Microsurgical Urethroplasty for Complex Bulbar Urethral Strictures Using the Radial Forearm Free Flap Prelaminated with Buccal Mucosa

Abstract

Background Complex bulbar urethral strictures are a heterogeneous group, including those secondary to radiotherapy, failed previous open urethroplasty, and total bulbar necrosis following pelvic trauma. Traditional urethroplasty techniques in this group are unpredictable. We describe a novel technique of a buccal mucosa–prelaminated radial forearm free flap urethroplasty, which seeks to improve the quality of life for this group of patients.

Methods Known, reliable techniques from two surgical specialties were combined to create a novel surgical solution, consisting of a radial forearm free flap prelaminated with buccal mucosa. Prospective data were collected on patient and stricture characteristics, complications, and results, including voiding flow rates, urethrography, and cystourethroscopy. Success was defined as the ability to void per urethra. The procedure was performed in four patients, previously considered unreconstructable and who were suprapubic catheter dependent.

Results Microsurgical transfer was successful in all four cases. All patients were voiding per urethra and remained catheter free at a minimum of 12-month follow-up. There was no significant donor morbidity and all patients were able to return to their usual occupation. Mean voiding flow rates were 17.3 mL/s. Flexible cystoscopy revealed well-vascularized, patent neomucosa.

Conclusions We demonstrate proof of concept for a novel technique of microsurgical urethroplasty. We believe this technique may have widespread application in the treatment of radiation-induced and other complex urethral strictures where traditional urethroplasty has limited success.

Keywords

urethroplasty - urethral stricture - prelamination - buccal mucosa - free flap

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