Successful urethral reconstruction with scrotal skin island flap and pudendal thigh flap for urethral stricture and urethrocutaneous fistula

Abstract

Abstract Introduction: One of the complications following transurethral resection of the prostate is urethral stricture formation. There are several treatment methods for urethral obstructions, such as urethral dilation with urethral sounds, direct vision internal urethrotomy with a cold knife or laser, and urethral reconstruction. However, urethrocutaneous fistulae, periurethral and scrotal abscesses are complications that result from urethral dilation and direct vision internal urethrotomy. Patient concerns: A 66-year-old male patient complained of difficulty in voiding for 3 years accompanied by urinary frequency and incomplete emptying. He had no underlying chronic diseases. He underwent transurethral resection of the prostate, however, urinary frequency and a weak urine stream persisted for 2 weeks. Diagnoses: According to physical examination and cystoscopy, the patient was diagnosed with urethrocutaneous fistula and urethral stricture. Interventions: Initially, urethral sounding and direct vision internal urethrotomy were performed, however, complications such as urethrocutaneous fistula, periurethral and scrotal abscesses occurred. Urethral reconstruction was performed as a two staged procedure involving urethral fistulectomy, cutaneous urethrotomy, debridement and suprapubic cystostomy in the first stage followed by reconstruction using scrotal skin island and pudendal thigh flaps six months later. Outcomes: Improved voiding and no wound dehiscence were observed on postoperative day 56. After a follow-up period of 2 years, there was no evidence of urinary retention nor incomplete emptying. However, there was minimal residual paresthesia from the medial thigh to the left hemi-scrotal skin. Conclusion: Urethral reconstruction with scrotal skin island and pudendal thigh flaps can be a successful treatment method owing to abundant blood supply and less skin tension.