TREATMENT OF COMPLEX ANTERIOR URETHRAL STRICTURE DISEASE WITH MESH GRAFT URETHROPLASTY

Purpose: Treatment of complex anterior urethral strictures complicated by a lack of sufficient penile skin for primary flap repair has gener ally consisted of 2-stage scrotal inlay urethroplasty. Scrotal skin ha s shortcomings, most notably hair formation, diverticula and stricture recurrence from urine induced dermatitis. As an alternative, we prese nt our results with staged mesh graft urethroplasty using split-thickn ess skin, which is nonhair-bearing, easier to size and seemingly less permeable to urine penetration. Materials and Methods: Between 1990 an d 1995, 20 men underwent mesh graft urethroplasty for complex strictur es, most after failed urethroplasty. Meshed split-thickness skin graft from the thigh (17 men) or full-thickness foreskin (3) was used. Resu lts: Overall median time to closure was 5.5 months, and 6 men required revision before closure (revision of ostia in 3, chordee release in 2 and lysis of graft adhesions in 1). A successful outcome, as evidence d by retrograde urethrography and history, was achieved in 12 of 15 me n (80%) with a median followup of 38 months. Five men have not undergo ne closure due to patient refusal (2) or because the graft is not read y to be closed (3). Of the failures 2 men had retrograde urethrographi c evidence of stricture at the proximal anastomosis and 1 had recurren t stenosis of the entire neourethra by 2 years. Conclusions: Mesh graf t urethroplasty is not a panacea but it is a valuable adjunct in the t reatment of complex urethral strictures, offering comparable results t o and benefits over scrotal inlay procedures. In a significant percent age of cases it is a multistage rather than a 2-stage procedure.