Urethroplasty following total phallic reconstruction

Area of Science:

• Urology
• Reconstructive Surgery
• Microsurgery

Background:

• Total phallic reconstruction can lead to urethral strictures, particularly at the anastomosis site.
• Ischemia and kinking at the neophallus base exacerbate stricture formation.
• Traditional urethroplasty techniques are often unsuitable for these complex cases.

Purpose of the Study:

• To review the experience with penile reconstruction in 15 patients with urethral strictures.
• To evaluate the effectiveness of various urethroplasty techniques, focusing on extragenital grafts and flaps.
• To identify promising approaches for managing urethral strictures in the neophallus.

Main Methods:

• 15 patients (17-50 years old) underwent phallic reconstruction using radial forearm or fibula flaps.
• Nine urethroplasties were performed on 8 patients, utilizing techniques such as mesh grafts, skin tubes, bladder mucosa, labial flaps, and buccal mucosa onlay grafts.
• Stricture lengths varied from 3 to 12 cm, with urethroplasty performed 2-34 months post-construction.

Main Results:

• Buccal mucosa urethroplasty resulted in an average urinary flow rate of 18 cc/sec.
• No strictures recurred in patients treated with buccal mucosa grafts.
• These outcomes were superior to other urethroplasty techniques used in this cohort.

Conclusions:

• A comprehensive range of surgical options is essential for reconstructive surgeons.
• Buccal mucosa grafting emerges as a highly promising approach for urethral strictures in patients with reconstructed phalluses.
• This technique addresses the unique challenges of the recipient bed in neophallus repairs.