Efficacy of ventral onlay autologous tunica vaginalis graft in bulbar urethroplasty: An 11- year experience

Background: Urethral stricture disease in men has historically been one of the most challenging urological problems. The treatment of complex urethral strictures, in particular, poses a major challenge due to urethral scarring and fibrosis of the surrounding corpus spongiosum. Although various tissue types have been proposed for surgical reconstruction, the optimal graft material remains a subject of ongoing debate. In this study, we aimed to analyze the efficacy of using a ventral onlay autologous tunica vaginalis graft (TVOG) in bulbar urethroplasty. Methods: Data from 43 patients diagnosed with bulbar urethral stricture and treated with the ventral onlay TVOG technique at our clinic between 2011 and 2022 were retrospectively reviewed. Patient age, American Society of Anesthesiologists (ASA) score, stricture length, number of internal urethrotomies performed, operative time, etiological factors, body mass index (BMI), length of hospital stay, time-dependent uroflowmetry Qmax values, and postoperative complications were recorded. Criteria for success were defined as patient satisfaction, a Qmax value exceeding 16 mL/s, patent urethrogram findings, and the absence of any need for dilation or further instrumentation during the follow-up period. Results: The overall success rate was 74,4%. Failure occurred in 6 cases due to severe wound infection. Recurrent urethral stricture was detected in 5 cases. Superficial surgical site infection or hematoma was observed in 6 cases. No diverticulum formation was observed in any patient. Successful voiding was achieved in a total of 33 cases, with uroflowmetry Qmax values measured at 17 mL/s or higher. Comparison of Qmax values demonstrated a statistically significant difference (p < 0.05). Furthermore, no patient reported scrotal pain or discomfort during the follow-up period. Conclusions: The outcomes of using ventral onlay TVOG in bulbar urethroplasty appear favorable. Based on the data obtained from our study, it can be concluded that TVOG may be considered an alternative method in this field.