Twin penile skin flap, is it the answer for repair of long anterior urethral strictures?

OBJECTIVE: To present our twin ventral penile skin flap technique for the management of complex long anterior urethral strictures not caused by lichen sclerosis (LS), with evaluation of surgical outcome and complications. PATIENTS AND METHODS: We retrospectively reviewed patients diagnosed with long complex anterior urethral strictures who were all referred to Ain Shams University hospital and operated on by three reconstructive surgeons. The surgical procedure was carried out as follows: exposure of the urethra through a ventral longitudinal penile skin incision and another perineal incision; two ventral longitudinal dartos-based penile skin flaps are used for urethral augmentation as onlay flaps. Clinical data were collected in a dedicated database. Preoperative, intraoperative, and postoperative follow-up data for each patient were recorded and analysed. A descriptive data analysis was performed. RESULTS: Between January 2012 and February 2015, 47 patients diagnosed by urethrograms as having long anterior urethral strictures, with a mean (SD, range) length of 17.56 (2.09; 14–21) cm, were managed by twin penile skin flap repair. Four patients were lost to follow-up, thus 43 patients constituted the study cohort. The mean (range) follow-up period was 31 (22–36) months. The overall success rate was 95.35% (41/43). At 12-months postoperatively, the 41 successful cases had a mean (SD, range) peak urinary flow rate of 20.26 (3.06, 14–25) mL/s and American Urological Association Symptom Score of 5.6 (1.85, 3–8). Postoperative complications included urethrocutaneous fistula in three patients (6.97%), mild sacculation of the flap in seven patients (16.52%), post-micturition dribbling in 34 patients (79.07%), decreased penile girth in two patients (4.65%), and chordae of <15° with no need for repair in three patients (6.97%). CONCLUSIONS: In the presence of a favourable urethral plate and ample non-hirsute penile skin, one-stage twin penile skin flap urethroplasty provides excellent results for non-LS related complex strictures, with minimal acceptable complications. It proved to be especially efficient in circumcised patients.