In urethral stricture disease, it is known that anastomostic urethroplasty with complete excision of scar tissue provide the best long-term outcome for short bulbar urethral strictures. Longer strictures are dealt with by onlay urethroplasties employing tissue substitution, using either flaps or grafts. In recent times, the buccal mucosa graft, whether laid dorsally or ventrally, has gained popularity.1,2 However, substitution urethroplasty often involves the incision of stricture only, leaving scar tissue behind. In an attempt to overcome this problem, Guralnick and Webster introduced the augmented anastomostic urethroplasty, where stricture of up to 2 cm is excised.3 However, this may not be possible in cases where the stricture is longer. Often, only the most diseased portion of the urethra is excised and the remaining portion of strictured tissue remains in-situ. In this regard, we report a novel technique – combined ventral cum dorsal onlay buccal grafts with complete excision of diseased urethra – to manage a bulbar urethral stricture greater than 2 cm.
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