Experience with Penile Circular Fasciocutaneous Flap in the Treatment of Long Anterior Urethral Strictures

Abstract

Objective: To evaluate our experience with penile circular fasciocutaneous flap urethroplasty for the repair of long penile and bulbar strictures. Patients and Methods: Between February 2003 and April 2005, a total of 21 circumcised patients with a mean age of 39 (range 11 – 79) years underwent penile circular fasciocutaneous flap urethroplasty for urethral strictures involving the penile and bulbar tracts. The average stricture length was 7 cm. Follow-up included retrograde urethrography at 3 weeks, 3 months and 12 to 18 months, and thereafter when needed, and evaluation of the urinary flow. The mean follow-up was 25.6 months (range 7 to 44 months). The clinical outcome was defined as success when the patient had a good urinary stream, a post void residual urine <50 cc, a peak urinary flow speed >20 ml/sec, a normal and smooth caliber of the urethra as shown on retrograde urethrography and no urinary tract infection. Results: Our initial success rate was 86% (18/21 patients). An immediate successful outcome was achieved in 15/21 (71%) patients. Three patients had an unsatisfactory urinary stream in the immediate post-operative period which resolved after a single dilation or optical urethrotomy. With a mean follow-up of 26 months 2 patients developed a stricture at the proximal site of the repaired urethra necessitating resection and re-anastomosis. One patient with lichen sclerosus developed recurrence of the stricture and was subjected to suprapubic cystostomy, then further staged reconstruction was done. Immediate post-operative complications were encountered in 4 patients in the form of secondary hemorrhage, ischemia and sloughing of the penile skin, urethrocutaneous fistula which closed spontaneously and a decreased sensation at the lower limb in one patient each.
Conclusion: Circular fasciocutaneous flap urethroplasty is a highly effective single-stage method of reconstructing long urethral strictures. It provides ample tissue for urethral substitution

Africain Journal of Urology Vol. 14 (2) 2008: pp. 81-85