Dorsal Onlay versus Ventral Onlay Urethroplasty for Anterior Urethral Stricture: A Meta-Analysis

BACKGROUND: Ventral and dorsal sides of urethra were chosen to place grafts in free graft onlay urethroplasty. As the advantages and disadvantages of these two sites are still unclear, we systemically analyzed clinical articles reported in the literature. MATERIALS AND METHODS: The literature till October 2007 regarding the use of ventral/dorsal graft urethroplasty in anterior urethral strictures was searched using the MEDLINE, Cochrane Library, and EMBASE databases. 'Urethral stricture' or 'urethral stenosis' and 'urethroplasty' or 'urethral reconstruction' were used as search terms. Data were analyzed independently by two reviewers. RESULTS: 49 studies (1,263 cases) were included. The success rates of ventral onlay urethroplasty (750 cases) and dorsal onlay (513 cases) were 82.5 and 86.9% (p = 0.034). Buccal mucosa graft had the highest success rate (88.1%) and had a similar rate between the dorsal and ventral onlay techniques (89.2 vs. 87.6%, p = 0.472). For free skin graft, the dorsal onlay success rate was higher than ventral (84.7 vs. 74.7, p = 0.016). Bulbar urethral stricture achieved the higher success rate than pendulous urethral stricture (87.4 vs. 77.6%, p = 0.019). CONCLUSIONS: Dorsal onlay is better than ventral onlay in free skin graft urethroplasty. Bulbar urethra is the most suitable site for graft onlay urethroplasty, and buccal mucosa graft is helpful for achieving good results.