3 THE TWO- STAGED URETHRAL AND PENILE RECONSTRUCTION USING VASULARISED SCROTAL FLAP AND BUCCAL MUCOSAL GRAFT

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Traum & Reconstructive Surgery (1)1 Apr 20133 THE TWO- STAGED URETHRAL AND PENILE RECONSTRUCTION USING VASULARISED SCROTAL FLAP AND BUCCAL MUCOSAL GRAFT Abhishek Pandey, Joern Beier, Cristina Raita, and Hansjoerg Keller Abhishek PandeyAbhishek Pandey Hof, Germany More articles by this author , Joern BeierJoern Beier Hof, Germany More articles by this author , Cristina RaitaCristina Raita Hof, Germany More articles by this author , and Hansjoerg KellerHansjoerg Keller Hof, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1377AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Urethroplatsy with BMG for urethral strictures can be done as a single stage procedure in most of the cases. However, complicated strictures with fully destructed urethra and penile skin because of complete scarring pose a challenge. In this prospective study we determine the success rates after the two- staged repairs. METHODS Out of 700 (07/1994- 06/2012) consecutive urethroplasties because of urethral stricture in our tertiary referral centre 21 (3%) patients underwent a two - staged procedure. All of these 21 were included in the study. All of them were so-called Hypospadias cripple with a complete destroyed urethra a penile deviation and a complete loss of penile skin because of extended scarring. The number of previous failed operative procedures was 5.5 (5-30). The mean stricture length was 10.5 cm (4-18). At first we removed the scarred penile skin and the destructed urethra. The BMG was transplanted on the ventral aspect and an urethrostomy was performed. After 4-6 months the graft was tubularised and covered with a pedicled scrotal flap. Data for this study were prospectively recorded with the help of standardised questionnaires, self reported, postally and by evaluating uroflow and residual urine every three months in the first year and six monthly thereafter. In the case of uroflow less than 20 ml/s and/ or residual urine more than 50 ml and/ or evidence of urinary tract infection, an urethroscopy and urethrography was done. RESULTS At a mean follow up of 37.5 months (3-85), 19/21 (90.4%) of the patients are recurrence free. In one case the scrotal flap became necrotic while in one more we noted necrosis of urethral plate. CONCLUSIONS In case of fully destroyed urethra and a complete loss of penile skin the two- staged procedure using BMG followed by coverage by a pedicled scrotal flap is a highly effective procedure. The results are comparable with the single staged primary reconstruction, done for uncomplicated cases. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e1 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abhishek Pandey Hof, Germany More articles by this author Joern Beier Hof, Germany More articles by this author Cristina Raita Hof, Germany More articles by this author Hansjoerg Keller Hof, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...