Penile urethroplasty: thecniques and outcomes using buccal mucosa grafts

Contemporary Urology 2006; 18: 25-33.
Penile urethroplasty may represents a simple problem in patients with urethral stricture in which the penis is normal, but may represents a difficult challenge in patients with urethral stricture associated with failed hypospadias repair or Lichen sclerosus (LS), in which the penis is fully involved in the disease. In our experience, failed hypospadias repair and Lichen sclerosus are the most frequent cause (62%) of penile urethral strictures (data submitted for publication). Basically, the surgical procedure for the repair of penile urethral stricture is selected according to etiology of disease. In patients with normal penis, the penile skin, the urethral plate, the corpus spongiosum and dartos fascia are available for urethral reconstruction and one-stage urethroplasty is worldwide the solution of choice. In patients with failed hypospadias repair when the penile skin, the urethral plate and dartos fascia are unavailable for urethral reconstruction a multi-stage urethroplasty could be advisable. Moreover, in patients with LS the use of buccal mucosa as substitute material is mandatory, because LS is a skin disease, thus any skin used for the repair may also become diseased and usually is diseased in course.The selection of surgical technique for penile urethra reconstruction may have a great respect for the status of the all penile tissue and components: glans, penile skin, urethral plate, corpus spongiosum, dartos fascia, and the urethroplasty would be based on the proper anatomical characteristics that everyone of these penile tissues provide in order to ensure flap or graft taking and survival. Certainly, sexual function can be placed at risk by any surgery on the genitalia and dissection must avoid interference with neurovascular supply to the penis, and the use of flaps or grafts should not compromise penile length, should not cause penile chordee and certainly should not untowardly affect penile appearance.