Reconstructive UrologyThe Use of Penile Skin Graft Versus Penile Skin Flap in the Repair of Long Bulbo-penile Urethral Stricture: A Prospective Randomized Study
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.
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Cited by (24)
European Association of Urology Guidelines on Urethral Stricture Disease (Part 1): Management of Male Urethral Stricture Disease[Formula presented]
2021, European UrologyCitation Excerpt :Two small randomised controlled trials reported similar patency rates between grafts and flaps (Table 10). However, flaps were associated with more morbidity (superficial penile skin necrosis, penile torsion, penile hypoesthesia, and postvoid dribbling) and longer operation time [90,91]. Castagnetti and Rigamonti [92] showed that grafts used as a tube have a significantly higher complication rate than onlay grafts (odds ratio: 5.86; 95% confidence interval: 1.5–23.4).
Urethral Complications After Metoidioplasty for Genital Gender Affirming Surgery
2021, Journal of Sexual MedicineCitation Excerpt :To allow for this desire, urethral lengthening procedures are needed during metoidioplasty.2 As any other form of urethral reconstruction (hypospadias correction,3 urethroplasty for urethral strictures4,5), urethral lengthening procedures are associated with urethral complications such as urethral fistula and stricture.1 Several Series have reported on urethral complications related to metoidioplasty.6-14
Male Urethral Stricture: American Urological Association Guideline
2017, Journal of UrologyCitation Excerpt :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.
Flap
2011, Journal of UrologyA TriNetX Registry Analysis of the Need for Second Procedures following Index Anterior and Posterior Urethroplasty
2023, Journal of Clinical Medicine