The stricture of the distal urethra and the meatus due to lichen sclerelosus - a new technique for reconstruction (1. Filmpreis 2011)
J. Beier1, A. Pandey1, H. Keller1
1Klinikum Hof, Klinik für Urologie, Kinderurologie und Urologische Onkologie, Hof, Germany
Introduction: The reconstruction of a stricture of the penile urethra and the meatus due to lichen sclerosis is a challenge for reconstructive surgeons and associated with a high rate of recurrence and complications. We present a new technique for reconstruction using buccal mucosa graft (BMG) keeping the meatus at the tip of the glans without transecting it.
Materials and methods: 4 weeks before reconstruction the stricture is opened by visual urethrotomy (VU) and the extension is determined. For reconstruction a 10 Fr. Catheter is inserted by smoothly dilating the urethra. Skin incision runs laterally to the urethra up to the coronary sulcus. The corpus spongiosum is exposed and the glans is undermined from the coronary sulcus to the tip of it, which is perforated. The strictured urethra is incised from the meatus up to the healthy part of the urethra without transecting the glans. BMG is implanted ventrally by a running suture 6.0 monocryl. The graft is shifted under the glans to the tip of it, trimmed and sutured to the glans epithelium so that the meatus is open for 24 Fr. The graft is covered by corpus spongiosum after inserting a 20 Fr. catheter by a running suture 4.0. This is possible because 4 weeks before a VU has been performed and the tissue is still smooth. The wound is closed and the indwelling catheter is kept in place for 1 and the suprapubic tube for 3 weeks respectively.
Results: By a mean follow up of more than 3 years we have performed more than 50 procedures without any recurrence at the meatus.
Conclusion: Buccal mucosa graft is not only an excellent tissue for the reconstruction of strictures of the bulbar but also for the distal urethra and meatus caused by lichen sclerosis.