Single‐stage segmental urethral replacement using combined ventral onlay fasciocutaneous flap with dorsal onlay buccal grafting for long segment strictures

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Single‐stage urethral segment replacement has historically poor outcomes and two‐stage repairs are now more common. We present a novel approach to the single‐stage repair with initial outcomes similar to two‐stage repairs. OBJECTIVE • To present our experience with repairing long‐segment urethralstrictures in a single‐stage using a combined tissue‐transfer technique. PATIENTS AND METHODS • In all, 14 men underwent urethroplasty where a segment of urethra was completely replaced using a dorsal onlay buccal mucosa graft and a ventral onlay fasciocutaneous flap in a singlestage. • Primary success was defined as an open urethra at >6 months follow‐up with no need for additional surgical intervention. • Secondary success was defined as the need for a single postoperative endoscopic procedure before stricture stabilization. • Failure was the need for multiple endoscopic procedures, repeat urethroplasty, urinary diversion or intermittent dilatation. RESULTS • The mean (sd) stricture length was 9.75 (4.6) cm. The mean (sd) neourethral length was 5.4 (2.7) cm. Stricture location was penile/bulbar in 12men, and bulbar alone in two. Primary success was achieved in nine of the 14 men at a median (range) follow‐up of 2.5 (0.5–9.43) years. • The mean (sd) time to recurrence in the five initial failures was 340 (376) days. • Secondary success was achieved in two men after a single endoscopic procedure for an overall success in 11 of 14 men. • Patients that recurred had longer strictures (12.8 vs 8.7 cm, P= 0.04) than initial successes, but neourethral lengths were similar (6.2 vs 5.1 cm, P= 0.5). • In all, three of the 14 men failed, two of whom required a repeat urethroplasty. CONCLUSIONS • Our initial outcomes were favourable using the combined tissue‐transfer technique for segmental urethral replacement with initial and secondary success rates similar to those reported for two‐stage repairs. • This technique is not suitable for all patients as it requires healthy penile skin, but appears to be effective when a single‐stage repair is desirable.