The use of pedicled appendix graft for substitution of urethra in recurrent urethral stricture.
BACKGROUND
Recurrent posterior urethral strictures after failed urethroplasty may need urethral substitution. Skin or mucosal grafts, currently used for this purpose, have a high complication rate. The authors describe the use of pedicled appendix for posterior urethral substitution.


METHODS
Two boys with pelvic fracture urethral distraction injuries were treated for recurrent posterior urethral strictures after a failed perineal anastomotic urethroplasty. Through a perineal-transpubic approach the stricture tissue was excised, which resulted in a gap of 5 to 7 cm between the healthy ends. The vermiform appendix was mobilised on its own pedicle and transposed to the perineum; the proximal end of appendix was anastomosed to the prostatic urethra and the distal end (tip discarded) to the bulbar/penile urethra. Omentum was transposed to wrap the anastomosis and fill the dead space.


RESULTS
Normal micturition was restored in both patients. No further treatment was required after 1 dilatation in the first case. Both patients are continent. Potency status remains unchanged from the preoperative period with normal erections in 1 case. Follow-up (1 to 3 years) has been satisfactory with no complications.


CONCLUSIONS
The appendix is a promising organ for posterior urethral replacement. It can be brought to the perineum on its own vascular pedicle.
Aggarwal
Satish K
SK
New Delhi, India. dr_satish_aggarwal@yahoo.com
Goel
Deepak
D
Gupta
Chhavi R
CR
Ghosh
Sourabh
S
Ojha
Hemant
H
D000293:Adolescent; D000714:Anastomosis, Surgical; D001065:Appendix / Q000098:blood supply / Q000601:surgery*; D002648:Child; D006801:Humans; D008297:Male; D010502:Perineum / Q000601:surgery; D012008:Recurrence; D013524:Surgical Flaps / Q000098:blood supply; D016896:Treatment Outcome; D014521:Urethra / Q000293:injuries / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods