Changing practice in anterior urethroplasty

Objective To describe our experience of penile urethral repair and reconstr uction, cataloguing the change in practice from one-stage flap to two-stage free graft procedures for anterior urethroplasty. Patients and methods Between January 1992 and December 1996, 79 patients un derwent anterior urethroplasty, Of the 45 one-stage bulbar patch urethropla sties, 37 (76%) used buccal mucosal free grafts rather than flaps. Of the 3 4 penile urethroplasties, 26 (82%) (including all of the circumferential re constructions) were two-stage procedures. Results Buccal mucosal free grafts were at least as good as local skin naps for patch urethroplasty and two-stage repairs gave much better results tha n one-stage repairs for total circumferential reconstruction of the penile urethra. Conclusions For a patch urethroplasty of an uncomplicated stricture in the bulbar urethra, buccal mucosal free grafts are now the material of choice, For a patch urethroplasty of an uncomplicated stricture in the penile ureth ra the Orandi procedure remains the 'gold standard'. For a circumferential repair of the urethra, particularly the penile urethra, a two-stage repair using a free graft gives better results than a one-stage repair using a nap .