1-Stage Repair of Obliterative Distal Urethral Strictures With Buccal Graft Urethral Plate Reconstruction and Simultaneous Onlay Penile Skin Flap

Purpose: When penile skin is available, onlay flap reconstruction is an excellent choice for 1-stage repair of complex hypospadias and strictures involving the glans, fossa navicularis and penile urethra. When the urethra is deficient circumferentially, tube flaps are an option but there is a high failure rate. We report our 8-year experience with 1-stage reconstruction using a dorsal buccal mucosa graft to reconstruct the deficient urethral plate with repair completed using an onlay penile skin flap. Materials and Methods: A total of 12 patients with a mean age of 42.8 years (range 16 to 77) underwent dorsal buccal grafting with ventral skin flap repair. Buccal mucosa was quilted to the penile ventral corpora to reconstruct the dorsal urethral aspect. Most surgeries included buccal graft reconstruction of the glans and fossa navicularis. Onlay penile skin flap repair was then performed to complete the reconstruction. Results: All 12 patients were free of disabling chordee or urethral stricture disease at a mean 39-month followup (range 7 to 96). In 1 patient a small urethrocutaneous fistula developed, which was repaired. In another patient a fistula and medium caliber fossa navicularis narrowing developed with associated chordee, which were successfully repaired. Conclusions: Dorsal buccal grafting with ventral flap reconstruction appears to be an excellent option to repair circumferential urethral deficiency when penile skin is available, especially when chordee correction with distal urethral plate reconstruction is required.