Substitution Urethroplasty for Bulbar Urethral Strictures

  • Akio HoriguchiEmail author
  • Masayuki Shinchi


Open surgical repair using free grafts or pedicled skin flaps, called substitution urethroplasty, is the gold standard procedure for bulbar urethral strictures not suitable for excision and primary anastomosis. Buccal mucosa harvested from the inner cheek is an ideal urethral substitute and is the tissue most often used for substitution urethroplasty because of its compatibility with urethral tissue, the ease of harvesting and handling it. Since the start of widespread use of the buccal mucosa graft in substitution urethroplasty, the use of pedicled skin flaps have become less common. Most bulbar urethral strictures can be repaired by one-stage urethroplasty, and buccal mucosa graft onlay augmentation is the most preferred procedure. Onlay augmentation on the ventral side (ventral onlay) or dorsal side (dorsal onlay) has been widely used, and other options are dorsal inlay with ventral sagittal urethrotomy or lateral onlay with one-sided urethral dissection. The success rate is the same for the different graft positions. In bulbar urethral strictures with obliterative or nearly obliterative segments, either a two-sided dorsal plus ventral onlay augmentation or a combination of excision and primary anastomosis and onlay augmentation (augmented anastomotic urethroplasty) is the procedure of choice. In this chapter, a practical strategy of substitution bulbar urethroplasty mainly using buccal mucosa graft is described.


Bulbar urethra Urethral stricture Urethral substitute Substitution urethroplasty Buccal mucosa 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of UrologyNational Defense Medical CollegeTokorozawa-City, SaitamaJapan

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