Endoscopic Urethroplasty Using Buccal Graft for Male Membranous Urethral Stricture. 2023

Garrett Ungerer, and Jayson Kemble, and Michael Sischka, and Felicia L Balzano, and Jonathan N Warner
Mayo Clinic, Rochester, MN.

To demonstrate a new minimally invasive endoscopic approach to urethroplasty. The procedure was performed in a male patient with prior history of prostate cancer managed by radiation who subsequently developed an 8 mm flow-limiting membranous urethral stricture. After stricture dilation a 1 cm wide strip of superficial mucosa was resected from the bladder neck past the area of stricture, creating a bed for the graft to lay. Buccal mucosa graft was harvested in standard fashion. With the graft outside the urethra and using the RD 180 endoscopic suturing device, a suture is placed in the proximal end of the graft, then through the bladder neck, and back through the graft. As the suture is pulled, the pulley phenomenon advances the graft into place on the bladder neck. The graft is then anchored to the posterior urethra with secure straps. A catheter is placed to hold the graft flat during the healing process. The procedure lasted 2.5 hours without any complications. Estimated blood loss was 50cc, and the patient was discharged after the procedure. Catheter was removed at 4weeks. Cystoscopy at 10weeks post-op showed good graft viability, with peak flow improving to 20 mL/s compared to 4 mL/s preoperatively. At 6months, he continues to do well without evidence of recurrent urethral stricture. Endoscopic urethroplasty using buccal graft appears to offer a safe and effective repair option for management of ureteral strictures.

UI MeSH Term Description Entries
D008297 Male Males
D001743 Urinary Bladder A musculomembranous sac along the URINARY TRACT. URINE flows from the KIDNEYS into the bladder via the ureters (URETER), and is held there until URINATION. Bladder,Bladder Detrusor Muscle,Detrusor Urinae,Bladder Detrusor Muscles,Bladder, Urinary,Detrusor Muscle, Bladder,Detrusor Muscles, Bladder
D003251 Constriction, Pathologic The condition of an anatomical structure's being constricted beyond normal dimensions. Stenosis,Stricture,Constriction, Pathological,Pathologic Constriction,Constrictions, Pathologic,Pathologic Constrictions,Pathological Constriction,Stenoses,Strictures
D003558 Cystoscopy Endoscopic examination, therapy or surgery of the urinary bladder. Cystoscopic Surgical Procedures,Surgical Procedures, Cystoscopic,Cystoscopic Surgery,Surgery, Cystoscopic,Cystoscopic Surgeries,Cystoscopic Surgical Procedure,Cystoscopies,Procedure, Cystoscopic Surgical,Procedures, Cystoscopic Surgical,Surgeries, Cystoscopic,Surgical Procedure, Cystoscopic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014521 Urethra A tube that transports URINE from the URINARY BLADDER to the outside of the body in both the sexes. It also has a reproductive function in the male by providing a passage for SPERM. External Urethral Sphincter,External Urinary Sphincter,Internal Urethral Sphincter,Internal Urinary Sphincter,Internal Vesical Sphincter,Urethral Sphincters,External Urethral Sphincters,External Urinary Sphincters,Internal Urethral Sphincters,Internal Urinary Sphincters,Internal Vesical Sphincters,Sphincter, External Urethral,Sphincter, External Urinary,Sphincter, Internal Urethral,Sphincter, Internal Urinary,Sphincter, Internal Vesical,Sphincter, Urethral,Urethral Sphincter,Urethral Sphincter, External,Urethras,Urinary Sphincter, External,Urinary Sphincter, Internal,Vesical Sphincter, Internal
D014525 Urethral Stricture Narrowing of any part of the URETHRA. It is characterized by decreased urinary stream and often other obstructive voiding symptoms. Urethral Stenosis,Anterior Urethral Stricture,Posterior Urethral Stricture,Urethral Stricture, Anterior,Urethral Stricture, Posterior,Anterior Urethral Strictures,Posterior Urethral Strictures,Stenoses, Urethral,Stenosis, Urethral,Stricture, Urethral,Strictures, Urethral,Urethral Stenoses,Urethral Strictures,Urethral Strictures, Anterior,Urethral Strictures, Posterior

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