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Purpose: To report our initial experience with urethral reconstruction using a combined dorsal lingual mucosal graft (LMG) and ventral onlay preputial flap for long obliterative or near-obliterative strictures in circumcised patients., Materials and Methods: This was a retrospective study of 10 patients from January 2015 to June 2017 with long obliterative or near-obliterative anterior urethral strictures and circumcised prepuces. All patients underwent a combined approach using a dorsally LMG and a narrow preputial onlay flap ventrally to create a 26-30 Fr. neourethra over a 14-Fr Foley catheter. Success was defined as no requirement for additional urethral instrumentation. The follow-up period ranged from 6 to 32 months., Results: The patients ranged in age from 17 to 44 years (mean, 32.3±9.59 years) and stricture length ranged from 9 to 12.5 cm (mean, 10.77±1.15 cm). Four strictures were obliterative and six were near-obliterative. Two patients had a history of prior urethroplasty. The length of the LMGs harvested ranged from 11 to 14 cm (mean, 12.8±1.03 cm). The preputial flaps available were from 1 to 1.5 cm in width (1.29±0.16 cm) and the desired length. Maximum urinary flow rate (Qmax) achieved ranged from 12 to 26 mL/s (mean, 20.46±3.71 mL/s) after 3 months. One patient needed a single direct visualized internal urethrotomy and another patient develop temporary superficial penile necrosis. The success rate was 90%., Conclusions: Long obliterative and near-obliterative penile and penobulbar urethral strictures can still be treated in circumcised patients using available preputial skin along with lingual mucosa with good outcomes., Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose.

Objective: Histopathological changes in oral (buccal or lingual) mucosa after exposure to urine are still not completely understood. We evaluated these changes in free oral mucosal graft integrated in human urethra. Material and methods: Total 19 patients with recurrent urethral stricture after oral mucosa urethroplasty (buccal 12 and lingual 7) were prospectively evaluated. Intraoperatively integrated buccal or lingual mucosal graft sample that was previously engrafted to urethra was completely excised along with healthy oral mucosa, and it was sample processed for histopathological evaluation by dedicated pathologist. Preoperative clinical data were properly collected from all the study participants. Results: The mean age of the patients was 30 years, and the mean preoperative peak flow rate was 4.2 mL/s. Etiology of initial stricture was idiopathic in 13 (68.42%) patients and traumatic urethral catheterization in 6 (31.58%) patients. Mean interval from previous buccal mucosal urethroplasty to current urethroplasty was 21.9 months (range 12-46 months). On repeat urethroplasty, the mean stricture segment length was 59.2 (38-77) mm [60.08 (38-74.6) mm buccal, and 58.32 (39.6-77) mm lingual]. These integrated oral mucosal grafts maintained their histopathological characteristics in all patients except some kind of changes like submucosal fibrosis in seven (58.33%) cases of buccal and vacuolar degeneration in five (71.42%) cases of lingual mucosal urethroplasty. Conclusion: Histopathological characteristics of integrated oral (buccal and lingual) mucosal grafts were maintained even on exposure to urine except some changes like submucosal fibrosis and vacuolar degeneration. Impact of these changes require further research. [ABSTRACT FROM AUTHOR]

Aims: This is a prospective study of the use and efficacy of a novel technique of circumferential tubularised lingual mucosal graft (LMG) in obliterative and near obliterative bulbar urethral stricture of >2 cm where excisional and augmented anastomotic urethroplasty are not feasible. Materials and Methods: The stenotic urethral segment was opened dorsally in midline and fibrosed urethra was excised taking care to preserve the healthy spongiosum tissue. LMG (av. Length 3 cm) was placed from one end of corporal body towards spongy tissue in a circumferential manner. Another LMG was placed in similar manner to deal with longer stricture. The urethra was tubularised over 14 Fr silicone catheter. Results: A total of 12 men, of mean age 47 years underwent this procedure. The mean follow up period was 11 months starting from July 2014 till manuscript submission. Follow up included voiding cystourethrogram at 3 weeks, cystoscopy at 3 months (one patient didn't turned up) and subsequent follow up. Mean stricture length was 4.66 cm (range, 3-8.5 cm) and mean operative time was 195 min. (range, 160 to 200 min.). The technique was successful (normal voiding with no need for any post-operative procedure) in 11(91.6%) patients. One patient developed early recurrence at 4 month of surgery and had anastomotic stricture which was successfully managed by direct visual internal urethrotomy. Conclusion: Single stage circumferential tubularised graft urethroplasty is an excellent technique for strictures that include segments of obliterative and near obliterative diseased urethra. It provide a wider neourethra than patch graft urethroplasty. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to compare the outcome of buccal and lingual mucosa graft (LMG) augmentation urethroplasty along with donor sites morbidities in anterior urethra stricture. Subjects and Methods: From September 2010 to January 2014, 125 patients underwent single stage augmentation urethroplasty. They were randomly divided into two groups to receive either buccal mucosa graft (BMG) or LMG. The patients were prospectively followed for complications and outcome. Results: Baseline characteristics such as mean age, etiology, stricture length, and location were comparable in both groups. Overall success rate for Group 1 and Group 2 were 69.2% and 80%, respectively. Mean follow-up periods were 28.2 and 25 months in Group 1 and Group 2, respectively. Conclusions: LMG provides the better outcome with fewer immediate and delayed complications as compared to BMG. The length of stricture and width of graft were main factors affecting the outcome. [ABSTRACT FROM AUTHOR]