Reconstruction of the long urethral strictures with the buccal mucosal free graft.

Introduction: Reconstruction of the long urethral strictures is a difficult task in urology. The most frequently used method is augmentation with the free buccal mucosal graft. Material and methods: Restrospective analysis of 57 patients with the long urethral stricture was performed. All patients were evaluated endoscopically and radiologically before the surgery. Buccal mucosal graft harvested from the inner side of the cheek (unilateral or bilateral) was used for the urethral reconstruction in all patients. Follow-up was one year. Results: Complete follow up is achieved in 44/57 (77.2%)patients. The most important etiology of the strictures was previous iatrogenic trauma (instrumentation). The strictures were the most frequently located in the bulbar urethra. Preoperative exact evaluation of the stricture length was possible in only 35/57 patients (61.4%). Overall success rate of the surgery was 38/44 (86.3%). Complications occurred in 6/44 (13.7%) of patients-primary graft failure and urinary fistula. Mean preoperative IPSS was 19,2±5,2, and postoperative 10.3±3,2 (p<0.0001). IPSSQOL was 4.9±3.7 before the surgery, 2.9±1,1 after the surgery(p<0.001). Persistent urinary infection was present in 12/44(27.2%) patients. Conclusion: Buccal mucosal free graft could be successfully used in the reconstruction of long urethral strictures. However, complications are not uncommon, and residual symptoms still exist after the surgery, and could not be neglected.