[One-stage replacement of an extended urethral defect after gunshot injury with a combined flap]

Publications devoted to single-stage total substitution of long-segment urethral defects are sporadic and characterized by a small number of observations. The complexity of the clinical case presented in this article is determined by its etiology (combined mine-blast injury with traumatic amputation of the scrotum and both testicles, complicated by the formation of a urethro-perineal fistula) and the length of the urethral defect, measuring 7 cm. A 24-year-old male underwent single-stage substitution urethroplasty 6 months after the injury, involving excision of the urethral fistula and neourethra formation through dorsal grafting of a buccal mucosal graft combined with ventral transposition of a transferred preputial flap on a fascial pedicle. This technique may be considered a possible alternative to multi-stage urethroplasty, provided there is careful patient selection, taking into account their age, preferences, and the availability of relevant experience at the urological center.