Two-stage urethra-plasty

Abstract

Between 1977 and 1996 we treated 176 patients suffering from complicated urethral strictures with the mesh-graft urethroplasty. This operation technique has replaced the Bengt-Johanson-Operation which had been used frequently until that date. The Cecil-Operation has been totally abandoned, because in our opinion the usage of scrotal skin in urethral reconstruction is obsolete today. The mesh-graft technique is based on the free transfer of meshed prepuce (full-thickness skin or split-thickness skin) in a two stage procedure. In 37 patients the inner layer of the prepuce was used, in 63 patients we only used split-thickness skin grafts and in 76 patients we applied a combination of both, the inner layer of the prepuce in addition to a split-thickness skin graft. After complete healing of the graft (first stage) the formation of the neourethra follows as the second stage procedure. The mesh graft procedure can be used to treat all kinds of strictures independent of the etiology or localisation. Hair growth, diverticula development and stone formation that are observed frequently as complications with scrotal skin substitutes can be avoided. Due to these advantages encouraging long term results could be obtained with the mesh graft urethroplasty. In 162 patients (92%) with a minimum follow-up of 7 years we achieved a successful result of the operations, a significant improvement could be obtained in 7 patients (4%). Unfortunately in further 7 cases (4%) the operation method ultimately failed. In particular in patients with complicated and severe strictures after numerous unsuccessful prior reconstructive attempts, extensive long strictures and strictures in paraplegic patients, mesh graft urethroplasty has been shown to be a safe and reliable treatment option.