Urethroplasty of extensive penile urethral strictures with a longitudinal ventral tubed flap of penile skin (modified Orandi urethroplasty): 20 years of follow-up of two cases

The surgical treatment of extensive urethral strictures remains a controversial topic; although techniques have evolved, there is still no definite method of choice. Since 1968, when Orandi presented an original technique for one-stage urethroplasty using a penile skin flap, the Orandi technique has become the most prevalently used one-stage procedure for anterior urethral strictures. We present a 20-year follow-up experience with one-stage reconstruction of long urethral strictures using a longitudinal ventral tubed flap of penile skin, with some important technical changes to Orandi’s original technique to overcome the deficient vascularity caused by periurethral scar tissue. In 1997, a 55-year-old male patient complained of severe voiding difficulty and a weak urinary stream because of transurethral resection of the prostate due to benign prostatic hyperplasia. Another 47-year-old male patient had the same problem due to self-removal of a Foley catheter in 2002. In both patients, a urethrogram demonstrated extensive strictures involving the long segment of the anterior urethra. A rectangular skin flap on the ventral surface of the penis was used considering the appropriate length, diameter, and depth of the neourethra. The modified Orandi flap provided a pedicled strip of penile skin measuring an average of 8 cm. The mean duration of follow-up was 20.5 years. A long-term evaluation revealed stable performance characteristics without any complications.

Keywords

Surgical flap - Urethroplasty - Urethral stricture

Publication History

Received: 24 July 2019

Accepted: 15 June 2020

Article published online:
25 March 2022

• REFERENCES

• 1 Andrich DE, Mundy AR. What is the best technique for urethroplasty?. Eur Urol 2008; 54: 1031-41
• 2 Sachse H. Treatment of urethral stricture: transurethral slit in view using sharp section. Fortschr Med 1974; 92: 12-5
• 3 Lee YJ, Lee BK. Tubularized penile-flap urethroplasty using a fasciocutaneous random pedicled flap for recurrent anterior urethral stricture. Arch Plast Surg 2012; 39: 257-60
• 4 Park KR, Kim TG, Lee J. et al. Single-stage reconstruction of extensive defects after Fournier’s gangrene with an exposed iliac crest and testes. Arch Plast Surg 2013; 40: 74-6
• 5 Lee YJ, Kim SW. Current management of urethral stricture. Korean J Urol 2013; 54: 561-9
• 6 Devine PC, Fallon B, Devine Jr CJ. Free full thickness skin graft urethroplasty. J Urol 1976; 116: 444-6
• 7 Morey AF, McAninch JW. When and how to use buccal mucosal grafts in adult bulbar urethroplasty. Urology 1996; 48: 194-8
• 8 Kahveci R, Kahveci Z, Sirmali S. et al. Urethral reconstruction with autologous vein graft: an experimental study. Br J Plast Surg 1995; 48: 500-3
• 9 Koshima I, Inagawa K, Okuyama N. et al. Free vascularized appendix transfer for reconstruction of penile urethras with severe fibrosis. Plast Reconstr Surg 1999; 103: 964-9
• 10 Gil-Vernet J, Arango O, Gil-Vernet A. et al. A new biaxial epilated scrotal flap for reconstructive urethral surgery. J Urol 1997; 158: 412-20
• 11 Elia R, Pafitanis G, Ciudad P. et al. Accessory penis: a rare method of peno-urethral separation of sexual function and voiding following successful complex hypospadias reconstruction with a free ileum flap. Arch Plast Surg 2019; 46: 381-5
• 12 Teven CM, Yu JW, Zhao LC. et al. Extended medial sural artery perforator free flap for groin and scrotal reconstruction. Arch Plast Surg 2020; 47: 354-59
• 13 Barbagli G, Morgia G, Lazzeri M. Retrospective outcome analysis of one-stage penile urethroplasty using a flap or graft in a homogeneous series of patients. BJU Int 2008; 102: 853-60
• 14 Boorman JG, Brown JA, Sykes PJ. Morbidity in the forearm flap donor arm. Br J Plast Surg 1987; 40: 207-12
• 15 Whitson JM, McAninch JW, Elliott SP. et al. Long-term efficacy of distal penile circular fasciocutaneous flaps for single stage reconstruction of complex anterior urethral stricture disease. J Urol 2008; 179: 2259-64
• 16 Schwentner C, Seibold J, Colleselli D. et al. Anterior urethral reconstruction using the circular fasciocutaneous flap technique: long-term follow-up. World J Urol 2011; 29: 115-20
• 17 Choi DS, Lee JW, Yang JD. et al. Correction of problematic hypospadias with dartos fascia-reinforced flap and slanted incision of fistula. Arch Plast Surg 2013; 40: 766-72
• 18 Buckley J, McAninch J. Distal penile circular fasciocutaneous flap for complex anterior urethral strictures. BJU Int 2007; 100: 221-31
• 19 Orandi A. One-stage urethroplasty. Br J Urol 1968; 40: 717-9
• 20 Greenwell TJ, Venn SN, Mundy AR. Changing practice in anterior urethroplasty. BJU Int 1999; 83: 631-5