Korean J Urol.  2012 Oct;53(10):737-740. 10.4111/kju.2012.53.10.737.

Tubal Buccal Mucosa Graft without Anastomosis of the Proximal Urethra for Long Segment Posterior Urethral Defect Repair

• Min BD
• Lee ET
• Kim WT
• Kim YJ
• Yun SJ
• Lee SC
• Kim WJ

• KMID: 1856996
• DOI: http://doi.org/10.4111/kju.2012.53.10.737

Abstract

A 31-year-old man was referred for further management of a urethral stricture. He was a victim of a traffic accident and his urethral injury was associated with a pelvic bone fracture. He had previously undergone a suprapubic cystostomy only owing to his unstable general condition at another hospital. After 3 months of urethral injury, direct urethral anastomosis was attempted, but the surgery failed. An additional 4 failed internal urethrotomies were performed before the patient visited Chungbuk National University Hospital. Preoperative images revealed complete posterior urethral disruption, and the defect length was 4 cm. We performed a buccal mucosa tubal graft without anastomosis of the proximal urethra for a long segment posterior urethral defect. The Foley catheter was removed 3 weeks after the operation and the patient was able to void successfully. After 8 months, he had normal voiding function without urinary incontinence.

Keyword

Mouth mucosa; Transplants; Urethral stricture

MeSH Terms

Accidents, Traffic
Adult
Catheters
Cystostomy
Humans
Mouth Mucosa
Pelvic Bones
Transplants
Urethra
Urethral Stricture
Urinary Incontinence

Figure

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  FIG. 1 Urethrocystography via urethra and cystostomy catheter revealed complete posterior urethral disruption; the defect was 4 cm.

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  FIG. 2 (A) Two 5.0×2.5 cm and 5.0×2.0 cm sized grafts were harvested. The grafts were defatted and tubed around a 20 Fr Foley catheter by using interrupted 4-0 polyglactin sutures. (B) An 18 Fr sound was placed on the proximal urethral end through the suprapubic route and from the defected segment to the perineum was carefully perforated along with finger palpation of the sound tip. (C and D) The 20 Fr Foley catheter with tubal buccal mucosa graft was successfully interposed in the defective urethral segment. (E) Illustration of buccal mucosal interposition in the defective urethral segment.

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  FIG. 3 (A) Postoperative urethrogram showing a good urethral shape with no contrast leaks. (B) Postoperative uroflowmetry showed normal flow shape with no residual urine.

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