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Objectives: Penile urethral stricture disease not associated with hypospadias is rare, and there is a wide range of commonly used surgical repair techniques for this disease. We sought to compile a multi‐institutional database of patients who had surgical correction of strictures in the penile urethra not limited to the meatus, and who had no history of hypospadias, for analysis using the Trauma and Urologic Reconstructive Network of Surgeons length, urethral segment and etiology classification system. Methods: A retrospective database from 13 institutions was compiled of patients who had undergone surgical correction of Trauma and Urologic Reconstructive Network of Surgeons length, urethral segment and etiology urethral stricture segments S2b/S2c and excluding E5, with a minimum follow‐up time of 4 months. Failure was defined as cystoscopically confirmed recurrence of a stricture measuring less than 16‐Fr. Results: We analyzed 222 patients with a median age of 57 years and a follow‐up of 49 months. The overall surgical success rate was 80.2%. On multivariate analysis, the two variables identified that were predictive of surgical success were stricture length ≤2 cm as well as use of a buccal mucosa graft as compared to use of a fasciocutaneous flap, which had success rates of 83% and 52%, respectively (P = 0.0004). No statistically significant differences were found based on incisional approach or surgical technique, nor were outcomes different based on etiology or preoperative patient demographics. Conclusions: Surgical repair of penile urethral strictures of non‐hypospadiac origin have a favorable overall success rate, at 80.2%. Regardless of incisional approach or surgical technique, all operations appear to have similar outcomes other than repairs using fasciocutaneous flap, which were statistically less successful than those using buccal mucosa graft. [ABSTRACT FROM AUTHOR]

Objectives: To verify the utility of triangular extension of a hinge flap in buccal mucosal staged urethroplasty to resolve stomal stenosis after the first stage and ultimately prevent restenosis. Methods: A total of 23 patients (triangular extension group) were studied in 2013–2019. In the first stage, buccal mucosa was transplanted, and an extended triangle portion of the mucosa was placed beside the proximal and/or distal stoma that was created when the stricture segment of the urethra was resected. In the second stage, during tubularization of the urethral plate, an incision was made at the stoma to increase the caliber to which the triangular extension was inserted. The procedure was considered successful when a 17‐Fr flexible cystoscope passed through the reconstructed urethra at 6 months after the second‐stage urethroplasty and no additional surgery or bougie dilation required. The clinical course of the triangular extension group was compared with 24 patients who underwent conventional staged urethroplasty (control group). Results: In total, 20 patients from each group underwent second‐stage surgery. No patients in the triangular extension group required additional revision surgery because of stomal stenosis after first‐stage surgery, whereas five (20%) control patients did. Urethroplasty was successful in 19 patients (95%) in the triangular extension group and in 19 patients (95%) in the control group. Uroflowmetry after the second‐stage surgery indicated that the mean maximum urinary flow rate was 21.5 and 15.8 mL/s after triangular extension and the control procedure, respectively (P = 0.027). Conclusions: The triangular extension technique reduces the need for revision surgery and prevents postoperative restenosis. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the long‐term outcomes of dorsal onlay urethroplasty using lingual mucosal graft for repairing urethral strictures associated with genital lichen sclerosis. Methods: This study included 36 patients who had lichen sclerosis long anterior urethral strictures that were managed with dorsal onlay urethroplasty using lingual mucosal graft, and were followed up ≥5 years. Preoperatively, we measured the maximum urinary flow rate and the International Prostate Symptom Score, then every 3 months in the first year, and annually thereafter. During follow up, patients with obstructive symptoms were subjected to urethrography and/ or urethroscopy. A successful urethroplasty was defined as normal voiding and no need for further intervention. Results: Of the 36 patients, two were lost during the follow up, thus 34 patients were involved in the assessment. After lingual mucosal graft urethroplasty, there were significant improvements in maximum urinary flow rate and International Prostate Symptom Score (P < 0.0001). This improvement was sustained during the 5‐year follow‐up period. The median follow‐up period was 66.5 months (interquartile range 64–70 months). The overall success rate in this study was 88.2%. Postoperative complications that required intervention were reported within the first year in four (11.8%) patients. Oral site complications were mild in the early postoperative period with no long‐term complications. Conclusions: Dorsal onlay urethroplasty using lingual mucosal graft is a reliable and durable procedure for repairing lichen sclerosis urethral stricture. It provides a long‐term success rate with few failures occurring within the first year. Lingual mucosal graft harvesting is associated with minor, immediate oral complications, and no long‐term morbidity. [ABSTRACT FROM AUTHOR]

The use of buccal mucosal grafts for the reconstruction of urethral strictures is an established procedure. Because of its robustness, the buccal mucosal graft could also potentially provide an alternative for other indications in reconstructive urology. We report here six consecutive patients who received a buccal mucosal graft for ureteral strictures, glans reconstruction and stoma stenosis. The follow up for all patients ranged from 26 to 50 months. The buccal mucosal graft showed excellent functional results for the ureteral strictures and stenosis from ureterocutaneostomy. For glans reconstructions, the buccal mucosal grafts delivered excellent cosmetic and functional results without causing meatal stenosis. We conclude the buccal mucosal graft can be used in reconstructive surgery beyond the reconstruction of urethral strictures. [ABSTRACT FROM AUTHOR]

Editorial Comment to Dorsal onlay urethroplasty using lingual mucosal grafts for lichen sclerosis anterior urethral strictures repair: Long-term outcomes 4 Horiguchi A. Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: current topics and reviews. 5 Aldaqadossi HA, Eladawy M, Shaker H, Kotb Y, Elgamal S, Azazy S. Dorsal onlay urethroplasty using lingual mucosal grafts for lichen sclerosis anterior urethral strictures repair: long-term outcomes. [Extracted from the article]