Grand Journal of Urology
E-ISSN : 2757-7163

Reconstructive Urology
Original Article
Grand J Urol 2025;0(0):, DOI: 10.5505/GJU.2026.83584
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.
Case Report
Grand J Urol 2025;5(2):062-065, DOI: 10.5505/GJU.2025.65487
Urethral stones are rare, accounting for less than 1% of all urinary system stones. These stones may present with obstructive symptoms or remain asymptomatic. Hair-bearing urethral diverticula, which can form after surgical interventions such as hypospadias repair, are an uncommon cause of urethral stone formation. However, urethral stones leading to infertility are extremely rare. A 38-year-old male patient presented to the urology outpatient clinic with complaints of infertility. Physical examination revealed a palpable mass in the penoscrotal region. Further evaluations and imaging identified this mass as a urethral stone within a hair-bearing urethral diverticulum. The patient"s history revealed a childhood hypospadias repair. Open surgery was performed for stone removal and diverticulectomy. Semen analysis at the six-month postoperative follow-up showed an improvement in semen volume from 1 mL preoperatively to 2.5 mL, reaching normal levels. Additionally, nine months after the procedure, the patient's spouse was confirmed to be pregnant. Long-term follow-up revealed no postoperative complications. This case highlights the importance of considering urethral pathologies in infertile patients with a history of urethral surgery. Such conditions can be effectively treated with open surgery, potentially restoring fertility.