A comparative study of long-term results of Buccal Mucosal Graft and Penile Skin Flap techniques in the management of diffuse anterior urethral strictures: first report in Iran.

PURPOSE To compare Buccal Mucosa Graft with Penile Skin Flap techniques in the management of anterior urethral diffuse strictures longer than 3 cm. MATERIALS AND METHODS Thirty seven patients with a mean age of 28.5 (range 5 to 50) years had been treated by these two techniques using the ventral onlay patch from February 1997 to March 2002. Patients' follow-up included physical examination, history taking, retrograde urethrography, cystoscopy and uroflowmetry at the month six, at the end of the first and the second years, and then yearly if required. RESULTS These techniques were applied for anterior urethral strictures (bulbar and penile) longer than 3 cm. Buccal mucosal graft (BMG) was used in 18 patients and penile skin flap (PSF) in 19. Mean follow-up was 27.5 (range 6 to 50) months. Mean age was 30.8+/-11.8 years for BMG group and 27.8+/-15.6 years for PSF group. Urethral stricture etiology, surgery history, and previous endoscopic surgery history were similar in both groups. The stricture site in BMG group was penile in 2 patients (11.1%), bulbar in 8 patients (44.4%), and penobulbar in 8 patients (44.4%). In PSF group the stricture site was penile in 11 patients (57.9%), bulbar in 5 patients (26.3%) and penobulbar in 3 patients (15.8%). Success rate in 6-month follow-up was 93.9% for BUG group and 83% for PSF. By performing dilatation and internal rethrotomy for mild strictures, the success rate with mean follow-up of 27.5 months was 13.8% for BMG group and 78.9% for PSF. Only one patient from BMG developed temporary impotence for about 12 months. CONCLUSION BMG and PSF are considered as simple and proper techniques with good long term outcomes in the management of diffuse anterior urethral strictures. These 2 techniques could be applied in patients with history of several surgeries. The results of BMG were better than PSF, still, this difference was not statistically significant.