Graft Urethroplasty for Urethral Stricture: Ventral Onlay versus Dorsal Onlay_Chinese Journal of Evidence-Based Medicine

Authors：

LIAO Xunzhong ¹ , WANG KunJie ¹ , WANG Li ² ,  LI Hong ¹

1. Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China2. Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

LI Hong, Email: LiHong_19560707@163.com

Keywords：

Urethral stricture; Urethroplasty; Graft

DOI：

10.7507/1672-2531.20080041

Video：

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Objective　 To compare and assess the efficacy of ventral/dorsal onlay graft urethroplasty in the treatment of urethral stricture.
Methods　 We searched pertinent English literature via MEDLINE (1966 to 2007), EMBASE (1977 to 2007) and The Cochrane Library (Issue 4, 2007) for the use of ventral/dorsal graft urethroplasty in the reconstruction of urethral defect associated with urethral stricture. Data were extracted by two reviewers independently and analyzed by SPSS 13.0 software.
Results　 A total of 50 studies involving 1 264 patients were included. Ventral onlay graft urethroplasty was used in 751 patients with a success rate of 82.6%, while dorsal onlay graft urethroplasty was used in 513 patients with a success rate of 86.9% (ventral vs. dorsal, χ2=4.432, P=0.035). Oral mucosa graft had the highest success rate (88.1%) of all grafts, and the success rate of free skin graft onlay urethroplasty was associated with the location of graft placement (ventral vs. dorsal, P=0.016). Concerning the location of stricture, urethroplasty for bulbar urethral stricture achieved the best results, with a success rate of 87.7%, which was also associated with the location of graft placement (ventral vs. dorsal, P=0.025).
Conclusion　 Dorsal onlay graft urethroplasty is better than ventral onlay. It is better to place the free skin graft in the dorsal part of urethra. Bulbar urethral stricture is more suitable for graft onlay urethroplasty than penile urethral stricture.

Citation： LIAO Xunzhong,WANG KunJie,WANG Li,LI Hong. Graft Urethroplasty for Urethral Stricture: Ventral Onlay versus Dorsal Onlay. Chinese Journal of Evidence-Based Medicine, 2008, 08(3): 182-189. doi: 10.7507/1672-2531.20080041 Copy

1.	Devine PD, Horton CE, Devine EJ, et al. Use of full thickness skin grafts in repair of urethral strictures. J Urol, 1963, 99: 67-71.
2.	Brannan W, Ochsner MG, Fuseliser HA. Anterior urethral strictures: experience with free graft urethroplasty. J Urol, 1973, 109: 265-267.
3.	James MB, John HT, Crane DB. Single stage urethroplasty as treatment for stricture disease. J Urol, 1978, 120(4): 412-413.
4.	Barbagli G, Selli C, Tosto A, et al. Dorsal free graft urethroplasty. J Urol, 1996, 155(1): 123-126.
5.	Iselin CE, Webster GD. Dorsal onlay graft urethroplasty for repair of bulbar urethral stricture. J Urol, 1999, 161(3): 815-818.
6.	Kessler TM, Schreiter F, Kralidis G, et al. Long-term results of surgery for urethral stricture: A statistical analysis. J Urol, 2003, 170(3): 840-844.
7.	Andrich DE, Leach CJ, Mundy AR. The Barbagli procedure gives the best results for patch urethroplasty of the bulbar urethra. BJU Int, 2001, 88(4): 385-389.
8.	Meneghini A, Cacciola A, Cavarretta L, et al. Bulbar urethral stricture repair with buccal mucosa graft urethroplasty. Eur Urol, 2001, 39(3): 264-267.
9.	Heinke T, Gerharz EW, Bonfig R, et al. Ventral onlay urethroplasty using buccal mucosa for complex stricture repair. Urology, 2003, 61 (5): 1004-1007.
10.	Nielsen MA, Bueschen AJ, Lloyd LK. Free full thickness (patch) graft urethroplasty: Long-term follow-up. Urology, 1985, 26(6): 562-565.
11.	El-Kasaby AW, M Fath-Alla, AM Noweir, et al. The use of buccal mucosa patch graft in the management of anterior urethral strictures. J Urol, 1993, 149: 276-278.
12.	P Omo-Dare. Reconstruction of the urethra for stricture:description and evaluation of a technique. J Urol, 1970, 103: 69-74.
13.	Ransley PG, Duffy PG, Irene LO, et al. The use of bladder mucosa and combined bladder mucosa/preputial skin grafts for urethral reconstruction. J Urol, 1987, 138: 1096-1098.
14.	Wessells H, McAninch JW, Schreiter F. Use of free grafts in urethral stricture reconstruction. J Urol, 1996, 155(6): 1912-1915.
15.	Blum JA, feeney MJ, Howe GE, et al. Skin patch uretrhoplasty: 5-year followup. J Urol, 1982, 127(5): 909.
16.	Monfort G, Bretheau D, Di Benedetto V, et al. Urethral stricture in children: Treatment by urethroplasty with bladder mucosa graft. J Urol, 1992, 148(5): 1504-1506.
17.	Green Jr.R, Herr HW, Martin DC. Urethral stricture disease: Experience with patch graft urethroplasty. Military Medicine, 1980, 145(2): 126-128.
18.	Devine PC, Fallon B, Devine Jr CJ. Free full thickness skin graft urethroplasty. J Urol, 1976, 116(4): 444-446.
19.	Demirbilek S, Yalcinkaya F, Atayurt H. Bladder mucosa in posterior urethral repair. Int Urol & Nephro, 1997, 29(1): 59-62.
20.	Berger B, Sykes Z, Freedman M. Patch graft urethroplasty for urethral stricture disease. J Urol, 1976, 115(6): 681-684.
21.	McLaughlin MD, Thrasher JB, Celmer A, et al. Buccal mucosal urethroplasty in patients who had multiple previous procedures. Urology, 2006, 68(6): 1156-1159.
22.	Venn SN, Mundy AR. Early experience with the use of buccal mucosa for substitution urethroplasty. BJU, 1998, 81(5): 738-740.
23.	Fisher MB, Santucci RA. Extraction of UroLume endoprosthesis with one-stage urethral reconstruction using buccal mucosa. Urology, 2006, 67(2): 423. e9-423. e10.
24.	Elliott SP, Metro MJ, McAninch JW. Long-term followup of the ventrally placed buccal mucosa onlay graft in bulbar urethral reconstruction. J Urol, 2003, 16(95): 1754-1757.
25.	Fichtner J, Filipas D, Fisch M, et al. Long-term outcome of ventral buccal mucosa onlay graft urethroplasty for urethral stricture repair. Urology, 2004, 64(4): 648-650.
26.	Kane CJ, Tarman GJ, Summerton DJ, et al. Multi-institutional experience with buccal mucosa onlay urethroplasty for bulbar urethral reconstruction. J Urol, 2002, 167(3): 1314-1317.
27.	Al-Qudah HS, Santucci RA. Extended complications of urethroplasty. Int Braz J Urol, 2005, 31(4): 315-325.
28.	Fiala R, Vidlar A, Vrtal R, et al. Porcine Small Intestinal Submucosa Graft for Repair of Anterior Urethral Strictures. Eur Urol, 2007, 51(6): 1702-1708.
29.	Lewis JB, Wolgast KA, Ward JA, et al. Outpatient anterior urethroplasty: Outcome analysis and patient selection criteria. J Urol, 2002, 168(3): 1024-1026.
30.	Lopez JA, Valle J, Timon A, et al. Use of autologous buccal mucosal graft for urethral surgery in males. Eur Urol, 1996, 29(2): 227-230.
31.	Kellner DS, Fracchia JA, Armenakas NA. Ventral onlay buccal mucosal grafts for anterior urethral strictures: Long-term followup. J Urol, 2004, 171(2): 726-729.
32.	Boccon-Gibod L, Le Portz B. One-stage urethroplasty for urethral stricture. Free full thickness skin graft versus cutaneous island flap urethroplasty. Eur Urol, 1984, 10(1): 32-35.
33.	Levine LA, Elterman L. Urethroplasty following total phallic reconstruction. J Urol, 1998, 160(2): 378-382.
34.	El-Kassaby AW, Retik AB, Yoo JJ, et al. Urethral stricture repair with an off-the-shelf collagen matrix. J Urol, 2003, 169(1): 170-173.
35.	Berger AP, Deibl M, Bartsch G, et al. A comparison of one-stage procedures for post-traumatic urethral stricture repair. BJU Int, 2005, 95(9): 1299-1302.
36.	Barbagli G, Guazzoni G, Palminteri E, et al. Anastomotic Fibrous Ring as Cause of Stricture Recurrence After Bulbar Onlay Graft Urethroplasty. J Urol, 2006, 176(2): 614-619.
37.	Pansadoro V, Emiliozzi P, Gaffi M, et al. Buccal mucosa urethroplasty in the treatment of bulbar urethral strictures. Urology, 2003, 61(5): 1008-1010.
38.	Mantovani F, Trinchieri A, Castelnuovo C, et al. Reconstructive Urethroplasty Using Porcine Acellular Matrix. Eur Urol, 2003, 44(5): 600-602.
39.	Gupta NP, Ansari MS, Dogra PN, et al. Dorsal buccal mucosal graft urethroplasty by a ventral sagittal urethrotomy and minimal-access perineal approach for anterior urethral stricture. BJU Int, 2004, 93(9): 1287-1290.
40.	Asopa HS, Garg M, Singhal GG, et al. Dorsal free graft urethroplasty for urethral stricture by ventral sagittal urethrotomy approach. Urology, 2001, 58(5): 657-659.
41.	Donkov II, Bashir A, Elenkov CH, et al. Dorsal onlay augmentation urethroplasty with small intestinal submucosa: Modified Barbagli technique for strictures of the bulbar urethra. Int J Urol, 2006, 13(11): 1415-1417.
42.	Raber M, Naspro R, Scapaticci E, et al. Dorsal onlay graft urethroplasty using penile skin or buccal mucosa for repair of bulbar urethral stricture: Results of a prospective single center study. Eur Urol, 2005, 48(6): 1013-1017.
43.	Radopoulos D, Tzakas C, Dimitriadis G, et al. Dorsal on-lay preputial graft urethroplasty for anterior urethra strictures repair. Int Urol Nephro, 2007, 39(2): 497-503.
44.	Barbagli G, De Stefani S, Sighinolfi MC, et al. Experience with fibrin glue in bulbar urethral reconstruction using dorsal buccal mucosa graft. Urology, 2006, 67(4): 830-832.
45.	Parsons JK, Wright EJ. Extraction of UroLume endoprostheses with one-stage urethral reconstruction. Urology, 2004, 64(3): 582-584.
46.	Mantovani F, Trinchieri A, Castelnuovo C, et al. Reconstructive Urethroplasty Using Porcine Acellular Matrix. Eur Urol, 2003, 44(5): 600-602.
47.	Gelman J, Rodriguez Jr E. One-Stage Urethral Reconstruction for Stricture Recurrence After Urethral Stent Placement. J Urol, 2007, 177(1): 188-191.
48.	Hauser S, Bastian PJ, Fechner G, et al. Small intestine submucosa in urethral stricture repair in a consecutive series. Urology, 2006, 68(2): 263-266.
49.	Xu YM, Qiao Y, Sa YL, et al. Substitution Urethroplasty of Complex and Long-Segment Urethral Strictures: A Rationale for Procedure Selection. Eur Urol, 2007, 51(4): 1093-1099.
50.	Simonato A, Gregori A, Lissiani A, et al. The tongue as an alternative donor site for graft urethroplasty: A pilot study. J Urol, 2006, 175(2): 589-592.
51.	Joseph JV, Andrich DE, Leach CJ, et al. Urethroplasty for refractory anterior urethral stricture. J Urol, 2002, 167(1): 127-129.
52.	Dubey D, Kumar A, Mandhani A, et al. Buccal mucosal urethroplasty: A versatile technique for all urethral segments. BJU Int, 2005, 95(4): 625-629.
53.	Bhargava S, Chapple CR. Buccal mucosal urethroplasty: Is it the new gold standard? BJU Int, 2004, 93(9): 1191-1193.
54.	Barbagli G, Palminteri E, Rizzo M. Dorsal onlay graft urethroplasty using penile skin or buccal mucosa in adult bulbourethral strictures. J Urol, 1998, 160(4): 1307-1309.
55.	Pansadoro V, Emiliozzi P, Gaffi M, et al. Buccal mucosa urethroplasty for the treatment of bulbar urethral strictures. J Urol, 1999, 161(5): 1501-1503.
56.	Dubey D, Kumar A, Bansal P, et al. Substitution urethroplasty for anterior urethral strictures: A critical appraisal of various techniques. BJU Int, 2003, 91(3): 215-218.
57.	Hunter Wessells, Allen F. Morey, et al. Single stage reconstruction of complex anterior urethral stricture:combined tissue transfer techniques. J Urol, 1997, 157: 1271-1274.
58.	Devine PC, Sakati IA, Poutasse EF, et al. One stage urethroplasty: repair of ureteral strictures with a free full thickness patch of skin. J Urol, 1968, 99(2): 191-193.
59.	Greenwell TJ, Venn SN, Mundy AR. Changing practice in anterior urethroplasty. BJU int, 1999, 83: 631-635.
60.	Morey AF, McAninch JW. When and how to use buccal mucosal grafts in adult bulbar urethroplasty. Urology, 1996, 48: 194-198.
61.	Morey AF, McAninch JW. Technique of harvesting buccal mucosa for urethral reconstruction. J Urol, 1996, 155: 1696-1697.
62.	Al-Qudah HS, Cavalcanti AG, Santucci RA. Early catheter removal after anterior anastomotic (3 days) and ventral buccal mucosal onlay (7 days) urethroplasty. Int Braz J Urol, 2005, 31(5): 459-464.
63.	Barbagli G, Selli C, Tosto A. Reoperative surgery for recurrent strictures of the penile and bulbous urethra. J Urol,1996,156(1): 76-77.
64.	Barbagli G, Selli C, Di Cello V, et al. A one-stage dorsal free-graft urethroplasty for bulbar urethral strictures. BJU, 1996, 78(6): 929-932.
65.	Iselin CE, Webster GD. Dorsal onlay urethroplasty for urethral stricture repair. World J Urol, 1998, 16: 181-185.
66.	Dubey D, Sehgal A, Srivastava A, et al. Buccal mucosal urethroplasty for balanitis xerotica obliterans related urethral strictures: The outcome of 1 and 2-stage techniques. J Urol, 2005, 173(2): 463-466.
67.	Bakbagli G, Palminteri E, Guazzoni G, et al. Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: Are results affected by the surgical technique? J Urol, 2005, 174(3): 955-957.
68.	Barbagli G, Palminteri E, Lazzeri M, et al. Interim outcomes of dorsal skin graft bulbar urethroplasty. J Urol, 2004, 172(4): 1365-1367.
69.	Andrich DE, Mundy AR. Substitution Urethroplasty With Buccal Mucosal-free Grafts. J Urol, 2001, 165: 1131-1134.

1. Devine PD, Horton CE, Devine EJ, et al. Use of full thickness skin grafts in repair of urethral strictures. J Urol, 1963, 99: 67-71.
2. Brannan W, Ochsner MG, Fuseliser HA. Anterior urethral strictures: experience with free graft urethroplasty. J Urol, 1973, 109: 265-267.
3. James MB, John HT, Crane DB. Single stage urethroplasty as treatment for stricture disease. J Urol, 1978, 120(4): 412-413.
4. Barbagli G, Selli C, Tosto A, et al. Dorsal free graft urethroplasty. J Urol, 1996, 155(1): 123-126.
5. Iselin CE, Webster GD. Dorsal onlay graft urethroplasty for repair of bulbar urethral stricture. J Urol, 1999, 161(3): 815-818.
6. Kessler TM, Schreiter F, Kralidis G, et al. Long-term results of surgery for urethral stricture: A statistical analysis. J Urol, 2003, 170(3): 840-844.
7. Andrich DE, Leach CJ, Mundy AR. The Barbagli procedure gives the best results for patch urethroplasty of the bulbar urethra. BJU Int, 2001, 88(4): 385-389.
8. Meneghini A, Cacciola A, Cavarretta L, et al. Bulbar urethral stricture repair with buccal mucosa graft urethroplasty. Eur Urol, 2001, 39(3): 264-267.
9. Heinke T, Gerharz EW, Bonfig R, et al. Ventral onlay urethroplasty using buccal mucosa for complex stricture repair. Urology, 2003, 61 (5): 1004-1007.
10. Nielsen MA, Bueschen AJ, Lloyd LK. Free full thickness (patch) graft urethroplasty: Long-term follow-up. Urology, 1985, 26(6): 562-565.
11. El-Kasaby AW, M Fath-Alla, AM Noweir, et al. The use of buccal mucosa patch graft in the management of anterior urethral strictures. J Urol, 1993, 149: 276-278.
12. P Omo-Dare. Reconstruction of the urethra for stricture:description and evaluation of a technique. J Urol, 1970, 103: 69-74.
13. Ransley PG, Duffy PG, Irene LO, et al. The use of bladder mucosa and combined bladder mucosa/preputial skin grafts for urethral reconstruction. J Urol, 1987, 138: 1096-1098.
14. Wessells H, McAninch JW, Schreiter F. Use of free grafts in urethral stricture reconstruction. J Urol, 1996, 155(6): 1912-1915.
15. Blum JA, feeney MJ, Howe GE, et al. Skin patch uretrhoplasty: 5-year followup. J Urol, 1982, 127(5): 909.
16. Monfort G, Bretheau D, Di Benedetto V, et al. Urethral stricture in children: Treatment by urethroplasty with bladder mucosa graft. J Urol, 1992, 148(5): 1504-1506.
17. Green Jr.R, Herr HW, Martin DC. Urethral stricture disease: Experience with patch graft urethroplasty. Military Medicine, 1980, 145(2): 126-128.
18. Devine PC, Fallon B, Devine Jr CJ. Free full thickness skin graft urethroplasty. J Urol, 1976, 116(4): 444-446.
19. Demirbilek S, Yalcinkaya F, Atayurt H. Bladder mucosa in posterior urethral repair. Int Urol & Nephro, 1997, 29(1): 59-62.
20. Berger B, Sykes Z, Freedman M. Patch graft urethroplasty for urethral stricture disease. J Urol, 1976, 115(6): 681-684.
21. McLaughlin MD, Thrasher JB, Celmer A, et al. Buccal mucosal urethroplasty in patients who had multiple previous procedures. Urology, 2006, 68(6): 1156-1159.
22. Venn SN, Mundy AR. Early experience with the use of buccal mucosa for substitution urethroplasty. BJU, 1998, 81(5): 738-740.
23. Fisher MB, Santucci RA. Extraction of UroLume endoprosthesis with one-stage urethral reconstruction using buccal mucosa. Urology, 2006, 67(2): 423. e9-423. e10.
24. Elliott SP, Metro MJ, McAninch JW. Long-term followup of the ventrally placed buccal mucosa onlay graft in bulbar urethral reconstruction. J Urol, 2003, 16(95): 1754-1757.
25. Fichtner J, Filipas D, Fisch M, et al. Long-term outcome of ventral buccal mucosa onlay graft urethroplasty for urethral stricture repair. Urology, 2004, 64(4): 648-650.
26. Kane CJ, Tarman GJ, Summerton DJ, et al. Multi-institutional experience with buccal mucosa onlay urethroplasty for bulbar urethral reconstruction. J Urol, 2002, 167(3): 1314-1317.
27. Al-Qudah HS, Santucci RA. Extended complications of urethroplasty. Int Braz J Urol, 2005, 31(4): 315-325.
28. Fiala R, Vidlar A, Vrtal R, et al. Porcine Small Intestinal Submucosa Graft for Repair of Anterior Urethral Strictures. Eur Urol, 2007, 51(6): 1702-1708.
29. Lewis JB, Wolgast KA, Ward JA, et al. Outpatient anterior urethroplasty: Outcome analysis and patient selection criteria. J Urol, 2002, 168(3): 1024-1026.
30. Lopez JA, Valle J, Timon A, et al. Use of autologous buccal mucosal graft for urethral surgery in males. Eur Urol, 1996, 29(2): 227-230.
31. Kellner DS, Fracchia JA, Armenakas NA. Ventral onlay buccal mucosal grafts for anterior urethral strictures: Long-term followup. J Urol, 2004, 171(2): 726-729.
32. Boccon-Gibod L, Le Portz B. One-stage urethroplasty for urethral stricture. Free full thickness skin graft versus cutaneous island flap urethroplasty. Eur Urol, 1984, 10(1): 32-35.
33. Levine LA, Elterman L. Urethroplasty following total phallic reconstruction. J Urol, 1998, 160(2): 378-382.
34. El-Kassaby AW, Retik AB, Yoo JJ, et al. Urethral stricture repair with an off-the-shelf collagen matrix. J Urol, 2003, 169(1): 170-173.
35. Berger AP, Deibl M, Bartsch G, et al. A comparison of one-stage procedures for post-traumatic urethral stricture repair. BJU Int, 2005, 95(9): 1299-1302.
36. Barbagli G, Guazzoni G, Palminteri E, et al. Anastomotic Fibrous Ring as Cause of Stricture Recurrence After Bulbar Onlay Graft Urethroplasty. J Urol, 2006, 176(2): 614-619.
37. Pansadoro V, Emiliozzi P, Gaffi M, et al. Buccal mucosa urethroplasty in the treatment of bulbar urethral strictures. Urology, 2003, 61(5): 1008-1010.
38. Mantovani F, Trinchieri A, Castelnuovo C, et al. Reconstructive Urethroplasty Using Porcine Acellular Matrix. Eur Urol, 2003, 44(5): 600-602.
39. Gupta NP, Ansari MS, Dogra PN, et al. Dorsal buccal mucosal graft urethroplasty by a ventral sagittal urethrotomy and minimal-access perineal approach for anterior urethral stricture. BJU Int, 2004, 93(9): 1287-1290.
40. Asopa HS, Garg M, Singhal GG, et al. Dorsal free graft urethroplasty for urethral stricture by ventral sagittal urethrotomy approach. Urology, 2001, 58(5): 657-659.
41. Donkov II, Bashir A, Elenkov CH, et al. Dorsal onlay augmentation urethroplasty with small intestinal submucosa: Modified Barbagli technique for strictures of the bulbar urethra. Int J Urol, 2006, 13(11): 1415-1417.
42. Raber M, Naspro R, Scapaticci E, et al. Dorsal onlay graft urethroplasty using penile skin or buccal mucosa for repair of bulbar urethral stricture: Results of a prospective single center study. Eur Urol, 2005, 48(6): 1013-1017.
43. Radopoulos D, Tzakas C, Dimitriadis G, et al. Dorsal on-lay preputial graft urethroplasty for anterior urethra strictures repair. Int Urol Nephro, 2007, 39(2): 497-503.
44. Barbagli G, De Stefani S, Sighinolfi MC, et al. Experience with fibrin glue in bulbar urethral reconstruction using dorsal buccal mucosa graft. Urology, 2006, 67(4): 830-832.
45. Parsons JK, Wright EJ. Extraction of UroLume endoprostheses with one-stage urethral reconstruction. Urology, 2004, 64(3): 582-584.
46. Mantovani F, Trinchieri A, Castelnuovo C, et al. Reconstructive Urethroplasty Using Porcine Acellular Matrix. Eur Urol, 2003, 44(5): 600-602.
47. Gelman J, Rodriguez Jr E. One-Stage Urethral Reconstruction for Stricture Recurrence After Urethral Stent Placement. J Urol, 2007, 177(1): 188-191.
48. Hauser S, Bastian PJ, Fechner G, et al. Small intestine submucosa in urethral stricture repair in a consecutive series. Urology, 2006, 68(2): 263-266.
49. Xu YM, Qiao Y, Sa YL, et al. Substitution Urethroplasty of Complex and Long-Segment Urethral Strictures: A Rationale for Procedure Selection. Eur Urol, 2007, 51(4): 1093-1099.
50. Simonato A, Gregori A, Lissiani A, et al. The tongue as an alternative donor site for graft urethroplasty: A pilot study. J Urol, 2006, 175(2): 589-592.
51. Joseph JV, Andrich DE, Leach CJ, et al. Urethroplasty for refractory anterior urethral stricture. J Urol, 2002, 167(1): 127-129.
52. Dubey D, Kumar A, Mandhani A, et al. Buccal mucosal urethroplasty: A versatile technique for all urethral segments. BJU Int, 2005, 95(4): 625-629.
53. Bhargava S, Chapple CR. Buccal mucosal urethroplasty: Is it the new gold standard? BJU Int, 2004, 93(9): 1191-1193.
54. Barbagli G, Palminteri E, Rizzo M. Dorsal onlay graft urethroplasty using penile skin or buccal mucosa in adult bulbourethral strictures. J Urol, 1998, 160(4): 1307-1309.
55. Pansadoro V, Emiliozzi P, Gaffi M, et al. Buccal mucosa urethroplasty for the treatment of bulbar urethral strictures. J Urol, 1999, 161(5): 1501-1503.
56. Dubey D, Kumar A, Bansal P, et al. Substitution urethroplasty for anterior urethral strictures: A critical appraisal of various techniques. BJU Int, 2003, 91(3): 215-218.
57. Hunter Wessells, Allen F. Morey, et al. Single stage reconstruction of complex anterior urethral stricture:combined tissue transfer techniques. J Urol, 1997, 157: 1271-1274.
58. Devine PC, Sakati IA, Poutasse EF, et al. One stage urethroplasty: repair of ureteral strictures with a free full thickness patch of skin. J Urol, 1968, 99(2): 191-193.
59. Greenwell TJ, Venn SN, Mundy AR. Changing practice in anterior urethroplasty. BJU int, 1999, 83: 631-635.
60. Morey AF, McAninch JW. When and how to use buccal mucosal grafts in adult bulbar urethroplasty. Urology, 1996, 48: 194-198.
61. Morey AF, McAninch JW. Technique of harvesting buccal mucosa for urethral reconstruction. J Urol, 1996, 155: 1696-1697.
62. Al-Qudah HS, Cavalcanti AG, Santucci RA. Early catheter removal after anterior anastomotic (3 days) and ventral buccal mucosal onlay (7 days) urethroplasty. Int Braz J Urol, 2005, 31(5): 459-464.
63. Barbagli G, Selli C, Tosto A. Reoperative surgery for recurrent strictures of the penile and bulbous urethra. J Urol,1996,156(1): 76-77.
64. Barbagli G, Selli C, Di Cello V, et al. A one-stage dorsal free-graft urethroplasty for bulbar urethral strictures. BJU, 1996, 78(6): 929-932.
65. Iselin CE, Webster GD. Dorsal onlay urethroplasty for urethral stricture repair. World J Urol, 1998, 16: 181-185.
66. Dubey D, Sehgal A, Srivastava A, et al. Buccal mucosal urethroplasty for balanitis xerotica obliterans related urethral strictures: The outcome of 1 and 2-stage techniques. J Urol, 2005, 173(2): 463-466.
67. Bakbagli G, Palminteri E, Guazzoni G, et al. Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: Are results affected by the surgical technique? J Urol, 2005, 174(3): 955-957.
68. Barbagli G, Palminteri E, Lazzeri M, et al. Interim outcomes of dorsal skin graft bulbar urethroplasty. J Urol, 2004, 172(4): 1365-1367.
69. Andrich DE, Mundy AR. Substitution Urethroplasty With Buccal Mucosal-free Grafts. J Urol, 2001, 165: 1131-1134.

Chinese Journal of Evidence-Based Medicine

Graft Urethroplasty for Urethral Stricture: Ventral Onlay versus Dorsal Onlay

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