further follow up was performed after 3 and 6 months by uroflowmetry, estimation of post void residual urine with abdomino-pelvic ultrasound. Urethrography was done after 6 month postoperative. A successful outcome was defined as absence of any obstructive symptoms, with Qmax of 14 ml/s or higher without auxiliary postoperative intervention. Patient who needed subsequent urethral procedures (optical internal urethrotomy, urethral dilatation), repeat urethroplasty or urinary diversion were considered as failures. RESULTS: The period of follow-up was 6 months in all patients. The overall success rate was 87.5%. The mean maximum urinary flow rate (Q max) increased postoperatively from 6.31 mL/s to 21.23 mL/s at 6 months of follow-up. Five patients (12.5%) were failed: Long-segment recurrent strictures was developed in 3 cases (7.5%) who were treated by redo urethroplasty. Re-stricture at proximal anastomotic site in one patient (2.5%) and re-stricture at distal anastomotic site in one patient (2.5%) and the two patients were treated by VIU followed by dilatation. Conclusions: The surgical technique for harvesting of a lingual mucosal graft is simple, safe, and easy to be done by the urologist, with minimal early postoperative complications and no long term aesthetic or functional complications at the donor site.Lingual mucosa is a reliable alternative graft for substitution urethroplasty either in one or two stages for treatment of anterior urethral strictures with high success rate.