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Objectives: To investigate the versatility of the ventral urethrotomy approach in bulbar reconstruction with buccal mucosa (BM) grafts placed on the dorsal, ventral or dorsal plus ventral urethral surface. Patients and methods: Between 1999 and 2008, 216 patients with bulbar strictures underwent BM graft urethroplasty using the ventral-sagittal urethrotomy approach. Of these patients, 32 (14.8%; mean stricture 3.2 cm, range 1.5-5) had a dorsal graft urethroplasty (DGU), 121 (56%; mean stricture 3.7, range 1.5-8) a ventral graft urethroplasty (VGU), and 63 (29.2%; mean stricture 3.4, range 1.5-10) a dorsal plus ventral graft urethroplasty (DVGU). The strictured urethra was opened by a ventral-sagittal urethrotomy and BM graft was inserted dorsally or ventrally or dorsal plus ventral to augment the urethral plate. Results: The median follow-up was 37 months. The overall 5-year actuarial success rate was 91.4%. The 5-year actuarial success rates were 87.8%, 95.5% and 86.3% for the DGU, VGU and DVGU, respectively. There were no statistically significant differences among the three groups. Success rates decreased significantly only with a stricture length of >4 cm. Conclusions: In BM graft bulbar urethroplasties the ventral urethrotomy access is simple and versatile, allowing an intraoperative choice of dorsal, ventral or combined dorsal and ventral grafting, with comparable success rates. �� 2012 Arab Association of Urology. Production and hosting by Elsevier B.V. All rights reserved.

Purpose: To describe the technique and results of penis-sparing surgery combined with a cosmetic neo-glans reconstruction for benign, pre-malignant or malignant penile lesions. Patients and methods: Twenty-one patients (mean age 61 years) with penile lesions with a broad spectrum of histopathology underwent organ-sparing surgery with neo-glans reconstruction, using a free split-thickness skin graft harvested from the thigh. Three patients were treated by glans-skinning and glans-resurfacing, 10 by glansectomy and neo-glans reconstruction, four by partial penectomy and a neo-glans reconstruction, and four by neo-glans reconstruction after a traditional partial penectomy. Results: The mean follow-up was 45 months; all patients were free of primary local disease. All patients were satisfied with the appearance of the penis after surgery, and recovered their sexual ability, although sensitivity was reduced as a consequence of glans/penile amputation. Conclusion: In benign, premalignant or malignant penile lesions, penis-sparing surgery combined with a cosmetic neo-glans reconstruction can be used to assure a normally appearing and functional penis, while fully eradicating the primary local disease. © 2011 Arab Association of Urology. Production and hosting by Elsevier B.V. All rights reserved.

OBJECTIVE To retrospectively report the long-term results of the use of a small intestinal submucosa (SIS) graft in bulbar urethral repair. METHODS From 2003 to 2007, 25 men (mean age 40.5 years) with bulbar strictures underwent patch graft urethroplasty using SIS placed on the dorsal or ventral or dorsal plus ventral surface of the urethra. The mean follow-up period was 71 months (range 52-100). The clinical outcome was considered a failure when any postoperative instrumentation, including dilation, was needed. RESULTS Of the 25 cases, 19 (76%) were successful and 6 (24%) were failures. No postoperative complications were related to the use of heterologous graft material, such as infection or rejection. The failure rate was 14% for strictures 4 cm. CONCLUSION At long-term follow-up, in bulbar stricture repair, SIS grafts showed similar results to penile skin grafts but were less effective than buccal mucosa grafts. The use of SIS as graft material should not be the first choice but represents an alternative option for patients with bulbar strictures that are not long and who refuse the harvesting or are not ideal candidates for buccal mucosa or penile skin grafts. Larger series of patients with longer follow-up are needed before widespread use can be advocated. UROLOGY 79: 695-701, 2012. (C) 2012 Elsevier Inc.