Experience with penile circular fasciocutaneous flap in the treatment of long anterior urethral strictures

ABSTRACT

To evaluate our experience with penile circular fasciocutaneous flap urethroplasty for the repair of long penile and bulbar strictures. 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 20 ml/sec, a normal and smooth caliber of the urethra as shown on retrograde urethrography and no urinary tract infection. 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. Circular fasciocutaneous flap urethroplasty is a highly effective single-stage method of reconstructing long urethral strictures. It provides ample tissue for urethral substitution