Combined buccal mucosa graft and genital skin flap for reconstruction of extensive anterior urethral strictures.

OBJECTIVES: Buccal mucosa has become the graft material of choice for substitution urethroplasty, but the tissue may be insufficient to completely reconstruct an extensive or panurethral stricture. We reviewed our experience with the combination of buccal mucosa and a genital skin flap to assess the efficacy of this approach in this setting.

METHODS: Eighteen patients underwent single-stage urethral reconstruction at our institution from November 1997 to May 2003 using a buccal mucosa onlay graft and a penile and/or scrotal island flap. After surgery, patients were evaluated with voiding urethrography at 3 weeks, followed by flexible cystoscopy at 6 and 12 months and as needed thereafter.

RESULTS: The mean stricture length was 15.1 cm (range 9.5 to 22), with an average graft length of 6.3 cm and flap of 8.5 cm. The stricture etiology included multiple hypospadias repair failures in 4 (22.2%), prior instrumentation in 4 (22.2%), pelvic trauma in 3 (16.7%), balanitis xerotica obliterans in 3 (16.7%), and unknown in 4 (22.2%) of the 18 patients. At the last follow-up visit, 3 patients (16.7%) had had recurrent stricture noted on follow-up cystoscopy.

CONCLUSIONS: In this series, the combination of buccal mucosa and a genital skin flap proved to be a reliable and durable method of single-stage repair for extensive and panurethral stricture disease. The use of longitudinal island flaps and patient repositioning during surgery seemed to contribute to a decreased incidence of local and systemic morbidity.