Elsevier

Urology

Volume 77, Issue 5, May 2011, Pages 1232-1237
Urology

Reconstructive Urology
The Use of Penile Skin Graft Versus Penile Skin Flap in the Repair of Long Bulbo-penile Urethral Stricture: A Prospective Randomized Study

https://doi.org/10.1016/j.urology.2010.08.064Get rights and content

Objectives

To evaluate the use of penile circular skin graft versus flap as a ventral onlay for bulbo-penile stricture urethra.

Material and Methods

Between 2003 and 2009, 37 patients with bulbo-penile stricture were randomized to penile methods circular skin graft (PCG = 18) or flap (PCF = 19). Inclusion criteria included postinstrumentation or idiopathic stricture. Exclusion criteria were unhealthy skin and previous urethrotomy/urethroplasty. Patients had urethrogram at three weeks, three months, one year, and urethroscopy when needed. Any subsequent urethrotomy/urethroplasty was considered a failure. Chi-square and Student's t test were used for analysis.

Results

Patients' ages were 45.3 (range: 30–65) and 45.5 (35-60) yr in PCG&PCF respectively. Stricture length was 15.2 (10-22) &14.1 (9-21) cm in PCG&PCF respectively. The stricture was postinstrumentation in 9 and 11 and idiopathic in 9 and 8 patients in PCG&PCF respectively. Mean follow up was 36.2 (12-60) and 37.1 (range: 13-24) months in PCG and PCF respectively. Operative time was significantly shorter in PCG than in PCF (203.3 and 281.6 min, respectively; P = .000). Early postoperative complications were similar in both groups. Superficial skin necrosis occurred only in the PCF group (3 cases). Late complications of mild postvoid dribbling occurred similarly in both groups. One patient in PCF had a urethro-cutaneaous fistula at the level of fossa navicularis that was repaired later. Stricture recurred in 5 (27.7%) and 4(21%) patients in PCG and PCF, respectively (P = .249). Four patients had visual internal urethrotomy (2, 2), four needed anastmotic urethroplasty (2, 2) in PCG and PCF, respectively, and one needed buccal mucosal graft in the PCG group.

Conclusions

At intermediate follow-up, both penile circular graft and flap had similar and high success as a ventral onlay for repair of long bulbo-penile stricture with a low rate of complications.

Section snippets

Patients and Methods

Between January 2003 and January 2009, 37 patients who were diagnosed with anterior bulbo-penile urethral stricture disease were randomized to receive either distal penile full-thickness circular graft (n = 18) or distal penile circular fasciocutaneous flap (n = 19).

Inclusion criteria included patients who were diagnosed with bulbo-penile stricture urethra not amenable for anastmotic urethroplasty (Fig. 1) that involved the bulbar urethra and extended into the penile urethra and for whom the

Results

The mean age of the patients was 45.3 years (range: 30–65) and 45.5 years (range: 35-60) in the PCG and the PCF groups, respectively. The stricture length was 15.2 cm (range: 10-22) and 14.1 cm (range: 9-21) in the PCG and PCF groups, respectively. The meatus was not included in the stricture disease in all patients.

The cause of the stricture was postinstrumentation in nine and 11 patients and idiopathic in nine and eight patients in the PCG and PCF groups, respectively. Both groups were

Discussion

The distal penile skin in general has many advantages as a source for substitution urethroplasty. It is nonhirsute, flexible, and versatile in addition to its proximity to the urethra.9 It is considered the best source of a vascularized pedicled flap with many advantages, including maximal flap length, thick pedicle, and excellent cosmetic results.10

The penile skin graft pioneered by Devine also has its advantages because it is techniqualy less demanding and is easy to harvest and place in the

Conclusions

Our study showed that the use of distal penile circular skin graft and flap as a ventral onlay for substitution urethroplasty in repair of long bulbo-penile stricture urethra is a versatile technique. Distal penile circular skin graft urethroplasty is less time-consuming; yet, both procedures have a good and similar success rate at intermediate follow-up with a low rate of complications. However, further studies and longer follow-up are needed to confirm these results.

Acknowledgments

We would like to thank Kaled Aboulhagag, Department of Public Health and Statistics, for his statistical assistance.

References (24)

Cited by (24)

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    Multi-segment strictures (frequently referred to as panurethral strictures) are most commonly defined as strictures over 10 cm in length spanning long segments of both the penile and bulbar urethra. Reconstruction of panurethral strictures should be addressed with all of the tools in the reconstructive armamentarium, including fasciocutaneous flaps, oral mucosal grafts or other ancillary tissue sources, and may require a combination of these techniques.29–31 Regardless of technique and combinations, success rates appear similar in all of these small series.

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