Reconstruction of Membranous Urethral Strictures

  • Javier C. Angulo
  • Reynaldo G. Gómez
  • Dmitriy Nikolavsky
Surgery (J Simhan, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Surgery


Purpose of Review

Due to the proximity of the rhabdosphincter and cavernous nerves to the membranous urethra, reconstruction of membranous urethral stricture implies a risk of urinary incontinence and erectile dysfunction. To avoid these complications, endoscopic management of membranous urethral strictures is traditionally favored, and bulboprostatic anastomosis is reserved as the main classical approach for open reconstruction of recalcitrant membranous urethral stricture. The preference for the anastomotic urethroplasty among reconstructive urologists is likely influenced by the familiarity and experience with trauma-related injuries. We review the literature focusing on the anatomy of membranous urethra and on the evolution of treatments for membranous urethral strictures.

Recent Findings

Non-traumatic strictures affecting bulbomembranous urethra are typically sequelae of instrumentation, transurethral resection of the prostate, prostate cancer treatment, and pelvic irradiation. Being a different entity from trauma-related injuries where urethra is not in continuity, a new understanding of membranous urethral anatomy is necessary for the development of novel reconstruction techniques. Although efficacious and durable to achieve urethral patency, classical bulboprostatic anastomosis carries a risk of de-novo incontinence and impotence. Newer and relatively less invasive reconstructive alternatives include bulbar vessel-sparing intra-sphincteric bulboprostatic anastomosis and buccal mucosa graft augmented membranous urethroplasty techniques. The accumulated experience with these techniques is relatively scarce, but several published series present promising results. These approaches are especially indicated in patients with previous transurethral resection of the prostate in which sparing of rhabdosphincter and the cavernous nerves is important in attempt to preserve continence and potency. Additionally, introduction of buccal mucosa onlay grafts could be especially beneficial in radiation-induced strictures to avoid transection of the sphincter in continent patients, and to preserve the blood supply to the urethra for incontinent patients who will require artificial urinary sphincter placement. The evidence regarding erectile functional outcomes is less solid and this item should be furtherly investigated.


Urethral stricture Membranous urethra Urinary incontinence Erection Surgical technique Mouth mucosa 



The authors acknowledge José María Gil Vernet for the illustration of Professor Salvador Gil Vernet and also José Domínguez for photographic assistance.

Compliance with Ethical Standards

Conflict of Interest

Javier C. Angulo and Dmitriy Nikolavsky each declare no potential conflicts of interest.

Reynaldo G. Gómez is an advisor and mentor for Boston Scientific and speaker for Eli-Lilly.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Barry JM. Visual urethrotomy in the management of the obliterated membranous urethra. Urol Clin North Am. 1989;16:319–24.PubMedGoogle Scholar
  2. 2.
    Goel MC, Kumar M, Kapoor R. Endoscopic management of traumatic posterior urethral stricture: early results and followup. J Urol. 1997;157:95–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Myers JB, McAninch JW. Management of posterior urethral disruption injuries. Nat Clin Pract Urol. 2009;6:154–63.CrossRefPubMedGoogle Scholar
  4. 4.
    •• Gimbernat H, Arance I, Redondo C, Meilán E, Andrés G, Angulo JC. Treatment for long bulbar urethral strictures with membranous involvement using urethroplasty with oral mucosa graft. Actas Urol Esp. 2014;38:544–51. Dorsal onlay urethroplasty with buccal mucosa graft for long bulbar urethral strictures with membranous involvement is successful in 92.9% and seems advantageous with respects to bulbo-prostatic anastomosis with no case developing de novo incontinence, despite 64.3% had previous TURP. CrossRefPubMedGoogle Scholar
  5. 5.
    •• Blakely S, Caza T, Landas S, Nikolavsky D. Dorsal onlay urethroplasty for membranous urethral strictures: urinary and erectile functional outcomes. J Urol. 2016;195:1501–7. Dorsal onlay urethroplasty with buccal mucosa graft for membranous urethral stricture does not compromise continence or erectile function, even after radiation. CrossRefPubMedGoogle Scholar
  6. 6.
    Gómez R, Scarberry K. Anatomy and techniques in posterior urethroplasty. Trans Androl Urol 2017 (accepted in press).Google Scholar
  7. 7.
    Lumen N, Hoebeke P, Willemsen P, De Troyer B, Pieters R, Oosterlinck W. Etiology of urethral stricture disease in the 21st century. J Urol. 2009;182:983–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Strasser H, Bartsch G. Anatomy and innervation of the rhabdosphincter of the male urethra. Semin Urol Oncol. 2000;18:2–8.PubMedGoogle Scholar
  9. 9.
    Wang X, Liu T, Zhao J, Sun J, Chen Y, Sun P, et al. Normal anatomic relationship between urethral sphincter complex and zones of prostrate in young Chinese males on MRI. Int J Clin Exp Med. 2015;8:16918–25.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Hollabaugh RS Jr, Dmochowski RR, Steiner MS. Neuroanatomy of the male rhabdosphincter. Urology. 1997;49:426–34.CrossRefPubMedGoogle Scholar
  11. 11.
    Song LJ, Lu HK, Wang JP, Xu YM. Cadaveric study of nerves supplying the membranous urethra. Neurourol Urodyn. 2010;29:592–5.PubMedGoogle Scholar
  12. 12.
    •• Hinata N, Murakami G, Miyake H, Abe S, Fujisawa M. Histological study of the cavernous nerve mesh outside the periprostatic region: anatomical basis for erectile function after nonnerve sparing radical prostatectomy. J Urol. 2015;193:1052–9. Cavernous nerve mesh form a U-shaped column attached to the lateral and postrior aspects of the rhabdosphincter. Dorsal incision on membranous urethra allows best sparing of both cavernous and pudendal nerves. CrossRefPubMedGoogle Scholar
  13. 13.
    Delmas V, Benoit G, Gillot C, Hureau J. Anatomical basis of the surgical approach to the membranous urethra. Anat Clin. 1984;6:69–78.CrossRefPubMedGoogle Scholar
  14. 14.
    •• Shah AP, Mevcha A, Wilby D, Alatsatianos A, Hardman JC, Jacques S, et al. Continence and micturition: an anatomical basis. Clin Anat. 2014;27:1275–83. The rhabdosphincter covers the inferior side of the prostate and is located at the level of the membranous urethra where fibers are oriented in a horse-shoe shape and without anatomical fixation to the levator ani muscle. Voluntary closure of the urethra in males is executed by the external urethral sphincter alone, that is under voluntary control via the pudendal nerve. CrossRefPubMedGoogle Scholar
  15. 15.
    Koraitim MM. The male urethral sphincter complex revisited: an anatomical concept and its physiological correlate. J Urol. 2008;179:1683–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Hinata N, Murakami G. The urethral rhabdosphincter, levator ani muscle, and perineal membrane: a review. Biomed Res Int 2014;2014:906921. doi:, 1, 18.
  17. 17.
    Gosling JA, Dixon JS, Critchley HO, Thompson SA. A comparative study of the human external sphincter and periurethral levator ani muscles. Br J Urol. 1981;53:35–41.CrossRefPubMedGoogle Scholar
  18. 18.
    Gil-Vernet JM, Arango O, Álvarez-Vijande R. Topographic Anatomy and its development in urology in the 20th century. The work of Salvador Gil Vernet. Eur J Anat. 2016;20:231–47.Google Scholar
  19. 19.
    Strasser H, Tiefenthaler M, Steinlechner M, Eder I, Bartsch G, Konwalinka G. Age dependent apoptosis and loss of rhabdosphincter cells. J Urol. 2000;164(5):1781–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Mundy AR, Andrich DE. Posterior urethral strictures. In: Brandes SB, Morey AF, editors. Advanced male urethral and genital reconstructive surgery. 2nd ed. New York: Humana Press; 2014. p. 273–87.CrossRefGoogle Scholar
  21. 21.
    •• Campos-Juanatey F, Portillo Martín JA, Gómez Illanes R, Velarde RL. Nontraumatic posterior urethral stenosis. Actas Urol Esp. 2017;41:1–10. Endoscopic therapy is often the initial surgical approach to nontraumatic posterior urethral stricture. Prostate cancer treatment and BPH surgery are leading causes and often require complex surgeries that may lead to urinary incontinence. CrossRefPubMedGoogle Scholar
  22. 22.
    Nielsen KK, Nordling J. Urethral stricture following transurethral prostatectomy. Urology. 1990;35:18–24.CrossRefPubMedGoogle Scholar
  23. 23.
    Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP): incidence, management, and prevention. Eur Urol. 2006;50:969–79.CrossRefPubMedGoogle Scholar
  24. 24.
    Stein DM, Santucci RA. Pro: endoscopic realignment for pelvic fracture urethral injuries. Transl Androl Urol. 2015;4:72–8.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Tausch TJ, Morey AF. Con: Bulbomembranous anastomotic urethroplasty for pelvic fracture urethral injuries. Transl Androl Urol. 2015;4:79–83.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Velarde-Ramos L, Gómez-Illanes R, Campos-Juanatey F, Portillo-Martín JA. Traumatic lesions of the posterior urethra. Actas Urol Esp. 2016;40:539–48.CrossRefPubMedGoogle Scholar
  27. 27.
    Mundy AR, Andrich DE. Pelvic fracture-related injuries of the bladder neck and prostate: their nature, cause and management. BJU Int. 2010;105:1302–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Fu Q, Zhang J, Sa YL, Jin SB, Xu YM. Recurrence and complications after transperineal bulboprostatic anastomosis for posterior urethral strictures resulting from pelvic fracture: a retrospective study from a urethral referral centre. BJU Int. 2013;112:E358–63.CrossRefPubMedGoogle Scholar
  29. 29.
    Gelman J, Wisenbaugh ES. Posterior urethral strictures. Adv Urol. 2015;2015:628107.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Reid RE, Berman SM, Laor E, Tolia BM, Schweizerhof SP. Continence mechanisms following transphincteric urethroplasty. Eur Urol. 1988;15:66–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Whitson JM, McAninch JW, Tanagho EA, Metro MJ, Rahman NU. Mechanism of continence after repair of posterior urethral disruption: evidence of rhabdosphincter activity. J Urol. 2008;179:1035–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Mundy AR, Andrich DE. Posterior urethral complications of the treatment of prostate cancer. BJU Int. 2012;110:304–25.CrossRefPubMedGoogle Scholar
  33. 33.
    • Chi AC, Han J, Gonzalez CM. Urethral strictures and the cancer survivor. Curr Opin Urol. 2014;24:415–20. Prostate cancer survivors treated with ablative therapies or radiation are at risk of bulbomembranous urethral stricture formation. Urethroplasty is a feasible and durable treatment options and should be considered in the appropriate patient. CrossRefPubMedGoogle Scholar
  34. 34.
    • Milose JC, Gonzalez CM. Urethroplasty in radiation-induced strictures. Curr Opin Urol. 2015;25:336–40. Radiation-induced urethral strictures are most often located in the membranous and proximal bulbar urethra and meticulous dissection and complex scar excision to the level of the prostatic apex is often needed. There are higher rates of postoperative incontinence in these pateints when compared to urethroplasty without radiation exposure. PubMedGoogle Scholar
  35. 35.
    Primiceri G, Castellan P, Marchioni M, Schips L, Cindolo L. Bladder neck contracture after endoscopic surgery for benign prostatic obstruction: incidence, treatment, and outcomes. Curr Urol Rep. 2017;18(10):79. Scholar
  36. 36.
    Browne BM, Vanni AJ. Management of urethral stricture and bladder neck contracture following primary and salvage treatment of prostate cancer. Curr Urol Rep. 2017;18(10):76. Scholar
  37. 37.
    Lumen N, Oosterlinck W. Challenging non-traumatic posterior urethral strictures treated with urethroplasty: a preliminary report. Int Braz J Urol. 2009;35:442–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Colapinto V, McCallum RW. Urinary continence after repair of membranous urethral stricture in prostatectomized patients. J Urol. 1976;115:392–6.CrossRefPubMedGoogle Scholar
  39. 39.
    Webster GD, Sihelnik S. The management of strictures of the membranous urethra. J Urol. 1985;134:469–73.CrossRefPubMedGoogle Scholar
  40. 40.
    • Myers JB, Brant WO, Hotaling JN, Lenherr SM. Urethral strictures and artificial urinary sphincter placement. Urol Clin North Am. 2017;44:93–103. Urethral strictures at the bladder neck, membranous urethra, or site of a previous artificial urethral sphincter (AUS) erosion are problems that profoundly affect the timing and treatment success of AUS placement. CrossRefPubMedGoogle Scholar
  41. 41.
    Herschorn S, Elliott S, Coburn M, Wessells H, Zinman L. SIU/ICUD consultation on urethral strictures: posterior urethral stenosis after treatment of prostate cancer. Urology. 2014;83(3 Suppl):S59–70.CrossRefPubMedGoogle Scholar
  42. 42.
    Turner-Warwick R. Complex traumatic posterior urethral strictures. J Urol. 1977;118:564–74.CrossRefPubMedGoogle Scholar
  43. 43.
    Pierce JM Jr. Posterior urethral stricture repair. J Urol 1979;121:739–742.Google Scholar
  44. 44.
    Quartey JK. A modified perineal approach to reconstruction of membranous urethra for stricture. J Urol. 1988 Apr;139:780–3.CrossRefPubMedGoogle Scholar
  45. 45.
    Pierce JM Jr. Exposure of the membranous and posterior urethra by total pubectomy. J Urol 1962;88:256–258.Google Scholar
  46. 46.
    Allen TD. The transpubic approach for strictures of the membranous urethra. J Urol. 1975;114:63–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Waterhouse K, Laungani G, Patil U. The surgical repair of membranous urethral strictures: experience with 105 consecutive cases. J Urol. 1980;123:500–5.CrossRefPubMedGoogle Scholar
  48. 48.
    Turner-Warwick R. The repair of urethral strictures in the region of the membranous urethra. J Urol. 1968;100:303–14.CrossRefPubMedGoogle Scholar
  49. 49.
    Morehouse DD. Current indications and technique of two-stage repair for membranous urethral strictures. Urol Clin North Am. 1989;16:325–8.PubMedGoogle Scholar
  50. 50.
    Kishev S. Surgical repair of stricture of the membranous urethra. II. Posterior approach to the membranous urethra. Urol Int. 1972;27:12–23.CrossRefPubMedGoogle Scholar
  51. 51.
    Flynn BJ, Delvecchio FC, Webster GD. Perineal repair of pelvic fracture urethral distraction defects: experience in 120 patients during the last 10 years. J Urol. 2003;170:1877–80.CrossRefPubMedGoogle Scholar
  52. 52.
    Fu Q, Xu YM, Zhang J, Jin SB, Sa YL. Use of anastomotic urethroplasty with partial pubectomy for posterior urethral obliteration injuries: 10 years experience. World J Urol. 2009;27:695–9.CrossRefPubMedGoogle Scholar
  53. 53.
    Koraitim MM. Post-traumatic posterior urethral strictures: preoperative decision making. Urology. 2004;64:228–31.CrossRefPubMedGoogle Scholar
  54. 54.
    Koraitim MM, Kamel MI. Perineal repair of pelvic fracture urethral injury: in pursuit of a successful outcome. BJU Int. 2015;116:265–70.CrossRefPubMedGoogle Scholar
  55. 55.
    • Kovell RC, Skokan AJ. Tissue preservation techniques at the time of urethroplasty for urethral stricture disease. Curr Urol Rep. 2017;18(7):56. Genitourinary reconstructive surgeons have developed and refined a number of techniques that seek to decrease the impact of urethroplasty on local tissues including blood supply and innervation. CrossRefPubMedGoogle Scholar
  56. 56.
    Schreiter F, Schönberger B, Olianas R. Reconstruction of the bulbar and membranous urethra. In: Schreiter F, Jordan GH, editors. Urethral reconstructive surgery. Heidelberg: Springer; 2006. p. 107–20.CrossRefGoogle Scholar
  57. 57.
    Turner-Warwick R. The surgery of some strictureas and stenoses. Some principles of the surgical treatment of strictures and stenoses of the urinary tract. Ann R Coll Surg Engl. 1972;50:318–20.PubMedPubMedCentralGoogle Scholar
  58. 58.
    Webster GD, Ramon J. Repair of pelvic fracture posterior urethral defects using an elaborated perineal approach: experience with 74 cases. J Urol. 1991;145:744–8.CrossRefPubMedGoogle Scholar
  59. 59.
    Mundy AR, Andrich DE. Entero-urethroplasty for the salvage of bulbo-membranous stricture disease or trauma. BJU Int. 2010;105:1716–20.CrossRefPubMedGoogle Scholar
  60. 60.
    Koraitim MM. On the art of anastomotic posterior urethroplasty: a 27-year experience. J Urol. 2005;173:135–9.CrossRefPubMedGoogle Scholar
  61. 61.
    Kizer WS, Armenakas NA, Brandes SB, Cavalcanti AG, Santucci RA, Morey AF. Simplified reconstruction of posterior urethral disruption defects: limited role of supracrural rerouting. J Urol. 2007;177:1378–81.CrossRefPubMedGoogle Scholar
  62. 62.
    Cooperberg MR, McAninch JW, Alsikafi NF, Elliott SP. Urethral reconstruction for traumatic posterior urethral disruption: outcomes of a 25-year experience. J Urol. 2007;178:2006–10.CrossRefPubMedGoogle Scholar
  63. 63.
    Singh SK, Pawar DS, Khandelwal AK, Jagmohan. Transperineal bulboprostatic anastomotic repair of pelvic fracture urethral distraction defect and role of ancillary maneuver: a retrospective study in 172 patients. Urol Ann. 2010;2:53–7.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Fu Q, Zhang J, Sa YL, Jin SB, Xu YM. Recurrence and complications after transperineal bulboprostatic anastomosis for posterior urethral strictures resulting from pelvic fracture: a retrospective study from a urethral referral centre. BJU Int. 2013;112:E358–63.CrossRefPubMedGoogle Scholar
  65. 65.
    Meeks JJ, Brandes SB, Morey AF, Thom M, Mehdiratta N, Valadez C, et al. Urethroplasty for radiotherapy induced bulbomembranous strictures: a multi-institutional experience. J Urol. 2011;185(5):1761–5.CrossRefPubMedGoogle Scholar
  66. 66.
    •• Hofer MD, Zhao LC, Morey AF, Scott JF, Chang AJ, Brandes SB, Gonzalez CM. Outcomes after urethroplasty for radiotherapy induced bulbomembranous urethral stricture disease. J Urol. 2014;191:1307–12. Radiotherapy induced bulbomembranous urethral strictures can be successfully managed (69.7%) with excision and primary anastomosis but patients should be counceled on the potential risks of urinary incontinence (35.7%) and erectile dysfunction (50.9%, de novo 7%). Google Scholar
  67. 67.
    •• Rourke K, Kinnaird A, Zorn J. Observations and outcomes of urethroplasty for bulbomembranous stenosis after radiation therapy for prostate cancer. World J Urol. 2016;34:377–382. Radiotherapy induced bulbomembranous urethral strictures can be successfully managed (85.7%) with a combination of techniques that include excision and primary anastomosis, buccal mucosal graft onlay and penile island flap onlay. Adverse change in continence occurred in 25.7% (13.3% in patients without previous TURP). Adverse change in erectile function occurred in 30.4%, exclusively in the anastomotic urethroplasty group. Google Scholar
  68. 68.
    Mundy AR. Urethroplasty for posterior urethral strictures. Br J Urol. 1996;78:243–7.CrossRefPubMedGoogle Scholar
  69. 69.
    •• Chung PH, Esposito P, Wessells H, Voelzke BB. Incidence of stress urinary incontinence following posterior urethroplasty for radiation-induced urethral strictures. Urology. 2017; Retrospective review of patients who underwent posterior excision and primary anastomosis urethroplasty for radiation-induced urethral stricture after prostate cancer therapy and for pelvic fracture related injuries secondary to blunt trauma. Stress urinary incontinence is less common in trauma patients than in radiation-induced stricture.
  70. 70.
    Glass AS, McAninch JW, Zaid UB, Cinman NM, Breyer BN. Urethroplasty after radiation therapy for prostate cancer. Urology. 2012;79:1402–5.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Al-Rifaei MA, Zaghloul S, Al-Rifaei AM. Bulboprostatic anastomotic urethroplasty with preservation of potency: anatomical study, operative approach and clinical results. Scand J Urol Nephrol. 2005;39:163–8.CrossRefPubMedGoogle Scholar
  72. 72.
    Dalpiaz O, Mitterberger M, Kerschbaumer A, Pinggera GM, Bartsch G, Strasser H. Anatomical approach for surgery of the male posterior urethra. BJU Int. 2008;102:1448–51.PubMedGoogle Scholar
  73. 73.
    Gómez R. Bulbomembranous urethroplasty: External sphincter-sparing approach. Urology Times, Feb 2016, ?page=0,0 (last Access 09 Dec 2017).
  74. 74.
    Jordan GH, Eltahawy EA, Virasoro R. The technique of vessel sparing excision and primary anastomosis for proximal bulbous urethral reconstruction. J Urol. 2007;177:1799–802.CrossRefPubMedGoogle Scholar
  75. 75.
    Gur U, Jordan GH. Vessel-sparing excision and primary anastomosis (for proximal bulbar urethral strictures). BJU Int. 2008;101:1183–95.CrossRefPubMedGoogle Scholar
  76. 76.
    •• Gomez RG, Campos RA, Velarde LG. Reconstruction of pelvic fracture urethral injuries with sparing of the bulbar arteries. Urology. 2016;88:207–12. Preservation of proximal arterial blood supply to the bulb during pelvic fracture urethral injury repair is feasible and safe. Well-perfused reconstruction should heal better and, at least theoretically, avoid the ischemic failure of the urethroplasty. CrossRefPubMedGoogle Scholar
  77. 77.
    •• Virasoro R, Zuckerman JM, McCammon KA, DeLong JM, Tonkin JB, Capiel L, Rovegno AR, Favre G, Giudice CR, Eltahawy EA, Gur U, Jordan GH. International multi-institutional experience with the vessel-sparing technique to reconstruct the proximal bulbar urethra: mid-term results. World J Urol. 2015;33:2153-7. Preservation of blood supply during reconstruction of proximal bulbar urethra is reproducible and could minimize complications of excision and primary anastomosis. Google Scholar
  78. 78.
    Kibbey RG 3rd. Patch graft urethroplasty: a review with emphasis on use for strictures in the region of the membranous urethra. J Urol 1976;115:155–158.Google Scholar
  79. 79.
    Dubey D, Kumar A, Mandhani A, Srivastava A, Kapoor R, Bhandari M. Buccal mucosal urethroplasty: a versatile technique for all urethral segments. BJU Int. 2005;95:625–9.CrossRefPubMedGoogle Scholar
  80. 80.
    González J, Mateo E, Lista F, Andrés G, Angulo J. Defining the case for anastomotic or substitution urethroplasty in complex urethral stricture with membranous involvement: analysis of a personal prospective series. Eur Urol Suppl. 2011;10:267–8.CrossRefGoogle Scholar
  81. 81.
    Vasudeva P, Nanda B, Kumar A, Kumar N, Singh H, Kumar R. Dorsal versus ventral onlay buccal mucosal graft urethroplasty for long-segment bulbar urethral stricture: a prospective randomized study. Int J Urol. 2015;22:967–71.CrossRefPubMedGoogle Scholar
  82. 82.
    Barbagli G, Montorsi F, Guazzoni G, Larcher A, Fossati N, Sansalone S, et al. Ventral oral mucosal onlay graft urethroplasty in nontraumatic bulbar urethral strictures: surgical technique and multivariable analysis of results in 214 patients. Eur Urol. 2013;64:440–7.CrossRefPubMedGoogle Scholar
  83. 83.
    •• Ahyai SA, Schmid M, Kuhl M, Kluth LA, Soave A, Riechardt S, et al. Outcomes of ventral onlay buccal mucosa graft urethroplasty in patients after radiotherapy. J Urol. 2015;194:441–6. The success rate of ventral onlay buccal mucosa graft urethroplasty after radiotherapy seems aceptable (71.1%) but with increased risk of de novo urinary incontinence (10.5%). CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Javier C. Angulo
    • 1
  • Reynaldo G. Gómez
    • 2
  • Dmitriy Nikolavsky
    • 3
  1. 1.Departamento Clínico, Facultad de Ciencias Biomédicas, Hospital Universitario de GetafeUniversidad Europea de MadridGetafeSpain
  2. 2.Hospital del TrabajadorUniversidad Andrés BelloSantiagoChile
  3. 3.Department of UrologySUNY Upstate Medical UniversitySyracuseUSA

Personalised recommendations