The Battle of the Onlays: Ventral vs Dorsal Buccal Mucosa Graft Urethroplasty

Abstract

Stricture urethra is a common condition faced by urosurgeons in their daily clinical practice, of which bulbar urethra is the most common site with a variety of management options. For substitution urethroplasty, options available are skin, dartos fascia, bladder mucosa, intestinal mucosa, labial, lingual and   buccal mucosal graft. Buccal mucosal graft (BMG) is most preferred for reconstruction of anterior urethra.  BMG  was  initially  kept  on  the  dorsal surface   of   the  urethra  but,  the graft  can  be  kept  ventrally  also. In this study, we  are  comparing  the  success  rate  of  ventral  onlay  BMG  and dorsal  onlay  BMG  for  bulbar urethral stricture to determine the easier and shortest  surgical  method  of  bulbar  urethral  stricture reconstruction  repair. Totally 40 Patients with Bulbar Urethral Stricture more than 3 cm  were  studied  prospectively  as  well  as  retrospectively  for  over  a  period  of  2 years  at  various  hospitals  in  Chennai  performed  by  the same  team  of  urosurgeons. We concluded that success rate for ventral onlay BMG urethroplasty is equal to dorsal onlay BMG urethroplasty for bulbar urethral stricture. There is lesser operative time for ventral onlay on comparing with dorsal onlay. With previous history of urethrotomy, ventral onlay is preferred because of increased success rate.