V10-05 Synergizing Solutions: Bladder Mucosa Graft Urethroplasty in Concurrent Management of Urethral Stricture and Bladder/Prostate Conditions

You have accessJournal of UrologyLower Tract Reconstruction (Including Transgender) I (V10)1 May 2024V10-05 SYNERGIZING SOLUTIONS: BLADDER MUCOSA GRAFT URETHROPLASTY IN CONCURRENT MANAGEMENT OF URETHRAL STRICTURE AND BLADDER/PROSTATE CONDITIONS Amr A. Elbakry, Jeffery Lin, and Lee C. Zhao Amr A. ElbakryAmr A. Elbakry , Jeffery LinJeffery Lin , and Lee C. ZhaoLee C. Zhao View All Author Informationhttps://doi.org/10.1097/01.JU.0001009392.30237.90.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Buccal mucosa has been the most widely used graft material for urethroplasty. The use of bladder mucosa grafts has been reported for anterior urethroplasty; however, it did not gain popularity as buccal mucosa which is easier to harvest with less morbidity and complications. We are describing our novel approach for clinical scenarios when concurrent management of urethral stricture and bladder or prostate pathology, can offer an opportunity to utilize the bladder mucosa as a graft. METHODS: The first patient is a 72-year-old male who has bulbar urethral stricture, associated with a large bladder diverticulum. He has a history of hypospadias repair and excision and primary anastomosis urethroplasty for bulbar urethral stricture 5 years ago. Decision was made to proceed with Transvesical Single Port (SP) robotic diverticulectomy, with the use of the bladder mucosa lining the diverticulum for urethral reconstruction. Two teams worked simultaneously. The first team performed robotic diverticulectomy with harvesting of bladder mucosa. The second team dissected the bulbar urethra. The strictured segment was identified and incised dorsally. The bladder mucosa was harvested and delivered to the urethroplasty team to complete dorsolateral onlay urethroplasty. The first team completed the diverticulectomy and closure of the bladder wall. The second patient is a 76-year-old male with history of enlarged prostate. During attempted TURP, he was diagnosed with a bulbar urethral stricture. We elected to proceed with management of both enlarged prostate and urethral stricture simultaneously. Two team approach was utilized. After docking the SP robot directly into the bladder, we harvested the bladder mucosa over the median lobe of the prostate. The graft was delivered to the urethroplasty team. Urethroplasty was completed in a similar fashion. Robotic SP simple prostatectomy was then performed. After excision of the entire adenoma, the bladder mucosa was advanced circumferentially to the urethra. RESULTS: This approach was performed for three patients. Operative time ranged from 107 to 243 minutes. Estimated blood loss was 50-200 ml. No perioperative complications. All 3 patients had subjective increase in the stream strength and a low PVR on follow up. All patients were free of any further interventions. CONCLUSIONS: We presented a novel approach for utilizing bladder mucosa in urethra reconstruction in patient with urethral stricture associated with certain bladder and prostate conditions requiring surgical intervention. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e827 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Amr A. Elbakry More articles by this author Jeffery Lin More articles by this author Lee C. Zhao More articles by this author Expand All Advertisement PDF downloadLoading ...