Current controversies in anterior urethral stricture repair: free-graft versus pedicled skin-flap reconstruction

Abstract

Reconstruction of long anterior urethral strictures that cannot be excised and reanastomosed remains controversial. We critically reviewed the literature on free-graft and pedicled skin-flap urethroplasty to determine the optimal method of repair. Overall, free grafts were successful in 84.3% of cases and flaps, in 85.9%. Buccal mucosa grafts are the most successful method for reconstruction of bulbar urethral strictures. For strictures in the penile urethral or a compromised graft bed a distal penile skin flap is the most reliable and tested approach. Dorsal free-graft urethroplasty may be considered when penile skin deficiency prevents use of a flap. For the most complex strictures, in which a flap is not possible and the graft bed is of poor quality, a mesh graft in two stages may be the only option. Thus, for reconstruction of complex anterior urethral strictures, both free-graft and flap procedures remain indispensable.

Oral mucosa grafts for urethral reconstruction

“…[21] Subsequently, other publications focused on techniques of harvesting the graft, as well as the available sites that could avoid or minimize donor site morbidity. [1,[20][21][22][23][24][25][26][27] This led Filipas et al, to attest to the long-term suitability of mucosal grafts after exposure to urine. [3] The period from the late 1990s to the present times has seen more articles focusing on donor site morbidity in cases of oral mucosal grafts and its implications.…”

“…Tolstunov and Pogrel [23] 1996 Wessells and McAninch [24] 1996 Lopez et al [25] 1996 Iizuka et al [26] 1997 Eppley et al [1] 1998 Filipas et al [3] Long-term suitability after exposure to urine 2003 Dublin and Stewart [28] Donor site morbidity and its implications 2004 Fichtner et al [29] 2004…”

An engineered muscle flap for reconstruction of large soft tissue defects

“…In contrast, flaps are autologous tissues that can be transferred with their own blood supply and therefore, preferred for repair of large defects. However, the duration of the surgical operation, the scant availability of quality vascularized flaps, and donor site morbidity often limit their use (6).…”

Penile fasciocutaneous flap urethroplasty in long segment urethral stricture

“…[6] Comparing graft and flap methods, both have the same success rates. [6][7][8] Flap and graft could be placed in dorsal or ventral side of the urethra. In a meta-analysis, success rates of ventral and dorsal replacement have been found the same (87.6% vs. 89.2%).…”