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Long-term outcomes from a multi-institutional experience with prefabricated composite gracilis-buccal mucosal flap for reconstruction of devastated urethras

  • Urology - Original Paper
  • Published:
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Abstract

Purpose

Patients with devastated bulbar urethras have limited surgical options to restore normal upright voiding. We investigated the long-term feasibility of using two independently vascularized urethral hemi-plates lined with buccal mucosal graft (BMG) to treat these patients.

Methods

A multi-institutional retrospective review was conducted for patients that underwent this staged repair. In stage-1, the affected urethra is dissected and removed or prepared for a dorsal inlay augmentation. Two BMG segments are harvested; one graft is quilted on corpora cavernosa and urethra, creating an augmented perineal urethrostomy, and the other is quilted on the exposed distal gracilis muscle. Stage-2 utilizes the gracilis-BMG composite to recreate ventral bulbar urethra. The primary outcome measure was stricture recurrence. Secondary outcome measures included patient-reported outcome measures (PROMs).

Results

Five patients with mean age of 50 years (45–56) underwent staged repairs at two institutions between 7/2014 and 4/2016. All patients presented with suprapubic tubes and underwent at least one prior failed repair (1–9). Mean stricture length was 7.2 cm (5–9). Mean time between stage-1 and stage-2 repairs was 6.2 weeks (1–10). At a mean follow-up of 61 months (39–87), there were no recurrences. The mean uroflow was 20 cc/s (9–42) with a mean PVR of 59 cc (0–157). Four patients completed post-operative surveys; all reported at least a moderate improvement in their condition on Global Response Assessment (GRA), and a mean IPSS of 7.3 (0–26).

Conclusions

Our bi-institutional case series demonstrates that this technique is a feasible option for devastated urethras with long-term durability.

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Funding

The authors have no relevant financial or non-financial interests to disclose. The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA

    Joshua Sterling, Jessica Schardein & Dmitriy Nikolavsky

  2. Kulkarni Reconstructive Urology Center, Pune, Maharahstra, India

    Pankaj M. Joshi & Sanjay B. Kulkarni

Authors
  1. Joshua Sterling
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  2. Jessica Schardein
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  3. Pankaj M. Joshi
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  4. Sanjay B. Kulkarni
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  5. Dmitriy Nikolavsky
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by JS. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Dmitriy Nikolavsky.

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Ethical approval

This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the IRB of SUNY Upstate who determined that our study did not need ethical approval and an IRB official waiver of ethical approval was granted.

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Sterling, J., Schardein, J., Joshi, P.M. et al. Long-term outcomes from a multi-institutional experience with prefabricated composite gracilis-buccal mucosal flap for reconstruction of devastated urethras. Int Urol Nephrol 54, 1047–1052 (2022). https://doi.org/10.1007/s11255-022-03154-z

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  • DOI: https://doi.org/10.1007/s11255-022-03154-z

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