Dorsal onlay urethroplasty for urethral stricture repair

Full-thickness penile skin grafts have long proved to be valuable in substitution urethroplasty. However, occasional cases of poor graft take, sacculation, or shrinkage of the repairs have mitigated their success. A determining factor in the outcome of grafts is their mechanical support. Historically, ventral placement of the graft has been used, primarily because of the simplicity of access and the excellent graft bed offered by the spongy tissue. However, mechanical support in this location is suboptimal in comparison with that offered by the corpora cavernosa. Recently, dorsal placement of the graft has been proposed, allowing the skin patch to be spread fixed on the tunica albuginea of the corporal bodies overlying the stricture. Fixation of the graft may minimize its retraction and increase its neovascularization. To date, this innovation has proved to be very promising.