DOI: 10.36347/sjams.2023.v11i08.017

Pages: 1480-1485

Background: Urethral strictures pose a significant challenge in urological practice, and substitution urethroplasty using a buccal mucosal graft is a widely accepted surgical technique. However, the optimal placement of the graft, whether dorsal onlay, ventral onlay or dorsolateral onlay is still unresolved. This study aimed to compare the outcomes of dorsolateral and ventral onlay buccal mucosal graft urethroplasty for long-segment bulbar urethral strictures. Methods: A prospective, quasi-experimental study was conducted at the Department of Urology, Dhaka Medical College Hospital, from July 2018 to September 2019. Fifty patients with long-segment bulbar urethral strictures were equally divided into two groups: Group-A (dorsolateral onlay) and Group B (ventral onlay). Patients were followed up for six months, and the groups were compared based on the International Prostate Symptom Score (IPSS), quality of life, maximum flow rate (Qmax), findings of retrograde urethrogram and voiding cystourethrogram, urethroscopic findings, complications and success rate. Results: Preoperative stricture lengths in Group-A and Group B were 3.62 ± 0.46 cm and 3.42 ± 0.54 cm respectively. Mean IPSS improved in both groups after surgery, with no significant difference between them. Mean Qmax also improved in both groups, with no significant difference between them. Success rates were 88% and 84% in Group-A and Group B respectively. Complications included wound hematoma, wound infection, and urethral diverticulum, while urethrocutaneous fistula and erectile dysfunction were not observed. Stricture recurrence rates were 12% in Group-A and 16% in Group B. Overall, both techniques demonstrated similar effectiveness and outcomes. Conclusion: Dorsolateral and ventral onlay buccal mucosal graft urethroplasty techniques yielded favourable short-term outcomes with low complication rates for long-segment bulbar urethral strictures. Both approaches were equally effective in terms of success ...