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Year : 2001  |  Volume : 17  |  Issue : 2  |  Page : 145-151

Single stage reconstruction of complex anterior urethral strictures

Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Correspondence Address:
Anant Kumar
Department of Urology, SGPGIMS, Lucknow - 226 014
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Source of Support: None, Conflict of Interest: None

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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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