Modified annular penile skin flap for repair of pan-anterior urethral stricture

Abstract

Objective

To review our experience with a zigzag shape annular penile fasciocutaneous flap (modified McAninch flap) for reconstruction of pan-anterior urethral strictures.

Patients and methods

From 2003 to 2006, 30 male patients with pan-anterior urethral stricture were repaired by single-stage urethroplasty using a modification of the annular penile flap of McAninch for augmentation of a long anterior urethral stricture (zigzag annular penile fasciocutaneous flap). The procedure was total bulbopenile urethral mobilization, stricturotomy, and ventrally positioned zigzag annular penile island fasciocutaneous flap. Age of patients ranged from 20–60 years. Range of stricture length was 15–20 cm. All strictures were bulbopenile post inflammatory or post catheter with exclusion of BXO in all cases by clinical picture and pre-operative biopsy. Follow up period was 24 months.

Results

Urethral patency was documented clinically, urodynamically, by RUG, and by urethroscopy for 26 male patients for whom repair was performed by use of this technique. Re-stricture occurred in four patients, fistula in one patient, and post voiding dripping in two patients.

Conclusions

A meticulously fashioned zigzag annular penile skin flap could be raised to bridge a urethral defect up to 20 cm long and has the advantage of one-stage repair. No additional grafts are needed. Cosmetic outcome included a straight penis in all cases.