Graft Plus Fasciocutaneous Penile Flap for Nearly or Completely Obliterated Long Bulbar and Penobulbar Strictures

Background: Graft plus flap urethroplasty is gaining momentum in patients with nearly or completely obliterated urethral strictures, in whom staged procedures or perineal urethrostomy is the only possible alternative. However, graft plus flap urethroplasty is mainly adopted for strictures involving...

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Autores principales:	Pankaj M. Joshi, Marco Bandini, Sandeep Bafna, Vipin Sharma, Amey Patil, Shreyas Bhadranavar, Christian Yepes, Guido Barbagli, Francesco Montorsi, Sanjay B. Kulkarni
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2022
Materias:	Buccal mucosa graft Bulbar stricture Urethroplasty Fasciocutaneous penile flap Reconstructive urology Diseases of the genitourinary system. Urology RC870-923 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
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spelling	oai:doaj.org-article:e2f9311c40424f74b70d093481da387c2021-11-28T04:38:21ZGraft Plus Fasciocutaneous Penile Flap for Nearly or Completely Obliterated Long Bulbar and Penobulbar Strictures2666-168310.1016/j.euros.2021.10.009https://doaj.org/article/e2f9311c40424f74b70d093481da387c2022-01-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S266616832102721Xhttps://doaj.org/toc/2666-1683Background: Graft plus flap urethroplasty is gaining momentum in patients with nearly or completely obliterated urethral strictures, in whom staged procedures or perineal urethrostomy is the only possible alternative. However, graft plus flap urethroplasty is mainly adopted for strictures involving the penile urethra. Objective: To report our experience on graft plus flap urethroplasty for bulbar and penobulbar reconstruction. Design, setting, and participants: Between January 2014 and June 2020, patients with nearly or completely obliterated long (>4 cm) bulbar or penobulbar strictures, who required graft plus flap urethroplasty, were considered for this study. Surgical procedure: The bulbar and the penile urethra were accessed through a perineal incision and penile invagination when required. Grafts were harvested from cheek, lingual, or preputial skin and quilted over the corpora to reconstruct the dorsal plate of the neourethra. The fasciocutaneous penile flap recreated the ventral plate of the neourethra. The corpus spongiosum was flapped over the neourethra to prevent the formation of diverticula. Measurements: Any need for instrumentation after surgery was defined as the primary failure. Obstructive symptoms or maximum flow rate (Qmax) below 10 ml/s, with or without a need for instrumentation, was defined as a secondary failure. Results and limitations: We identified 15 patients who met the inclusion criteria. The median stricture length was 7 cm (interquartile range [IQR] 5–8 cm). The inner cheek was the preferred site for graft harvesting (53.3%). No perioperative complication of Clavien-Dindo grade ≥III were recorded in the first 30 postoperative days. The median Qmax at catheter removal was 23 ml/min (IQR 21.5–26 ml/min). The median follow-up was 25 mo (IQR 10–30 mo). The primary success rate was 86.7% (13/15) and the secondary success rate was 73.3% (11/15). Post-traumatic strictures represent a contraindication for this technique. Conclusions: In referral centers, graft plus flap urethroplasty represents a feasible option for patients with nearly or completely obliterated long (>4 cm) strictures. Our study demonstrated that this option is also feasible for strictures involving mainly the bulbar urethra. Patient summary: Perineal urethrostomy should be considered as the last option in patients with a nearly or completely obliterated bulbar urethral stricture. Nowadays, graft plus fasciocutaneous penile flap augmentation enriched our armamentarium of bulbar urethra reconstruction.Pankaj M. JoshiMarco BandiniSandeep BafnaVipin SharmaAmey PatilShreyas BhadranavarChristian YepesGuido BarbagliFrancesco MontorsiSanjay B. KulkarniElsevierarticleBuccal mucosa graftBulbar strictureUrethroplastyFasciocutaneous penile flapReconstructive urologyDiseases of the genitourinary system. UrologyRC870-923Neoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENEuropean Urology Open Science, Vol 35, Iss , Pp 21-28 (2022)
institution	DOAJ
collection	DOAJ
language	EN
topic	Buccal mucosa graft Bulbar stricture Urethroplasty Fasciocutaneous penile flap Reconstructive urology Diseases of the genitourinary system. Urology RC870-923 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Buccal mucosa graft Bulbar stricture Urethroplasty Fasciocutaneous penile flap Reconstructive urology Diseases of the genitourinary system. Urology RC870-923 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Pankaj M. Joshi Marco Bandini Sandeep Bafna Vipin Sharma Amey Patil Shreyas Bhadranavar Christian Yepes Guido Barbagli Francesco Montorsi Sanjay B. Kulkarni Graft Plus Fasciocutaneous Penile Flap for Nearly or Completely Obliterated Long Bulbar and Penobulbar Strictures
description	Background: Graft plus flap urethroplasty is gaining momentum in patients with nearly or completely obliterated urethral strictures, in whom staged procedures or perineal urethrostomy is the only possible alternative. However, graft plus flap urethroplasty is mainly adopted for strictures involving the penile urethra. Objective: To report our experience on graft plus flap urethroplasty for bulbar and penobulbar reconstruction. Design, setting, and participants: Between January 2014 and June 2020, patients with nearly or completely obliterated long (>4 cm) bulbar or penobulbar strictures, who required graft plus flap urethroplasty, were considered for this study. Surgical procedure: The bulbar and the penile urethra were accessed through a perineal incision and penile invagination when required. Grafts were harvested from cheek, lingual, or preputial skin and quilted over the corpora to reconstruct the dorsal plate of the neourethra. The fasciocutaneous penile flap recreated the ventral plate of the neourethra. The corpus spongiosum was flapped over the neourethra to prevent the formation of diverticula. Measurements: Any need for instrumentation after surgery was defined as the primary failure. Obstructive symptoms or maximum flow rate (Qmax) below 10 ml/s, with or without a need for instrumentation, was defined as a secondary failure. Results and limitations: We identified 15 patients who met the inclusion criteria. The median stricture length was 7 cm (interquartile range [IQR] 5–8 cm). The inner cheek was the preferred site for graft harvesting (53.3%). No perioperative complication of Clavien-Dindo grade ≥III were recorded in the first 30 postoperative days. The median Qmax at catheter removal was 23 ml/min (IQR 21.5–26 ml/min). The median follow-up was 25 mo (IQR 10–30 mo). The primary success rate was 86.7% (13/15) and the secondary success rate was 73.3% (11/15). Post-traumatic strictures represent a contraindication for this technique. Conclusions: In referral centers, graft plus flap urethroplasty represents a feasible option for patients with nearly or completely obliterated long (>4 cm) strictures. Our study demonstrated that this option is also feasible for strictures involving mainly the bulbar urethra. Patient summary: Perineal urethrostomy should be considered as the last option in patients with a nearly or completely obliterated bulbar urethral stricture. Nowadays, graft plus fasciocutaneous penile flap augmentation enriched our armamentarium of bulbar urethra reconstruction.
format	article
author	Pankaj M. Joshi Marco Bandini Sandeep Bafna Vipin Sharma Amey Patil Shreyas Bhadranavar Christian Yepes Guido Barbagli Francesco Montorsi Sanjay B. Kulkarni
author_facet	Pankaj M. Joshi Marco Bandini Sandeep Bafna Vipin Sharma Amey Patil Shreyas Bhadranavar Christian Yepes Guido Barbagli Francesco Montorsi Sanjay B. Kulkarni
author_sort	Pankaj M. Joshi
title	Graft Plus Fasciocutaneous Penile Flap for Nearly or Completely Obliterated Long Bulbar and Penobulbar Strictures
title_short	Graft Plus Fasciocutaneous Penile Flap for Nearly or Completely Obliterated Long Bulbar and Penobulbar Strictures
title_full	Graft Plus Fasciocutaneous Penile Flap for Nearly or Completely Obliterated Long Bulbar and Penobulbar Strictures
title_fullStr	Graft Plus Fasciocutaneous Penile Flap for Nearly or Completely Obliterated Long Bulbar and Penobulbar Strictures
title_full_unstemmed	Graft Plus Fasciocutaneous Penile Flap for Nearly or Completely Obliterated Long Bulbar and Penobulbar Strictures
title_sort	graft plus fasciocutaneous penile flap for nearly or completely obliterated long bulbar and penobulbar strictures
publisher	Elsevier
publishDate	2022
url	https://doaj.org/article/e2f9311c40424f74b70d093481da387c
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Graft Plus Fasciocutaneous Penile Flap for Nearly or Completely Obliterated Long Bulbar and Penobulbar Strictures

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