Korean J Urol.  2007 Aug;48(8):863-869. 10.4111/kju.2007.48.8.863.

The Therapeutic Effect of Perineal Urethroplasty using a Gracilis Muscle Flap in a Recurrent Complete Posterior Urethral Stricture

Affiliations
  • 1Department of Urology, Bundang CHA Hospital, Pochon CHA University College of Medicine, Seongnam, Korea. ytleeuro@cha.ac.kr

Abstract

PURPOSE
To evaluate the usefulness of a gracilis muscle flap for the reconstruction of a complete posterior urethral stricture, where previous treatment had failed.
MATERIALS AND METHODS
Between March 1998 and April 2006, 56 patients, in whom previous urethroplasty or visual internal urethrotomy had failed, were treated with a gracilis muscle flap. All patients had been referred from other institutions. Of the 56 treated patients, 32(group I) underwent perineal urethroplasty, using a stepwise approach of urethral mobilization, including bulbar urethra mobilization, separation of the corporal bodies, inferior pubectomy and retrocrural urethral re-routing 24(group II) underwent perineal urethroplasty, with a gracilis muscle flap for replacement of the dead space, using a stepwise approach.
RESULTS
The mean stricture lengths were 2.7(0.5-5.5) and 3.5cm(1.0-6.5) in groups I and II, respectively(p=0.135). The success rates were 87.5 and 95.8% in groups I and II, respectively(p=0.279). The success rates of patients with urethral stricture of greater than 3cm were 71.4 and 100% in groups I and II, respectively(p=0.037). The success rates of patients who had undergone previous perineal urethroplasty were 82.6 and 100% in groups I and II, respectively(p=0.045). A gracilis muscle flap made no difference to the incidences of erectile dysfunction and incontinence. The incidences of restricture were 15.6 and 0% in groups I and II, respectively (p=0.042).
CONCLUSIONS
Our results showed that a gracilis muscle flap can be useful method with a stricture greater than 3cm in length and in patients having undergone previous perineal urethroplasty.

Keyword

Urethral stricture; Urethroplasty; Gracilis muscle; Complications

MeSH Terms

Constriction, Pathologic
Erectile Dysfunction
Humans
Incidence
Male
Urethra
Urethral Stricture*

Figure

  • Fig. 1 The thigh skin incisions and gracilis muscle mobilization.

  • Fig. 2 Schematic drawing of the technique for the transfer of the gracilis muscle: (A) origin of the gracilis muscle at the pubis symphysis, (B) branch of the medial circumflex femoral artery, (C) medial circumflex branch of the profundal femoral artery, (D) profundal femoral artery, (E) insertion of the gracilis muscle at the medial tibial condyle.

  • Fig. 3 Transposition of the gracilis muscle around an end to end urethral anastomosis.


Reference

1. Lee YT. Urethral injury. Korean J Urol. 2006. 47:221–231.
2. Turner-Warwick R. Whitfield HN, Hendry WF, editors. Pelvic fracture urethral injuries. Textbook of genitourinary surgery. 1995. 1st ed. New York: Churchill Livingstone;865–871.
3. Mundy AR. Urethroplasty for posterior urethral strictures. Br J Urol. 1996. 78:243–247.
4. Baskin LS, Constantinescu SC, Howard PS, McAninch JW, Ewalt DH, Duckett JW, et al. Biochemical characterization and quantitation of the collagenous components of urethral stricture tissue. J Urol. 1993. 150:642–647.
5. Webster GD, Mathes GL, Selli C. Prostatomembranous urethral injuries: a review of the literature and a rational approach to their management. J Urol. 1983. 130:898–902.
6. Netto NR Jr, Lemos GC, Claro JF. Internal urethrotomy as a complementary method after urethroplasties for posterior urethral stenosis. J Urol. 1989. 141:50–51.
7. Jakse G, Marberger H. Excisional repair of urethral stricture. Follow-up of 90 patients. Urology. 1986. 27:233–236.
8. Abdel-Hakim A, Bernstein J, Hassouna M, Elhilali MM. Visual internal urethrotomy in management of urethral strictures. Urology. 1983. 22:43–45.
9. Pierce JM. Posterior urethral stricture repair. J Urol. 1979. 121:739–742.
10. Pierce JM. Exposure of the membranous and posterior urethra by total pubectomy. J Urol. 1962. 88:256–258.
11. Webster GD, Robertson CN. The vascularized skin island urethroplasty: its role and results in urethral stricture management. J Urol. 1985. 133:31–33.
12. Barbagli G, Selli C, Tosto A. Reoperative surgery for recurrent strictures of the penile and bulbous urethra. J Urol. 1996. 156:76–77.
13. Turner-Warwick R. The use of pedicle grafts in the repair of urinary tract fistulae. Br J Urol. 1972. 44:644–656.
14. Turner-Warwick R. Complex traumatic posterior urethral strictures. J Urol. 1977. 118:564–574.
15. Jung BI, Chung MK, Yoon JB. Clinical significance of corporeal body separation and inferior pubectomy in complex posterior urethral strictures. Korean J Urol. 1993. 34:130–137.
16. Turner-Warwick R. Prevention of complications resulting from pelvic fracture urethral injuries and from their surgical management. Urol Clin North Am. 1989. 16:335–358.
17. Zinman L, Libertino JA. Libertino JA, editor. Surgery of vesicovaginal fistula. Pediatric and adult reconstructive urologic surgery. 1987. 2nd ed. Baltimore: Williams and Wilkins;388–402.
18. Garlock JA. Closure intractable vesicovaginal fistula by use of pedicled muscle flap. New Concept Surg Gynecol Obstet. 1928. 47:255–260.
19. Ingelman-Sundberg A. Method for surgical treatment of vesicovaginal and rectovaginal fistulas in irradiated tissue. Arch Gynakol. 1953. 183:498–500.
20. Chambers HL, Balfour J. The incidence of impotence following pelvic fracture with associated urinary tract injury. J Urol. 1963. 89:702–703.
21. Koraitim MM. The lesions of 145 posttraumatic posterior urethral strictures treated in 17 years. J Urol. 1995. 153:63–66.
22. Gibson GR. Impotence following fractured pelvis and ruptured urethra. Br J Urol. 1970. 42:86–88.
23. Dhabuwala CB, Hamid S, Katsikas DM, Pierce JM. Impotence following delayed repair of prostatomembranous urethral disruption. J Urol. 1990. 144:677–678.
24. Khan MS, Thornhill JA, Grainger R, McDermott TE, Butler MR. Rupture of the male membranous urethra. Ir J Med Sci. 2000. 169:208–210.
25. Mitchell JP. Endoscopy of the ruptured urethra. J Urol. 1984. 90:395–397.
26. Zincke H, Furlow WL. Long-term results with transpubic urethroplasty. J Urol. 1985. 133:605–606.
27. Morehouse DD, Mackinnon KJ. Management of prostatomembranous urethral disruption: 13-year experience. J Urol. 1980. 123:173–174.
28. Chancellor MB, Heesakkers JP, Janknegt RA. Gracilis muscle transposition with electrical stimulation for sphincter incontinence: a new approach. World J Urol. 1997. 15:320–328.
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