Current controversies in anterior urethral stricture repair: free-graft versus pedicled skin-flap reconstruction.
Reconstruction of long anterior urethral strictures that cannot be excised and reanastomosed remains controversial. We critically reviewed the literature on free-graft and pedicled skin-flap urethroplasty to determine the optimal method of repair. Overall, free grafts were successful in 84.3% of cases and flaps, in 85.9%. Buccal mucosa grafts are the most successful method for reconstruction of bulbar urethral strictures. For strictures in the penile urethral or a compromised graft bed a distal penile skin flap is the most reliable and tested approach. Dorsal free-graft urethroplasty may be considered when penile skin deficiency prevents use of a flap. For the most complex strictures, in which a flap is not possible and the graft bed is of poor quality, a mesh graft in two stages may be the only option. Thus, for reconstruction of complex anterior urethral strictures, both free-graft and flap procedures remain indispensable.
Section of Urology, University of Arizona, Tucson 85724-5077, USA. hwessell@u.arizona.edu
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McAninch
D005069:Evaluation Studies as Topic; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation; D013524:Surgical Flaps; D014525:Urethral Stricture / Q000601:surgery*