Reconstruction of strictures of the fossa navicularis and meatus with transverse island fasciocutaneous penile flap.

PURPOSE: Reconstruction of post-prostatectomy strictures involving the fossa navicularis and external urethral meatus following benign prostatic hyperplasia treatment is challenging in terms of creating a functional and cosmetically appealing penis. We reviewed our results with the use of ventral transverse island fasciocutaneous penile flap in the reconstruction of these strictures.

MATERIALS AND

METHODS

Between 1997 and 2007 a total of 26 men (mean age 59 years, range 49 to 76) with post-prostatectomy distal urethral strictures underwent urethral reconstruction with a ventral transverse island fasciocutaneous penile flap. All patients had undergone multiple urethral dilatations. Stricture length was less than 1.5 cm in all cases. Urethral catheter was removed within 3 weeks. Followup included an initial uroflowmetry obtained 1 month after removal of the catheter followed by re-assessment at third month. The patients were followed for urinary pattern changes and/or irritative symptoms with a mean followup of 30.2 months (range 4 to 96).

RESULTS

Mean maximum urine flow rate at first month assessment was 17 ml per second. Flap necrosis and fistula developed in 1 patient 3 months after surgery. In the remaining patients stricture was not evident. A mild urinary splaying was observed in all patients which improved significantly within 6 weeks. A functional and cosmetic outcome was achieved in 96% of the patients.

CONCLUSIONS

Reconstruction of post-prostatectomy strictures involving the fossa navicularis and external meatus with ventral transverse island fasciocutaneous penile flap is an efficient method for the restoration of a functional and cosmetic penis with preserved glandular integrity.