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Single-stage buccal mucosal graft urethroplasty for meatal stenoses and fossa navicularis strictures: a monocentric outcome analysis and literature review on alternative treatment options

  • Valentin Zumstein
  • Roland Dahlem
  • Valentin Maurer
  • Phillip Marks
  • Luis A. Kluth
  • Clemens M. Rosenbaum
  • Tim A. Ludwig
  • Christian P. Meyer
  • Silke Riechardt
  • Oliver Engel
  • Margit Fisch
  • Malte W. VetterleinEmail author
Original Article
  • 31 Downloads

Abstract

Objectives

To describe the operative technique and report outcomes from the largest series of patients who underwent single-stage dorsal inlay buccal mucosal graft urethroplasty (BMGU) for isolated meatal stenoses and fossa navicularis strictures.

Patients and methods

First, we evaluated patients who underwent single-stage BMGU for distal urethral strictures (meatus and fossa navicularis) between 2009 and 2016 at our department. Clinical and surgical characteristics were prospectively collected in an institutional database. Recurrence was defined as symptomatic need of any instrumentation during follow-up, was retrospectively assessed by patient interview, and recurrence-free survival was plotted using Kaplan–Meier curves. Second, a systematic literature review was performed through Medline to summarize the available evidence on distal urethroplasty using flaps or grafts.

Results

Of 32 patients, 16 (50%) presented with a hypospadias-associated stricture, followed by seven (22%), five (16%), and four (13%) patients with iatrogenic, inflammatory, and congenital strictures, respectively. At a median follow-up of 42 months (IQR 23–65), single-stage dorsal inlay BMGU was successful in 22 patients (69%), and estimated recurrence-free survival rates were 79% and 74% at 12 and 24 months, respectively. Overall, 62 patients from five studies in the literature review underwent BMGU for isolated distal strictures and success rates ranged from 56 to 100%.

Conclusion

Recurrent meatal stenoses and fossa navicularis strictures represent some of the most complex uro-reconstructive challenges. Inlay BMGU proves to be a valid and efficient last-resort single-stage technique. However, higher recurrence risk must be considered and staged urethroplasty should be discussed individually. Prospective randomized controlled trials are needed to prove the superiority of flaps, grafts or staged approaches over each other in this context.

Keywords

Lichen sclerosus et atrophicus Mouth mucosa Recurrence Systematic review Urethroplasty 

Notes

Acknowledgements

Almut Gödde, Jule Lamp, Carla Loewe, and Justus Stahlberg assisted with data collection. Simon Benz assisted with photo editing.

Author contributions

VZ: project development, data collection, manuscript writing. RD: project development, data analysis, manuscript writing. VM: data collection, manuscript editing. PM: manuscript editing. LAK: project development, manuscript editing. CMR: manuscript editing. TAL: manuscript editing. CPM: manuscript editing. SR: manuscript editing. OE: manuscript editing. MF: project development, manuscript editing. MWV: project development, data collection, data analysis, manuscript writing.

Compliance with ethical standards

Conflict of interest

All authors have no conflict of interest to disclose.

Statement of human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UrologyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Department of UrologyCantonal Medical Center St. GallenSt. GallenSwitzerland
  3. 3.Department of UrologyUniversity Medical Center FrankfurtFrankfurt (Main)Germany
  4. 4.Department of UrologyAsklepios Medical Center BarmbekHamburgGermany

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