Modification of minced buccal mucosal graft endourethral urethroplasty: A pilot study.

Introduction: The minced buccal mucosal graft endourethral urethroplasty (MBGEU) is our novel technique of combining direct vision internal urethrotomy with buccal mucosal graft urethroplasty. We assessed success at 30-months of follow-up. Secondary objectives were to compare the changes in the American Urological Association (AUA) symptom score, peak flow rate (Qmax), and post-void residue (PVR) postoperatively.

Methods: This pilot study (CTRI/2021/09/036651) was conducted at a tertiary-care center and included 30 male patients with primary, <2 cm bulbar urethral strictures. A 1 cm × 1 cm buccal mucosal graft was harvested, minced, centrifuged, and suspended in fibrin glue. After a cold knife urethrotomy, a 12-Fr Foley was placed. An 11-Fr cystourethroscope was passed by the side of the catheter, and the suspension was instilled through a 5-Fr ureteric catheter over the urethrotomy site.

Results: The success rate of MBGEU was 93.33% at 12 months, 90% at 18 months, 83.3% at 24 months, and 76.6% at 30 months. The stricture recurred in seven patients. The AUA score reduced by 15, 15, 16, 16, 15.5, and 15.5 points from the baseline at 3, 6, 12, 18, 24, and 30 months (P < 0.01). There was a significant increase in the Qmax by 17 ml/s and a significant reduction in the PVR by 73.5 ml at 30 months (P < 0.01). No donor site morbidity was seen. There were no postoperative complications.

Conclusion: The medium-term success of MBGEU is encouraging. However, a longer follow-up and further studies with a larger sample size and a comparative arm are required.