Scrotal Flap Research Articles

V06-05 "GIL-VERNET" SCROTAL-PERINEOSTOMY: SURGICAL TECHNIQUE

You have accessJournal of UrologyLower-Tract Reconstruction I: Sling/ Sphincter/ Penile & Urethral Reconstruction (V06)1 Apr 2020V06-05 "GIL-VERNET" SCROTAL-PERINEOSTOMY: SURGICAL TECHNIQUE Alfredo Gil-Vernet*, Manuel CÉspedes, Jordi Ropero, and Franklin DÍaz Alfredo Gil-Vernet*Alfredo Gil-Vernet* More articles by this author , Manuel CÉspedesManuel CÉspedes More articles by this author , Jordi Ropero Jordi Ropero More articles by this author , and Franklin DÍazFranklin DÍaz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000885.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In 1967, at the XIV Congress of the Société Internationale d'Urologie, Prof. JM Gil-Vernet first described a two-stage urethroplasty for post-traumatic urethral strictures using an inverted "U-shaped" flap of scrotal skin with a broad perineal base (Traitement des Sténoses Post-Traumatiques de l'Urètre, München: 1967, vol. 2, pp. 271–3). The in-depth anatomical study of scrotal vascularization led us to the subsequent development of the biaxial epilated scrotal flap (“BAES-flap”) that we have applied for the reconstruction of complex urethral strictures. In patients with multioperated anterior stricture, panurethral disease secondary to lichen sclerosus, and especially in those advanced age patients with comorbidities, performing a definitive perineal urethrostomy can be considered a technique of choice. Unlike the taut perineal skin, the elasticity, length and availability of the scrotal "BAES-flap”, allows a wide anastomosis to the edges of the posterior urethra without tension. METHODS: The video describes step by step our surgical technique for the creation of a definitive perineo-scrotal urethrostomy in a patient with a panurethral stricture disease. A similar maneuver to facilitate the placement of stitches in the deep posterior urethra like those described previously by John Blandy in 1986 and by George Webster in 1993, is depicted in detail. RESULTS: The scrotal “BAES-flap” allows a tension-free perineal urethrostomy to be performed and at the same time places the new meatus away from the perianal area, which also contributes to improving patient's hygiene and quality of life. CONCLUSIONS: The characteristics and versatility of the scrotal "BAES-flap” facilitate the realization of a perineal urinary diversion in the most complex cases. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e557-e557 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alfredo Gil-Vernet* More articles by this author Manuel CÉspedes More articles by this author Jordi Ropero More articles by this author Franklin DÍaz More articles by this author Expand All Advertisement PDF downloadLoading ...

The Bilateral Pedicled Epilated Scrotal Flap: A Powerful Adjunctive for Creation of More Neovaginal Depth in Penile Inversion Vaginoplasty

BackgroundPenile inversion vaginoplasty is a commonly performed genital gender-affirming procedure in transgender women. The creation of an adequate functional neovaginal depth in cases of too little usable penile skin is a challenge. The bilateral pedicled epilated scrotal flap (BPES-flap) can be used as an easy adjunctive technique and may serve as a tool in the surgical armamentarium of the gender surgeon. AimTo describe the use, dissection, design subtypes, and surgical outcomes of the BPES-flap in vaginoplasty. MethodsPerioperative considerations and different flap design subtypes were described to illustrate the possible uses of the BPES-flap in vaginoplasty. A retrospective chart study was performed on the use of this flap in 3 centers (blinded for review purposes). OutcomesThe main outcome measures are description of surgical technique, flap design possibilities, and postoperative complications. ResultsA total of 42 transgender women were included (median age: 28 years (range 18–66), mean body mass index: 24.5 ± 3.5). The mean penile length and width preoperatively were 9 ± 3.1 and 2.9 ± 0.2 cm, respectively. With a mean follow up of 13 ± 10 months, total flap necrosis occurred in one case (2.4%). Partial flap necrosis occurred also in one. Neovaginal reconstruction was successful in all patients with a mean vaginal depth of 13.5 ± 1.3 cm and width of 3.3 ± 1.3 cm. Partial prolapse of the neovaginal top occurred in 3 patients (7%). Clinical ImplicationsThe BPES-flap is a useful addition to the arsenal of surgeons performing feminizing genital reconstructive surgery. Strengths & LimitationsStrenghts comprise (1) the description of the surgical technique with clear images, (2) completeness of data, and (3) that data are from a multicenter study. A weakness is the retrospective nature with limited follow-up time. ConclusionThe BPES-flap is a vascularized scrotal flap that can be raised on the bilateral inferior superficial perineal arteries. It may be used for neovaginal depth creation during vaginoplasty and may be quicker to perform than full-thickness skin grafting.Nijhuis THJ, Özer M, van der Sluis WB, et al. The Bilateral Pedicled Epilated Scrotal Flap: A Powerful Adjunctive for Creation of More Neovaginal Depth in Penile Inversion Vaginoplasty. J Sex Med 2020;17:1033–1040.

Review of penile reconstructive techniques.

Reconstructive surgery of the penis holds many unique challenges due to the unique physiological properties of the tissues. Much of the effort involved therefore goes to preserving as much of the native tissue as possible whilst novel and creative methods have been adopted to repair defects and in creation of neophallus. A search of the PubMed database was carried out using the following keywords: 'penile trauma', 'penile cancer', 'lichen sclerosus', 'glansectomy', 'glans resurfacing', 'penile-sparing surgery', 'micropenis', 'aphallia', 'female-to-male sex reassignment surgery', 'scrotal flap' and 'genital lymphoedema'. Results for glans resurfacing in treating cancer showed low local recurrence rates at 0-10% whilst 90% of lichen sclerosus patients reported complete resolutions of pain and pruritis. For repairs of penile shaft skin defects the literature supports the use of full-thickness skin graft and pedicled scrotal flaps. The radial artery-based forearm free flap remains the best option for neophallus creation in terms of function, sensation and cosmesis but unfortunately leaves a disfiguring scar and involves multiple stages. Some novel techniques have been developed to circumvent these issues and are discussed. This article presents an update on the important developments in the field of penile reconstructive surgery.

Male-to-Female Gender-Affirming Surgery Using Nile Tilapia Fish Skin as a Biocompatible Graft

Insufficient penile skin is common during vaginoplasty for male-to-female transition. This issue may be compensated by a scrotal skin flap, with the drawback of hair growth [1]. In recent studies, Nile tilapia skin was successfully used for the surgical management of Mayer-Rokitansky-Küster-Hauser syndrome [2,3] and vaginal stenosis [4,5]. This study aims to describe a novel technique for primary vaginoplasty in male-to-female gender-affirming surgery using Nile tilapia skin as a biocompatible graft to ensure adequate vaginal depth. Stepwise demonstration of the procedure with narrated video footage. Transgender health clinic. A 29-year-old patient with gender dysphoria was referred to our office because of a desire for gender-affirming surgery. A physical examination revealed normal male genitalia with a 14-cm-long penis. Before surgery, approval from the institutional review board and written permission from the patient were obtained. After orchiectomy, penile disassembly, perineal dissection, and urethroplasty were performed, and a hollow Nile tilapia skin mold was prepared and sutured to the distal edge of the remaining penile skin. This structure was inverted, covering the newly created canal. The neocavity was then filled with a handmade inflatable vaginal mold, held in place by sutures in the labia majora. Finally, labiaplasty and clitoroplasty were conducted. After 7 days, the inflatable mold was removed, and the use of progressively larger dilators was initiated. After 3 weeks, a neovagina that was 16 cm long and able to accommodate the width of 2 fingers was detected. At that time, the Nile tilapia skin was completely reabsorbed into the neovaginal mucosa. There were no complications in the early postsurgical period. Nile tilapia skin, a safe, low-cost, and easy-to-use biocompatible material, may be an alternative option to scrotal skin grafts for neovaginal augmentation in primary vaginoplasty for male-to-female gender transition. However, further studies are needed to confirm this assertive.

Extensive Genital Warts in Man Hampering Conjugal Life: A Case Report

Genital warts, commonly known as condyloma acuminata, caused by the proliferation of squamous epithelial cells in the presence of sexually transmission of human papilloma Virus (HPV) infection. In human, HPV infection results in simple condyloma acuminatum, giant condyloma or Buschke-LÖwenstein tumour, and seldom penile carcinoma. There are several modalities of treatment options available for genital warts- medical and surgical, alone or in combination. Sometimes extensive genital warts represent a district entity resulting from HPV infection and require surgical management. We present the case of a 42-year-old male; rickshaw puller had multiple professional female sexual partners, who presented with extensive genital warts in penoscrotal region. Lesions were treated due to failure of medical management, by wide electrosurgical excision and rotation scrotal skin flaps
 Anwer Khan Modern Medical College Journal Vol. 11, No. 1: Jan 2020, P 82-85

Fournier's gangrene: a review of reconstructive options.

IntroductionFournier’s gangrene is a rapidly progressive necrotizing fasciitis of the genital and perineal tissues with a high mortality rate. Early diagnosis and treatment with fluid resuscitation, surgical debridement and wide-spectrum antibiotics are essential in the management of Fournier’s gangrene. After primary treatment, reconstructive surgery is often necessary for coverage of soft-tissue defects. This review article aims to provide an overview of the main reconstructive procedures used in Fournier’s gangrene.Material and methodsA literature search was performed on the subject of reconstructive surgery in Fournier’s gangrene.ResultsTechniques of reconstructive surgery for soft-tissue defects following Fournier’s gangrene include skin grafts, local advancement flaps, scrotal flaps, multiple fasciocutaneous and myocutaneous flaps, and testicular transposition. The surgical goal is to achieve the best functional and cosmetic result possible with minimal morbidity. Advantages and disadvantages of each technique and potential indications are discussed.ConclusionsCharacteristics of the defect, patient preference and surgeon experience should guide the choice of reconstructive procedure. Further comparative studies are needed to optimize results.

Midline raphe scroti artery flap for penile shaft reconstruction

Aim: To investigate a novel method for penile shaft reconstruction. Methods: Penile tissue loss is caused by injury, infections, obesity or cancer resection. Reconstructive techniques comprise skin grafts with the risk of scarring and tissue rigidity. To develop an alternative reconstructive procedure, the pertinent vascular anatomy was studied on fresh cadavers instilled with red latex, which permitted the design of the midline raphe scrotal artery flap (MiRA). After anatomical proof-of-feasibility, penile reconstruction was performed in adult patients with classic buried penis or after cancer resection. Results: Anatomical studies revealed a novel finding of two scrotal septa, each with the terminal branch of the internal pudendal artery. Pedicled on both arteries, a neurovascular island flap could be harvested. In the presence of excess scrotal tissue, the entire circumference of the penile shaft could be covered by this flap. Patients with penile skin defects and excess scrotal tissue were eligible for flap harvest. The flap was raised either as an extended island flap pedicled on both septal arteries for complete penile shaft coverage, or as a VY-flap for partial reconstruction; the donor site was closed primarily. Post-operative complications included swelling or partial wound dehiscence. There were no flap losses or perfusion problems. Patients reported full sensitivity to the penile shaft skin and sufficient skin elasticity for erection. Conclusion: The MiRA flap is a technically safe neurovascular flap suitable for the reconstruction of partial or full defects of the penile shaft, such as after type III buried penis surgery, and provides sufficiently elastic and sensitive skin for functional penile reconstruction.

Penile resurfacing using a reverse bilateral anterior scrotal artery flap

Rationale:Circumcision is one of the most frequently used surgical procedures worldwide. Extensive penile skin defects, which can occur as a rare but severe complication of circumcision, are serious and frustrating problems for patients who experience them. Procedures for correcting these problems can pose a challenge to plastic surgeons in the clinic.Patient concerns:A 31-year-old man was admitted to our care with an extensive defect of the penile skin caused by a circumcision performed 20 days previously.Primary diagnoses:Infection, necrosis, and defects of the penile skin.Interventions:A reverse bilateral anterior scrotal flap was used to correct complete penile skin loss following debridement of the infected and necrotic tissue.Outcomes:The patient experienced no complications during the 10-year follow-up period. The patient reported normal erectile function and the ability to perform intercourse.Lessons:The reverse bilateral anterior scrotal artery flap is suitable for repairing skin defects of the penis and allows for satisfactory cosmetic and functional improvement following defects of the penile skin.

Complications after Self-injection of Chemical Substances into the Penis

Illicit injection of different, exogenous substances into the penis for enlargement purposes is a practice that is still met in some of the Eastern countries of Europe. Our study conducted over a period of 3 years (2016-2019) at the Urology Clinic from Tirgu Mures,highlights the complications that can occurre after the injection of different chemical substances, such as liquid paraffin, vaseline, olive oil etc., into the penile subcutaneous tissue with the purpose of augmentation. We report 7 patients presenting several complications some of them severe such as: extensive fibrosis, ulceration, penile deformity, erectile dysfunctions, requiring different surgical procedures. The surgical technique was selected according to the extension of fibrosis or necrosis:excision of the necrotic, fibrotic tissue, scrotal skin flap reconstruction etc. In our study, we found 7 patients that accomplished the inclusion criteria. Five patients were diagnosed with penile fibrosis after self-injection of Kanamycin, and two of the patients had the same diagnosis after self-injection of Vaseline. In 2 patients, the postoperative outcome was complicated by wound dehiscence and necrosis, requiring other reconstructive surgeries, and in 5 patients postoperative recovery was a favorable one, without significant complications. In the management of complications of illicit injection of different, exogenous substances into the penis, penile tunneling with scrotal flap technique seems to offer good results due to the vascular flap, allowing faster wound healing and a superior aesthetic and functional result.

Complications and management for penile augmentation with acellular dermal matrix

To investigate and analyze the complications of penile augmentation with acellular dermal matrix (ADM) and following management. This was a retrospective review of all patients who received penile augmentation with ADM between June 2016 and January 2019. The patients were evaluated with outpatient physical examination. Related complications and following management were summarized and analyzed. Between June 2016 and January 2019, ADM was used as filling material on 78 patients (mean age: 31.14 years, range: 21-66 years), who were successfully received penile augmentation surgery. In the follow-up three months, the penile circumference was increased by 1.1 cm (0.5-2.1 cm) on average. The mean follow-up time was 12.20 months. In this study, there were 47 (60.26%, 47/78) patients with erectile discomfort, 91.49% (43/47) of whom manifested as erectile traction. There were 12 (15.38%, 12/78) patients with delayed healing, improved by daily regular dressing change. There were 10 (12.82%, 10/78) patients with unobvious augmentation effect. There were 9 (11.54%, 9/78) patients with stamp-like changes of ADM. There were 8 (10.26%, 8/78) patients with wound hematoma and 7 (8.97%, 7/78) patients with foreskin edema, relieved by compression with wrap. There were 4 (5.13%, 4/78) patients with wound infection and 3 (3.85%, 3/78) patients with skin necrosis of the dorsal side, which could be treated with ADM removal and repair surgery with bipedicle scrotal flap. And there were 2 (2.56%, 2/78) patients suffering psychological influence. Finally, most patients with various complications recovered successfully, however 7 patients (8.97%, 7/78) underwent ADM removal surgery. Using ADM as filling material could achieve positive effect in penile augmentation but the complications are common and cannot be neglected. Standardized surgical methods, rigorous postoperative care, and adequate notification with patients can effectively reduce the complications of penile augmentation with ADM. To treat properly and timely for complications can obtain satisfactory results.

Teknik two step-cutaneous plasty shaft Penis dengan scrotal skin pada kasus parafinoma penis: laporan kasus

Background: Penile injection of paraffin is one of procedure that people think can increase penile size. Nevertheless, many people do not know if paraffin injection causes significant adverse effects such as penile paraffinoma. A surgical procedure by wide excision of skin and subcutaneous tissue infiltrated by paraffin continued with appropriate phalloplasty could be done as definitive therapy with the good aesthetic and functional result. This case report aims to present penile parafinoma or sclerosing lipogranuloma due to subcutaneous penile injection of paraffin, its management and the result after surgical procedure.Case: A 40-year-old man came to the Urology Polyclinic, Mangusada Badung Regional Hospital who presented with penile swelling and pain for 3 days. There was a history of subcutaneous penile injection of paraffin about one-year ago by non-medical personnel. On examination of genital organ, there was swelling on entire penile skin with tenderness and induration. A surgical procedure was performed using a two-step cutaneous plasty technique with scrotal flaps on the shaft of the penis. After two months, the surgical procedure gave an excellent penile aesthetic and functional result.Conclusion: Penile parafinoma is a lipogranulomatous inflammatory reaction due to injection of paraffin substance, which cases are still found today, especially in Indonesia. Reconstructive surgery is the definitive therapy to overcome aesthetic or functional problems.

Successful Reconstruction of the Penile Skin Loss Using a Scrotal Flap as a Result of Complete Resection Following a Traditional Circumcision: A Case Report

Background: Circumcision is the oldest and most common surgical procedure in the world. One out of three adult males is subjected to this procedure at some point in their lives. Circumcision is done for different reasons, most often to meet religious and/or cultural obligations. Though rare, there exist medical indications for this procedure. As in all surgical procedures, there are early or late complications or morbidities associated with circumcision ranging from mild to severe. The factors that influence the rate of occurrence of complications include: the surgical technique applied, the degree of asepsis during the procedure, and the expertise of the practitioner carrying out the procedure. Case Presentation: This is the case of a 20-year-old black male. He presented in the emergency department of the Douala Laquintinie Hospital (DLH) two hours after circumcision with persistent bleeding from the penile wound. This was performed by a traditional healer using the technique of guillotine. Examination of the external genitalia revealed a wound on the penis with loss of skin over the whole penile shaft. Under spinal anesthesia, a reconstruction intervention which involved a single step scrotal skin flap advancement over the penile shaft was done. We noted satisfactory healing process with a pleasing aesthetic appearance of the penis. He confirmed satisfactory penile erection and sexual activity two months after hospital discharge. Conclusion: Circumcision is a simple surgical procedure that can result to life threatening complications or high morbidity more often when performed by an unskilled practitioner. Education of the population on the safer sites of circumcision can help in the prevention and early management of complications.

HP-06-005 Penile skin preservation technique for reconstruction surgery of penile paraffinoma

Penile resurfacing with various scrotal flaps is a simple, effective, and reliable reconstructive armamentarium to treat penile paraffinoma. However, scrotal flaps often result in heavy hair-bearing penile skin causing dyspareunia or shortening of penile length. We introduce a new penile skin preservation technique for reconstruction surgery of penile paraffinoma. From March 2007 to April 2018, 23 patients underwent excision of paraffinoma with the penile skin preservation technique. Complete removal of the subcutaneous tissue was done, including paraffinoma. No. 10 surgical blades were used to peel off the skin as thin as possible in order to get paraffinoma-free skin. The preserved penile skin was given an end to end anastomosis to the circumferential incision site. Multiple anchoring fixation sutures of the penile skin were made on the underlying tissue. Dressing of chopped gauze soaked with antibiotic saline solution was done on the skin to help preserve it and keep it fixed on the penis.

Re: The Staged Urethroplasty with Vascularised Scrotal Flap and Buccal Mucosa Graft after Failed Hypospadias Surgery: A Reliable Technique with a Novel Tool.

Re: The Staged Urethroplasty with Vascularised Scrotal Flap and Buccal Mucosa Graft after Failed Hypospadias Surgery: A Reliable Technique with a Novel Tool.

PENILE PARAFFINOMA RECONSTRUCTION WITH SCROTAL FLAP AND SURGICAL OUTCOME: A CASE REPORT

Objective: To present a case of penile paraffinoma reconstructed with scrotal flap. Case presentation: We report a case of 33-year-old male patient with penile paraffinoma. The patient had a history of injecting liquid paraffin into his penis two times – at 6 months and 2 months prior to his admission to the hospital. His IIEF-5 was 10 (moderate erectile dysfunction). The penile shaft was circumferentially enlarged. There was ulceration on the ventral aspect with signs of inflammation on the surrounding skin. Discussion: We perform a complete excision of paraffinoma. The raw surface was repaired with a one-stage scrotal flap. At six-month follow up, the wound was good, and the patient was able to micturate normally. He was able to achieve painless erection, and IIEF-5 score was improved. Conclusion: A one-stage scrotal flap may offer a good choice in defect closure in penile paraffinoma reconstruction.

Penile skin preservation technique for reconstruction surgery of penile paraffinoma.

PurposePenile resurfacing with various scrotal flaps is a simple, effective, and reliable reconstructive armamentarium to treat penile paraffinoma. However, scrotal flaps often result in heavy hair-bearing penile skin causing dyspareunia or shortening of penile length. We introduce a new penile skin preservation technique for reconstruction surgery of penile paraffinoma.Materials and MethodsFrom March 2007 to April 2018, 23 patients underwent excision of paraffinoma with the penile skin preservation technique. Complete removal of the subcutaneous tissue was done, including paraffinoma. No. 10 surgical blades were used to peel off the skin as thin as possible in order to get paraffinoma-free skin. The preserved penile skin was given an end to end anastomosis to the circumferential incision site. Multiple anchoring fixation sutures of the penile skin were made on the underlying tissue. Dressing of chopped gauze soaked with antibiotic saline solution was done on the skin to help preserve it and keep it fixed on the penis.ResultsThe skin survived completely without necrosis in 19 patients (82.6%), with the mean duration of healing being 21.9 days. The penis after the operation looked natural in color and shape. Partial necrosis after the operation was shown on 4 patients (17.4%), whom were all later treated with the scrotal skin free graft. The final results were successful without any cosmetic or functional complications, such as skin contracture.ConclusionsPenile resurfacing with the penile skin preservation technique is a new effective reliable method for skin-intact paraffinoma which produces good functional and cosmetic results.

Reconstruction after Fournier gangrene: Our approaches and outcomes

Context: Fournier's gangrene is a necrotizing infection of the perianal region and scrotum. It progresses quite quickly and is fatal. Treatment involves debridement of the necrotized tissues, broad-spectrum antibiotherapy, and fluid replacement therapy. Delayed reconstruction can be planned after clinical stabilization. While there is a wide range of reconstruction options, no ideal method is applicable to all patients. Aims: By presenting our results for Fournier's gangrene reconstruction surgery at our center, we aim to discuss surgical approaches for the condition, and their pros and cons. Settings and Design: Retrospective analysis. Subjects and Methods: Sixteen patients who underwent Fournier's gangrene reconstruction in 2014–2018 at Balikesir Ataturk City Hospital were analyzed retrospectively. The mean age, defect size and location, concomitant diseases, mean time to reconstruction, reconstruction method, hospital stay after reconstruction, and complication rates were reported. Results: All patients were male. The most common comorbidity was diabetes mellitus (75%). The mean time to reconstruction was 48.4 days. Scrotal flap alone was the most common reconstruction method (56.25%). Bilateral superomedial thigh flap was used in four patients with total scrotal defect (25%). Gracilis musculocutaneous flap was combined with scrotal flap for three patients (18.75%), with defect extending to the perianal region. The mean hospital stay after reconstruction was 8.6 days. Two patients (12.5%) developed wound dehiscence. Conclusions: No ideal method is applicable to all patients. Rather, the patient age, expectations, and general condition; defect characteristics; and the surgeon's experience determine the ideal method.

Surgical Techniques for Correction of Penile Paraffinoma.

BackgroundPenile augmentation using injection of a foreign body into penile skin was mainly performed by non-medical personnel. Majority of these patients end up with complication of an abnormal mass formation known as penile paraffinoma.MethodsWe described three different surgical techniques for correction of penile paraffinoma based on our single-centre experience. Informed consents were obtained from patients whose photographs were taken during the operation step.ResultsIn general, three patients had simple excision biopsy with primary suturing, four patients underwent single stage excision of circumferential granuloma with bilateral scrotal skin flap reconstruction and one patient experienced dual stage procedure. Three of them were injected with paraffin, one with silicone and the remaining four were unable to identify the substance used. All patients successfully underwent the surgical procedure and four of them had minor post-operative surgical site infection and wound gapping.ConclusionAll patients recovered well and the mean International Index of Erectile Function (IIEF-5) score obtained was 24.25. In our experience, excision biopsy was adequate for focal mass and reconstructive surgery using bilateral scrotal flap was suitable for circumferential mass.

Surgical selection and outcome for treating the post-traumatic posterior urethral strictures via transperineal approach

Objective To evaluate the outcome of various operative selection for treating posterior urethral stricture via transperineal approach. Methods The clinical data of 5 000 patients with posterior urethral stricture or obstruction from January 1990 to January 2017 were analyzed retrospectively. All patients were male. The age of those patients ranged from 18 months to 77 years old, mean 36.6 years old. Pelvic crush injury caused by car accident occurred in 2010 cases. Falling injury occurred in 1680 cases. Pelvic compressed injury occurred in 1 310 cases. Accompanied visceral damage occurred in 2 590 cases, including the liver and spleen rupture in 920 cases, lower limb fracture in 1 200 cases. 2 200 cases accepted urethral realignment under emergency. 2 800 cases were treated with pubic cystostomy. All patients were undergone a retrograde and voiding urethrogram. 562 patients accepted urethral ultrasongraphy, and 2 448 patients accepted urethroscopy. 204 patients accepted MRI examination. The mean stricture length was 4.3 cm, ranged from 1.8 to 8.6 cm. Posterior urethral stricture was found in 810(16.2%)cases. The complete obstruction of posterior urethra was found in 4 190(83.8%)cases, of which the length of the distraction defects≤3 cm was found in 2 650(53.0%)cases and the length of the distraction defects>3 cm was found in 1 540(30.8%)cases. Bladder calculi was found in 2 300 cases. The perineal fistula or abscess was noticed in 290 cases. False passage was found in 460 cases. Urethra rectum fistula was found in 160 cases. Bladder neck open was noticed in 89 cases. Repairing was performed via a simple anastomosis after urethral mobilization in 1 700 patients, via separation of the corporeal bodies in 1 302 patients, via separation of the corporeal bodies and inferior pubectomy in 1 910 patients and via scrotal skin flap urethroplasty in 68 patients. Pull-through operation was performed in 20 patients. Results Postoperative follow-up were conducted from 6 to 72 months with average duration of 23 months. The overall successive results after operation was 92.2%(4 608/5 000), which the Qmax was more than 15 ml/s .The successive rate of urethroplasty were 97%(1 649/1 700 )in simple anastomosis; 93%(1 211/1 302 )in separation of the corporeal bodies; 88% (1 680/1 910) in separation of the corporeal bodies and inferior puberctomy; 78%(53/68) in scrotal skin flap urethroplasty and 83%(15/18) in pull-through operation. The successive rate were 96%(778/810)in posterior urethral stricture; 95%(2 517/2 650)in distraction with the length of obstruction less than 3 cm and 86%(1 324/1 540)in distraction with the length of obstruction more than 3 cm. Conclusions The transperineal end to end anastomotic urethroplasty has become the first-line therapy for posterior urethral atresia. The length of the strictures or distraction defect which is lower than 3 cm is much more successfully corrected. Key words: Urethral stricture; Urological surgical procedure; Transperineal; Wound and injuiry

124 Use of Bilateral Pedicled Scrotal Flaps to Restore Penile Shaft Defects: Technic and Results

124 Use of Bilateral Pedicled Scrotal Flaps to Restore Penile Shaft Defects: Technic and Results