216 Early Data Supporting Ventral Onlay Pseudospongioplasty for Penile Urethral Strictures
Authors: Perez A , Nolte A , Demus T , Mallory C , Jivanji D , Jamieson S , Boyer J , Cordon B 
Published: April 2022

ABSTRACT

Introduction
Augmented urethroplasty with buccal mucosal graft remains one of the mainstays of urethral stricture management, and location of graft placement depends on surgeon preference as well as patient-specific factors. Historically, ventral graft placement has been preferred in the bulbar urethra due to a robust blood supply provided by a thicker corpus spongiosum at the bulb. While, in the penile urethra, dorsal placement is traditionally preferred due to limited spongiosum in this location and concern for poor graft take. Some have advocated for ventral onlay placement in the penile urethra, arguing this placement decreases dissection thereby preserving vascularization of the urethra. We present promising results and outcomes for ventral onlays in the penile urethra, which we cover with periurethral vascularized tissue as a “pseudospongioplasty” to provide a supportive, vascular bed for graft survival.

Objective
We aimed to assess the efficacy of ventral buccal mucosal graft positioning for treatment of penile urethral strictures using the pseudospongioplasty technique.

Methods
We retrospectively reviewed clinical and procedural characteristics for all patients that underwent urethroplasty at our institution from August 2016 through February 2021. Patients were divided into one of three groups based on their operative approach: (1) pseudospongioplasty in the penile urethra, (2) spongioplasty in the bulbar urethra, (3) and bulbopenile strictures requiring a combined approach. Key outcomes variables included recurrence rates and complication rates.

Results
50 patients fit our inclusion criteria. We identified 18 patients that underwent isolated spongioplasty in the bulbar urethra, 19 patients that underwent isolated pseudospongioplasty in the penile urethra, and 13 patients with bulbopenile strictures that had simultaneous spongioplasty and pseudospongioplasty. All procedures used buccal mucosa as a ventral onlay. Median stricture length (cm) for spongioplasty, pseudospongioplasty and both were 4.0 (3-5) and 4.25 (3.5-6) and 8 (6-10), respectively. There were three 30-day complications in each group. Figure 1 shows the Kaplan Meier curves for recurrence in the three study groups, rates were not statistically different using spongioplasty as a reference group (p=0.83 and p=0.72 for pseudospongioplasty and combined, respectively). When compared to spongioplasty, the relative risk of recurrence in pseudospongioplasty and combined were 0.41 (0.05-2.44, p=0.344) and 1.56 (0.30-8.21, p=0.593), respectively. Meanwhile the relative risk for complications were 0.94 (0.15-5.77, p=0.942) and 1.5 (0.24-9.61, p=0.657), for pseudospongioplasty and combined respectively.

Conclusions
Supporting recent literature concerning ventral onlay graft positioning in the penile urethra, a pseudospongioplasty appears to provide enough of a supportive vascular bed for graft survival. There are few published series demonstrating its effectiveness; however, we show that pseudospongioplasty in the penile urethra has comparable outcomes to conventional spongioplasty in the bulbar urethra.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific