Substitution urethroplasty: Buccal mucosal graft Vs local flaps - A prospective randomized study

Introduction: Urethral stricture is a common condition with varying etiology and management, determined by cause, site and length of stricture. Materials and methods: We presented here a randomized prospective trial comparing dorsal onlay buccal mucosa graft and penile skin flap urethroplasty at our institute over 3 years period. Results: Total 22 patients underwent substitution urethroplasty during this period. The mean age and follow up was 31.31 years and 9 months respectively. The most common cause of stricture urethra was post inflammatory (40.90%) followed by traumatic (36.36%) and balanitis xerotica obliterence (22.72%). Majority had combined penobulbar stricture (45.45%), followed by penile (31.81%) and bulbar (22.7%). The average size of the urethral stricture was 6.81 cm. The most common symptom of presentation of stricture urethra was thin stream (100%) followed by dysuria (80%), frequency (71.42%) and dribbling (30%). Most of the patients underwent surgical procedure prior to presentation; urethral dilatation done in 13 (59.05%) patients followed by visual internal urethrotomy 7 (31.81%) patients and suprapubic cystostomy in 4 (18.18%) patients. Of 22 patients, 10 (45.45%) underwent local flap and 12 (54.54%) patients buccal mucosal graft. Out of 10 local flap technique, 8 (36.36%) patients underwent ventral longitudinal flap and 2 (9.09%) underwent Quartey flap. Out of 12 buccal mucosal graft technique, 5 (22.72%) patients underwent ventral onlay graft, 5 (22.72%) dorsal onlay and 2 (9.09%) tube circumferential graft. Total success rate was 72.72%. Success rate was higher with buccal mucosal graft (83.33%) compared to local flap technique (60%). Among local flap technique, ventral longitudinal flap (62.5%) had better results than quartey flap (50%). Among buccal mucosal graft dorsal onlay graft had best (100%) results followed by ventral onlay (80%) and then tube circumferencial graft (50%). Patients with smaller stricture length (2.5-7.5 cm) had better (75%) results. Patients with combined penobulbar (90%) and BXO as etiology (80%) also had better results. Conclusion: The success rate of buccal mucosal free graft substitution urethroplasty is better than local penile skin flaps in patients with anterior urethral strictures.