Back to Program


Management of complex anterior urethral strictures with multi-stage buccal graft urethroplasty.
Spencer I. Kozinn, MD, Niall J. Harty, MD, Alex Vanni, MD, Leonard Zinman, MD, Jill Buckley, MD.
Lahey Clinic Medical Center, Burlington, MA, USA.

BACKGROUND: We aim to describe indications and outcomes of salvage urethral reconstruction utilizing the combination of urethrectomy with buccal graft replacement.
METHODS: We retrospectively identified 50 consecutive patients undergoing a multi-stage urethral reconstruction between 2003 and 2008. Demographic and surgical outcomes data, including need for first stage revision, pre- and post-operative urine flow rates, and failure of reconstruction, was collected on all patients.
RESULTS: See Tables 1 and 2. 29 (58%) patients went on to urethral tubularization, 3 (6%) patients are pending closure, and 18 (36%) patients have undergone first stage only with no current plan for completion. The mean age in those who underwent urethral closure is 41.7 (14-75), compared to 47.5 (21-80) in those pending or who have foregone closure. Etiology of the majority of strictures included hypospadius (n=22, 44%) and balanitis xerotica obliterans (BXO) (n=17, 34%). 20% of the patients had panurethral disease, with the rest involving varying lengths of the anterior urethra. Mean follow up was 19 months (range 1-53). 10 patients required revision of their first stage, with 3 patients requiring at least 2 repairs. Urine flow rates increased on average from 7.0 mL/sec pre-operatively to 20.7 mL/sec postoperatively. In total, 5 patients failed reconstruction, requiring scheduled balloon dilations to maintain urethral patency.
CONCLUSIONS: Urethrectomy with salvage reconstruction in a staged fashion is the optimal option for complex anterior urethral stricture resolution. Younger men with a hyposapdiac etiology trend towards urethral closure when compared to men with lichen sclerosus as a stricture cause.

Stricutre Etiology
Stricture EtiologyUrethral Closure (n=29)First Stage Only (n=21)
Hypospadius17 (59%)5 (24%)
BXO5 (17%)7 (33%)
Hypospadius/BXO4 (14%)1 (5%)
Other3 (10%)8 (38%)

Stricture Location
Urethral Closure (n=29)First Stage Only (n=21)
Bulbopendulous58
Mid-pendulous84
Distal pendulous/ Fossa Navicularis114
Panurethral55

Back to Program