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

Kuan-Jung Lin¹, Chi-Cheh Lin^1,2,3, Alex Tong-Long Lin^1,2,3, Kuang-Kuo Chen^1,2,3

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

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 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.