title: Dorsal placement of the pedicled preputial/penile onlay flap for anterior urethral stricture: is it more logical?
abstract: OBJECTIVE
  We present our preliminary experience in the management of inflammatory anterior urethral strictures with a dorsally/dorsolaterally placed penile/preputial vascularized flap and discuss the distinct advantages of this procedure over a traditional ventrally placed flap.
  
  
  METHODS
  Twelve patients (age, 20-66 years; mean age, 40.5 years) with recurrent inflammatory strictures of the penile and/or bulbar urethra (penile, 2; bulbar, 5 and bulbopenile, 5) were treated with dorsally/dorsolaterally placed penile/preputial (penile skin, 5; prepuce, 7) vascularized flap substitution urethroplasty. Prior to surgery, 7 patients had suprapubic cystostomy for acute urinary retention and 5 had a mean peak flow rate of 6.2 ml/sec. Inferior pubectomy was performed as an adjunct in two patients to facilitate proximal placement of the flap. Follow-up (5 to 24 months; mean, 15.5) included uroflowmetry and retrograde urethrograms at 6, 12 and 18 months, and thereafter as required.
  
  
  RESULTS
  The mean stricture length was 5.8 cm (range, 3 to 12 cm) and all strictures were associated with dense spongifibrosis. Temporary urethral fistulae, which healed spontaneously, occurred in 4 patients. The clinical and radiological outcome during the mean follow up of 15.5 months was gratifying. The mean peak flow rate improved to 24.2 ml/sec. No stricture recurrence has been noted to date. Sacculation of the flap, diverticulum formation and post-void dribble have not been encountered. None of the patients developed chordee or erectile dysfunction.
  
  
  CONCLUSIONS
  Dorsal onlay preputial/penile flap urethroplasty is a versatile procedure in the treatment of inflammatory anterior urethral strictures. The dorsal pedicle flap may be anatomically and functionally more logical as compared to the traditional ventrally placed flap.
authors.affiliation: Department of Urology & Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, India. gurunadharaot@yahoo.com
authors.forename: H S
authors.initials: HS
authors.lastname: Rao
authors.forename: M
authors.initials: M
authors.lastname: Bhandari
authors.forename: D
authors.initials: D
authors.lastname: Dubey
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000601:surgery*; D013524:Surgical Flaps; D014525:Urethral Stricture / Q000601:surgery*