الفهرس 
List of contentsOnly 14 pages are availabe for public view
 |  | from | 87 |  |  |
| | | from | 87 | | |
Abstract
Introduction : Urethral stricture is a relatively common urologic problem associated with a significant economic burden. There are many management options available for urethral stricture disease commencing with less invasive urethral dilatation, urethral stenting, and urethrotomy, progressing to anastomotic and substitution urethral reconstruction. The best means of substitution urethroplasty remains controversial, and the superiority of one technique over another has not yet been clearly defined. This is attributed to paucity of prospective randomized and other well-conducted trials on the management of anterior urethral stricture disease. So, the level of evidence on the surgical treatment of anterior urethral strictures and the guidelines on which technique to use in each particular circumstance is low. Methods : The study was conducted in a single tertiary referral center (Urology and Nephrology Center in Mansoura, Egypt) .Eligible patients who presented with long segment anterior urethral stricture were asked to participate in this study. An informed consent form in line with Good Clinical Practice and the Declaration of Helsinki was obtained before surgical intervention. All cases of PSF group were performed under spinal anesthesia while cases of BMG group were performed under general anesthesia. Before removal of urethral catheter, pericatheter retrograde urethrogram was routinely carried out after three weeks. Any extravasation was managed by extending the period of catheterization to a maximum of 5 weeks. Follow up was carried out at 3 and 6 months postoperative and consisted of: urine analysis, urine culture, uroflowmetry, IPSS, retrograde urethrography and Sexual function questionnaire (IIEF). Results : Between November 2017 and December 2019, a total of 30 patients with anterior urethral strictures requiring substitution urethroplasty were divided into 2 groups to receive either dorsal onlay buccal mucosa urethroplasty or ventral onlay penile skin flap urethroplasty . At 6 month-follow up: the overall success rate was 76.66 % (23 patients out of 30), including 11 patients in the PSF group (78.56 %) and 12 patients in the BMG group (75%) which was statistically insignificant between the 2 groups (p=0.5). In those with successful outcome, the mean Qmax was 23.03 ± 9.6 ml/s. It increased to 20.7 ± 9.3 ml/s in the PSF and 25.2 ± 9.8 ml/s in BMG group (p=0.37). Also, the mean IPSS was 6 ± 2.5. It improved to 6 ± 2.56 in the PSF and 6.7 ± 2.63 in BMG group (p=0.16). The mean IIEF in success group was 28.1 ± 1.4. It was 28.14 ± 1.61 in PSF group and 28.2 ± 1.42 in BMG group (p=0.6). Conclusions : At short term follow up, both ventral onlay penile skin flap and dorsal onlay buccal mucosa urethroplasty were shown to be safe and effective techniques for management of long segment anterior urethral strictures with similar success rates, similar patients satisfaction and low postoperative morbidity. Further studies with longer follow up period and larger sample size are needed for better evaluation of these techniques and their long term outcomes.