Abstract

Objective: To assess outcomes of staged bulbar urethroplasty using bilateral perineal skin flaps as urethral plate substitutes in patients with obliterative or nearly obliterative bulbar urethral strictures.

Materials and Methods: A retrospective analysis was conducted on 19 male patients with severe bulbar urethral strictures who underwent two-stage urethroplasty using scrotal or penile fasciocutaneous flaps. Inclusion criteria included urethral mucosa widths less than 3 mm and stricture length exceeding 3 cm. Initially, perineal skin flaps reconstructed the urethral plate. Six months later, a tubularized neourethra was created using scrotal or penile flaps. Patients were evaluated preoperatively and at 1 month and 6 months postoperatively using uroflowmetry and International Prostate Symptom Score (IPSS).

Results: Patient ages ranged from 27 to 76 years, with a median of 60. The median stricture length was 4.6 cm. For those with cystostomy, median IPSS at six months post-surgery was 5 (range: 0-8). Postoperative Qmax values at first (Qmax-1) and sixth months (Qmax-6) were 22 ml/s (range: 14–26 ml/s) and 21 ml/s (range: 14–29 ml/s). In patients with urinary difficulties, the maximum urinary flow rate (Qmax) improved from 4.6 to 20 ml/s post-surgery (p = 0.0001), with IPSS reduction from 23 to 4 (p = 0.005). Complications were minimal, with no infections, fistulas, or penile deformities. Two patients developed circular strictures requiring internal urethrotomy, and three experienced terminal dribbling.

Conclusion: Staged urethroplasty using bilateral perineal skin flaps is viable and effective for complex bulbar urethral strictures. This method shows favorable functional and cosmetic outcomes with low complications, particularly where single-stage repair is unfeasible.