[SINGLE-STAGE URETHROPLASTY USING A PREPUTIAL SPIRAL GRAFT FOR PANURETHRAL STRICTURE: A CASE REPORT]

In male patients with panurethral stricture who desire to void in a standing position, substitution urethroplasty is indicated. Although oral mucosa and penile skin are comparable substitute tissues, a single graft is often insufficient in length for extensive strictures. The junctions between multiple grafts have been identified as a significant risk factor for postoperative restenosis. We report a case of single-stage urethroplasty utilizing a continuous preputial spiral graft to eliminate the need for such junctions. A 72-year-old male presented with a 5-year history of a weakened urinary stream. Retrograde urethrography revealed an extensive stricture extending from the proximal bulbar urethra to the external meatus. Despite periodic urethral dilation every three months, he was referred to our department for definitive treatment. Because the patient had sufficient redundant prepuce, we performed urethroplasty using a preputial spiral graft. Through a transperineal approach, the penis was invaginated to expose the entire anterior urethra. Unilateral dissection and mobilization of the corpus spongiosum were performed. The urethra was incised dorsally to expose the stricture. A 5-cm wide circumferential segment of penile skin was harvested as a cylinder. This graft was then incised spirally to a width of 2 cm, creating a single, seamless graft 20 cm in length. The graft was quilted onto the corpora cavernosa and sutured to the urethral mucosal edges for reconstruction. Spontaneous voiding commenced 14 days postoperatively. At the 4-month follow-up, the patient maintained a good urinary stream without requiring further intervention.