Outcome of buccal mucosal graft urethroplasty versus direct vision internal urethrotomy in recurrent bulbar urethral stricture

Abstract

Recurrent bulbar urethral stricture is a frequent and challenging urologic condition. Buccal Mucosal Graft (BMG) urethroplasty and Direct Vision Internal Urethrotomy (DVIU) are both modalities of treatment used in recurrent bulbar urethral strictures. BMG urethroplasty is effective for recurrent bulbar urethral stricture treatment; however, DVIU is also an alternative if urethral strictures recur after 6 months. To compare the outcome of Buccal Mucosal Graft (BMG) Urethroplasty and Direct Vision Internal Urethrotomy (DVIU) in recurrent bulbar urethral strictures. This quasi-experimental study was conducted at the National Institute of Kidney Diseases and Urology (NIKDU) from March 2022 to August 2023. The procedure was applied to 93 male patients. Each patient was selected based on inclusion and exclusion criteria. Participants were selected by purposive sampling. Buccal mucosal graft (BMG) urethroplasty was considered group A, and direct vision internal urethrotomy (DVIU) was considered group B. Recurrence was determined by poor urine flow rate, an increase in American Urological Association (AUA) symptom score from baseline, a high post-void residual urine (PVR), and the need for re-intervention. Comparison of quantitative data was done by an independent sample t-test, One-way ANOVA test, Kruskal-Wallis test, Mann Whitney U test and qualitative data by chi-square (ꭓ2) test. The median maximum flow rate (Q-max) at baseline was 6 ml/s and 7 ml/s in group A and B respectively. After 12 months of intervention was 20 ml in group A and 16 ml in group B. That means group A has a higher flow rate than group B. Both groups showed similar complications with minimum morbidity. Median American Urological. Association Symptom score (AUA-SS) at baseline was 15 and 13 in group A and B respectively. After 12 months of intervention was 7 in group A and 11 in group B. The mean PVR at baseline was 110 ml and 120 ml in group A and B respectively. After 12 months of intervention was 28 ml in group A and 50 ml in group B. A statistically significant (p