ABSTRACT
Objective: This procedure was introduced to evaluate the use of tissue expanders in patients with complex anterior urethral strictures and hypospadias cripples where there is not enough healthy penile skin to bridge the urethral defect or to cover the neourethra. Patients and Methods: Six patients with a mean age of 23.3 years were included in this study. Four patients presented with complex hypospadias after failed multiple repairs. Three of them presented with penoscrotal meatus; residual chordee and scarred ventral penile skin. The fourth patient had multiple proximal fistulas with a scarred narrow distal urethra. The fifth patient was circumcised with a concealed penis and a congenitally short urethra. The sixth patient was referred from another institution after previous unsuccessful urethrotomies and urethroplasties. He had a curved penis; a calcified urethral plate and a proximal penile urethral meatus after first-stage Johanson procedure. The tissue expander was placed under the dorsal penile skin through a subcoronal incision. Penile skin expansion was performed gradually over 5-8 weeks. Urethroplasty was then performed using the Thiersch-Duplay technique with penile covering using the excess dorsal penile skin. Results: Expansion of the dorsal penile skin was performed successfully in all cases. There were no complications related to the use of tissue expanders except for minimal discomfort at the start of expansion. Complications related to urethroplasty included mild skin infection and temporary penoscrotal urethrocutaneous fistula (which closed spontaneously); a subcoronal fistula that required surgical closure and disruption of the glandular sutures in one case each. Conclusions: The initial good results of this technique are encouraging in patients presenting after multiple failed urethroplasties. It seems to provide an alternative to free grafts; which at present is the only solution for such cases. However; further evaluation on a larger number of patients is required