Urethroplasty of extensive penile urethral strictures with a longitudinal ventral tubed flap of penile skin (modified Orandi urethroplasty): 20 years of follow-up of two cases

Abstract

The surgical treatment of extensive urethral strictures remains a controversial topic; although techniques have evolved, there is still no definite method of choice. Since 1968, when Orandi presented an original technique for one-stage urethroplasty using a penile skin flap, the Orandi technique has become the most prevalently used one-stage procedure for anterior urethral strictures. We present a 20-year follow-up experience with one-stage reconstruction of long urethral strictures using a longitudinal ventral tubed flap of penile skin, with some important technical changes to Orandi’s original technique to overcome the deficient vascularity caused by periurethral scar tissue. In 1997, a 55-year-old male patient complained of severe voiding difficulty and a weak urinary stream because of transurethral resection of the prostate due to benign prostatic hyperplasia. Another 47-year-old male patient had the same problem due to self-removal of a Foley catheter in 2002. In both patients, a urethrogram demonstrated extensive strictures involving the long segment of the anterior urethra. A rectangular skin flap on the ventral surface of the penis was used considering the appropriate length, diameter, and depth of the neourethra. The modified Orandi flap provided a pedicled strip of penile skin measuring an average of 8 cm. The mean duration of follow-up was 20.5 years. A long-term evaluation revealed stable performance characteristics without any complications.

Update on the management of penile and meatal strictures

“…As opposed to the modification by Barbagli, the authors tubularize a longitudinal ventral flap after exciding the obliterative part of the urethra to overcome poor vascularity. Although limited by the small sample of only two patients, long-term follow-up of > 20 years revealed stable voiding characteristics [23].…”

“…Another modification of Orandi's technique was recently presented in a case series by Heo et al [23]. As opposed to the modification by Barbagli, the authors tubularize a longitudinal ventral flap after exciding the obliterative part of the urethra to overcome poor vascularity.…”

Skin Flaps Utilization for Urethroplasty: Review Article

“…When it comes to repairing complex anterior urethral strictures in a single procedure, Heo et al (16) demonstrated the long-term success of using a circular fascio-cutaneous flap from the distal penile. Median follow-up was 7.3 years (range 1 month to 19.5 years), median stricture length was 8.2 cm (range 0-24), and overall success rates at 1, 3, 5, and 10 years were 95%, 89%, 84%, and 79%, respectively.…”

“…Among the most commonly reported side effects were hemorrhage, urinary extravasation, necrosis of the penile skin, and a loss of penile feeling. Repair of long, difficult penile or penobulbar urethral strictures continues to be one of McAninch's most often performed surgeries (16) .…”

Genital flaps for anterior urethral reconstruction

“…In addition to the anatomic description, the flap is also often described in the literature based on the eponym of the describing surgeon. For example, the longitudinal ventral penile skin flap with lateral pedicle placed as a ventral onlay is also referred to as the "Technique of Orandi" or "Orandi Flap" [27,28] . Further confusion can arise with modifications of classic descriptions, such as a tubularized "modified Orandi Flap" [29] .…”