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Updated: Mar 29, 2026

Vessel-sparing Excision and Primary Anastomosis

Vessel-sparing Excision and Primary Anastomosis

Published on: January 7, 2019

Two staged modified substitution urethroplasty using appendix-free flap.

Mehran Hiradfar¹, Reza Shojaeian¹, Parisa Saeedi Sharifabad²

¹Department of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran.

BMJ Case Reports

|November 22, 2015

Summary

This study presents a modified two-stage substitution urethroplasty technique using an appendix free flap for long posterior urethral defects. The method, involving microvascular anastomosis and inferior epigastric artery transposition, showed satisfactory outcomes in a pediatric case.

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Area of Science:

Urology
Microsurgery
Pediatric Surgery

Background:

Reconstructing long posterior urethral defects presents significant surgical challenges.
Substitution urethroplasty is a viable option for complex, recurrent urethral strictures.

Observation:

A modified two-stage substitution urethroplasty technique was employed in a 3-year-old boy with a 5 cm iatrogenic posterior urethral defect.
An appendix free flap, utilizing transposed inferior epigastric artery and saphenous vein for vascular supply, was used for urethral substitution.
The neourethra conduit was buried in the scrotum for 3 weeks with viability monitoring.

Findings:

The modified technique demonstrated satisfactory clinical outcomes at two-year follow-up, confirmed by ultrasound and cystoscopy.
Successful vascularization of the flap and recipient bed was crucial for the neourethra's viability.

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Implications:

This approach offers a potential alternative for managing extensive posterior urethral defects.
Inferior epigastric artery transposition and staged reconstruction may enhance blood supply to the neourethra, improving outcomes in substitution urethroplasty.