Reconstructive Urology

Original Article

Outcomes of Modified Lich–Gregoir Technique in the Management of Iatrogenic Distal Ureteral Injuries

Süleyman Şahin, Metin Savun, Çağrı Şevik, Yunus Çolakoğlu, Ramazan Uğur, Halil Lutfi Canat

Objective: To evaluate the surgical outcomes of iatrogenic distal ureteral injury repair using the modified Lich–Gregoir ureteroneocystostomy technique, focusing on perioperative parameters, complications, and long-term functional results. Materials and Methods: In this retrospective analysis, 23 patients who experienced iatrogenic distal ureteral injuries underwent repair using the modified Lich–Gregoir technique from January 2021 to January 2025. The preoperative evaluation included tests such as serum creatinine, urinalysis, renal ultrasound, and cross-sectional imaging, with selective use of retrograde pyelography or renal scintigraphy. Surgical outcomes were measured by examining ureteral patency, renal function, operative details, and complications, which were categorized using the Clavien–Dindo classification. Patient-reported outcomes were assessed through the Patient Global Impression of Change (PGI-C) scale. Results: The study included 11 men and 12 women, with a median age of 44 years. Gynecological surgery was the leading cause of injury, accounting for 52.2%, followed by urological surgery at 39.1%, and colorectal surgery at 8.7%. The median duration of surgery was 150 minutes, and patients typically stayed in the hospital for 4 days. A psoas hitch procedure was conducted in 3 patients, representing 13.0% of the group. The median follow-up period was 22 months. All patients (100%) experienced successful surgical outcomes. Complications were noted in two patients, with each experiencing a urinary tract infection and a wound infection, both at a rate of 4.3%. Based on PGI-C scores, 95.7% of patients felt "very much improved," while 4.3% reported being "much improved." Conclusion: The Lich–Gregoir ureteroneocystostomy, when modified, offers a reliable, safe, and effective surgical solution for treating injuries to the distal ureter caused by medical procedures.

Grand J Urol 2026;6(1):021-026, DOI: 10.5505/GJU.2026.83584

Staged Bulbar Urethroplasty Using Bilateral Perineal Skin Flaps as the Urethral Plate

Ali Atan, Murat Yavuz Koparal, Ender Cem Bulut, Burak Elmas, Fazlı Polat, Süleyman Yeşil

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

A Rare Case Report of Infertility Due to a Giant Hair-bearing Urethral Stone in a Urethral Diverticulum

Çağatay Özsoy, Erhan Ateş, Ahmet Emre Yıldız, Abdullah Akdağ, Arif Kol

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.