Successful Buccal Mucosal Graft Urethroplasty for Bulbar Urethral Stricture

Chief Complaints

A 31-year-old male patient with a body mass index (BMI) of 22 presented to the Urology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of poor urinary flow and difficulty in passing urine.

The patient had no known history of diabetes mellitus, hypertension, cardiac disease, chronic kidney disease, or any other significant medical condition. He had not undergone any previous major surgeries or urological procedures, and no other relevant past illnesses had been reported.

On examination, the patient was conscious, coherent, oriented, and hemodynamically stable. Clinical assessment was suggestive of chronic bladder outlet obstruction with reduced urinary flow. Abdominal examination did not reveal any acute tenderness or palpable abnormalities. There were no signs of systemic infection or renal impairment, and the remaining systemic examination was normal.

Upon admission to PACE Hospitals, following a detailed clinical assessment, the Urology team evaluated the patient for complaints of poor urinary flow and difficulty in passing urine, along with a review of his relevant medical history.

Clinical evaluation and urological investigations, including cystoscopy and retrograde urethrogram (RGU), revealed findings consistent with a bulbar urethral stricture causing chronic urinary retention. Further assessment also demonstrated a decompensated urinary bladder, chronic bladder outlet obstruction, and bilateral moderate hydroureteronephrosis, while renal function remained preserved.

Routine preoperative investigations, including complete blood picture, renal function tests, serum electrolytes, urine analysis, and anaesthetic fitness assessment, were performed to evaluate the patient's overall medical condition. These investigations were within acceptable limits and served as supportive assessments for surgical planning.

Based on the confirmed diagnosis, the patient was advised to undergo Bulbar Urethral Stricture Treatment in Hyderabad, India, under the expert care of the Urology Department.

After a detailed consultation with consultant laparoscopic urologists Dr. Abhik Debnath and Dr. K Ravichandra, along with senior consultant urologist and renal transplant surgeon Dr. Vishwambhar Nath, a comprehensive evaluation was performed to determine the most appropriate diagnostic and therapeutic approach.

Considering the patient’s history of poor urinary flow and chronic urinary retention, further evaluation confirmed a bulbar urethral stricture with chronic bladder outlet obstruction, a decompensated urinary bladder, and bilateral moderate hydroureteronephrosis. Routine investigations showed preserved renal function and otherwise stable clinical parameters.

Based on the clinical assessment, cystoscopy, retrograde urethrogram, and routine investigations showing stable parameters, it was determined that Buccal Mucosal Graft Urethroplasty was the most appropriate and effective management strategy. This approach was chosen to reconstruct the narrowed urethral segment, relieve bladder outlet obstruction, improve urinary flow, reduce chronic urinary retention, and prevent further damage to the bladder, ureters, and kidneys while ensuring better functional outcomes.

The patient and his family members were counselled regarding the diagnosis, clinical findings, planned procedure, and the importance of postoperative care and follow-up.

Following the decision, the patient was scheduled for Buccal Mucosal Graft Urethroplasty in Hyderabad at PACE Hospitals, under the expert care of the Urology Department.

The following steps were carried out during the procedure:

• Patient Preparation and Anaesthesia: After completion of all preoperative investigations, anaesthesia assessment, and informed consent, the patient was taken up for surgery under appropriate anaesthesia. The patient was positioned under strict aseptic precautions, and the surgical field was prepared for both urethral reconstruction and buccal mucosal graft harvesting.

• Preoperative Evaluation and Stricture Assessment: Before reconstruction, cystoscopy and retrograde urethrogram (RGU) were performed to identify the exact location, length, and severity of the bulbar urethral stricture. These findings helped the surgical team accurately plan the reconstructive procedure.

• Buccal Mucosal Graft Harvesting and Stricture Excision: A healthy graft was harvested from the inner lining of the cheek (buccal mucosa). The diseased urethral segment containing the stricture was carefully exposed, excised, and sent for histopathological examination (biopsy).

• Urethral Reconstruction: The harvested buccal mucosal graft was used to reconstruct the narrowed portion of the urethra. The graft was meticulously sutured to restore the urethral lumen, relieve the obstruction, and improve urinary flow while preserving the surrounding healthy tissues.

• Catheter Placement and Completion of Procedure: Following successful reconstruction, a urinary catheter was placed to support healing of the repaired urethra and maintain continuous urinary drainage. Adequate haemostasis was achieved, the surgical site was closed in layers, and the procedure was completed successfully without any intraoperative complications.
  

The patient had an uneventful postoperative recovery and remained hemodynamically stable during the hospital stay. He received intravenous treatment for infection prevention, pain relief, fever control, reduction of inflammation, and maintenance of hydration. The urinary catheter was kept in place to support healing of the reconstructed urethra and ensure continuous urine drainage. Regular monitoring was carried out for urine output, bleeding, catheter function, wound healing, oral graft-site recovery, and any signs of infection or urinary obstruction.

Upon discharge, the patient was prescribed oral medications for the prevention and treatment of infection, relief of postoperative pain, reduction of inflammation, and control of fever, as required. He was also advised to continue supportive medications to promote healing and recovery following surgery. The patient was instructed to take all prescribed medications as directed by the treating urologist and to avoid self-medication during the recovery period.

The patient was advised to follow a soft, low-spice diet, avoid hot foods and liquids, perform the recommended mouth exercises, and follow proper wound and catheter care. He was also advised to attend the scheduled follow-up visit.

The patient was informed to contact the emergency ward at PACE Hospitals in case of fever, severe pain, reduced or absent urine drainage, catheter blockage or displacement, increasing swelling, bleeding, lower abdominal discomfort, or any unusual discharge from the surgical site.

The patient was advised to return for a follow-up visit with the Urologist in Hyderabad at PACE Hospitals as scheduled for assessment of wound healing, catheter care, urinary flow, and further evaluation after catheter removal.

This case highlights the successful management of bulbar urethral stricture with chronic urinary retention and bilateral moderate hydroureteronephrosis using Buccal Mucosal Graft Urethroplasty. The procedure effectively relieved the urethral obstruction, restored urinary flow, and resulted in an uneventful recovery. The patient was discharged in a stable condition with appropriate postoperative advice and follow-up.