INTRODUCTION: Urethroplasty is the gold standard treatment for urethral stricture disease, regardless of the reconstructive technique utilized, because of its high success rate as compared with endoscopic urethrotomy or simple dilation. Among the different urethroplasty techniques, the Kulkarni Procedure has gained wide acceptance worldwide for strictures of varying etiologies. This is the first ever local experience study to review this one-sided dissection technique aimed at preserving the lateral blood and nervous supply to the urethra thereby increasing the chances of graft survival. METHODS: A retrospective review from October 2017 – October 2021 was done. Twenty male patients were included. Their ages ranged from 24 to 75 years old (mean age 43). The patient underwent one-sided urethral dissection followed by dorsal onlay mucosal graft urethroplasty. All the surgeries were performed by a single surgeon. On follow up, outcomes were measured using a variety of tools. Incidence of postoperative complications and stricture recurrence were likewise noted. RESULTS: In this study, 20 patients underwent one-sided dorsal onlay BMG (buccal mucosal graft) urethroplasty (Kulkarni technique), from October 2017 to October 2021.The outcome was deemed successful if the patient no longer needed additional procedures after the initial surgery. Of the 20 patients, 18 had successful outcomes. The other 2 patients had to undergo a redo urethroplasty. CONCLUSION This technique was shown to have an overall success rate of 92% in 24 patients, with a follow-up period of 12-55 months based on Kulkarni’s initial report in 2009. The results of the present study are similar wherein the overall success rate was 90% in 20 patients, but on a shorter follow up period. Despite the small sample size and short follow-up period, the results of the initial experience are very promising. As urologists gain more experience, they can achieve higher success rates in the future.

Urethral strictures in females are very uncommon. In selected populations of women who underwent urodynamic studies for obstructive symptoms, female urethral strictures represent 4-13% of the causes of bladder outlet obstruction. Literature is limited regarding surgical treatment for near-obliterative urethral strictures in female patients. In this paper, the authors aimed to report a novel technique of double-faced inlay buccal mucosal graft (BMG) urethroplasty, first described by Joshi in 2020. This is a case of a 35-year-old female with progressively worsening lower urinary tract symptoms, several months after undergoing cesarean section despite multiple internal urethrotomies. Grafts were placed both the anterior and posterior urethral walls with noted good urine flow with mild lower urinary tract symptoms on follow-up after 6 months. The combined dorsal and ventral inlay BMG urethroplasty is a feasible technique with good results for female patients with urethral strictures. To the authors’ knowledge, this is the first-ever reported case, for this novel technique, in the Philippines.

OBJECTIVE: To describe the technique and report the first transurethral buccal mucosal graft ventral inlay (Nikolavsky Technique) urethroplasty done in the Philippines, in a patient who had a fossa navicularis stricture extending to the distal penile urethra. METHODS: Reported here is a case of a twenty-seven-year-old male who had a 40% distal urethral mucosal tear, as seen on initial cystoscopy, following traumatic catherization. The urethral tear was initially managed with a foley catheter maintained for a month. However, the patient eventually developed a 4 cm stricture extending from the fossa navicularis to the distal penile urethra. A ventral buccal mucosal graft was placed on the denuded urethral plate as an inlay patch via the transurethral route. No skin incisions nor penile degloving was done RESULTS: Total operative time was four hours, including graft harvest time, with approximately 400 ml blood loss. The patient was sent home on the 3rd postoperative day. The urethral catheter was removed after 14 days. Post-operative follow-up was performed at 0-, 3- 6- and 12-months. A repeat voiding cystourethrogram was performed at 4 weeks showing no narrowing at the prior stricture site. On 12 months follow-up, uroflowmetry showed a Q-max of 20ml/sec with minimal residual urine. LUTS symptom scoring was at 7 and IIEF-5 score of 25 CONCLUSION Repair of distal urethral strictures can be done using transurethral ventral buccal mucosa graft inlay urethroplasty. It can be challenging for longer strictures (>4 cm) but easily reproducible for shorter ones. The technique demonstrated good results on medium term follow-up. To the authors’ knowledge, this is the first reported case that utilized this technique in the Philippines.

Body dysmorphia is a debilitating disorder that centralizes on a preoccupation with one’s physical appearance. Often, these individuals seek surgical correction in an effort to subdue this preoccupation. A majority of complications from feminizing gender reassignment surgery, consists of urethral stricture or stenosis, leading to voiding dysfunction. The patient is 39-year old male who underwent bilateral nipple removal, bilateral orchiectomy, scrotectomy and total penectomy with perineal urethrostomy, one year prior to consult. The patient eventually presented with acute urinary retention secondary to perineal urethrostomy stenosis. Urethroplasty with revision of perineal urethrostomy site using a buccal graft was done; and on follow up, he was noted to have good urine flow on uroflowmetry with mild lower urinary tract symptoms. Complex urethral strictures may be noted in patients with prior reconstructive history and lengthy areas of fibrosis. Although perineal urethrostomy is a valid surgical course of treatment for patients with complex strictures, improper technique, suboptimal patient factors, and, poor healing may lead to stenosis. The study aims to describe the use of a buccal graft as a viable alternative and easily reproducible technique to augment a revision perineal urethrostomy and lessen the recurrence of stenosis.

Human ; Male ; Adult: 25-44 Yrs Old ; Gender Reassignment Surgery ; Sex Reassignment Surgery