Combined Dorsal and Ventral Onlay Buccal Graft Technique for Large and Complex Penile Strictures

Nikolaos Mertziotis, Andreas Konandreas, Christos Kyratsas


Purpose: to present a modified technique of managing extensive
penile urethra strictures with dorsal and ventral onlay buccal
mucosa grafts, following the Palminteri technique, currently
used for bulbar urethra strictures. Patients and methods: From
October 2014 to January 2016, a total of 12 patients underwent
urethroplasty for penile urethra strictures, using dorsal and
ventral onlay grafts from buccal mucosa. The mean age of the
patients was 42.75 (17-71). All patients completed the IPSS and
QoL questionnaire and uroflowmetry was done preoperatively.
After surgery, the follow-up included completion of IPSS and
QoL questionnaire and measuring of uroflow at 1, 3, 6 and 12
months. Post-operative urethrography was performed in complex
cases or in the event of deterioration of voiding symptoms.
Results: The mean length of the strictures was 5.45 (2, 2-16)
cm. Mean Qmax changed from 3.45ml/sec preoperatively to
18.33 postoperatively, and mean IPS score significantly decreased
from 20.1 preoperatively to 8.98 postoperatively.All
values were statistically significant (p<0.001). No intra-operative
or immediate post-operative complications were recorded.
Only one patient with a complex, long stricture, which involved
the bulbar urethra as well, recurred and is currently managed by
self-dilatation. Two more patients, with indwelling suprapubic
catheter preoperatively, developed urinary tract infections post
operatively and were managed conservatively with no further
sequelae. Overall, at 12 months 11 out of 12 patients (91.6%)
had a marked improvement in quality of life and uroflowmetry
parameters. Conclusions: In the properly selected patient, the
combined use of double graft for penile urethral strictures can
be successful with minimal morbidity, at short-term follow-up


urethroplasty;penile strictures;double buccal graft

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1 Mangera A, Chapple C. Management of anterior urethral stricture:

an evidence-based approach. Curr Opin Urol. 2010; 20:453-458

Santucci RA, Mario LA, McAninch JW. Anastomotic urethroplasty

for bulbar urethral stricture: analysis of 168 patients. J Urol. 2002;


Barbagli G, Guazzoni G, Lazzeri M. One-stage bulbar urethroplasty:

retrospective analysis of the results in 375 patients. Eur Urol. 2008;


Palminteri E, Manzoni G, Berdondini E et al. Combined dorsal plus

ventral double buccal mucosa graft in bulbar urethral reconstruction.

Eur Urol. 2008; 53:81-90

Berger AP, Deibl M, Bartsch G, Steiner H, Varkarakis J, Gozzi C. A

comparison of one-stage procedures for post-traumatic urethral

stricture repair. BJU Int. 2005; 95:1299-1302

Mangeralowast A, Patterson J, Chapple C. A Systematic Review of

Graft Augmentation Urethroplasty Techniques for the Treatment

of Anterior Urethral Strictures, Eur Urol., Volume 59 Issue 5, May

, Pages 797-814

Andrich DE, Greenwell TJ, Mundy AR. The problems of penile urethroplasty

with particular reference to 2-stage reconstructions. J

Urol. 2003; 170:87-89

Dindo D, Demartines N, Clavien PA. Classification of Surgical Complications.

A New Proposal with evaluation in a cohort of 6336

patients and results of a survey. Ann Surg 2004; 240: 205–213

Jordan GH, Schlossberg SM, Devine CJ. Surgery of the penis and

urethra. In:P.C. Walsh, A.B. Retik, E. Darracott-Vaughan, A.J. Wein

(Editors). Campbell's urology edition 7(1998) .Philadelphia, PA:

Saunders; p.3316-3394

N.Mertziotis, C.Kyratsas,A. Konandreas. Combined ventral onlay

and dorsal onlay technique in complex and long penile stenosis.

VD40,Abstract Book 23th Panhellenic Congress, Rhodes ,Greece

oct 2016