Penile skin flap: a versatile substitute for anterior urethral stricture

Abstract

Purpose Penile skin flap uretroplasty is a useful technique for a long urethral stricture due to the ample length and surgical handling characteristics. We investigated the surgical technique and initial results of uretroplasty for anterior urethral strictures using a dorsal penile skin flap.Patients and methods From January 2003 to January 2018, a total of 77 patients underwent substitution urethroplasty using dorsal penile skin flap for bulbar urethral strictures in our institution. All patients were assessed preoperatively, and followed postoperatively by physical examination, urinalysis, retrograde and voiding urethrography, uroflowmetry and post-void residual urine measurement. Success was defined as no requirement of additional urethral instrumentation.Results The mean age was 45 years (10-87). The mean stricture length was 5cm (3-10cm). The mean flap length was 6cm. Urinary fistula was the most common postoperative complication. The mean follow-up was 60 months (6-120). The overall success rate was 88%. Recurrent strictures were found in 4 patients (5%) at 1 year. At 3 year follow-up, 5 (7%) more patients had recurrences. All recurrences were managed by internal urethrotomy.Conclusions Substitution urethroplasty using penile skin flap appear to be a safe and efficient technique for the treatment of a long and complex anterior urethral stricture. It provides encouraging cosmetic and functional results.

Recurrent Anterior Urethral Stricture: Challenges and Solutions

“…32 Adjunct voiding cystourethrogram is similarly commonly used for screening, with particular value in assessing posterior USD. 39 These techniques have the primary advantage of allowing the clinician to identify asymptomatic USD, and to 24,25 Skin flap 12-14% 25,26 Meatal/Fossa Navicularis Meatotomy 2-15% [27][28][29] BMG 7-44% [29][30][31] Skin flap 4-17% 29,31 evaluate the entire length of the urethra simultaneously in order to plan a potential revision operation (Figure 1). Magnetic resonance imaging (MRI) evaluation of USD is rarely employed given the expense of this diagnostic tool and the widely available and less expensive alternatives.…”

Editorial Comment: Dorsal oral mucosa graft in combination with ventral penile flap as an alternative to repair obliterative stenosis of the anterior urethra in a single surgical time

“…Recently we comment in International Brazilian Journal of Urology a important paper about the use of penile skin fap in anterior penile urethral stricture ( 1 , 2 ). In this previous paper Dr. Hmida shows that penile skin ap is easy to perform, do not need urethral mobilization and had a success rate of 88%.…”

“…In the present paper, Dr. Giudice in a interesting prospective study with the use in a single procedure the combination of dorsal onlay oral mucosa graft and ventral fasciocutaneous penile skin flap in in 21 patients with long segment urethral obliteration and shows that in only 14% of the patients the procedure failed. There are several options for the treatment of anterior urethral stricture ( 2 – 4 ). For long anterior strictures the use of grafts is very usual ( 4 – 6 ).…”

“…For long anterior strictures the use of grafts is very usual ( 4 – 6 ). The buccal mucosa grafts and fascio-cutaneous flaps are frequently used in long anterior urethral strictures ( 2 , 7 ). In this paper the authors shows that the combination of the two methods (dorsal onlay oral mucosa graft and ventral fasciocutaneous penile skin flap) could be a great option in complex cases of penile urethral stricture.…”

Bulbar urethral stricture: penile skin flap may be a good option?

“…The papers come from many different countries such as Italy, Brazil, USA, Turkey, China, France, Iran, Lebanon, Singapore, Colombia, Tunisia, India and Spain, and as usual the editor ´s comment highlights some papers. We decided to comment the paper about a very interesting topic: Penile skin flap for anterior urethral sctricture (1).…”