Urothroplasty by using the mucosa of diverticulum secondary to recurrence of urethral stricture

Abstract

Objective To assess the efficacy of urethroplasty by using the mucosa of diverticulum as the distal urethral for the recurrence of urethral stricture. Methods We reviewed our experience about 6 cases from Jan.2007 to Oct. 2012, including 5 hypospadias and 1 epispadias. The mean age of the patients was 28±16(12-45)month, range 12 to 45 months. The patients presenting urethral diverticulum should last for 6 months after urethroplasty, which should last for 6 months. The preoperative mean urinary flow rate was 5.1±1.4(range 3.1 to 7.3) ml/s. All the patients took the retrograde urethrography and cystoscopy to confirm the position and length of urethrostenosis. The positions of urethrostenosis were at the penis coronary in 5 cases and glans penis in 1 case. The mean length of stricture was 13.3±4.2( range 8.8 to 20.5) mm. The mean length of diverticulum was 37.5±15.3(range 21.8 to 55.2) mm. All patients received the urethral reconstruction by using the pedicel diverticulum mucosa. After resecting the stenosis urethra and exposed the whole diverticulum, we opened the diverticulum laterally and halved it. One was used for tabularized urethroplasty in situ, the other was flipped to the distal urethral as pedicel flap to remedy the defect of the urethral. Results Totally 6 cases received the procedure. The mean operating time was 133±48(range 84 to 192) min. Postoperatively, urethral catheter was remained 2 weeks. All the patients can urinate smoothly after removing the catheter. The postoperative mean urinary flow rate was 10.9±3.3(range 6.3 to 15.9) ml/s. The mean follow-up time was 2.2 yrs(range 1 to 4 years). At the end point of follow-up, all patients had not experienced a recurrent diverticulum or stricture at the anastomotic site. Urethrocutaneous fistula in the coronary glan was reported in 2 patients, which were finally cured after 2nd repair. No complication was found in other 4 patients. Conclusions Urethroplasty by flipping the mucosa of diverticulum takes full advantage of urinary mucosa that already existing, which can be very useful in those patients who are lack of foreskin. This approach can also reduce the patient′s pain by completing the urethroplasty in situ and avoiding staging operation. But up till now, it can only be applied to the urethral diverticulum secondary to urethrostenosis. It also demands flip flap skilled. And the long-term effects and complications still remain to be seen. Key words: Urethral diverticulum; Urothroplasty; Pedicel flap