Urethral Substitution Using an Intestinal Free Flap: A Novel Approach

Abstract

Patients who have extensive stricture disease, those in whom hypospadias repair fails and those who sustain significant urethral trauma pose a reconstructive challenge for genitourinary surgeons. We developed an additional reconstructive option for men with a severely diseased urethra when grafting procedures and local tissue flaps have failed or are otherwise contraindicated. A genitourinary reconstructive team performed novel intestinal free flap substitution urethroplasty in 2 patients. A segment of jejunum is harvested on a vascular pedicle and plicated into an appropriate size urethral substitute. Microvascular anastomoses allow this segment to remain viable and functional. The technical aspects of repair and surgical considerations are detailed. The 2 patients have a satisfactory functional and cosmetic outcome. At short followup the urethral lumen remained patent and the intestinal urethra remained viable and intact. Both patients have good urinary streams and are able to void in the standing position. This initial experience in 2 patients indicates that intestinal segment urethral substitution may be considered within the reconstructive armamentarium of genitourinary surgeons when more conventional options have failed or are contraindicated. Continued vigilant followup is necessary to detail any secondary complications. In addition, further experience with this technique by other surgeons would help determine its overall usefulness.