Urethroplasty of extensive penile urethral strictures with a longitudinal ventral tubed flap of penile skin (modified Orandi urethroplasty): 20 years of follow-up of two cases

The surgical treatment of extensive urethral strictures remains a controversial topic; although techniques have evolved, there is still no definite method of choice. Since 1968, when Orandi presented an original technique for one-stage urethroplasty using a penile skin flap, the Orandi technique has become the most prevalently used one-stage procedure for anterior urethral strictures. We present a 20-year follow-up experience with one-stage reconstruction of long urethral strictures using a longitudinal ventral tubed flap of penile skin, with some important technical changes to Orandi’s original technique to overcome the deficient vascularity caused by periurethral scar tissue. In 1997, a 55-year-old male patient complained of severe voiding difficulty and a weak urinary stream because of transurethral resection of the prostate due to benign prostatic hyperplasia. Another 47-year-old male patient had the same problem due to self-removal of a Foley catheter in 2002. In both patients, a urethrogram demonstrated extensive strictures involving the long segment of the anterior urethra. A rectangular skin flap on the ventral surface of the penis was used considering the appropriate length, diameter, and depth of the neourethra. The modified Orandi flap provided a pedicled strip of penile skin measuring an average of 8 cm. The mean duration of follow-up was 20.5 years. A long-term evaluation revealed stable performance characteristics without any complications.

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Revisiting One-Stage Urethroplasties for Distal Urethral Strictures

Journal of Clinical Medicine ◽

10.3390/jcm10245905 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5905

Author(s):

Matthias D. Hofer ◽

Lauren Folgosa Cooley ◽

Ayman Elmasri ◽

Francisco E. Martins

Keyword(s):

Surgical Technique ◽

Operative Time ◽

Scar Tissue ◽

Urethral Reconstruction ◽

One Stage ◽

Urethral Strictures ◽

Average Operative Time ◽

The Mean ◽

Flap Repairs

Background: Reconstructive approaches for distal urethral strictures range from simple meatotomy to utilizing grafts or flaps depending on the etiology, length and location. We describe a contemporary cohort of distal urethral strictures and report a surgical technique termed distal one-stage urethroplasty developed to address the majority of distal urethral strictures encountered. Methods: Thirty-four patients were included. The mean age was 56.7 years (range 15.7–84.9 years), the mean stricture length was 1.1 cm (0.5–1.5) and the mean follow-up was 42.5 months (28–61.3). Results: The vast majority of distal strictures (27/34 (79.4%)) were treated with our hybrid one-stage approach combining a distal urethral reconstruction with excision of the scar tissue without the need to use grafts or flaps. The average stricture length was 0.68 cm and average operative time was 24.43 min. Post-operative spraying was reported in a minority of patients (4/27 (14.8%)). The length of stricture and surgery were significantly longer in those 7/34 (20.6%) patients in whom grafts or flaps were used (2.88 cm and 154.8 min, respectively, p < 0.001 for both when compared to the hybrid one-stage approach). We noted 6/34 (17.6%) recurrences of distal urethral strictures, all of which were treated successfully with graft and flap repairs. Conclusions: The vast majority of distal urethral strictures are amenable to a distal one-stage urethroplasty, avoiding the use of grafts and/or flaps while achieving reasonable outcomes. This limited approach, at least initially, is associated with shorter operative time and time of catheter placement and avoids morbidity associated with graft or flap harvesting. Spraying of urine is seldomly encountered and comparable to other approaches addressing distal urethral strictures.

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Reconstruction of Long Anterior Urethral Strictures by Dorsally Quilted Penile Skin Flap

ISRN Urology ◽

10.5402/2012/651513 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Abdel Moneim M. Abuzeid ◽

M. S. Abdel Kader

Keyword(s):

Skin Flap ◽

Urine Flow ◽

Skin Flaps ◽

Penile Skin ◽

Internal Urethrotomy ◽

One Stage ◽

Urethral Strictures ◽

Skin Loss ◽

Dorsal Onlay ◽

One Year

Objective. To present the results of reconstruction of long (>5 cm), penile, bulbar, and bulbopenile urethral strictures by penile skin flap as dorsal onlay in one-stage procedure. Patients and Methods. Between January, 1998 and December, 2004, 18 patients (aged from 28-65 years) presented with long urethral strictures, 5.6–13.2 cm (penile in 6, bulbar in 2 and combined in 10 cases), those were repaired utilizing long penile skin flaps placed as dorsal onlay flap in one stage (Orandi flap 6 cm in 6 cases, circular flaps 7–10 cm in 8, and spiral flaps 10–15 cm in 4). Followup of all patients after reconstruction included urine flow rate at weekly intervals, RUG at 6–12 weeks, and urethrocystoscopy at 12 and 18 months. Results. The urethral patency was achieved in 77% of patients. The complications were fistula in one patient (5.5%), restricture occurred in 3 patients (16.6%) that required visual internal urethrotomy and two patients (11%) showed curvature on erection that dose not interfere with sexual intercourse. Diverticulum (penile urethra) was seen in one patient (5.5%) containing stones and was excised surgically. There was penile skin loss in 3 patients (16.6%). All patients completed at least one-year followup period. Conclusion. Free penile skin flaps offer good results (functional and cosmetic) in long penile and/or bulbar urethral strictures. Meticulously fashioned longitudinal, circular or spiral penile skin flaps could bridge urethral defects up to 15 cm long.

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386 LONG-TERM FOLLOW-UP OF DORSAL ONLAY GRAFT URETHROPLASTY USING PENILE SKIN OR BUCCAL MUCOSA IN ADULT BULBAR URETHRAL STRICTURES

European Urology Supplements ◽

10.1016/s1569-9056(10)60384-3 ◽

2010 ◽

Vol 9 (2) ◽

pp. 143

Author(s):

S. Tran ◽

F. Fateri ◽

G. Venzi ◽

C. Iselin

Keyword(s):

Buccal Mucosa ◽

Penile Skin ◽

Urethral Strictures ◽

Onlay Graft ◽

Long Term Follow Up ◽

Dorsal Onlay

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PD60-07 OUTCOME OF DORSAL ONLAY BUCCAL MUCOSAL GRAFT VERSUS VENTRAL ONLAY LOCAL PENILE SKIN FLAP IN COMPLEX ANTERIOR URETHRAL STRICTURES; A PROSPECTIVE RANDOMIZED STUDY

The Journal of Urology ◽

10.1016/j.juro.2017.02.2753 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Ahmed Tawakol ◽

Mohammed Abdel-Rassoul ◽

Mohamed El-Ghoneimy ◽

Mohamed El-Gammal

Keyword(s):

Skin Flap ◽

Randomized Study ◽

Prospective Randomized Study ◽

Penile Skin ◽

Urethral Strictures ◽

Buccal Mucosal Graft ◽

Dorsal Onlay

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One-stage buccal two-flap urethroplasty using the Kulkarni technique for extended anterior urethral strictures

Herald Urology ◽

10.21886/2308-6424-2020-8-4-44-52 ◽

2020 ◽

Vol 8 (4) ◽

pp. 44-52

Author(s):

M. I. Katibov ◽

M. M. Alibekov ◽

Z. M. Magomedov ◽

A. M. Abdulkhalimov ◽

V. G. Aydamirov

Keyword(s):

Urethral Stricture ◽

Significant Risk ◽

Significant Risk Factor ◽

Disease Recurrence ◽

Urinary Flow ◽

One Stage ◽

Urethral Strictures ◽

Prospective Control ◽

Onlay Technique

Introduction. The problem of extended urethral strictures treatment remains relevant due to the complexity of the supervision of such patients and the high frequency of disease recurrence after surgical treatment.Purpose of the study. Evaluation of the effectiveness of one-stage buccal urethroplasty according to the Kulkarni technique using two flaps for extended anterior urethral strictures.Materials and methods. The study included 18 men with an extended anterior urethral stricture, who underwent buccal urethroplasty by perineal access using the Kulkarni dorsolateral onlay technique using two flaps from January 2018 to March 2020, and a postoperative follow-up period of at least 6 months. The study was prospective. Control examination was carried out 3, 6, 12, 18 and 24 months after surgery. The criteria for the recurrence of urethral stricture were the presence of complaints of deterioration in the quality of urination in combination with a decrease in the maximum urinary flow rate of less than 12 ml/sec and the presence of residual urine in an amount of more than 100 ml, as well as the need to perform any surgical intervention to restore the normal passage of urine.Results. The age of the patients ranged from 32 to 72 years (median 58 years). The length of the stricture ranged from 6 to 11 cm (median, 8 cm). The stricture was localized in the penile segment in 11 (61.1%) cases and the penile and bulbar urethra in 7 (38.9%) cases simultaneously. An iatrogenic cause of urethral stricture occurred in 11 (61.1) patients, idiopathic in 5 (27.8%) patients and inflammatory in 2 (11.1%) patients. The stricture was primary in 12 (66.7%) cases and recurrent in 6 (33.3%). Spontaneous urination was preserved in 6 (33.3%) patients, cystostomy existed in 12 (66.7%) patients. The follow-up period after surgery ranged from 3 to 24 months (median - 12 months). Recurrence of urethral stricture was noted in 3 (16.7%) cases. The use of this technique for recurrent forms of the urethral stricture (recurrence after the previous urethroplasty) is the most significant risk factor for treatment failure. 1 (5.6%) case of erectile dysfunction and stress urinary incontinence has taken place of the late postoperative complications.Conclusions. The Kulkarni operation using two buccal flaps for extended strictures of the anterior urethra allows to achieve high rates of efficacy and safety of a treatment, however, the risk of failure increases significantly when used for the treatment of recurrent types of strictures.

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Penile-scrotal flap vaginoplasty versus inverted penile skin flap expanded with spatulated urethra: A multidisciplinary single-centre analysis

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2020.3.186 ◽

2020 ◽

Vol 92 (3) ◽

Author(s):

Giorgio Gentile ◽

Ardigò Martino ◽

Daniela Nadalin ◽

Martina Masetti ◽

Brigida Lilia Marta ◽

...

Keyword(s):

Skin Flap ◽

Penile Skin ◽

Psychological Analysis ◽

Compressive Neuropathy ◽

Increased Risk ◽

Vaginal Lubrication ◽

Group A ◽

Group B ◽

Satisfaction Rates

This study is aimed to compare outcomes of penile-scrotal flap vaginoplasty to inverted penile skin flap expanded with spatulated urethra as a singlecentre experience. Data regarding vaginoplasty performed between May 2003 and January 2014 were reviewed. Subjects were divided into two groups according to the surgical technique performed: perineal- scrotal flap vaginoplasty (Group A), and inverted penile skin flap expanded with spatulated urethra vaginoplasty (Group B). All patients underwent to psychological analysis before surgery. Functional follow-up was based on a modified validated Female Sexual Function Index. Overall, 67 patients with a mean (SD) age of 34 (±9.38) years underwent to surgery. 41 patients were included into the Group A and 26 into the Group B. Mean operative time among Groups A and B was 316 (±101.65) and 594 (±89.06) minutes, respectively (p<0.0001). Longer postoperative hospitalization was shown in Group B (14 days ± 4,51) than in Group A (10 days ± 2,49); (p<0.0001). Group B patients showed a higher anemization rate requiring blood transfusion (p=0.00014) as well as compressive neuropathy (p=0.038). In addition to this, necrosis of the skin flap was reported in 8 patients of Group B (p<0.0001). Comprehensive functional follow-up data was included; spontaneous vaginal lubrication was not reported in 82.4% of Group A vs 12.5% cases of Group B (p=0.0085). When compared to penile-scrotal flap vaginoplasty, inverted penile skin flap expanded with spatulated urethra technique shows an increased risk of complications with comparable satisfaction rates whereas a higher spontaneous vaginal lubrication is reported. Sexological support is of utmost importance in this setting.

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Foot Reconstruction by Free Flap Transfer

Foot & Ankle ◽

10.1177/107110078300400102 ◽

1983 ◽

Vol 4 (1) ◽

pp. 2-7 ◽

Cited By ~ 23

Author(s):

Michael B. Wood ◽

George B. Irons ◽

William P. Cooney

Keyword(s):

Free Flap ◽

Skin Flap ◽

Flap Transfer ◽

One Stage ◽

Free Flap Transfer ◽

Foot Reconstruction ◽

Cutaneous Innervation

Free skin flap transfer for foot salvage and reconstruction was done in 10 patients whose follow-up exceeded 1 year. Nine of the 10 had successful results, and generally all achieved the desired reconstructive goal in one stage, with a minimum of hospitalization and disability time. In using a free skin flap transfer in weightbearing locations, the need for cutaneous innervation of the flap should be considered, but such innervation is not necessary for success.

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