Use of platelet gel in the treatment of extended urethral strictures using buccal mucosa

Objective. To develop a method for using platelet gel in surgical interventions for extended urethral strictures using buccal urethral ligation and to evaluate its effectiveness.
Materials and methods. The study included 13 male patients with penile and bulbar urethral strictures. All patients underwent a clinical examination before surgery and at 3, 6, and 12 months postoperatively, including a medical history, a questionnaire using the International Prostate Score System, a complete urine analysis and culture; uroflowmetry, ultrasound examination of the genitourinary system with measurement of residual urine volume and urethral stricture extent, and retrograde urethrography. Following the examination, the patients underwent urethral reconstructive surgery using a buccal autograft and platelet-rich gel. The gel was applied to the buccal autograft intraoperatively, during its fixation to the corpus spongiosum, and also by irrigating and applying it to the anastomotic area during anastomotic urethroplasty.
Results. The average age of the study participants was 55.0 ± 4.7 years. Seven patients were diagnosed with a bulbar urethral stricture, and six with a penile urethral stricture. The average urethral stricture length was 4.84 ± 0.99 cm. The duration of the surgery was 149.23 ± 38.23 min. The surgery concluded with the placement of a cystostomy in one patient, and the placement of a urinary catheter in the others. Twelve months after surgery, a follow-up examination in the study group revealed stenosis of the distal anastomosis in one patient, requiring a repeat procedure—internal optical urethrotomy. Satisfactory voiding was observed in 12 patients.
Conclusion. Buccal autograft urethral stricture substitution using platelet gel demonstrated a 92.31% efficacy rate in long-term follow-up of patients with urethral strictures. The use of platelet gel in the treatment of extensive urethral strictures using buccal mucosa does not worsen wound healing, is not accompanied by wound suppuration, graft shrinkage, or urethral lumen narrowing. No signs of graft rejection or reduction were observed during follow-up. Platelet gel can be used to improve the results of urethral stricture substitution.

1. Alwaal A., Blaschko S.D., McAninch J.W., Breyer B.N. Epidemiology of urethral strictures. Transl Androl Urol. 2014; 3(2): 209– 213. doi: 10.3978/j.issn.2223-4683.2014.04.07.

2. Bischoff R., Marcon J., Schulz G.B., et al. Perioperative outcomes and trends of surgical correction of male urethral strictures. J Clin Med. 2025; 14(7): 2171. doi: 10.3390/jcm14072171.

3. Vorobev V.A., Prokopev E.Y., Pushkarev A.M., Kogan M.I. Treatment outcomes of glandular urethral strictures. Vestnik urologii. 2025; 13(3): 107–125. doi: 10.21886/2308-6424-2025-13-3-107-125. (in Russian)

4. Wessells H., Morey A., Souter L., et al. Urethral stricture disease guideline amendment. J Urol. 2023; 210(1): 64–71. doi: 10.1097/JU.0000000000003482.

5. Robine E., Rigaud J., Luyckx F., et al. [Analysis of success rates of uretroplasty for adult male bulbar urethral stricture]. Prog Urol. 2017; 27(2): 49–57.. doi: 10.1016/j.purol.2016.12.003. (in French)

6. Alonso-Morales A., Montiel-Jarquín Á.J., Camarillo-Noriega C.A., et al. Uretroplasty with oral mucosal graft in patients with anterior urethral stenosis. Comparative study with conventional treatment. Cir Cir. 2021; 89(2): 206–211. doi: 10.24875/CIRU.20000123. (in Spain)

7. Wang A., Chua M., Talla V., et al. Lingual versus buccal mucosal graft for augmentation urethroplasty. Int Urol Nephrol. 2021; 53(5): 907–918. doi: 10.1007/s11255-020-02720-7.

8. Godoi T.T.F., Rodrigues B.L., Huber S.C., et al. Platelet-Rich Plasma Gel Matrix (PRP-GM): Description of a New Technique. Bioengineering (Basel). 2022; 9(12): 817. doi: 10.3390/bioengineering9120817.

9. Potapnev M.P., Arabey A.A., Kondratenko G.G., et al. Soluble platelet factors and regenerative medicine. Zdravoohranenie. 2014; 9: 32–40. (in Russian)

10. Dos Santos R.G., Santos G.S., Alkass N., et al. The regenerative mechanisms of platelet-rich plasma. Cytokine. 2021; 144: 155560. doi: 10.1016/j.cyto.2021.155560.

11. Barbagli G., Palminteri E., Guazzoni G., et al. Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique? J Urol. 2005; 174(3): 955–958.

12. Awad S.M.T., Ahmed M.A.M., Abdalla Y.M.O., et al. Buccal mucosal graft urethroplasty for anterior urethral stricture, experience from a low-income country. BMC Urol. 2021; 21(1): 171. doi: 10.1186/s12894-021-00918-0.

13. Eleweedy S. Long-term outcomes of single stage dorsal onlay buccal mucosa urethroplasty for different anterior urethral strictures. Urology & Nephrology Open Access. 2017; 5: 357–360.