Investig Clin Urol.  2018 May;59(3):213-219. 10.4111/icu.2018.59.3.213.

Technique for single-stage reconstruction of obliterative or near-obliterative long urethral strictures in circumcised patients

• Yadav SS
• Singh VK
• Tomar V
• Agarwal N
• Gulani A

• KMID: 2410596
• DOI: http://doi.org/10.4111/icu.2018.59.3.213

Abstract

PURPOSE
To report our initial experience with urethral reconstruction using a combined dorsal lingual mucosal graft (LMG) and ventral onlay preputial flap for long obliterative or near-obliterative strictures in circumcised patients.
MATERIALS AND METHODS
This was a retrospective study of 10 patients from January 2015 to June 2017 with long obliterative or near-obliterative anterior urethral strictures and circumcised prepuces. All patients underwent a combined approach using a dorsally LMG and a narrow preputial onlay flap ventrally to create a 26-30 Fr. neourethra over a 14-Fr Foley catheter. Success was defined as no requirement for additional urethral instrumentation. The follow-up period ranged from 6 to 32 months.
RESULTS
The patients ranged in age from 17 to 44 years (mean, 32.3±9.59 years) and stricture length ranged from 9 to 12.5 cm (mean, 10.77±1.15 cm). Four strictures were obliterative and six were near-obliterative. Two patients had a history of prior urethroplasty. The length of the LMGs harvested ranged from 11 to 14 cm (mean, 12.8±1.03 cm). The preputial flaps available were from 1 to 1.5 cm in width (1.29±0.16 cm) and the desired length. Maximum urinary flow rate (Qmax) achieved ranged from 12 to 26 mL/s (mean, 20.46±3.71 mL/s) after 3 months. One patient needed a single direct visualized internal urethrotomy and another patient develop temporary superficial penile necrosis. The success rate was 90%.
CONCLUSIONS
Long obliterative and near-obliterative penile and penobulbar urethral strictures can still be treated in circumcised patients using available preputial skin along with lingual mucosa with good outcomes.

Keyword

Foreskin; Mouth mucosa; Reconstructive surgical procedures; Urethral stricture

MeSH Terms

Catheters
Constriction, Pathologic
Follow-Up Studies
Foreskin
Humans
Inlays
Mouth Mucosa
Mucous Membrane
Necrosis
Reconstructive Surgical Procedures
Retrospective Studies
Skin
Transplants
Urethral Stricture*

Figure

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  Fig. 1 Technique of delivering through perineal wound.

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  Fig. 2 Combined substitution urethroplasty. Lingual mucosal graft (LMG) quilted over ventral surface of corporal bodies and one side edge of longitudinally oriented preputial flap sutured to the right side margin of LMG incorporating tunica albuginea.

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  Fig. 3 Harvested preputial island flap.

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  Fig. 4 Dorsal lingual mucosal graft and ventral preputial flap substitution urethroplasty.

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  Fig. 5 Dorsal lingual mucosal graft, residual urethral plate, and preputial flap.

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  Fig. 6 (A) Preoperative retrograde urethrogram (RGU). (B) Postoperative RGU after 2 years.

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