Barbagli's dorsal urethroplasty. Analysis of results and factors for success.

OBJECTIVES

Dorsal urethroplasty as described by Barbagli has gained wide acceptance in the treatment of urethral stricture, given the simplification afforded by obtaining a free graft versus a flap. We present a series of 50 patients treated in our department of urethral stricture by dorsal onlay free graft urethroplasty (Barbagli's technique), in combination or not to other techniques in more complex strictures.

METHODS

The average age of patients was 48.8 years (23-77), the mean follow up 42.9 months (12-96) and the most frequently observed etiology has been the inflammatory urethral stricture (50%).

RESULTS

Overall success rate was 82% (41 cases) and failure 18% (9 cases). In the longer follow-up group, there was a slight drop in success rate of 80% (24 cases) without any significant differences between groups (p= 0.9). Analyzing the variables length of free graft (p= 0.50, p> 36= 0.53), age (p= 0.12, p>36= 0.59), etiology of stricture (p= 0.77, p>36 = 0.77) and type of graft used (p=0.24, p>36= 0.38) did not show any influence on the final outcome of surgery, both in the total sample and the subgroup with follow-up > 36 months. The location of the stricture in bulbar urethra has shown better functional outcome than those operated on for strictures affecting also other urethral locations (p= 0.001) maintaining that result in the group of longer follow up (p>36= 0,001). The lack of treatment prior to urethral surgery has influenced the success of it, since 90.6% of patients without prior treatment before urethroplasty have seen a good functional outcome, compared to treatment prior to surgery that obtained a 66.7% (p= 0.03). This significance is also demonstrated in the group of follow-up > 36 months (p>36= 0.01).

CONCLUSION

The dorsal onlay free graft urethroplasty is a versatile and reproducible technique with acceptable results which allows combination with other techniques when the stenosis extends to the penile urethra. In exceptional cases of panurethral strictures secondary to lichen sclerosus when there is no significant spongiofibrosis and an acceptable urethral plate, can be applied to the whole urethra.