Surgical Techniques in Substitution Urethroplasty Using Buccal Mucosa

Introduction Since the resurgence in the use of buccal mucosa in substitution urethroplasty in the late 1980s and early 1990s, there has been controversy as to which surgical technique is the most appropriate for its application. Method The authors performed a literature review. Several centres have published widely on this topic, and the points considered include the use buccal mucosa (BM) in dorsal-onlay grafts, ventral-onlay grafts, tubularised grafts and the role of two-stage procedures. Results In experienced hands, the outcomes of both dorsal-onlay grafts and ventral-onlay grafts in bulbar urethroplasty are very similar. The dorsal-onlay technique is however possibly less dependent on surgical expertise and therefore more suitable for surgeons new to the practice of urethroplasty. The complications associated with ventral-onlay techniques can be minimised by meticulous surgical technique, but in series with longer follow-up still tend to be more prevalent. In penile urethroplasty, two-stage dorsal onlay of BM (after complete excision of the scarred urethra) still provides the best results, although in certain circumstances a onestage dorsal-onlay procedure is possible. In general, ventral-onlay of BM and tube graft procedures in the management of penile strictures are associated with much higher rates of recurrence and should therefore be avoided.