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Transurethral ventral buccal mucosa graft inlay for treatment of distal urethral strictures: international multi-institutional experience

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Abstract

Purpose

To critically evaluate a multi-institutional patient cohort undergoing single-stage distal urethral repair using a novel transurethral buccal mucosa graft inlay urethroplasty technique (TBMGI).

Methods

A retrospective multi-institutional review of consecutive patients with fossa navicularis (FN) strictures treated with a single-stage TBMGI technique at 12 institutions from March 2014–March 2018 was performed. Patient demographics, stricture characteristics, clinical and patient-reported outcomes were analyzed. The primary outcomes were stricture recurrence and complications. Secondary outcomes were change in maximum urinary flow rate (Qmax), PVR, and changes in IPSS, SHIM and global response assessment (GRA) questionnaire responses. Descriptive statistical analysis was used for evaluation of outcomes.

Results

Sixty-eight men met inclusion criteria. Median age and stricture length were 60 years (IQR 48–69) and 2 cm (IQR 2–3), respectively. Most common stricture etiology was lichen sclerosus (34%). Median operative time and EBL were 72 min (IQR 50–120) and 20 mL (IQR 10–43), respectively. Fifty-seven men completed ≥ 12-month follow-up. At a median follow-up of 17 months (IQR 13–22), 54 patients (95%) remained stricture-free. Median Qmax improved from 5 to 18 mL/s (p < 0.0001), PVR 76–21 mL (p < 0.0001), and IPSS 15–5 (p < 0.0001); IPSS-QOL score: 5–1 (p < 0.0001). SHIM score did not significantly change following repair (median 22–21 p = 0.85). On GRA assessment, a majority of men reported “marked” (64%) or “moderate” (28%) overall improvement. No patient developed fistula, glanular dehiscence, graft necrosis or chordee.

Conclusions

This novel minimally invasive transurethral urethroplasty technique is feasible and has demonstrated generalizable outcomes in a multi-institutional cohort with varying etiologies.

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Authors and Affiliations

  1. Department of Urology, SUNY Upstate Medical University, Syracuse, NY, 13078, USA

    Michael Daneshvar, Stephen Blakely & Dmitriy Nikolavsky

  2. Department of Urology, Einstein Healthcare Network/Fox Chase Cancer Center, Philadelphia, PA, USA

    Jay Simhan & Jacob Lucas

  3. Departamento Clinico, Facultad de Ciencias Biomedicas Y de La Salud, Universidad Europea de Madrid, Laureate Universitites, Madrid, Spain

    Javier C. Angulo

  4. Urologia Hospital Universitario de Getafe, Madrid, Spain

    Javier C. Angulo

  5. University of Nevada, Reno, NV, USA

    Craig Hunter

  6. Murac Health, Melbourne, Australia

    Justin Chee

  7. Hospital Regional Lic. Adolfo Lopez Mateos, Mexico City, Mexico

    Damian Lopez Alvarado

  8. Hospital Angeles Mocel, Mexico City, Mexico

    Erick Alejandro Ramirez Perez

  9. Ascension Health, Wichita, KS, USA

    Alosh Madala

  10. Sanatorio Allende, Córdoba, Argentina

    Juan José de Benito

  11. University of Lisbon, Hospital Santa Maria, Lisbon, Portugal

    Francisco Martins & João Felício

  12. University of Pittsburgh, Pittsburgh, PA, USA

    Paul Rusilko

  13. University of Colorado, Aurora, CO, USA

    Brian J. Flynn

Authors
  1. Michael Daneshvar
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  2. Jay Simhan
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  3. Stephen Blakely
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  4. Javier C. Angulo
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  5. Jacob Lucas
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  6. Craig Hunter
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  7. Justin Chee
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  8. Damian Lopez Alvarado
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  9. Erick Alejandro Ramirez Perez
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  10. Alosh Madala
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  11. Juan José de Benito
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  13. João Felício
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  14. Paul Rusilko
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  15. Brian J. Flynn
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  16. Dmitriy Nikolavsky
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Contributions

MD contributed to project development, data collection, data analysis, manuscript writing, manuscript editing. JS contributed to project development, data collection, data analysis, manuscript writing, manuscript editing. SB contributed to protocol development, project development, data collection, manuscript writing, manuscript editing. JCA contributed to data collection, data analysis, manuscript writing, manuscript editing. JL contributed to data collection, data analysis, manuscript editing. CH contributed to data collection, data analysis, manuscript writing, manuscript editing. JC contributed to data collection, data analysis, manuscript editing. DLA contributed to data collection, data analysis, manuscript editing. EARP contributed to data collection, data analysis, manuscript editing. AM contributed to data collection, data analysis, manuscript editing. JJdeB contributed to data collection, data analysis, manuscript editing. FM contributed to data collection, data analysis, manuscript editing. JF contributed to data collection, data analysis, data management, manuscript editing. PR contributed to data collection, data analysis, manuscript editing. BJF contributed to project development, data collection, data management, data analysis, manuscript editing. DN contributed to protocol development, project development, data collection, data management, data analysis, manuscript writing, manuscript editing.

Corresponding author

Correspondence to Dmitriy Nikolavsky.

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The authors declare that they have no conflict of interest and received no funding for this project.

Research involving human participants

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

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No identifiable personal data were used for this retrospective study.

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Cite this article

Daneshvar, M., Simhan, J., Blakely, S. et al. Transurethral ventral buccal mucosa graft inlay for treatment of distal urethral strictures: international multi-institutional experience. World J Urol 38, 2601–2607 (2020). https://doi.org/10.1007/s00345-019-03061-6

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  • DOI: https://doi.org/10.1007/s00345-019-03061-6

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