A novel composite two-stage urethroplasty for complex penile strictures: A multicenter experience

• Published in: Indian journal of urology Vol. 33; no. 2; pp. 155 - 158
• Main Authors: Joshi, Pankaj M, Barbagli, Guido, Batra, Vikram, Surana, Sandesh, Hamouda, Atef, Sansalone, Salvatore, Costi, Dimitris, Lazzeri, Massimo, Hunter, Craig, Desai, Devang J, Castiglione, Fabio, Kulkarni, Sanjay B
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.04.2017; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Analysis; Care and treatment; Fistula; Original; Patients; Penile diseases; Skin & tissue grafts; Surgery; Treatment outcome; Urine; Urogenital system; Urologic surgery
• ISSN: 0970-1591; 1998-3824
• DOI: 10.4103/0970-1591.203426

Complex penile strictures are usually repaired using a two-stage urethroplasty. Buccal mucosal graft (BMG) placed in the first stage can have a significant contraction rate, which may require a subsequent revision surgery. We describe a composite two-stage penile urethroplasty using BMG for patients of complex penile strictures who have some salvageable urethral plate. Within a multi-institutional cohort, 82 patients underwent a two-stage urethroplasty for complex stricture of the penile urethra. Of these 42 patients who underwent our composite two-stage penile urethroplasty using BMG implanted at the second-stage were included. Patients with genital lichen sclerosus or incomplete clinical records were excluded from this study. The primary outcome of the study was to evaluate stricture-free success rate. Of total 42, 4 patients were lost to follow-up. 42% of stricture etiology was failed hypospadias repair. Mean stricture length was 4.5 cm (range 3-8 cm). Seventeen (44.7%) patients had undergone the previous urethroplasty. At a median follow-up of 44 months, of 38 patients, 34 (89.5%) were successful, and 4 (10.5%) had a recurrence. No patient required revision surgery before the second-stage and required redo buccal graft harvesting for subsequent urethroplasty. The composite two-stage technique in repairing complex penile urethral strictures is a valid and reproducible surgical treatment for complex penile stricture and it may reduce the rate of contraction of the transplanted BMG.