Does the Extent of Urethral Dissection Affect Outcomes in Urethroplasty: Circumferential Mobilisation vs Lateral Dissection Only of Urethra

Abstract

Introduction & Objectives: Urethroplasty for anterior urethral strictures is surgically challenging with modifications described for better outcomes. We compared the outcomes of circumferential mobilisation vs lateral dissection only of urethra for patients undergoing dorsal onlay buccal mucosal graft urethroplasty. Materials & Methods: Between November 2018 & June 2021, all patients diagnosed with urethral stricture disease who satisfied the eligibility criteria were assigned to two groups: lateral dissection only vs circumferential mobilization of bulbar urethra after taking informed consent. Patients were evaluated with history, physical examination, ultrasound KUB, uroflowmetry and AUG + MCU. Intraoperative & postoperative parameters were compared across both the treatment groups and analysed. Results: Mean age of 94 patients was 48.14±15.89 years with 47 assigned to each group. Post inflammatory etiology (36.2%) was most common. Demographic criteria were comparable across both the treatment groups. Strictures were seen mostly in the bulbar urethra (Mean length =5.34±1.94cms). Mean length & width of the graft required was 7.17±2.0cms & 1.85±0.25cmsrespectively.86% showed improvement at 6 months with the success in lateral dissection group slightly higher, although not statistically significant. Peak flow rates were comparable across both the groups at 3 & 6 months of follow up. Conclusions: One sided lateral only dissection has comparable outcomes to circumferential mobilisation in terms improved flow rates at short term follow up.