The Treatment of Complex Urethral Strictures Using Ventral Onlay Buccal Mucosa Graft or Ventral Onlay Penile Skin Island Flap Urethroplasty: A Prospective Case Series

Objectives: To compare the outcome of free onlay Buccal Mucosa Graft (BMG) with onlay penile Skin Island Flap (SIF) urethroplasty in the treatment of complex urethral strictures. Patients and Methods: A prospective comparative study was conducted at the Universitas Academic Hospital in Bloemfontein, South Africa. Patients presenting with complex urethral strictures were allocated to receive either ventral onlay penile SIF urethroplasty or ventral onlay BMG urethroplasty. A complex urethral stricture was defined as a stricture length of more than 2.5 cm or previous failed procedures, including urethral dilatation, internal Optical Urethrotomy (OU) and urethroplasty. Successful treatment outcome or cure was defined as no further treatment of the urethral stricture required after urethroplasty. Statistical analysis was performed with the t-test or chi-square test as appropriate. Results: BMG and SIF urethroplasty were performed on 18 and 17 patients, respectively. The mean age of the patients was 49.1 years (range 21–77) for the SIF group and 44.3 years (range 27–73) for the BMG group (p= 0.28). The mean urethral stricture length in the BMG group was 2.9 cm (range 2.4–4.0) and 4.5 cm (range 2.4–7.0) in the SIF group (p= 0.002). The urethral stricture site was bulbar in 67% in the BMG group and 59% in the SIF group. The cure rate was 11/17 (64.7%) for the SIF group and 13/18 (72.2%) for the BMG group (p= 0.63). Conclusions: No statistically significant difference in outcome between BMG and SIF urethroplasty was observed. However, given the longer operation time and more extensive surgical dissection of SIF reported in other studies, we recommend onlay BMG urethroplasty for the treatment of complex strictures. Key Words: Urethral stricture, Urethroplasty, Buccal mucosa graft, Skin island flap