title: Anterior urethral reconstruction using the circular fasciocutaneous flap technique: long-term follow-up.
abstract: OBJECTIVE
  The circular fasciocutaneous skin flap technique (FCF) yields excellent short-term results for complex anterior urethral reconstruction. We performed an observational retrospective and descriptive study to report our long-term experience.
  
  
  METHODS
  A total of 36 adults with anterior urethral strictures (AUS) exceeding 3 cm underwent single-stage urethroplasty using the FCF. Exclusion criteria were: lichen sclerosus, absence of the urethral plate and hypospadias. All had a minimum follow-up of 7 years. Mean age was 49.7 years. Radiological work-up was supplemented by urethral ultrasound showing a mean stricture length of 5.9 cm. A circumferential island of distal penile skin was mobilized on a vascularized pedicle and used for urethral reconstruction. Tube repairs were not included. Outcome was considered a failure when post-operative instrumentation was needed. The Mann-Whitney U test was used for statistical analysis.
  
  
  RESULTS
  Mean follow-up was 96.7 months (86-117). All received a ventral onlay repair secondary to stricturotomy. Complication rate was 8.3% (3/36): A flimsy stricture at the proximal anastomotic site occurred in 1 requiring optical urethrotomy. In 2 patients, glans dehiscence was noted. No penile skin necrosis was observed proximal to the flap-harvesting site. We did not observe neurovascular lower extremity complications. Long-term success rates exceeded 90%.
  
  
  CONCLUSIONS
  FCF-urethroplasty yields excellent long-term results with no late stricture recurrence. All complications occurred early after surgery underlining the durability of pedicled genital skin flaps. Despite extensive stricture, disease complication rates and morbidity were low. In case of paucity of local skin or lichen scleroses, oral grafts are required for optimal treatment.
authors.affiliation: Department of Urology, Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Tuebingen, Germany. christian.schwentner@i-med.ac.at
authors.forename: Christian
authors.initials: C
authors.lastname: Schwentner
authors.forename: Joerg
authors.initials: J
authors.lastname: Seibold
authors.forename: Daniela
authors.initials: D
authors.lastname: Colleselli
authors.forename: Saladin H
authors.initials: SH
authors.lastname: Alloussi
authors.forename: Georgios
authors.initials: G
authors.lastname: Gakis
authors.forename: David
authors.initials: D
authors.lastname: Schilling
authors.forename: Karl-Dietrich
authors.initials: KD
authors.lastname: Sievert
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.forename: Christian
authors.initials: C
authors.lastname: Radmayr
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*