Dorsolateral onlay urethroplasty for anterior urethral strictures by a unilateral urethral mobilization approach

CONTEXT: For management of long segment anterior urethral stricture, dorsal onlay urethroplasty is currently the most favored single-stage procedure. Conventional dorsal onlay urethroplasty requires circumferential mobilization of the urethra, which might cause ischemia of the urethra in addition to chordee. AIMS: To determine the feasibility and short-term outcomes of applying a dorsolateral free graft to treat anterior urethral stricture by unilateral urethral mobilization through a perineal approach. SETTINGS AND DESIGN: A prospective study from September 2005 to March 2008 in a tertiary care teaching hospital. MATERIALS AND METHODS: Seventeen patients with long or multiple strictures of the anterior urethra were treated by a dorsolateral free buccal mucosa graft. The pendulous urethra was accessed by penile eversion through the perineal wound. The urethra was not separated from the corporal bodies on one side and was only mobilized from the midline on the ventral aspect to beyond the midline on the dorsal aspect. The urethra was opened in the dorsal midline over the stricture. The buccal mucosa graft was secured on the ventral tunica of the corporal bodies. STATISTICAL ANALYSIS USED: Mean and median. RESULTS: After a follow-up of 12-30 months, one recurrence developed and 1 patient needed an internal urethrotomy. CONCLUSIONS: A unilateral urethral mobilization approach for dorsolateral free graft urethroplasty is feasible for panurethral strictures of any length with good short-term success.