The Therapeutic Effect of Perineal Urethroplasty using a Gracilis Muscle Flap in a Recurrent Complete Posterior Urethral Stricture

Abstract

Purpose: To evaluate the usefulness of a gracilis muscle flap for the reconstruction of a complete posterior urethral stricture, where previous treatment had failed. Materials and Methods: Between March 1998 and April 2006, 56 patients, in whom previous urethroplasty or visual internal urethrotomy had failed, were treated with a gracilis muscle flap. All patients had been referred from other institutions. Of the 56 treated patients, 32 (group I) underwent perineal urethroplasty, using a stepwise approach of urethral mobilization, including bulbar urethra mobilization, separation of the corporal bodies, inferior pubectomy and retrocrural urethral re-routing 24 (group II) underwent perineal urethroplasty, with a gracilis muscle flap for replacement of the dead space, using a stepwise approach. Results: The mean stricture lengths were 2.7 (0.5-5.5) and 3.5cm (1.0-6.5) in groups I and II, respectively (p=0.135). The success rates were 87.5 and 95.8% in groups I and II, respectively (p=0.279). The success rates of patients with urethral stricture of greater than 3cm were 71.4 and 100% in groups I and II, respectively (p=0.037). The success rates of patients who had undergone previous perineal urethroplasty were 82.6 and 100% in groups I and II, respectively (p=0.045). A gracilis muscle flap made no difference to the incidences of erectile dysfunction and incontinence. The incidences of restricture were 15.6 and 0% in groups I and II, respectively (p=0.042). Conclusions: Our results showed that a gracilis muscle flap can be useful method with a stricture greater than 3cm in length and in patients having undergone previous perineal urethroplasty. (Korean J Urol 2007;48:863-869) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏