Changing practice in anterior urethroplasty

Abstract

Objective To describe our experience of penile urethral repair and reconstruction, cataloguing the change in practice from one‐stage flap to two‐stage free graft procedures for anterior urethroplasty. Patients and methods Between January 1992 and December 1996, 79 patients underwent anterior urethroplasty. Of the 45 one‐stage bulbar patch urethroplasties, 37 (76%) used buccal mucosal free grafts rather than flaps. Of the 34 penile urethroplasties, 26 (82%) (including all of the circumferential reconstructions) were two‐stage procedures. Results Buccal mucosal free grafts were at least as good as local skin flaps for patch urethroplasty and two‐stage repairs gave much better results than one‐stage repairs for total circumferential reconstruction of the penile urethra. Conclusions For a patch urethroplasty of an uncomplicated stricture in the bulbar urethra, buccal mucosal free grafts are now the material of choice. For a patch urethroplasty of an uncomplicated stricture in the penile urethra the Orandi procedure remains the ‘gold standard’. For a circumferential repair of the urethra, particularly the penile urethra, a two‐stage repair using a free graft gives better results than a one‐stage repair using a flap.