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URETHROPLASTY WITH A PEDICLED FLAP

For longer-stretching stenoses in the area of the penile or bulbar urethra, the procedure of urethroplasty with a pedicled flap is available. Flaps from the preputial skin or the penile skin are mainly used for this purpose. Obtaining grafts from the scrotal skin is considered obsolete due to complications caused by the hairiness of the skin flap. Crucial to the success of the procedure is the quality of the blood supply and the free mobility of the skin flap.1.

Impaired blood flow to the graft can lead to necrosis of the same, which is often associated with restructuring or fistula formation. Such complications have been reported in 15-30% of cases.2 In addition, penile skin harvest may result in reduced perfusion of the remaining skin and infection of the surgical site. Complications must be expected, especially in the long-term course, because of the characteristics of the skin flaps used. Since the graft is exposed to constant moisture, continuous expansion may occur, leading to residual urine formation and post-micturition dribbling. Because of the recurrences resulting from this, urethroplasty with a pedicled flap is being used less and less.3 Furthermore, retroperspective studies show that transplantation of oral mucosa is by far the more promising procedure.

1 Knispel HH. Harnröhrenstrikturen. In: Jocham D u. Miller, K. Praxis der Urologie. In zwei Bändern. Band II. 3,. überarbeit. und erw. Auflage. Georg Thieme Verlag. Stuttgart. 2007.
2 Ebd.
3 Fiala R, Vidlar A, Vrtal R, Belej K,Student V. Porcine small intestinal submucosa graft for repair of anterior urethral strictures. Eur Urol 2007; 51: 702–8.