Stenosis of the male urethra: single-stage canal reconstruction using a mobile, vascular, pedicled skin graft. 245 personal cases
Falandry, L.
Progres en Urologie Journal de l'Association Francaise d'Urologie et de la Societe Francaise d'Urologie 3(5): 753-770
1993
ISSN/ISBN: 1166-7087 PMID: 8130803 Document Number: 412281
A series of 269 patients treated for male urethral stenoses by the same operator using the same management technique from september 1984 to november 1992, inspired the author to describe an original one-stage canal reconstructive technique, using a mobile, nourished pedicled skin graft. The particularity of the technique resides on the large versatility of the pedicle, well vascularised, carved out from the subcutaneous cell tissue and the dartos. The scrotal or penile skin flap remains attached to the mobile pedicle, giving a much wider facility for use, both for penile urethra or perineal urethra repair. The technique allows a choice of two methods of plasty repair: the widening patch which aims at widening the urethral canal, and the tubularized graft, which aims at replacing part or an entire segment of the urethra. Analysis is made on 245 urethroplasties done for the cure of difficult urethral strictures which made up 80% of the total number of cases observed (fistulated in 56 cases, multi-operated in 47 cases), affecting the penile urethra for 47 cases, the pelvian urethra for 159 cases, and the membraneous bulb for 39 cases, associated lesions where found in 15.9% of the patients. 187 patients where treated by the widening patch process whereas 58 underwent neourethral reconstruction by the tubularized graft process. Post operative follow-up for over half of the total number of cases was 4 years. While 224 of the cases treated obtained good results (91.4%), for 15 patients, the results were considered intermediary (6.1%). Immediate cure was obtained for 87.2% of the cases. Lastly, 5 patients presented bad results (2.3%). Discussion and analysis are made on the execution of the technique as well as the post operative complications encountered: infection (8.9%), urine leakage (6.9-0), urethrocele (2%). Experience acquired from the use of this management technique, showed that it is particularly valuable for the cure of wide, recurrent, infected and fistulated stenoses. Its efficiency and reliability underline the value of this technique, whose particularity lies on the wide manageability of the graft, attached to the pedicle. Its particularity also lies on the eclectic choice offered as to the site where the graft is carved off (scrotal or penile) and the appropriate plasty to be used (widening patch or tubular graft), increasing considerably the favorable chances for surgical repair. Finally, the technique's particularity is in its wide indication, independently of the characteristics and the cause of the stenoses.