[Large cutaneous penile flap in the tubular reconstruction of the urethra in complex recurrent and extensive bulbar-membranous strictures].
The surgical treatment of choice for bulbar-membranous urethral strictures should remove the stricture and achieve an end-to-end anastomosis between two spatulated surfaces to achieve better patency (Turner-Warwick technique [13]). When this is not possible because of recurrence, complex or longer strictures the problem is to choose between various candidate tissue types susceptible of forming a dependable neourethra. With this in view, we have used over the last twenty years a wide range of urethroplastic operating techniques using of scrotal skin [4], bladder mucosa free grafts [3], and dermo-epidermal free mesh grafts [10]. We achieved a significant improvement of the postoperative results with a procedure originally proposed by Quartey [9]. A well vascularised flap is dissected from the whole dorsal penile skin, drawn as far as the perineum and pulled laterally to the cavernous bodies to form the neourethra. We can thus depend on suitable and viable tissue of up to 13 cm in length. A large scalped area of skin is corrected by covering the surface of the penis with a free epidermal mesh graft. Between February 1989 and December 1991, 28 patients with relapsed bulbar-membranous complex urethral strictures underwent urethroplasty with a penile-skin flap. Normal urethro-cystographic imaging and urinary flowmetry figures showed at a three-month follow-up. All patients reported satisfactory micturition and no fistula occurred. Erectile deficiency was not reported.