Purpose Total phallic reconstruction is often
complicated by recalcitrant strictures particularly at the native-to-neourethral
anastomosis, which may ultimately require definitive repair. Presumably these
strictures form as a result of relative ischemia at the anastomosis of tissues
of native urethra to fasciocutaneous tube flap, which is exacerbated by
kinking at the neophallus base. The traditional approaches to urethroplasty,
such as end-to-end anastomosis, and penile or preputial skin grafts and flaps,
are not available for this population. Therefore, extragenital grafts and
flaps become important for managing repair of urethral strictures in the
neophallus. In addition, an unusual recipient bed of fat and fascia
complicates the repair of these strictures. We review our experience with 15
patients who underwent penile reconstruction.
Materials and Methods A total of 15 patients
17 to 50 years old had a radial forearm flap except 1 who had a fibula based
flap. Nine urethroplasties were performed on 8 patients who were followed for
a mean of 31.8 months. The approaches comprised 3, 2-stage mesh graft
urethroplasties, 1 full-thickness skin tube graft, 1 bladder mucosa tube
graft, 1 vagina labial pedicle tube flap and, most recently, 3 buccal mucosa
onlay grafts. The length of strictures ranged from 3 to 12 cm. Urethroplasty
was performed 2 to 34 months after phallic construction.
Results Urinary flow rates in patients with
buccal mucosa urethroplasty averaged 18 cc per second and no strictures
recurred. These results are superior to those of other urethroplasty
techniques in this patient population.
Conclusions A full array of surgical options
must be available to the reconstructive surgeon but buccal mucosa grafting
seems to be a promising approach to strictures in this patient population.
Citation:
J Urol 1998 August;160(2):378-382.
