DefinePK

Research Objective

To evaluate the outcomes of ventral buccal mucosal graft urethroplasty at a tertiary care hospital.

Methodology

Case Control Study conducted retrospectively at the Department of Urology, CMC/SMBBMU Larkana, from January 2018 to December 2018. Data from 50 patients with anterior urethral stricture (more than 2 cm), negative urine culture, no history of diabetes mellitus, and no urinary incontinence were collected from hospital records. Exclusion criteria included more than two previous optical internal urethrotomies, bony deformity of lower legs, or enlarged prostate. Data collected included age, stricture size and location, clinical presentation, and routine investigations (Blood CP, ESR, urine culture, X-Ray retrograde urethrogram).

Methodology Flowchart

                        graph TD;
    A[Identify 50 patients with anterior urethral stricture] --> B[Collect patient data from records];
    B --> C[Record age, stricture details, clinical presentation, investigations];
    C --> D[Analyze data for outcomes and complications];
    D --> E[Evaluate success rate and complication frequency];
    E --> F[Formulate conclusions on ventral BMG urethroplasty];                    

Discussion

Ventral buccal mucosa grafting urethroplasty is presented as an effective treatment for anterior urethral strictures, offering good long-term results with a low complication rate. The study acknowledges that while dorsal placement of grafts may have comparable success rates, ventral placement is technically easier and provides better visualization. Potential complications like graft failure and pseudo-diverticulum formation are discussed, though not observed in this specific series. The study highlights the need for long-term follow-up and suggests that ventral BMG urethroplasty is a viable option comparable to dorsal and dorsolateral techniques.

Key Findings

The mean age of patients was 35.2 years (SD±15.25) with a mean duration of symptoms of 14.7 months (SD±9.98). The success rate of ventral onlay buccal mucosal graft urethroplasties was 90%. The main complications observed were transient swelling with altered sensation of the lip in 3 cases (6%), recurrent stricture at the proximal anastomosis in 1 case (2%) treated by direct vision internal urethrotomy, and impacted urethral stone in 1 case (2%) treated endoscopically. Urinary tract infections occurred in 2 cases (4%).

Conclusion

Ventral buccal mucosal graft urethroplasty provides excellent success rates and is technically easy to perform for patients with urethral stricture. It offers a low rate of complications, comparable to dorsal and dorsolateral buccal mucosal graft urethroplasty, with complications mainly occurring in the first year postoperatively.

Fact Check

1. Success Rate: The study reports a success rate of 90% for ventral onlay buccal mucosal graft urethroplasties in 50 patients.
2. Mean Age: The mean age of the patients included in the study was 35.2 years.
3. Complication Rate: Transient swelling with altered sensation of the lip was reported in 6% of cases (3 out of 50).

Mind Map