World journal of urology · 2025
Application of perineal pedicled tubular flap in the treatment of complex bulbomembranous urethral strictures.
СтатьяНазвание и аннотация: Перевод в очереди
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Deng Chao, Fang Wenzhuo, Song Lujie, Xu Yuemin, Sa Yinglong, Guo Hang, Liang Tao, Fu Qiang
Аннотация
OBJECTIVE: To evaluate the feasibility and clinical effectiveness of urethroplasty using a perineum-based scrotal flap (PBSF) for complex bulbomembranous urethral strictures (BMUS ≥ 5 cm with severe scarring).
METHODS: We retrospectively analyzed 26 patients with complex BMUS treated at Shanghai Sixth People's Hospital between January 2015 and June 2024. The median stricture length was 7.0 cm (IQR: 5.8-8.5). The preoperative maximum urinary flow rate (Qmax) was 2.8 ± 2.5 ml/s. Standard posterior urethroplasty steps were performed, and when tension-free anastomosis was not possible, a full-thickness pedicled perineal flap was harvested and tubularized to bridge the defect. A silicone catheter was left in place for 4 weeks. All patients underwent uroflowmetry, retrograde urethrography (RUG) and voiding cystourethrography (VCUG) to determine the stricture length, location and recurrence. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5).
RESULTS: Postoperative Qmax significantly improved to 18.1 ± 11.3 ml/s (P < 0.001). Nineteen patients (73.1%) achieved both anatomical and functional success. Seven patients experienced Clavien-Dindo grade III complications (26.9%). Anastomotic strictures (4 patients, 15.4%): two treated with internal urethrotomy, two underwent cystostomy). Hair growth with stone formation (2 patients, 7.7%): Both experienced recurrence after endoscopic lithotripsy. Urethral skin fistula (1 patient, 3.8%): successfully managed with re-urethroplasty. No significant change in erectile function was observed (P = 0.396).
CONCLUSION: PBSF urethroplasty provides well-vascularized tissue, flexible dimensions, and reliable tubularization. It is a viable option for long-segment BMUS, especially in patients with hairless perineal skin and when end-to-end anastomosis is not feasible.
METHODS: We retrospectively analyzed 26 patients with complex BMUS treated at Shanghai Sixth People's Hospital between January 2015 and June 2024. The median stricture length was 7.0 cm (IQR: 5.8-8.5). The preoperative maximum urinary flow rate (Qmax) was 2.8 ± 2.5 ml/s. Standard posterior urethroplasty steps were performed, and when tension-free anastomosis was not possible, a full-thickness pedicled perineal flap was harvested and tubularized to bridge the defect. A silicone catheter was left in place for 4 weeks. All patients underwent uroflowmetry, retrograde urethrography (RUG) and voiding cystourethrography (VCUG) to determine the stricture length, location and recurrence. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5).
RESULTS: Postoperative Qmax significantly improved to 18.1 ± 11.3 ml/s (P < 0.001). Nineteen patients (73.1%) achieved both anatomical and functional success. Seven patients experienced Clavien-Dindo grade III complications (26.9%). Anastomotic strictures (4 patients, 15.4%): two treated with internal urethrotomy, two underwent cystostomy). Hair growth with stone formation (2 patients, 7.7%): Both experienced recurrence after endoscopic lithotripsy. Urethral skin fistula (1 patient, 3.8%): successfully managed with re-urethroplasty. No significant change in erectile function was observed (P = 0.396).
CONCLUSION: PBSF urethroplasty provides well-vascularized tissue, flexible dimensions, and reliable tubularization. It is a viable option for long-segment BMUS, especially in patients with hairless perineal skin and when end-to-end anastomosis is not feasible.