Single-stage segmental urethral replacement using combined ventral onlay fasciocutaneous flap with dorsal onlay buccal grafting for long segment strictures

Authors


Bradley A. Erickson, 200 Hawkins Dr, 3 RCP, Iowa City, IA 52242, USA. e-mail: brad-erickson@uiowa.edu

Abstract

Study Type – Therapy (case series)

Level of Evidence 4

What's known on the subject? and What does the study add?

Single-stage urethral segment replacement has historically poor outcomes and two-stage repairs are now more common. We present a novel approach to the single-stage repair with initial outcomes similar to two-stage repairs.

OBJECTIVE

  • • To present our experience with repairing long-segment urethralstrictures in a single-stage using a combined tissue-transfer technique.

PATIENTS AND METHODS

  • • In all, 14 men underwent urethroplasty where a segment of urethra was completely replaced using a dorsal onlay buccal mucosa graft and a ventral onlay fasciocutaneous flap in a singlestage.
  • • Primary success was defined as an open urethra at >6 months follow-up with no need for additional surgical intervention.
  • • Secondary success was defined as the need for a single postoperative endoscopic procedure before stricture stabilization.
  • • Failure was the need for multiple endoscopic procedures, repeat urethroplasty, urinary diversion or intermittent dilatation.

RESULTS

  • • The mean (sd) stricture length was 9.75 (4.6) cm. The mean (sd) neourethral length was 5.4 (2.7) cm. Stricture location was penile/bulbar in 12men, and bulbar alone in two. Primary success was achieved in nine of the 14 men at a median (range) follow-up of 2.5 (0.5–9.43) years.
  • • The mean (sd) time to recurrence in the five initial failures was 340 (376) days.
  • • Secondary success was achieved in two men after a single endoscopic procedure for an overall success in 11 of 14 men.
  • • Patients that recurred had longer strictures (12.8 vs 8.7 cm, P= 0.04) than initial successes, but neourethral lengths were similar (6.2 vs 5.1 cm, P= 0.5).
  • • In all, three of the 14 men failed, two of whom required a repeat urethroplasty.

CONCLUSIONS

  • • Our initial outcomes were favourable using the combined tissue-transfer technique for segmental urethral replacement with initial and secondary success rates similar to those reported for two-stage repairs.
  • • This technique is not suitable for all patients as it requires healthy penile skin, but appears to be effective when a single-stage repair is desirable.

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