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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

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A Letter to the Editor to this article was published on 02 May 2020

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.

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Acknowledgements

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

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Author notes

  1. Valentin Zumstein and Roland Dahlem contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    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. Vetterlein

  2. Department of Urology, Cantonal Medical Center St. Gallen, St. Gallen, Switzerland

    Valentin Zumstein

  3. Department of Urology, University Medical Center Frankfurt, Frankfurt (Main), Germany

    Luis A. Kluth

  4. Department of Urology, Asklepios Medical Center Barmbek, Hamburg, Germany

    Clemens M. Rosenbaum

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  1. Valentin Zumstein
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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.

Corresponding author

Correspondence to Malte W. Vetterlein.

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All authors have no conflict of interest to disclose.

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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.

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

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Luis A. Kluth, Clemens M. Rosenbaum: Member of the Trauma and Reconstructive Urology Working Party of the EAU (European Association of Urology) YAU (Young Academic Urologists).

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Zumstein, V., Dahlem, R., Maurer, V. et al. Single-stage buccal mucosal graft urethroplasty for meatal stenoses and fossa navicularis strictures: a monocentric outcome analysis and literature review on alternative treatment options. World J Urol 38, 2609–2620 (2020). https://doi.org/10.1007/s00345-019-03035-8

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