The use of penile fasciocutaneous island flaps in the repair of complex anterior urethral strictures in Kumasi, Ghana

Abstract

Purpose: To evaluate the stricture characteristics of patients undergoing single-stage penile fasciocutaneous island flap ventral onlay urethroplasty and the surgery outcomes.

Methods: A prospective, cross-sectional study of all patients undergoing penile fasciocutaneous island flap ventral onlay urethroplasty for complex anterior urethral strictures at the Komfo Anokye Teaching Hospital between December 2011 and December 2018. A database of stricture characteristics, postoperative complications and outcome of repair was kept prospectively for all patients. Patients were reviewed at three, six, and twelve months postoperatively and yearly thereafter. A successful outcome was a peak flow rate > 15 ml/s, a patent urethra on retrograde urethrogram (RUG), restoration of a normal stream of urine with at most one attempt at urethral calibration or internal urethrotomy postoperatively. Data was entered into SPSS 17.0 for analysis.

Results: Forty-seven patients were operated on over the study period. The median age was 48.0 years (range: 2.5–82 years) and mean stricture length was 6.3 ± 3.8 cm. The majority (25; 53.2%) of patients had strictures involving both the penile and bulbar urethra. Catheterisation was the aetiology in 36 (76.6%) of the strictures, whilst urethritis was the cause in nine (19.1%). The average duration of surgery was 149.2 minutes and the overall success rate at first surgery was 85.1%. There were eight (17.0%) cases of wound haematoma, six (12.8%) of surgical site infections and two (4.3%) of urethrocutaneous fistula. Three patients (6.4%) had urethral diverticulum and seven (14.9%) had stricture recurrence.

Conclusion: Single-stage penile fasciocutaneous ventral onlay flap urethroplasty for complex anterior urethral strictures is appropriate in selected cases with a high success rate.