Failure rates similar for ventral, dorsal buccal mucosa grafts

In patients undergoing single-stage bulbar urethroplasty with buccal mucosa for urethral strictures, neither dorsal nor ventral onlay of the graft is inherently superior, data from a retrospective review suggest.

In a study reported here yesterday, urologists from the University of Washington, Seattle analyzed data from all procedures performed by two experienced reconstructive surgeons from 2001 to 2011. It included 41 patients who underwent dorsal onlay and 62 who underwent ventral onlay.

The population was heterogeneous in their preoperative characteristics. The dorsal onlay group was more likely than the ventral onlay group to have prior urethroplasty and multiple direct vision internal urethrotomies, indicating the dorsal group was more complicated, said first author Bradley Figler, MD, who worked on the study with Hunter Wessells, MD, and colleagues.

Median follow-up was 14.7 months for the dorsal onlay group and 34.6 months for the ventral onlay group. Failure, defined as the need for endoscopic or open revision of the reconstruction or placement of a suprapubic catheter for urinary retention, occurred in six patients (15%) in the dorsal onlay group and in 12 patients (19%) in the ventral onlay group. There was no statistically significant difference in failure rate between groups, and in a logistic regression analysis, graft position was not predictive of urethroplasty failure.

"Buccal musoca is generally well accepted as a graft material for bulbar urethroplasty, but it remains contentious whether dorsal or ventral placement of the graft is preferred," Dr. Figler said. "Our data suggests that as long as patients are selected properly, dorsal and ventral onlay buccal mucosa grafting is equivalent. We acknowledge selection bias is a potential limitation of our study, and prospective studies are necessary to determine the true efficacy of these approaches."

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