Skin island urethroplasty in deep urethral lesions - A long-term follow-upof 25 consecutive patients

Strictures and ruptures of the bulbomembranous urethra have traditionally b een treated by a two-stage scrotal skin inlay technique (Johanson B. Recons truction of the male urethra in strictures. Acta Chir Scand 1953; Suppl 176 ). For the last 10 years we have treated the patients instead with a skin-d artos island flap pedicled on intertesticular septal vessels. The skin isla nd has been taken from the scrotum, the penile base, or the penile shaft. T wenty-five consecutive patients were treated until 1993 and followed up for at least 5 years. Five of the patients had had open urethroplasty before. Fifteen of the patients had urethral strictures and 10 had complete rupture s. Of the 25 patients 6 had to have a further operation; in 4 patients this was because of restricture, in 1 patient a urethral pouch had to be reduce d, and in the final patient the operation was both for restricture and pouc h formation. At final follow-up impaired micturition occurred in three pati ents; two of them had had a ruptured urethra treated previously, and one ha d a chronic infectious stricture. Problems related to hirsutism were low. N o obvious advantage was detected from using distal penile skin, so a skin-d artos island from the penile base is advocated. In conclusion, a one-stage skin-dartos island flap pedicled on the intertesticular septal vessels may be recommended in the treatment of both strictures and complete ruptures in the bulbornembranous urethra.