Abstract
ABSTRACTPurpose:Obliterative urethral stenosis is a type of urethral lesion that compromises the whole corpus spongiosum's circumference. We present our experience in resolving complex long segment urethral obliteration in a single procedure using a combination of dorsal onlay oral mucosa graft (OMG) and ventral fasciocutaneous penile skin flap.Materials and methods:A prospectively maintained database was reviewed, which included data of men presenting long, obliterative strictures. Patients were excluded if they were lost to follow-up before one year. Failure was defined as need for further urethral instrumentation.The surgical technique used consisted on the fixation of OMG to the tunica albuginea of the corpus cavernosum, thus creating a new urethral plate. Penile or foreskin flaps were employed to complete the ventral aspect. Postoperative follow-up was done with a voiding cystourethrography at week 3.Results:A total of 21 patients were included with a median age of 49 years. Mean follow-up was 25 months. Failure was found for 3 patients (2 of them needing dilations and only one required a new urethral reconstruction).Conclusion:Single stage combination of dorsal OMG with ventral fasciocutaneous penile flap showed good results for selected patients affected with obliterative urethral stenosis.
Highlights
The obliterative stenosis (OS) of a urethral segment is a type of urethral lesion that compromises the whole circumference of the corpus spongiosum, leaving sparse urethral plate and a hostile ground for a comfortable urethroplasty
Even the simplest stricture requires the expertise of a well-trained surgeon that profoundly understands the urethral anatomy
To aid in the process of learning how to deal with different surgical scenarios, many ‘principles’ have been established. One of these is the Johanson principle [3], that establishes a procedure based on a marsupialization of the strictured urethra, followed by a second surgical stage approximately 4 to 6 months after the first repair has settled
Summary
The obliterative stenosis (OS) of a urethral segment is a type of urethral lesion that compromises the whole circumference of the corpus spongiosum, leaving sparse urethral plate and a hostile ground for a comfortable urethroplasty.Most urethral strictures can be solved in a single intervention using either grafts, flaps, or resection and primary anastomosis [1, 2]. When the damaged urethral plate segment is long and involves its whole circumference, these resources fall short and traditionally a two-staged urethroplasty following the Johanson principles is usually advised [3]. This technique leaves patients with an hypospadic urethra for at least 6 months, and renders the possibility of needing a second intervention, but often a third or more. The use of dorsal oral mucosa graft (OMG) in combination with ventral penile fasciocutaneous flap to address obliterative stenosis of the anterior urethra in a single stage has already been described, and success outcomes as high as 83.3% have been reported [4, 5]. The reports on this technique consist on series of a short number of patients, and new reports with larger cohorts are in need to further validate this approach as an option for treating OS of the anterior urethra
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