Penile Circular Fasciocutaneous (McAninch) Flap as an Option for Complex Anterior Urethral Stricture in Case of Non-Viable Buccal Mucosal Graft

Abstract

A 65-year-old male presented with the symptoms of lower urinary tract obstruction for 8 months. He was circumcised in infancy. He developed acute urinary retention and suprapubic cystostomy was done. Local examination revealed post circumcision status with stenosis of external urethral meatus. There was no evidence of lichen sclerosus et atrophicus. He was a chronic smoker and tobacco chewer, hypertensive on treatment. Oral cavity showed grade II trismus and submucosal fibrosis with tobacco staining. His blood urea was 31 mg/dl, serum creatinine 0.9 mg/dl and hemoglobin was 12 g/dl. His urine culture was sterile, ultrasound (US) showed no hydroureteronephrosis or prostatomegaly and uroflowmetry showed a flat pattern with Qmax of 3 ml/sec. Retrograde urethrogram (RGU) showed distal penile urethral stricture [Table /Fig-1a,b]. Patient was taken up for penile circular fasciocutaneous flap urethroplasty as his donor site for buccal mucosa was not available due to trismus and submucous fibrosis. Patient was placed in dorsal lithotomy under central neuraxial blockade. Circular penile skin flap was marked and a 1.4cm wide circumferential dartos based fasciocutaneous flap was harvested. The flap was 12cm in length after splitting dorsally. A ventral urethrotomy was made over the distal tip of the catheter and extended proximally until the normal caliber urethra is encountered. The most proximal and distal portions of the flap are secured to the normal urethra using interrupted 4-0 vicryl and flap suturing was completed [Table/ Fig-2a-e]. Pericatheter RGU was done after 3 weeks and uroflowmetry showed a good flow [Table/ Fig-3].