Investig Clin Urol.  2019 Jul;60(4):319-325. 10.4111/icu.2019.60.4.319.

A novel slit-integration method of graft urethroplasty in the prevention of ring recurrence: Short-term results of a pilot study

• Ajape AA
• Kuranga SA
• Olanipekun HB
• Mohammed T

• KMID: 2450550
• DOI: http://doi.org/10.4111/icu.2019.60.4.319

Abstract

PURPOSE
To describe and evaluate the efficacy of the slit-integration method in the prevention of ring recurrence after graft substitution urethroplasty.
MATERIALS AND METHODS
This was a pilot study of selected patients with urethral stricture disease who required urethroplasty from January 2016 to December 2018. Patients were recruited into the study after they granted informed consent about the procedure.
RESULTS
A total of eight patients were involved in this pilot study. The mean age (±standard deviation, SD) of the patients and the mean stricture length (±SD) were 44.25 (±11.07) years and 3.88 (±1.25) cm, respectively. The peno-bulbar region was the most frequently involved. The majority of the patients, 7 of 8 patients, underwent buccal mucosal graft repair with a mean graft length of 5.88 cm (range, 4-8 cm). There was leak during pericatheter urethrography in one patient. The mean (±SD) urethral calibers of the distal and proximal urethral anastomotic sites following urethroplasty were 26.00 (±1.85) and 25.25 (±1.83) at 1 week after removal of the urethral catheter stent and 27.75 (±0.71) and 27.75 (±0.71) at 12 months postoperatively, respectively. The mean maximum flow rate (±SD) at the 6- and 12-month follow-up was 20.25 (±1.83) and 21.88 (±1.73) mL/s, respectively.
CONCLUSIONS
A slit-graft appropriately quilted into the corresponding urethrotomy incisions at the proximal and distal summit of the urethral stricture segments appears to mitigate the occurrence of ring contracture after urethroplasty. A randomized controlled trial of this technique with additional outcome assessment will be required to validate this observation.

Keyword

Pericatheter urethrogram; Ring recurrence; Slit-graft urethroplasty; Urethral calibration; Urethral stricture

MeSH Terms

Constriction, Pathologic
Contracture
Financing, Organized
Follow-Up Studies
Humans
Informed Consent
Methods*
Pilot Projects*
Recurrence*
Stents
Transplants*
Urethral Stricture
Urinary Catheters

Figure

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  Fig. 1 Retrograde urethrogram (of one of our patients) demonstrating peno-bulbar urethral stricture.

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  Fig. 2 ‘Slit-graft’ incorporation on the dorsal urethrotomy graft bed.

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  Fig. 3 Schematic representation of ‘slit-graft’ incorporation anastomosis.

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  Fig. 4 Harvested ‘slit-incorporated’ graft (full-thickness skin graft) ready to be used for grafting.

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