The transverse penile pedicle flap urethroplasty: description of a simplified technique for the dissection of the Fascio-cutaneous flap.

Abstract

Introduction/Objective: Urethroplasty is often required for long urethral stricture s or urethra l strictures that have recurred after repeated urethral dilatations or urethrotomy. The transvers penile skin pedicled flap is very versatile for the reconstruction of long urethral stricture. However the meticulous sharp dissection required to develop it takes a long time to do and may be associated with button hole injuries to the vascular pedicle and the penile skin. We describe a simplified technique of raising the flap which docs not require sharp dissection and is very quick to accomplish. Method: Technique involves using a circumcising distal penile shaft skin incision to de-glove the penis by blunt dissection. The skin substitute, adequate to give appropriate urethra calibre is similarly dissceted bluntly along with its vascular pedicle from the proximal penile skin. T h e techniques used to facilitate successful blunt dissection arc described. Result: In 9 adults with long, multiple urethral strictures, the average time to develop the flap was 15 minutes and complication have been limited to temporary urethro-cutancous fistula at the ventral part of the circular skin closure. These fistulac closed on conservative treatment. No patient suffered button-hole injuries to cither the vascular pedicle or the penile skin. Conclusions: This modification to the standard sharp dissection is very quick to accomplish. It also avoids the creation of button-hole injuries to cither the vascular pedicle or the penile skin. It should make the use of this versatile llap more attractive in the reconstruction of long urethral strictures in those who may wish to use this option for reconstruction of long urethral strictures.