Abstract
ABSTRACTThe objective of this study is describing a technique with the use of a tunica vaginalis flap (TVF) to cover the suture line during anterior urethroplasty in patients with kippered urethra due to chronic indwelling catheterization (CIC). We studied 5 patients (mean age=50.2) with a neurogenic bladder that developed urethral erosion after a long period of CIC. Foley catheter was removed on the 14th postoperative day. One patient developed wound infection and utethrocutaneous fistula, which was conservatively managed and after 12 months of follow-up all the patients didn't report difficulties in intermittent self-catheterization. In conclusion, a urethroplasty with TVF technique may be a viable method for repairing penile urethral erosions, but further studies are required with a bigger sample to confirm our results.
Highlights
The use of flaps is very important to protect the suture line and avoid fistulas in surgical corrections of penile urethral strictures
1 patient (20%) developed, after the surgery wound infection and urethra-cutaneous fistula, which was conservatively managed with the use of 2g of cephalexin for 10 days and with urethral catheterization for 14 days
In our sample we observed only one immediate complication after the catheter removal in a patient that developed a wound infection and a small urethracutaneous fistula, which was conservatively managed with antibiotics and urethral catheterization
Summary
The use of flaps is very important to protect the suture line and avoid fistulas in surgical corrections of penile urethral strictures. The tunica vaginalis flap (TVF) was used as an additional cover of suture line and fistula prevention in hypospadias and epispadias with an acceptable complication rate and good cosmetic results [1]. The use of TVF as the dorsal component of a two-stage urethroplasty in anterior urethral strictures presented significant fibrosis and this kind of flap is not suitable in Bracka surgery [2]. Urethral strictures occur in about 5 to 20% of patients as a complication of chronic indwelling catheterization (CIC) [3]. Penile urethral erosion (kippered urethra) is a rare complication of CIC, with some studies reporting it to occur more frequently in men with neurogenic bladder [3]. There are techniques described for repairing the ventral urethral erosions but a standardized approach is not yet available [4, 5]
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Schedule a callMore From: International braz j urol : official journal of the Brazilian Society of Urology
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