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Page 4 of 7 Guerra et al. Plast Aesthet Res 2022;9:42 https://dx.doi.org/10.20517/2347-9264.2021.136

Table 1. Comparison of success rates for different techniques
Number of Mean length F/U Success rate Time to recurrence
Source Location Intervention
patients (cm) (yr) (%) (mo)
[23]
Ahyai et al. 35 B & BM 2.9 BMGU 2.2 71.1 17
(2015)
[22]
Rourke et al. 72 BM 2.1 EPA (65%) 4 91 29.8
(2016)
6.1 Graft/Flap 75
(35%)
[20]
Hofer et al. 38 B & BM 2.4 EPA (92%) 3.5 69.7 10.1
(2014)
4.25 Graft/Flap (8%) 5.5 85 7
B: Bulbar; BM: bulbomembranous; EPA: excision and primary anastomosis; BMGU: buccal mucosa graft urethroplasty; F/U: follow up.

[21]
in some cases, a cystoscopy control for stricture recurrence based on the evolution of the patient .
In the study by Hofer et al. (2014) of the 72 men with radiation-induced urethral strictures, 66 (91.7%)
underwent urethroplasty with EPA and the remaining 6 (8.3%) underwent substitution urethroplasty using
a graft or flap . The reconstruction was eventually successful in 46 (69.7%) men. Time to reappearance was
[20]
observed to be 10.2 months and was associated with stricture length greater than 2 cm (P = 0.013). RT type
did not have a significant impact on risk. In general, EPA is a successful technique for bulbomembranous
urethra in patients with RT strictures [21,22] .

Rourke et al. (2016) retrospectively reviewed outcomes in 35 patients with bulbomembranous stenosis for
[22]
RT undergoing urethroplasty . Of these, 20 had undergone EBRT and 15 BT, presenting with RT-
associated stenosis with an average stricture length of 3.5 cm. Almost half of the patients enrolled before the
urethroplasty with an indwelling suprapubic catheter as the baseline. The anastomotic repair was performed
in 23 patients (65.7%); 12 patients required intraoperative tissue transfers, with either buccal mucosa graft
(20.0%) or penile island flap (14.3%). Urethral patency was achieved in 30 patients (85.7%) and confirmed
with cystoscopy; no significant difference was observed between the operative techniques. However, 31.4%
of patients experienced a complication, but all of these complications, reported within 90 days, were Clavien
Grades I-II .
[22]
Short-term complications, which include wound and urinary tract infections, occur infrequently and are
usually managed easily. Problems with chordee and erectile dysfunction are uncommon.

Substitution urethroplasty
When EPA is not possible for urethral stricture, substitution urethroplasty has become the key treatment,
especially with BMG. As for the benefits of BMG, it shows decreased propensity for contraction, its lamina
propria is thin with excellent vascularization, it has not been exposed to irradiation, and it has excellent
[23]
elasticity, which allows it to be easily adapted according to the recipient bed shape . Long strictures have
been found difficult to treat, especially in the irradiated urethras. It is important to fix the graft to a well-
vascularized field when performing urethroplasty with dorsal or ventral onlay approaches. Furthermore, a
previously irradiated urethra is often poorly vascularized, thereby impeding wound healing [23,24] . There is
currently insufficient evidence regarding ventral onlay BMG and dorsal urethroplasty for the treatment of
urethral strictures.

The corpus spongiosum is necessary for the survival of the ventral onlay BMG graft. The most important
benefits of the ventral approach are that the urethra, especially proximal, is easier to reach, exposure of the
narrow segment is better facilitating evaluation and graft placement, and mobilization of the bulbar urethra