| ORIGINAL ARTICLE |
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| Year : 2001 | Volume
: 17
| Issue : 2 | Page : 145-151 |
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Single stage reconstruction of complex anterior urethral strictures
Deepak Dubey, Aneesh Srivastava, Rakesh Kapoor, Anant Kumar, Mahendra Bhandari, Anil Mandhani
Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Correspondence Address:
Anant Kumar
Department of Urology, SGPGIMS, Lucknow - 226 014
India
 Source of Support: None, Conflict of Interest: None  | Check |
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Purpose: Single stage reconstruction of long, complex urethral strictures is technically demanding and may require the use of more than one tissue transfer technique. We describe our experience in the management of such strictures with a variety of urethroplasty techniques.
Materials and Methods: Between 1989 and 1999, 25 men (mean age 38.5 years) underwent single stage reconstruction of panurethral, multiple segment or focally dense strictures [mean length 11.2 cm (range 8-17 cm)]. 8 patients had combined substitution urethroplasty with a circumpenile fasciocutaneous flap and a free graft of bladder/buccal mucosa or tunica vaginalis . flap. In 10 patients a single tissue transfer technique was used. 3 patients underwent an augmented roof/floor strip urethroplasty with a penile skin flap. 4 patients with multiple segment strictures (separate pendulous and bulbar) underwent distal onlay flap and proximal anastomotic urethroplasty.
Results: The median ,follow-up was 46.5 months (range 6-88 months). The mean postoperative flow rate improved to 22.5 ml/sec. 2 patients developed fistulae requiring repair. Recurrent stricture developed in 5 (20.8%) patients, of which 2 were managed with visual internal urethrotomy, 2 with anastomotic urethroplasty and 1 with a two-stage procedure. Pseudodiverticulum and post-void dribbling were seen in 6 (25%) patients.
Conclusions: Successful outcome of single stage reconstruction of long complex strictures can be achieved with a combination of various tissue transfer methods. The urologist who has a thorough knowledge of penile skin and urethral vascular anatomy and a wide array of substitution techniques in his armamentarium can undertake approach to such strictures. |
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