Reconstruction of Long Anterior Urethral Strictures by Dorsally Quilted Penile Skin Flap

Abstract

Objective. To present the results of reconstruction of long (>5 cm), penile, bulbar, and bulbopenile urethral strictures by penile skin flap as dorsal onlay in one-stage procedure. Patients and Methods. Between January, 1998 and December, 2004, 18 patients (aged from 28-65 years) presented with long urethral strictures, 5.6–13.2 cm (penile in 6, bulbar in 2 and combined in 10 cases), those were repaired utilizing long penile skin flaps placed as dorsal onlay flap in one stage (Orandi flap 6 cm in 6 cases, circular flaps 7–10 cm in 8, and spiral flaps 10–15 cm in 4). Followup of all patients after reconstruction included urine flow rate at weekly intervals, RUG at 6–12 weeks, and urethrocystoscopy at 12 and 18 months. Results. The urethral patency was achieved in 77% of patients. The complications were fistula in one patient (5.5%), restricture occurred in 3 patients (16.6%) that required visual internal urethrotomy and two patients (11%) showed curvature on erection that dose not interfere with sexual intercourse. Diverticulum (penile urethra) was seen in one patient (5.5%) containing stones and was excised surgically. There was penile skin loss in 3 patients (16.6%). All patients completed at least one-year followup period. Conclusion. Free penile skin flaps offer good results (functional and cosmetic) in long penile and/or bulbar urethral strictures. Meticulously fashioned longitudinal, circular or spiral penile skin flaps could bridge urethral defects up to 15 cm long.