Dorsal onlay augmentation urethroplasty with small intestinal submucosa: Modified Barbagli technique for strictures of the bulbar urethra

Aim: To present the results from one clinic's experience of using small intestinal submucosa (SIS) in augmentation urethroplasty for management of strictures of the bulbar urethra. Methods: Urethral surgery was performed in nine men with strictures 4-6 cm. All of the patients were evaluated by history, physical examination, retrograde urethrogram, and uroflowmetry. Four layers of SIS were soaked in saline or Ringer's solution for 15 minutes at 37 degrees C, and the inner surface of the patch was gently fenestrated with a thin scalpel. The patch was spread-fixed onto the tunica albuginea. The mucosa was sutured to the submucosal graft first at 2-3 mm inwards from the SIS margins, then the spongiosum tissue was attached to the margins with interrupted absorbable sutures. Results: Of the nine patients who underwent augmentation urethroplasty using SIS, only one had re-stricture at 6 months due to urethral infection. At 18 months after the surgery the uroflowmetry of the other eight patients was 20-21 mL/s. In terms of complications, six patients reported having post-micturition dribbling, and seven patients reported lack of morning erections for 35-69 days after surgery. Conclusions: Using SIS is a safe procedure; however, long-term follow-up is needed to substantiate the good short-term results.