Salvage urethroplasty using skin grafts for previously failed long‐segment urethral strictures

Abstract

The aim of this study was to describe a technique using full-thickness skin grafts (FTSGs) from different parts of the body for salvage urethroplasties and the present outcomes. A total of 24 men underwent urethroplasties for strictures averaging 7.7 cm (range, 5-17 cm) in length, using FTSGs from the inner arm, inner thigh, or abdominal skin. Each of these cases had at least one failed urethroplasty. Twenty-four patients underwent surgery for 26 urethral strictures, with a mean follow-up period of 23.2 (5-44) months and a mean operation time of 140 (115-180) minutes. Reconstruction of the urethra with skin grafting was successful in 18 out of the 26 procedures during the first attempt (69%). A "redo" skin grafting was performed for the eight failed cases, with four successful procedures (50%). Overall, the success rate was 84% (22 out of 26 urethral strictures); however, the failed cases developed abscesses and later, ureterocutaneous fistulas. No hair formation from the skin grafts was seen. Skin grafts provide useful alternative graft sources for previously failed long-segment urethral strictures in which the buccal mucosae are not available or are insufficient for salvage urethroplasties with an acceptable success rate.

Redo-urethroplasty for the management of recurrent urethral strictures in males: a systematic review

“…Different graft sources provided success rates of 80% for skin grafts from the arm, 60% inner thigh skin graft, 50% for abdominal skin graft as reported by one study by Sevinc et al [32] and 60% for scrotal skin graft reported by Andrich et al [29].…”

“…Three studies reporting anterior strictures focused on hypospadias cases with 5 studies not discussing the location of the urethroplasty. The mean length of the stricture was reported in six studies with the mean length reported between 4 and 8 cm [32–34, 39, 41, 43].…”

“…Three studies utilised a scrotal skin flap (scrotal inlay, Orandi flap, Barbagli patch) [20, 24, 29], with a further three using a penile skin (penile island flap) [16, 18, 40]. However, studies utilised a range of graft donor sites including abdominal skin [32], inner thigh skin [32], synthetic mesh [36], arm skin [32], post-auricular skin [20], lingual mucosa [24, 39], tunica vaginalis [38] and forearm free flap [19].…”

“…Only four studies described details of the frequency of the follow-up regime. Uroflowmetry frequency varied at between 3 and 6 months in two studies [32, 35], with urethrography used one month post-operatively [45] and annually [31]. Average length of follow-up varied widely across studies between 4 and 114 months.…”

Approaches in the treatment of urethral strictures

“…Ureteroscopy is performed at months 1, 3, 6, and 12 after the removal of the catheters. At each follow-up visit, complete urine examination, uroflowmetry, and postmicturition residual volume measurementshould be performed (51,52).…”