Home | Health | Urology - Nephrology
UroToday.com - There has been recent literature to support the use of dorsally placed buccal mucosa grafts in the treatment of strictures of the female urethra. The father of dorsal buccal onlays in males, Guido Barbagli and his colleagues from Arezzo Italy, reports on a small series of females undergoing dorsal onlay buccal graft urethroplasties. The report is published in the October 2006 issue of the Journal of Urology. Over a three month period, 3 females with urethral strictures underwent substitution urethroplasties with a dorsally placed buccal mucosa graft. Mean age of the patient was 53.7 years. Stricture etiology was unknown in one patient, ischemic in 1 (occurring after prolonged catheterization during a coma) and iatrogenic in one (occurring after a diverticulum repair). All patients were evaluated with voiding cystourethrography pre-operatively. The surgical procedure is described. A 10 Fr urethral catheter is placed. All women then had a 5-6 cm long and 2-3 cm wide buccal graft harvested from the right inner cheek. The dorsal part of the urethra is exposed by making an inverted U-shaped incision over the meatus from the 3 o'clock to 9 o'clock position. A plane is developed between the urethra and the underlying clitoral cavernosal tissue to free the entire length of the urethra. The bladder neck is identified by palpation of the urethral catheter balloon and this is marked with a 5-zero stitch. The urethra is opened along the entire length of the urethra from the meatus to the bladder neck marking stitch. The buccal graft is then sutured to the right and then to the left urethral edge- it is tailored to 1.5 cm wide prior to placement. The augmented urethra is then quilted to the clitoral body to cover the new urethral roof. The graft is tapered distally to allow for a normal slit like meatus. The urethral catheter is maintained for 15 days at which time another VCUG is performed. Results showed that all women, with at least six months of follow-up were stricture-free. All had normal voiding dynamics and no woman complained of urinary incontinence. The authors dispel the notion that a dorsal approach may damage the striated sphincter complex and also that this approach may affect the neurovascular bundle of the clitoris. Anatomical and radiographic studies have confirmed the presence of this bundle dorsal to the clitoral body and neurosensory complications were not seen. The clitoral bodies have proven to provide great support for the buccal graft. This report, by one the leading experts and proponents of the dorsally placed buccal mucosa graft in men, provides hope for this technique to be expanded for use in women. Roberto Migliari, Pierluigi Leone, Elisa Berdondini, M. De Angelis, Guido Barbagli and Enzo Palminteri J Urol. 2006 Oct; 176 (4, part 1 of 2): 1473-76 Reviewed by UroToday.com Contributing Editor Michael J. Metro, M.D. UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.
Article Source: http://www.content.onlypunjab.com
To access the latest urology news releases from UroToday, go to:www.urotoday.com
Please Rate this Article
5 out of 54 out of 53 out of 52 out of 51 out of 5
Not yet Rated
