One-stage urethroplasty for complicated urethral strictures using axial penile skin island flap.
ABSTRACT Surgical repair of urethral strictures complicated by multiple scrotal/perineal urethrocutaneous fistulae (watering-can perineum) can be very problematic. The perineal/scrotal skin is either not available or is riddled with infection, fibrosis or granulomata and therefore unsuitable as a graft source. The presence of infection makes free grafts from other sites unlikely to survive. Furthermore, extensive fibrosis may prevent excision and re-anastomosis as well as internal urethrotomy. The absence of preputial skin in circumcised patients compounds these problems. We have used a one-stage, transverse vascularized cutaneous penile flap to repair 20 cases of these complicated strictures. The graft took in 100% and no absolute repair failure was registered. In spite of obvious pre-operative infection, the result of repair was judged excellent in 17 patients (85%) and very fair in 3 (15%).
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ABSTRACT: Background: Island flap techniques currently used in urethroplasty utilize the prepuce and the dorsal penile skin. Our experience with a one-stage island flap urethroplasty for urethral strictures utilizing the ventral penile skin is described. Patients and Method: This is a longitudinal study of seventy six consecutive patients with impassable and complicated urethral strictures treated using this technique over a seven-year period. Sixty were bulbous while sixteen were bulbomembranous urethral strictures. Following operation the patients were assessed using urine flow rates, urethrograms and some urethroscopy. Restrictures were successfully reoperated. Results: Sixty-eight patients (89.5%) had satisfactory voiding with good urine stream without complication at one year after operation. Five patients (6.6%) had restricture and three (3.9%) others had urethral bagginess and postmicturition dribbling. The overall complication rate was 10.5%. At three years after initial operation and reoperation seventy-five patients (98.7%) were voiding satisfactorily. There was one complete failure, no death. Conclusion: This technique has produced satisfactory results compared with other similar techniques in current use. Further work is required to make valid conclusions about the value of this procedure.Nigerian Journal of Surgical Research (ISSN: 1595-1103) Vol 8 Num 3-4.