Scrotal and perineal flaps for anterior urethral reconstruction

The use of scrotal and perineal flaps for anterior and posterior urethral reconstruction has been unfairly maligned with claims of poor waterproofing qualities, formation of diverticula, and the potential to import hair into the urethra. Actually, scrotal and perineal skin do not appear to differ from other genital skin with regards to permeability to surface liquids, and although these islands are difficult to tailor, when properly prepared they are no more likely to create diverticula than other genital skin islands. Similarly, if the flap is prepared from hirsute skin, hair will be imported into the urethra; however, hairless scrotal areas can be mobilized as skin islands, and the skin overlying the perineal artery is non-hirsute or nearly non-hirsute in many individuals.