title: Single-stage dorsal inlay for reconstruction of recurrent peno-glandular stenosis.
abstract: OBJECTIVE
  To evaluate the validity of a single-stage dorsal inlay for recurrent peno-glandular stenosis following previous endourological or open urethroplastic surgery. Urethral glanular reconstruction included a deep dorsal incision followed by complete scar excision to create a deep groove presenting well-vascularized recipient bed ensuring appropriate graft healing.
  
  
  METHODS
  Between April 2002 and January 2008, a total of 34 patients (mean age 51.5 years, 14-85 years) were enrolled in the study. Congenital anomalies included hypospadia (n = 19, 53%) and epispadia (n = 2, 6%). Condition of strictures was either iatrogenic (n = 7), due to infection (n = 5), or traumatic (n = 1). Foreskin grafts were used in 13 cases, foreskin and buccal mucosa in one case, penile skin in 6 cases, and inguinal skin/thigh (harvested by electrodermatom) in 14 cases. The combination of meticulous scar excision with a deep incision of the glans was used to provide a well-vascularized grafting bed, thus ensuring excellent graft healing. The outcome analysis included urinary flow, urethral calibration >18 ch, voiding cystometry, and patient's satisfaction in a follow-up regime every 3 months.
  
  
  RESULTS
  The average graft length was 4.7 cm (median 8, range 1.5-14). Mean follow-up was 70 months. In 31 patients (91%), no recurrent glanular stenosis was observed resulting in a post-operative flow of average 26.2 ml/s (11-53). Three post-operative wound infections occurred resulting in stricture recurrence, which was treated with internal urethrotomy, buccal mucosa, or penile skin inlay, respectively. Cosmetic results were satisfactory in all patients. Post-operative voiding parameters were significantly improved (P < 0.001).
  
  
  CONCLUSIONS
  The single-stage dorsal inlay for reconstruction of peno-glandular stenosis represents a reliable method even if the urethral plate is severely scarred or has been excised during previous surgery. The good results imply that a well-vascularized graft and the technical approach seem to be more important than the substitute material.
authors: Urologische Klinik und Poliklinik, Klinikun der Universität München-Campus Großhadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 Munich, Germany. patrick.bastian@med.uni-muenchen.de
authors: Patrick J
authors: PJ
authors: Bastian
authors: Margit
authors: M
authors: Mayer
authors: Stefan
authors: S
authors: Tritschler
authors: Alexander
authors: A
authors: Roosen
authors: Philipp
authors: P
authors: Nuhn
authors: Ricarda M
authors: RM
authors: Bauer
authors: Christian
authors: C
authors: Gozzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010409:Penile Diseases / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000592:standards*; D012008:Recurrence; D012086:Reoperation / Q000379:methods / Q000592:standards; D016038:Skin Transplantation / Q000379:methods / Q000592:standards; D014521:Urethra / Q000002:abnormalities / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D055815:Young Adult