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Penile circular fasciocutaneous flaps to reconstruct complex anterior urethral strictures
K Jeff Carney1, Jack W McAninch
1Department of Urology, University of California School of Medicine, San Francisco, CA, USA.
The Urologic Clinics of North America
|October 10, 2002
Summary
The circular fasciocutaneous penile flap offers a versatile solution for urethral reconstruction, providing ample, hairless tissue for complex strictures. This technique ensures superior outcomes in anterior urethral repair, even after previous failures.
Area of Science:
- Urology
- Plastic Surgery
- Reconstructive Surgery
Background:
- Urethral strictures, particularly long ones in the distal or pendulous urethra, pose significant reconstructive challenges.
- The viability of grafts in these areas can be compromised by the reduced substance of the corpus spongiosum.
- Previous urethroplasty attempts may fail, necessitating advanced reconstructive techniques.
Purpose of the Study:
- To evaluate the efficacy and versatility of the circular fasciocutaneous penile flap for urethral reconstruction.
- To determine its suitability for long strictures and complex cases.
- To compare outcomes of different flap applications, such as onlay versus tubularization.
Main Methods:
- Utilized the circular fasciocutaneous penile flap for tissue transfer and urethral reconstruction.
- Applied the flap for anterior urethral strictures, from the membranous area to the meatus.
- Compared onlay reconstruction with flap tubularization for urethroplasty.
- Combined the flap with other techniques for one-stage reconstructions when needed.
Main Results:
- The circular fasciocutaneous penile flap reliably provides 13-15 cm of hairless tissue, suitable for long strictures.
- Onlay reconstruction demonstrated superior initial and long-term outcomes compared to flap tubularization.
- The flap is versatile, usable throughout the anterior urethra and combinable with other techniques.
- Superior results were achieved even in complex, refractory strictures with prior failed reconstructions.
Conclusions:
- The circular fasciocutaneous penile flap is an ideal option for long anterior urethral strictures, offering ample, well-vascularized tissue.
- Onlay reconstruction using this flap provides better outcomes than tubularization.
- Its versatility and ability to facilitate one-stage reconstruction make it highly effective for complex cases, including those with previous surgical failures.