Devastated urethra with double block after urethral diverticulectomy procedure: A nightmare case salvaged with two-staged prelaminated gracilis flap with buccal mucosal graft.

Devastated bulbar urethra presents a major reconstructive challenge. We report a 67-year-old male with a double urethral block and missing segment following prior trauma and urethral diverticulectomy. A two-stage reconstruction was performed using gracilis muscle and buccal mucosa graft (BMG). In first stage, urethra was excised, dorsal and ventral neourethral plates were created with BMG, one on corpus cavernosum, the other on exposed gracilis. Twelve weeks later, both plates were anastomosed. Five-weeks urethrography showed no leakage, one year follow-up revealed normal voiding. This is the first reported use of this technique in Indonesia, demonstrating safety and feasibility for complex cases.