What is BMG Urethroplasty?: Buccal mucosal graft (BMG) urethroplasty is a well-established surgical technique used for the reconstruction of the urethra, particularly in patients with urethral stricture disease. This procedure involves harvesting a graft from the buccal mucosa (inner lining of the cheek) and using it to repair or reconstruct the urethra. BMG urethroplasty is considered the gold standard for long-segment anterior urethral strictures due to its high success rates, minimal donor site morbidity, and excellent long-term outcomes.
Epidemiology of Urethral Strictures
Urethral strictures are a relatively common urological condition, affecting men more frequently than women. They can arise from various causes, including trauma, infection, iatrogenic injury (such as catheterization or surgery), or congenital abnormalities. The prevalence of urethral strictures is estimated to be around 0.6% in the general population, with increasing incidence in older age groups due to previous interventions and chronic inflammatory conditions.
Indications for BMG Urethroplasty
BMG urethroplasty is indicated in patients with:
- Long-segment anterior urethral strictures (>2 cm)
- Recurrent urethral strictures after failed endoscopic management (DVIU or urethral dilation)
- Lichen sclerosus-related urethral strictures
- Complex or traumatic urethral strictures
- Iatrogenic strictures caused by catheterization or previous urological procedures
Preoperative Evaluation
Before undergoing BMG urethroplasty, a thorough diagnostic workup is essential to determine the severity and location of the stricture. Common investigations include:
- Retrograde Urethrography (RUG) and Voiding Cystourethrography (VCUG): These imaging modalities help in assessing the length and location of the stricture.
- Urethroscopy: Provides direct visualization of the stricture and adjacent urethral mucosa.
- Uroflowmetry and Post-Void Residual Measurement: Evaluates the functional impact of the stricture on urinary flow.
- MRI or Ultrasonography: Occasionally used in complex or recurrent strictures to assess fibrosis and periurethral involvement.
Surgical Technique of BMG Urethroplasty
The procedure involves multiple steps:
- Anesthesia and Positioning: The patient is placed in a lithotomy position under general or spinal anesthesia.
- Buccal Mucosal Graft Harvesting: A graft is harvested from the inner cheek or lip, typically measuring 4-6 cm in length.
- Stricture Excision and Urethral Mobilization: The affected segment of the urethra is accessed through a perineal or penile incision.
- Graft Placement: The BMG is carefully sutured onto the urethral defect using fine absorbable sutures.
- Closure and Catheterization: The reconstructed urethra is stented with a Foley catheter to facilitate healing, usually left in place for 2-3 weeks.
Postoperative Care and Recovery
- Patients are monitored for signs of infection, bleeding, or graft-related complications.
- Oral care is essential to promote healing at the buccal graft donor site.
- A follow-up RUG or VCUG is performed after catheter removal to confirm urethral patency.
- Patients are advised to avoid heavy physical activity and maintain adequate hydration.
Outcomes and Success Rates
BMG urethroplasty boasts high success rates, with studies reporting long-term success in 85-90% of cases. Factors influencing outcomes include the length of the stricture, patient comorbidities, and surgeon expertise. The use of BMG offers superior tissue integration, long-term durability, and minimal graft-related complications compared to skin or other graft sources.
Recent Advances and Ongoing Research
Recent advancements in BMG urethroplasty include:
- Tissue Engineering: Research into bioengineered urethral grafts aims to develop synthetic alternatives to buccal mucosa.
- Minimally Invasive Approaches: Robotic-assisted techniques and endoscopic-assisted urethroplasty are being explored.
- Long-Term Functional Outcomes: Studies continue to assess quality-of-life improvements and patient satisfaction following BMG urethroplasty.
Conclusion
BMG urethroplasty remains the gold standard for treating complex anterior urethral strictures, offering excellent long-term outcomes with minimal morbidity. The expertise of highly skilled urologists plays a crucial role in the success of this procedure.
At the Institute of Urology, Jaipur, Dr. M Roychowdhury and Dr. Rajan Bansal specialize in advanced urological procedures, including BMG urethroplasty. Their extensive experience, combined with state-of-the-art infrastructure, ensures optimal patient care. The Institute of Urology provides a comprehensive range of urological and general surgery services under one roof, including consultation, diagnostics, and surgical interventions, making it a premier center for urological excellence in India.
References
- Barbagli G, et al. (2020). “Buccal Mucosa Graft Urethroplasty: Evolution of the Technique and Current Trends.” European Urology.
- Kulkarni S, et al. (2019). “Long-Term Outcomes of Buccal Mucosal Urethroplasty: A Multicenter Study.” The Journal of Urology.
- Mundy AR, Andrich DE. (2017). “Urethral Stricture Disease and Reconstruction.” BJU International.
