Maximum Urine Flow Rate [Qmax] after one year of Buccal Mucosal Graft [BMG] Urethroplasty

Abstract

Introduction :Urethral stricture disease is a debilitating condition that can result in lifelong morbidity if not properly managed. This study aims to quantify the success rate of urethroplasty performed at KIST Medical College, using maximum urine flow rate measured by uroflowmetry as the primary outcome.

Methods: This prospective observational study was conducted at KIST Medical College Teaching Hospital, including all urethroplasties performed from August 2016 to August 2022. Medical records were reviewed for all cases meeting the inclusion criteria. Out of 72 patients, 63 responded to follow-up calls and attended outpatient department visits. Success was defined as no need for further intervention (e.g., dilation or optical urethrotomy) and maintaining a flow rate greater than 15 ml/s during follow-up. All patients underwent one-stage buccal mucosal graft urethroplasty, with the urethral catheter removed four weeks postoperatively and suprapubic drainage removed the next day after normal urination. Follow-up included clinical history, symptom reporting, urinalysis and culture, periodic uroflowmetry, ultrasonography, and cystourethrography at 1, 3, and 6 months and annually thereafter.

Results: Of the 63 patients eligible for the study, the mean age was 41.5 years (range: 14-72 years), with a median age of 40 years. The mean follow-up period was 38 months (range: 12-60 months). Trauma was the most common cause of stricture (23 patients, 36.5%), followed by lichen sclerosis (16 patients, 25.4%) and post-TURP strictures (12 patients, 19.0%). The success rate of urethroplasty was 83.15%. Fifteen patients reported dribbling urine, and four had a urinary tract infection in the last six months. Forty-eight patients were sexually active; six reported an inability to achieve satisfactory penile hardness during erection, and nine had reduced ejaculate volume. Stricture length and follow-up duration were inversely associated with the procedure's success rate, showing statistical significance.

Conclusion: Buccal mucosal graft urethroplasty is a reliable technique. Using a uroflow meter to measure the maximum urine flow rate is effective for monitoring urethral stricture recurrence during follow-up.