Single stage reconstruction of complex anterior urethral strictures

• Main Authors: Deepak Dubey, Aneesh Srivastava, Rakesh Kapoor, Anant Kumar, Mahendra Bhandari, Anil Mandhani
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2001-01-01
• Series: Indian Journal of Urology
• Subjects: Urethroplasty; Penile Skin Flap; Buccal Mucosa
• Online Access: http://www.indianjurol.com/article.asp?issn=0970-1591;year=2001;volume=17;issue=2;spage=145;epage=151;aulast=Dubey

Purpose: Single stage reconstruction of long, com-plex urethral strictures is technically demanding and may require the use of more than one tissue transfer technique. We describe our experience in the manage-ment of such strictures with a variety of urethroplasty techniques. Materials and Methods: Between 1989 and 1999, 25 men (mean age 38.5 years) underwent single stage re-construction of panurethral, multiple segment or focally dense strictures [mean length 11.2 cm (range 8-17 cm)]. 8 patients had combined substitution urethroplasty with a circumpenile fasciocutaneous flap and a free graft of bladder/buccal mucosa or tunica vaginalis . flap. In 10 patients a single tissue transfer technique was used. 3 patients underwent an augmented roof/floor strip ure-throplasty with a penile skin flap. 4 patients with multi-ple segment strictures (separate pendulous and bulbar) underwent distal onlay flap and proximal anastomotic urethroplasty. Results: The median ,follow-up was 46.5 months (range 6-88 months). The mean postoperative flow rate improved to 22.5 ml/sec. 2 patients developed fistulae requiring repair. Recurrent stricture developed in 5 (20.8%) patients, of which 2 were managed with visual internal urethrotomy, 2 with anastomotic urethroplasty and 1 with a two-stage procedure. Pseudodiverticulum and post-void dribbling were seen in 6 (25%) patients. Conclusions: Successful outcome of single stage re-construction of long complex strictures can be achieved with a combination of various tissue transfer methods. The urologist who has a thorough knowledge of penile skin and urethral vascular anatomy and a wide array of substitution techniques in his armamentarium can un-dertake approach to such strictures.