Anterior urethral reconstructions

Abstract

In the surgical treatment of urethral strictures many techniques have been proposed in the last 30 years. Nowadays, only some of them are currently used, because of complications correlated to these surgical procedures. Of course, our School has also changed indications for surgical procedures in urethral strictures. We can use two different kinds of surgical technique; excision of the stricture with an end-to-end anastomosis or urethroplasty. At the Institute of Urology of the University of Milan, 84 patients underwent end-to-end anastomosis: the 12 months follow-up showed 6 relapsed strictures, 1 fistula and 5 penile ventral flexures. In the field of multi-stage urethroplasty our greatest experience is related to the scrotal inlay technique (144 patients: 36 relapsed strictures, 65 phlogoses, 44 stones), while 18 patients underwent the procedure by the use of free epidermal mesh graft (1 fistula, 2 penile flexures, 2 necrosis of the graft). Concerning the one-stage procedures, the bladder mucosa graft seems to be reliable, and the complications observed were the following: 2 relapsed strictures, 3 fistules, 1 penile flexure; the lip mucosa graft represents a possible alternative: using this technique in 8 patients we had 2 recurrent strictures and 1 fistula. Recently we proposed a modified technique using a tubularlzed penile skin flap for complex, recurrent, extended bulbo-membranous strictures. 24 pts. underwent this surgical procedure. Only two stricture relapses have been found. The first four operated pts. had urethrocystograms which revealed a neourethra exceeding the normal caliber and this was resolved in consecutive cases by reducing the size of the flap.