The Results and Complications of Scrotal-Flap Urethroplasty for Stricture1

Abstract

Two years ago we described a method of urethroplasty using an inverted U-shaped scrota1 flap (Blandy et al., 1968) and referred to a preliminary series of 17 cases in whom the results seemed to be promising. We now report a larger series, comprising 70 patients, of whom 51 have completed both stages of the operation, and 21 have been followed for more than 3 years. During this time we have met with certain difficulties and complications as a result of which the original technique has been slightly modified. Composition of the Present Series.-The ages of the 70 patients in this series are shown in AGE OF PATIEhTS AT TIME OF URETHROPLASTY 20 NU. ui patients 10 Age 20 30 40 50 60 70 80 90 FIG. 1 Figure 1, where it will be seen that the majority are middle-aged but that the operation has been used in children and in the very old: our youngest patient was 7, the oldest 88.The zetiology of the strictures operated upon in this series is shown in Table I: the majority were the result of urethritis or injury. The length of history of these strictures varied considerably ( Table 11). Most of the inflammatory strictures belonged to an older generation whose gonorrhoea had been acquired many years previously, whilst those with short histories resulted from trauma or surgical misadventure. Only a small proportion of patients attending either The London Hospital or St Peter's Hospital with stricture were considered suitable for urethroplasty : their strictures were difficult to dilate, needed very frequent dilatation, were complicated by abscesses, infection, or fistulze, or they occurred in men too young to be condemned to a lifetime of frequently repeated instrumentation. The majority of men with urethral strictures were, and will continue to be, treated by regular bouginage (Devereux and Burfield, 1970). Figure 2 gives the time relationship between the first and second stages, and the follow-up of these patients. It will be noted that relatively large numbers of patients were operated on in 1965 and again in 1969 : these represent patients with particularly bad strictures selected from amongst those attending the outpatient clinics at The London and St. Peter's Hospitals.

Urethroplasty by Superficial Membranous Fascia for Long Urethral Strictures: A New Approach

“…Our 97% success rate is almost as favorable as that obtained by Blandy et al [9] who reported no recurrence of stricture or incontinence among their first 51 patients who underwent scrotal flap urethroplasty. In comparison with earlier perineal or scrotal flap operations, 1-stage repair with the superficial membranous fascia tubed flap seems technically simpler.…”

Current Management of Urethral Stricture

“…However, in patients who have experienced failed hypospadias repair or in whom the penile skin, urethral plate, and dartos fascia are not suitable for urethral reconstruction, two-stage urethroplasty is recommended [31,49]. Historically, complex lengthy urethral strictures were treated by two-stage scrotal inlay urethroplasty [50-52]. Unfortunately, the results of scrotal inlay urethroplasties were less than optimal.…”

The “7-Flap” Perineal Urethrostomy

“…In 1971, Blandy published an updated, retrospective PU experience using his previously described technique (6). None of the 70 reported cases, including 51 (73%, 51/70) who went on for further completion of a second stage Johansen urethroplasty had reported recurrent strictures, incontinence or impotence during a median 3 year follow up.…”