Feasibility and short-term outcomes of the dorsal inlay skin flap for challenging distal penile urethral strictures-a novel case series.

BACKGROUND

Distal penile +/- meatus and fossa navicularis urethral stricture disease (USD) presents major reconstructive challenges owing to poor local vascularity and a high risk of dorsal graft failure. This study describes the novel Dorsal External Skin Augmented Inlay (DESAI) flap urethroplasty, a single-stage technique designed to achieve durable patency in distal ischemic urethral strictures while preserving glans morphology and cosmesis.

CASE DESCRIPTION: A prospective case series of seven men (mean age 54.7±13.9 years) with distal penile USD and impaired local vascularity underwent DESAI flap urethroplasty by a single reconstructive urologist between 2020 and 2025. Four patients (57.1%) had previous failed reconstructions and one (14.3%) had prior pelvic radiotherapy (RT). Functional outcomes were assessed using maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and disease-specific quality-of-life (QoL) measures pre- and post-operatively. Statistical significance was defined as P<0.05. Mean follow-up was 7.3±6.6 (median 4; range 3-22) months. Mean Qmax increased from 7.6±9.5 to 19.9±6.9 mL/s (P=0.002). Mean IPSS improved from 20.4±4.0 to 2.9±2.5 (P<0.001), and mean QoL scores from 3.3±1.0 to 1.1±0.6 (P<0.001). A transient early decline in IIEF-5 (20.7±6.0 to 16.0±6.3; P<0.001) was observed. All patients (100%) had successful post-operative outcome defined as Qmax ≥15 mL/s without reintervention and reported subjective improvement in voiding and cosmetic satisfaction. No fistula, dehiscence, or flap necrosis occurred.

CONCLUSIONS

The DESAI flap urethroplasty provides a reliable, vascularised, single-stage solution for distal USD. By circumventing the need for graft neovascularisation, it achieves excellent functional recovery and patient satisfaction with minimal morbidity. Further multi-centre validation and long-term follow-up are warranted to confirm durability and broader applicability.