Abstract
Panurethral strictures are complex and long strictures that involve both the pendulous and bulbar urethra. Such strictures are among the most difficult to successfully reconstruct, and require the use of the entire surgical armamentarium. Surgical methods for reconstructing such long and diffuse strictures are: bilateral buccal mucosal grafts, “Q” penile skin flaps, McAninch (circular penile skin) flaps, Orandi (vertical penile skin) flap, or a combination of such onlay flaps and grafts. In these combination cases, the graft is typically placed proximally to benefit from spongiosal blood supply, and the flap placed on the distal bulb or pendulous urethra. Bilateral buccal grafts will allow repair in strictures up to 12 cm, while the mean penile lengths from flaps are roughly: Q flap (17 cm), Ornadi flap (9 cm), McAninch (15 cm). For refractory panurethral strictures, a staged urethroplasty using skin grafting is usually needed.
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