Abstract
Introduction and aim of the work: to evaluate the outcome of reconstruction of long segment (7cm) of anterior urethral stricture by penile spiral flap versus free grafts dorsally placed after stricturotomy of the dorsal aspect done in one (flap) or two (grafts) staged procures.
Material and methods: from January 1998 to December 2004, 18 patients with post- catheter long (> 5cm) anterior penobulbar urethral stricture were operated upon by total bulbopenile urethral mobilization, stricturotomy and dorsally positioned circular or spiral penile skin flap. During a similar period free grafts (genital, extra genital skin and buccal mucosa) were used for urethral reconstruction of long stricture of comparable length and caliber in 22 cases. Age of the patients in both groups ranged between 26 and 65 tears (median 39.5yaers). Stricture length varied between (5.6 and 10.8 cm). All strictures were bulbopenile post inflammatory or post catheter. Mean follow up was 36 (36 (6-56) months.
Results: urethral patency (on retrograde urethrography) was documented in 78% of flaps versus 69% in graft repair 3 years postoperatively (P=0.05). Restricture occurred in 18% of flaps versus 22% in grafts (p=0.09). Fistulae in 4% of flap repair versus 9% of graft repair. Cosmetic outcome including straight penis was similar in both cases.
Conclusions: both free grafts and genital skin flaps offer comparable results as regard functional outcome in anterior urethral stricture in meticulously fashioned spiral penile skin flaps could be raised to bridge a urethral defect up to 13 cm long, has the advantage of one stage repair and versatility for utilization in pendulous penile and fixed bulbar urethral stricture. Graft should not be utilized in penile urethral stricture except with cases with case of deficient penile (used in cases with failed previous repair or balanatits xerotica oblitarns).