Management of Panurethral Strictures by Preputial Graft Urethroplasty: Outcomes From a Tertiary Care Centre

Objective The aim of the study was to review our outcomes with preputial graft urethroplasty for panurethral strictures in a small subset of the Indian population. Patients and methods We conducted a retrospective review of case records of the patients who had undergone preputial graft urethroplasty in our center from July 2022 to July 2023. Parameters such as uroflowmetry and maximal urine flow rate (Qmax) before surgery and at 1 month, 6 months, and 1 year after surgery, International Index of Erectile Function (IIEF) before and after surgery, intraoperative length of stricture, intraoperative time, length of hospital stay, postoperative course and complications and recurrences were recorded and analyzed. This spiral prepuceal graft was developed from preputial skin 5 cm wide, which is harvested in the shape of a helix and can reach up to 25 cm in length. Results A total of 15 patients were included in this study. All 15 patients were chronic smokers and pan chewers and hence were not ideal candidates for buccal mucosal graft. Four patients had previously undergone buccal mucosal urethroplasty. The preoperative mean Qmax was 4.99 ± 1.70 mL/s. At the time of catheter removal at 1 month, Qmax improved significantly to 19.37 ± 4.16 mL/s (t = 10.412, p <0.001). After 1 year, the mean postoperative Qmax decreased slightly to 17.37 ± 5.03 mL/s (t = 3.196, p = 0.006) but remained higher than the pre-surgery levels. Five patients had Clavien Dindo Grade I complications such as penile edema (n=1), scrotal hematoma (n=1), epididymorchitis (n=1), penile skin necrosis (n=1), and fever (n=1). None of the patients had recurrence at a follow-up of 1 year. Conclusion The preputial spiral graft urethroplasty is a safe procedure for panurethral strictures, those with previous urethral surgeries, those with unsuitable oral mucosa, and an alternative to buccal mucosal graft urethroplasty and two-stage urethroplasty.