65 SIX-YEAR EXPERIENCE WITH DORSAL BUCCAL GRAFTING TO RECONSTRUCT THE FOSSA AND/OR URETHRAL PLATE WITH SIMULTANEOUS ONLAY FLAP REPAIR

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery II1 Apr 201065 SIX-YEAR EXPERIENCE WITH DORSAL BUCCAL GRAFTING TO RECONSTRUCT THE FOSSA AND/OR URETHRAL PLATE WITH SIMULTANEOUS ONLAY FLAP REPAIR Joel Gelman Joel GelmanJoel Gelman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.112AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES When penile skin is available, onlay flap reconstruction represents an excellent choice for one-stage repair for complex hypospadias and strictures involving the glans and fossa navicularis. When urethra is deficient circumferentially, tube flaps and staged repairs are options. During the reconstruction of an adult patient with untreated proximal hypospadias and disabling chordee in 1993, division of the urethral plate and excision of fibrous tissue corrected the majority of the curvature but created a 5 cm circumferential deficiency of the distal urethra. Given the success of dorsal buccal grafting of the treatment of stricture disease, buccal mucosa was used to recreate the urethral plate and a ventral penile skin flap was used to complete the one-stage repair. We now report our 6-year experience with this circumferential tissue transfer technique. METHODS Nine patients (Ages 22-77, mean 45) underwent dorsal buccal grafting with ventral flap repair. Three patients with untreated hypospadias and medium caliber stricture disease requested correction of disabling chordee. Three hypospadias patients underwent prior surgeries complicated by stricture disease and ventral displacement of the urethral meatus, and had redundancy of the dorsal penile skin. Two patients had recurrent obliterative strictures involving the urethral meatus, and one patient who sustained foley trauma developed a scrotal abscess and an 11 cm stricture of the penile/bulbar urethra. Buccal mucosa was quilted to the ventral corpora of the penis to reconstruct the dorsal aspect of the urethra and the majority of these surgeries included buccal graft reconstruction of the glans and fossa. Onlay penile skin flap repair was then performed to complete the reconstruction. RESULTS All patients are currently free of disabling chordee or obstruction at this time with a mean followup of 2-81 months (mean 28). One patient who underwent treatment of disabling chordee developed urethrocutaneous fistulas and recurrence of distal chordee and required staged re-do reconstruction. Two other patients developed fistulas that required closure and this was performed successfully. CONCLUSIONS Dorsal buccal grafting with ventral flap reconstruction appears to be an excellent option for the repair of circumferential urethral deficiency when penile skin is available, especially when chordee correction with urethral plate reconstruction is required. Orange, CA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e27 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joel Gelman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...