This document describes a surgical technique called combined inlay and onlay buccal mucosa urethroplasty for treating long and narrow bulbar urethral strictures. The technique involves making a vertical incision in the urethral plate to widen it and placing an additional inlay graft to reduce the size discrepancy between the plate and graft. Results in 22 patients showed significantly improved urine flow rates after surgery, with only 2 minor complications. The conclusion is that this technique avoids completely transecting the urethra, widens the plate anatomically, and reduces disparities, improving success rates for long narrow strictures.

1. COMBINED INLAY AND ONLAY BUCCAL
MUCOSA URETHROPLASTY FOR LONG
AND NARROW BULBAR URETHRAL
STRICTURES
DR. GAUTAM BANGA
RECONSTRUCTIVE UROLOGIST
CENTRE FOR URETHRA AND PENILE SURGERY (UPS)
NEW DELHI, INDIA

2. SHORT SEGMENT STRICTURE -6 FR URETROSCOPE
CAN BE NEGOTIATED –SINGLE SIDE BUCCAL
MUCOSA IS SUFFICIENT.

3. BUT WHAT TO DO ABOUT STRICTURE WHICH DOES
NOT EVEN HAVE A CALIBRE OF 6FR

4. INTRODUCTION:
 Long segment urethral strictures with a very narrow
lumen pose an immense challenges for buccal
mucosa augmentation urethroplasty.
 Larger discrepancy in size of the graft and the
native urethral plate makes it difficult to place the
sutures and also makes the graft vulnerable to
contracture and fibrosis.
 Increasing the width of the urethral plate by a
vertical midline mucosal incision and applying an
additional inlay buccal mucosal graft may lessen
the discrepancy and help in improving the
adequacy of the urethral lumen.

5. INTRODUCTION
 Other option to deal with these kind of strictures is
dorsal onlay and ventral inlay.
 Spongiofibrosis is never full thickness except in
traumatic injury ( straddle injury/blunt trauma)
 Partial thickness Spongiofibrosis and scarred
mucosa can be removed completely and replaced
by buccal mucosa.

6. SURGICAL TECHNIQUE:
 Lithotomy position
 Epidural + general anesthesia.
 Vertical perineal incision. Mobilization of bulbar
urethra
 Dorsal ( one side kulkarni’s technique)or ventral
urethrotomy
 Vertical midline incision or complete removal of
scarred urethral plate with removal of thin layer of
spongiofibrosis.
 Inlay and onlay grafting done
 Urethra closed over 16 fr

7. DISPARITY BETWEEN URETHRAL PLATE AND
BUCCAL MUCOSA

8. SCARRED URETHRAL PLATE AND THIN LAYER
OF SPONGIOFIBROSIS REMOVED

9. INLAY-ONLAY UNIFORMITY

11. RESULTS:
 Results were analysed on the basis of pre and post
operative uroflowmetry.
 Any kind of instrumentation was considered as
failure.
 Mean follow up 630 days.
 22 patients have significant better flow rate after
surgery
 One patient developed ring stricture near proximal
anastomosis and managed by urethral dilatation.
 One patient developed abscess followed by urine
leak and was managed conservatively with
indwelling catheter and antibiotics.

12. CONCLUSION
 Combined urethroplasty avoid complete transection
of urethra.
 It widens the native urethral plate in an anatomical
manner
 Reduces the disparity between urethral plate and
onlay buccal mucosa.
 improves the success rate of long and very narrow
bulbar urethra strictures][