Difficulty : ⭐️
For a long time, external and internal trauma have been identified as etiologies of recurrent urethral strictures. This etiology has now surpassed in frequency that of stenosis secondary to sexually transmitted infections.
Among the causes of urethral strictures, the frequency of Balanitica Xerotica Obliterans BXO) is undoubtedly underestimated. This aetiology is predictable when there is a visible lichen at the meatus or sulcus. It is probably very important in multi-operated or multi-aggressed urethras. Since BXO is a skin disease, it is illogical to perform a skin augmentation of the urethra at the site of the strictures. It is therefore appropriate to use another tissue: a muccosal tissue.
The buccal mucosa flap is the best tissue available today for performing an enlargement plasty of any stenotic urethra and we describe here how it is harvested.
Harvesting the mucosa of the cheek, after locating Stenon’s canal (opposite the second upper molar) and infiltration with adrenaline serum is the one that allows us to obtain a large flap that can reach 65 to 70 mm by 20 to 25 mm wide. The harvesting technique is detailed here.
Lip and tongue mucosa grafts are much more rarely used. Indeed, these grafts are smaller, pose more problems of retraction and the aftermath is more painful. They are therefore no longer recommended as first-line procedure.
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