Re: Impact of graft position on failure of single-stage bulbar urethroplasties with buccal mucosa graft.

OBJECTIVE To determine whether patency rates after bulbar urethroplasty with buccal mucosa graft onlay differ on the basis of whether the graft is placed ventrally or dorsally. METHODS This was a retrospective single-center study of all single-stage bulbar urethroplasties performed from 2001 to 2011 by 2 surgeons in which buccal mucosa was used as an onlay graft. Failure was defined as the need for endoscopic or open revision of the reconstruction or the placement of a suprapubic catheter for urinary retention. RESULTS A total of 103 patients were reviewed; 41 underwent dorsal onlay, and 62 underwent ventral onlay. Mean age was 40.8 years. Most patients (84%) underwent a previous procedure, which consisted of direct vision internal urethrotomy in 69%, dilation in 53%, and urethroplasty in 14%. Mean stricture length was 3.9 cm. At a mean follow-up of 36 months, failure occurred in 19 patients (12 ventral and 7 dorsal). The vast majority of these patients (79%) were successfully treated with a single dilation or direct vision internal urethrotomy. There was no difference in failure rate or time to failure according to whether graft position was ventral or dorsal. In multivariate analysis, diabetes was predictive of failure (odds ratio 8.7; 95% confidence interval 1.6-46.5; P = .01). CONCLUSION Single-stage bulbar urethroplasty with buccal mucosa graft is an effective procedure for patients with a bulbar urethral stricture that is not amenable to primary anastomosis. From our experience, we cannot conclude that dorsal or ventral graft position is inherently superior. Patients with diabetes may be more likely to require additional procedures after bulbar urethroplasty with buccal grafting.