The outcomes of modified Kulkarni's one-stage tongue mucosa graft urethroplasty in patients with anterior urethral stricture
Objective To evaluate the efficacy of modified Kulkarni's one-stage tongue mucosal urethroplasty.Methods From January 2020 to December 2022,42 patients with anterior urethral stricture treated by modified Kulkarni one-stage tongue mucous urethroplasty in Shanghai Sixth People's Hospital.Stricture etiology was iatrogenic in 15 cases,trauma in 5 cases,unknown in 5 cases,infection in 6 cases,and lichen sclerosus in 11 cases.Twenty-one patients had previously undergone urethroplasty.The mean age of patients was(48.1±16.2)years.Median stricture length was(6.4±3.0)cm,including 11 cases with two strictures and 3 cases with multiple stenoses.The average preoperative Qmax was(4.6±2.3)ml/s,and the average residual urine was(96.6±24.7)ml.For treatment methods,a midline perineal incision was made,penis was invaginated into the incision,the distal extent of the stenosis was identified,urethra was rotated and dissected only on the left side,and incised dorsally to expose the whole stricture longitudinally.The tongue mucosal graft was fixed to the underlying albuginea and the right margin of the graft was sutured to the left margin of the urethral plate.Foley F14 silicon catheter was inserted.The urethra was rotated to its original position thus covering the oral graft.The improvements were as follows:First,we used tongue mucosa instead of cheek mucosa;Second,for the stenosis involving the urethral meatus,the narrowed urethral meatus was incised on the left side,which was continuous with the incision on the left side of the distal narrow segment,and then tongue mucosa was used as a whole.The catheter was removed 4 weeks after surgery,followed up 1,3,6 months,and then once a year.Results All 42 patients underwent successful surgery without blood transfusion during the operation.The surgical time was 60-120 minutes.There were no complications such as infection,tissue necrosis,or bleeding during the perioperative period,and 16 patients complained of oral pain,which was relieved within one week after surgery.During the follow-up period,39 cases presented with unobtrusive urination.One month after extubation,the maximum urine flow rate was(25.6±5.7)ml/s,and the residual urine volume was(11.3±7.1)ml.Three months after extubation,the maximum urine flow rate was(25.3±5.7)ml/s,and the residual urine volume was(11.9±7.5)ml.Six months after extubation,the maximum urine flow rate was(24.8±5.9)ml/s,and the residual urine volume was(12.4±7.9)ml.Two patients had recurrent stenosis 2 months after surgery,of which 1 patient underwent urethral dilation and recovered unobstructed urination,and 1 patient had recurrent stenosis after urethral dilation for 2 times and was cured after urethroplasty.No local wound infection,urethral shrinkage,urethral diverticulum,or urinary fistula occurred during the follow-up for 6 to 42 months.Conclusions The modified Kulkami's one-stage tongue mucosa graft urethroplasty is suitable for most anterior urethral strictures,with high success rate,few complications,and avoidance of local wound complications.
Anterior urethral strictureSurgeryRepair and reconstructionTongue mucosalTransplant
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