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Novel single-stage preputial spiral graft for panurethral stricture: a step-by-step description of the technique

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Abstract

Purpose

To report the 12-month results of a novel urethroplasty technique relying on a spiral preputial graft for panurethral stricture disease.

Materials and methods

Twenty consecutive patients were treated between May and October 2021 at our center. A spiral preputial mucocutaneous graft is a foreskin-based graft, developed from a 5-cm-wide preputial skin, which is harvested using a helicoidal shape and can reach up to 20 cm in length. Stricture characteristics were assessed through preoperative retrograde and voiding cystourethrogram and maximum uroflowmetry data (Qmax). Complications were collected up to 30 days after surgery and graded using the Clavien–Dindo (C–D) classification. The patients were followed up to 12 months.

Results

Preoperative median Qmax was 6.5 ml/s [interquartile range (IQR): 4.0–8.7]. After a median follow-up of 12 months (IQR 12–13), six patients experienced at least one complication. Of them, two patients had grade 2 C–D complications, while only one developed a grade 3a C–D complication. The median postoperative Qmax was 16 ml/s (IQR: 13–18). Only one patient had early urethral stricture recurrence treated with dilatation after catheter removal. At one-year follow-up, no other patients had urethral stricture recurrence with an overall median Qmax of 15.1 ml/s (IQR 13.5–16.4).

Conclusions

Our novel single-stage spiral preputial graft urethroplasty for panurethral stricture treatment appears to be safe and could be used as a valid alternative to two-stage procedures or even to single-stage buccal mucosa graft augmentation.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Kulkarni Reconstructive Urology Center, Pune, India

    Sanjay B. Kulkarni, Pankaj M. Joshi & Marco Bandini

  2. Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy

    Giuseppe Basile & Marco Bandini

  3. Center for Reconstructive Urethral Surgery, Arezzo, Rome, Milan, Italy

    Marco Bandini

Authors
  1. Sanjay B. Kulkarni
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  2. Pankaj M. Joshi
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  3. Giuseppe Basile
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  4. Marco Bandini
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Contributions

SBK, PMJ, GB and MB were involved in protocol/project development. MB was involved in data collection or management.GB and MB analyzed the data and wrote and edited the manuscript.

Corresponding author

Correspondence to Giuseppe Basile.

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Supplementary Information

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Supplementary file1 (MP4 312334 KB)

345_2023_4514_MOESM2_ESM.docx

Supplementary file2 Supplementary Figure 1. Surgical steps of spiral preputial graft urethroplasty. A) After perineal invagination of the penis, a dorsal urethrotomy is created along the entire length of the urethral stricture until healthy tissue is encountered. B)The graft is created using a 5-cm-wide preputial skin, which is harvested using a helicoidal shape (DOCX 83 KB)

345_2023_4514_MOESM3_ESM.docx

Supplementary file3 Supplementary Figure 2. Surgical steps of spiral preputial graft urethroplasty. To create the spiral skin graft, two circumferential incisions were performed, the first 5 cm proximally in the outer preputial skin (A) and the second 5 mm below the coronal sulcus in the inner preputial mucosa (B) (DOCX 55 KB)

345_2023_4514_MOESM4_ESM.docx

Supplementary file4 Supplementary Figure 3. Surgical steps of spiral preputial graft urethroplasty. A)To facilitate the harvesting of the spiral preputial graft, the preputial mucocutaneous cylinder is placed around a 30cc syringe and fixed with two tourniquets on both extremities, which helped to stretch the cylinder itself B) The graft is anastomosed proximally at the level of the bulbo-membranous junction using three interrupted 4-0 polyglactin sutures. Then, the spiral graft is quilted to the corpora with three running sutures and anastomosed to the left margin of the native urethral plate. A continuous 4-0 polyglactin suture is to tabularize the neo-urethra by securing the corpus spongiosum to the lateral margin of the graft and the left corpus cavernosum (DOCX 61 KB)

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Kulkarni, S.B., Joshi, P.M., Basile, G. et al. Novel single-stage preputial spiral graft for panurethral stricture: a step-by-step description of the technique. World J Urol 41, 2459–2463 (2023). https://doi.org/10.1007/s00345-023-04514-9

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  • DOI: https://doi.org/10.1007/s00345-023-04514-9

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