The Use of Penile Skin Graft Versus Penile Skin Flap in the Repair of Long Bulbo-penile Urethral Stricture: A Prospective Randomized Study

Abstract

To evaluate the use of penile circular skin graft versus flap as a ventral onlay for bulbo-penile stricture urethra. Between 2003 and 2009, 37 patients with bulbo-penile stricture were randomized to penile methods circular skin graft (PCG = 18) or flap (PCF = 19). Inclusion criteria included postinstrumentation or idiopathic stricture. Exclusion criteria were unhealthy skin and previous urethrotomy/urethroplasty. Patients had urethrogram at three weeks, three months, one year, and urethroscopy when needed. Any subsequent urethrotomy/urethroplasty was considered a failure. Chi-square and Student's t test were used for analysis. Patients' ages were 45.3 (range: 30-65) and 45.5 (35-60) yr in PCG&PCF respectively. Stricture length was 15.2 (10-22) &14.1 (9-21) cm in PCG&PCF respectively. The stricture was postinstrumentation in 9 and 11 and idiopathic in 9 and 8 patients in PCG&PCF respectively. Mean follow up was 36.2 (12-60) and 37.1 (range: 13-24) months in PCG and PCF respectively. Operative time was significantly shorter in PCG than in PCF (203.3 and 281.6 min, respectively; P = .000). Early postoperative complications were similar in both groups. Superficial skin necrosis occurred only in the PCF group (3 cases). Late complications of mild postvoid dribbling occurred similarly in both groups. One patient in PCF had a urethro-cutaneous fistula at the level of fossa navicularis that was repaired later. Stricture recurred in 5 (27.7%) and 4(21%) patients in PCG and PCF, respectively (P = .249). Four patients had visual internal urethrotomy (2, 2), four needed anastomotic urethroplasty (2, 2) in PCG and PCF, respectively, and one needed buccal mucosal graft in the PCG group. At intermediate follow-up, both penile circular graft and flap had similar and high success as a ventral onlay for repair of long bulbo-penile stricture with a low rate of complications.