Skip to main content Skip to main navigation menu Skip to site footer

Graft procedure on urethroplasty, in comparison with flap procedure: a literature review



Abstract

Urethroplasty is a surgical procedure to reconstruct urethral patency on urethral stricture. There are several options for repairing urethral stricture in general, one of the examples is using graft or flap for augmentation urethroplasty. The indications of augmentation urethroplasty with graft are bulbar or penile urethral stricture, risk of tension on urethral anastomosis, and stricture more than 1 cm. Graft is less reliable because it has to be revascularized, easier to harvest, on the other hand flap has generous blood supply, but it was time-consuming to collect and to dissect. In case of bulbar urethral stricture with intact corpus spongiosum, graft had more advantages rather than flap because the anatomy of the urethra moves proximally giving thicker and more robust ventrally, and makes the graft suitable on vascular bed. Plenty of sites can be used to harvest graft for urethroplasty, there are buccal mucosa, genital skin, extragenital skin, lingual mucosa, bladder mucosa, and colonic mucosal graft. Although the treatment of urethroplasty depends on the length and location of stricture until today the comparison between the use of graft and flap in urethroplasty is still controversy and under debate.Some studies reported higher success rates in grafts than flaps procedure, but only few studies showed statistically significant difference. However, grafts procedure is easier, less operative time, and less morbidity, therefore leading to satisfaction in most of the patients.

Keywords: Urethroplasty buccal mucosal graft penile skin flap urethral stricture

References

  1. Browne BM, Vanni AJ. Use of Alternative Technique and Grafts in Urethroplasty. Urol Clin Am. 2017;44(1):-127-40.
  2. Bayne D, Gaither TW, Awad MA, Murphy GP, Osterberg EC, Breyer BN. Guidelines of guidelines: a review of urethral stricture evaluation, management, and follow up. Trans Androl Urol. 2017;6(2):288-94.
  3. Hillary CJ, Osman NI, Chapple CR. Current Trends In Urethral Stricture Management. Asian Journal of Urology. 2014;1(1)1:46-54.
  4. Wisenbaugh ES, Gelman J. The Use of Flaps and Grafts in the Treatment of Urethral Stricture Disease: Adv Urology. 2015: 979868.
  5. Levy AC. Vanni AJ. Refractory urethral stricture management: indications for alternative grafts and flaps. Curr Urol Rep. 2018;19(3):20.
  6. Bryk DJ, Yamaguchi Y, Zhao LC. Tissue transfer techniques in reconstructive urology. Korean J Urol. 2015;56:478-86.
  7. Ivo D, editors. Current Concept of Urethroplasty. Croatia: Intech. Jeneza Trdine; 2011.
  8. Syed SN, Muneer K, Showket AG et al. Outcome of Circumferential Penile Skin versus Dorsal On Lay Buccal Mucosal Urethroplasty for Long Anterior Urethral Strictures: A Prospective Single Centre Experience with Five Years Follow-Up. Journal of Surgery. 2016;5(1):18–22.
  9. Soliman MG, Farha MA, El Abd AS, Hameed HA, Gamal SE. Dorsal onlay urethroplasty using: a prospective randomized study. Scandinavian Journal of Urology. 2014;48:466–473.
  10. Hussein MM, Moursy E, Gamal W, Zaki M, Rashed A, Abozaid A. The Use of Penile Skin Graft Versus Penile Skin Flap in the Repair of Long Bulbo-penile Urethral Stricture: A Prospective Randomized Study. Urology. 2011;77(5):1233-37.
  11. Barbagli G, Morgia G, Lazzeri M. Retrospective outcome anal¬ysis of one-stage penile urethroplasty using a flap or graft in a homogeneous series of patients. BJU Int. 2008;102:853-60.
  12. Dubey D, Vijjan V, Kapoor R, Srivastava A, Mandhani A, Ku¬mar A, et al. Dorsal onlay buccal mucosa versus penile skin flap urethroplasty for anterior urethral strictures: results from a randomized prospective trial. J Urol. 2007;178:2466-9.
  13. Hosseini J, Soltanzadeh KA. Comparative Study of Long-Term Results of Buccal Mucosal Graft and Penile Skin Flap Techniques in the Management of Diffuse Anterior Urethral Strictures: First Report in Iran. Urol J. 2004;1(2):31-35.
  14. Wessells H, McAninch JW. Current controversies in anterior urethral stricture repair: free-graft versus pedicled skin flap reconstruction. World J Urol. 1998;16:175-180.
  15. Alsikafi NF, Eisenberg M, McAninch JW. Long-Term outcomes of Penile Skin Graft Versus Buccal Mucosal Graft for Substitution Urethroplasty of the Anterior Urethra. The Journal of Urology. 2005;173(4):87-88.

How to Cite

Duarsa, G. W. K., Pratama, P. K. D., Sabudi, I. M. N. G., & Oktavius, D. (2019). Graft procedure on urethroplasty, in comparison with flap procedure: a literature review. Bali Medical Journal, 8(3), 772–775. https://doi.org/10.15562/bmj.v8i3.1601
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
2

Total
2

Share

Search Panel

Gede Wirya Kusuma Duarsa
Google Scholar
Pubmed
BMJ Journal

Putu Kurnia Darma Pratama
Google Scholar
Pubmed
BMJ Journal

I Made Nugraha Gunamanta Sabudi
Google Scholar
Pubmed
BMJ Journal

Donny Oktavius
Google Scholar
Pubmed
BMJ Journal