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

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KAA Appiah
G Amoah
POM Maison
CK Gyasi-Sarpong
CK Adofo
EMT Yenli
A Koranteng
R Azorliade
K Otu-Boateng
A Badu-Peprah
RK Ametih
DA Mintah
A Otu
DK Barnes
DO Acheampong

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.

Article Details

Section
Review
Author Biographies

KAA Appiah, Kwame Nkrumah University of Science and Technology

Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Ghana

G Amoah, Komfo Anokye Teaching Hospital

Department of Surgery, Komfo Anokye Teaching Hospital, Ghana

POM Maison, University of Cape Coast

Department of Surgery, School of Medical Sciences, College of Health Sciences, University of Cape Coast, Ghana

CK Gyasi-Sarpong, Kwame Nkrumah University of Science and Technology

Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Ghana

CK Adofo, Seventh Day Adventist Hospital

Seventh Day Adventist Hospital, Dominase, Ghana

EMT Yenli, University for Development Studies

Department of Surgery, University for Development Studies, Ghana

A Koranteng, Komfo Anokye Teaching Hospital

Department of Surgery, Komfo Anokye Teaching Hospital, Ghana

R Azorliade, Komfo Anokye Teaching Hospital

Department of Surgery, Komfo Anokye Teaching Hospital, Ghana

K Otu-Boateng, Komfo Anokye Teaching Hospital

Department of Surgery, Komfo Anokye Teaching Hospital, Ghana

A Badu-Peprah, Komfo Anokye Teaching Hospital

Department of Radiology, Komfo Anokye Teaching Hospital, Ghana

RK Ametih, Komfo Anokye Teaching Hospital

Department of Surgery, Komfo Anokye Teaching Hospital, Ghana

DA Mintah, Komfo Anokye Teaching Hospital

Department of Surgery, Komfo Anokye Teaching Hospital, Ghana

A Otu, Komfo Anokye Teaching Hospital

Department of Surgery, Komfo Anokye Teaching Hospital, Ghana

DK Barnes, Swansea Bay University Health Board

Department of Anaesthesia, Swansea Bay University Health Board, United Kingdom

DO Acheampong, Komfo Anokye Teaching Hospital

Department of Surgery, Komfo Anokye Teaching Hospital, Ghana