(NDP23) Buccal mucosa urethroplasty for female urethral stricture—report of two cases and literature review
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  • 2015-11-29,
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尿道整形術 ─ 案例報告
林冠榮1、林志杰1,2,3、林登龍1,2,3、陳光國1,2,3
台北榮民總醫院泌尿部1;國立陽明大學醫學院 泌尿學科2書田泌尿科學研究中心3
Buccal mucosa urethroplasty for female urethral stricture—report of two cases and literature review
Kuan-Jung Lin1, Chi-Cheh Lin1,2,3, Alex Tong-Long Lin1,2,3, Kuang-Kuo Chen1,2,3
1Department of Urology, Taipei Veterans General Hospital, Taipei , Taiwan; 2Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 3Shu-Tien Urological Science Research Center , Taipei, Taiwan
Introduction:
Urethroplasty remains the principal surgical management for urethral stricture, especially in the increasing occasion of the discouraging high failure rate after repeated optic urethrotomy or otis urethrotomy. In the application of urethroplasty for adults, there were two major methodologies demonstrated in the past decades. One is the use of buccal mucosa graft and the other is dorsal approach for urethroplasty. Urethroplasty applying a mucosa graft to substitute the urethral mucosa is a well-established treatment for urethral strictures. Buccal mucosa graft urethroplasty should be considered as a treatment choice when urethral strictures are multiple or longer than 2 cm. We hereby present our preliminary experiences of buccal mucosa graft urethroplasty for the patients with nearly sealed urethral stricture.
Case presentation:
Case 1
A 55 years old female patient has the past history of pelvic bone fracture in 2002. Since then, she suffered from weak stream, intermittent dysuria, severe voiding difficulty, nocturia about 3 to 4 times per night and post-voiding dribbling. Pelvic vaginal exam showed normal urethral orifice but local tenderness over anterior vaginal wall. Uroflowmetry showed extremely decreasing maximal flow rate with 5 ml/sec (total voided volume: 278.6 ml).Under the first impression of ruling out female bladder outlet obstruction, videourodynamic study (VUDS) was arranged. However, failure to insert the examining urethral catheter occurred and subsequent fibrocystoscopy revealed severe urethral stricture. Direct vision internal urethrotomy (DVIU) was done and postoperative effect maintained only one week. Repeated DVIU was performed again three weeks later after first session. Due to the recurrent symptoms of difficult voiding and post-voiding dribbling and large amount post-void residual urine, she received clean intermittent catheterization. After further evaluation, urethraoplasty with dorsal onlay buccal mucosa graft (BMG) became the better management for her recurrent urethral stricture. Retrograde urethrogram revealed urethral stricture over proximal urethra with nearly sealed lumen (Figure 1). She accepted urethroplasty with BMG three months later and several adjuvant episodes of sounding (From 20 Fr. to 30 Fr.). She regained maximal free flow rate with 17.2 ml/sec and total resolution of lower urinary tract symptoms. There is no related post-urethroplasty complication noted.
Case 2
    This 54-year-old male patient presented with a straddle urethral injury over bulbar urethra on Sep. 15, 2014. Emergent suprapubic cystostomy was performed at local clinic on the next day. Since then, he started to suffer from difficult voiding and straining. Two months after urethral injury, he was referred to our institute for further management. Under the impression of bulbar urethral injury, he received primary DVIU. Nevertheless, he still suffered from straining voiding, weak stream and difficult urination after removal of Foley catheter. Even worse is acute urinary retention occurred one month after first session of DVIU. Subsequent cystoscopy revealed bulbar urethral stricture with pin hole like appearance. Retrograde urethrography and cystography revealed severe urethral stricture with nearly sealed segment of 2 cm in length, close to membranous urethra. Urethroplasty with dorsal onlay BMG was offered and performed on Jan. 23, 2015. Two months after urethroplasty, follow-up flexible cystoscopy can pass through easily. Two sessions of adjuvant transurethral balloon dilation were done for slight narrowing of proximal anastomosis site. Urethral diameter could be dilated to 22 French. During perioperative and follow-up period, postoperative urinary incontinence and erectile dysfunction were not reported by patient. In addition, lower urinary tract symptoms were almost resolved. 
Conclusion:
Urethroplasty with dorsal onlay BMG is a better treatment option for previous failure of DVIU, multiple urethral strictures, or longer segment of urethral stricture.
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    2015-11-29 17:13:00
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