Abstrcat
Introduction: Buccal mucosa has been advocated as an ideal graft material for urethral reconstruction . The graft either dorsally or ventrally placed. The ideal lactation of the graft ventrally r dorsally is still debatable.
We report our comparative experience with both methods for complex bulbar ureteral stricture reconstruction in adults.
Material and methods: from January 2002 through June 2004,25 patients presented with complex bulbar urethral stricture; their ages ranged from 18 to 44 years with a mean of 25±4 years. All of them have deficient penile skin. All our patients were assessed preoperatively with urethrogram, flow rate pre-operatively and postopeartively; our patients were randomized for repair by either ventrally or dorsally placed buccal mucosa path graft.
Results: follow up range from 12 to 30 months with average 22 months.
Follow up was performed with ascending urethrogarm, urine flow rate and urethroscopy for selected patient after 12 months. Average stricture lenthg awsa 3.6 ±1.8 cm. (range 2-6.5) as measured preoperative retrograde urethrogram. Average peak urinary flow rates increased from 7.9 ml preoperatively to 20 .1ml/sec second pot operatively(P<0.001) for the ventrally placed graft group and increased from 7.3 preopratively to 21.1 ml/sec postroperatively for the dorsally placed graft (P<0.001). postoperative retrograde urethrogram were available for25 patints and were normal 23. The overall complications rate was 8 % . Two patients required endoscopic incision
Conclusion: buccal mucsagratfts used as either ventral onlay or dosal onlay for bubalar urethral reconstruction yielded reproducibly exceelent rsulta with no statistically significant difference between the two methods, as well as minimal morbidity and law complication rates. Longer follow up is required to confirm the durability of our results.