Urethral Substitution Using an Intestinal
Free Flap: A Novel Approach
Gregory T. Bales, Dimitri D.
Kuznetsov, Hyung L. Kim and Lawrence J. Gottleib.
Sections of Urology and Plastic and
Reconstructive Surgery,
Department of Surgery, University of Chicago Medical Center, Chicago,
Illinois.
Abstract [Full Text] [PDF]
Abstract
Purpose Patients who have extensive stricture
disease, those in whom hypospadias repair fails and those who sustain
significant urethral trauma pose a reconstructive challenge for
genitourinary surgeons. We developed an additional reconstructive option for
men with a severely diseased urethra when grafting procedures and local
tissue flaps have failed or are otherwise contraindicated.
Materials and Methods A genitourinary
reconstructive team performed novel intestinal free flap substitution
urethroplasty in 2 patients. A segment of jejunum is harvested on a vascular
pedicle and plicated into an appropriate size urethral substitute.
Microvascular anastomoses allow this segment to remain viable and
functional. The technical aspects of repair and surgical considerations are
detailed.
Results The 2 patients have a satisfactory
functional and cosmetic outcome. At short followup the urethral lumen
remained patent and the intestinal urethra remained viable and intact. Both
patients have good urinary streams and are able to void in the standing
position.
Conclusions This initial experience in 2
patients indicates that intestinal segment urethral substitution may be
considered within the reconstructive armamentarium of genitourinary surgeons
when more conventional options have failed or are contraindicated. Continued
vigilant followup is necessary to detail any secondary complications. In
addition, further experience with this technique by other surgeons would
help determine its overall usefulness.
Citation:
J Urol 2002 July;168(1):182-184.
