A New Biaxial Epilated Scrotal Flap for Reconstructive Urethral Surgery

Arango, O.; Gil-Vernet, Alfredo; Gil-Vernet, Josemaria; Gelabert-Más, Antoni

doi:10.1097/00005392-199708000-00023

Cited by 4 publications

(5 citation statements)

References 14 publications

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“…These procedures have been used in only in relatively short urethral strictures, but could cause chordee and impotence due to their limited extensibility [6,7]. Options for performing urethroplasty with a flap include scrotal flaps [10], free flaps [11,12], and fasciocutaneous flaps. The authors used fasciocutaneous flaps, which are suitable for the reconstruction of wider strictures, as in the cases described herein [13].…”

Section: Discussionmentioning

confidence: 99%

“…Scrotal skin island flaps could cause urethral stones due to the presence of hair and diverticulum due to skin dilation [10]. Although radial or ulnar forearm free flaps or free ileum flaps could be used for multiple severe strictures of the penile urethra, with defects in the entirety of the cavernous urethra, the use of these flaps is limited due to donor site morbidity [14].…”

Section: Discussionmentioning

confidence: 99%

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Urethroplasty of extensive penile urethral strictures with a longitudinal ventral tubed flap of penile skin (modified Orandi urethroplasty): 20 years of follow-up of two cases

et al. 2020

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The surgical treatment of extensive urethral strictures remains a controversial topic; although techniques have evolved, there is still no definite method of choice. Since 1968, when Orandi presented an original technique for one-stage urethroplasty using a penile skin flap, the Orandi technique has become the most prevalently used one-stage procedure for anterior urethral strictures. We present a 20-year follow-up experience with one-stage reconstruction of long urethral strictures using a longitudinal ventral tubed flap of penile skin, with some important technical changes to Orandi’s original technique to overcome the deficient vascularity caused by periurethral scar tissue. In 1997, a 55-year-old male patient complained of severe voiding difficulty and a weak urinary stream because of transurethral resection of the prostate due to benign prostatic hyperplasia. Another 47-year-old male patient had the same problem due to self-removal of a Foley catheter in 2002. In both patients, a urethrogram demonstrated extensive strictures involving the long segment of the anterior urethra. A rectangular skin flap on the ventral surface of the penis was used considering the appropriate length, diameter, and depth of the neourethra. The modified Orandi flap provided a pedicled strip of penile skin measuring an average of 8 cm. The mean duration of follow-up was 20.5 years. A long-term evaluation revealed stable performance characteristics without any complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Urethroplasty of extensive penile urethral strictures with a longitudinal ventral tubed flap of penile skin (modified Orandi urethroplasty): 20 years of follow-up of two cases

et al. 2020

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“…A MPSF was harvested incorporating all the subcutaneous tissue between the skin and the bulbar urethra following the surgical technique described by Gil Vernet et al [ 2 ] for the elevation of scrotal skin flaps for urethroplasty. During this maneuver, the testicles, surrounded by the tunica vaginalis, were completely freed and positioned temporarily over the lower abdomen.…”

Section: Case Presentationmentioning

confidence: 99%

Mid-Perineal Scrotal Flap for the Repair of Urorectal Fistulas: A New Technique

Martinez-Piñeiro

2023

Urol Int

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Rectourethral fistula (RUF) is an infrequent but severe complication of the treatment of prostate cancer. Herein, we describe a new surgical approach used successfully in 3 patients that incorporates a partially de-epithelialized mid-perineal scrotal flap (MPSF), used as interposition flap, that can be used in almost every patient with RUF after radiotherapy, regardless of having or not a concomitant posterior urethra or bladder neck stricture or contracture that might require a simultaneous urethroplasty. The interposition flap includes well vascularized subcutaneous fat tissue by distal vascular branches of the internal pudendal vessels that reaches without tension the deep perineum up to the posterior bladder neck. The MPSF is a time efficient procedure that allows excellent access to the bulbar urethra and to the surgical plane between rectum and prostate and it does not require a separate incision for the flap harvesting procedure when required.

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“…The internal posterior scrotal arteries supply a sensate central perineoscrotal flap 32 employed in neovaginoplasty as well as a sensate biaxial epilated scrotal flap, which can measure up to 20-cm and can be used to treat bulbomembranous urethral strictures in one setting. 33 Because the cutaneous blood supply of the scrotum is interconnected between the anterior scrotal arteries and branches of the superficial perineal arteries on the posterior scrotum, 34 a centrally pedicled or island scrotal sensate flap as large as 10-to 12-cm long by 5-cm wide can be created, which is useful in reconstruction after trauma or cancer-related surgical excisions. The cutaneous shaft of the penis can be included in a posteriorly pedicled scrotal flap, as has been performed in vaginoplasty for sex reassignment surgery, 35 because there is an anastomotic communication of the internal anterior scrotal arteries, the cremasteric arteries, the internal posterior scrotal arteries, and even occasional terminal branches of the superficial external pudendal arteries at the base of the penis will provide distal perfusion to such a flap.…”

mentioning

confidence: 99%