Single-stage dorsal inlay split-skin graft for salvage anterior urethral reconstruction

OBJECTIVE To report our initial experience and extended follow-up of single-stage dorsal inlay skin-graft urethroplasty for salvaging recurrent anterior urethral stricture (AUS), as urethral reconstruction remains a challenge, particularly in patients with recurrent AUS after previous surgery, and a paucity of local skin frequently requires free graft reconstruction techniques. PATIENTS AND METHODS In all, 27 patients (mean age 48.12 years, range 17-79) with recurrent AUS had a dorsal inlay urethroplasty using extragenital split-thickness skin grafts. An electrical dermatome was used for graft harvesting. All patients had contraindications for buccal mucosal grafting (e.g. radiotherapy, leukoplakia). The assessment before repair comprised a clinical investigation, urine analysis, uroflowmetry, retrograde and voiding cystogram, urethral ultrasonography and endoscopy. The follow-up was based on an assessment of flow rate and postvoid residual volume. Success was defined by the absence of symptoms and stable maximum flow rate, while any further instrumentation was considered a failure. RESULTS The mean (range) stricture length was 8.35 (3-14) cm. The overall complication rate was 7%, with no complications during surgery. During the mean (range) follow-up of 32.43 (5-46) months, 25 (93%) of the patients were successfully cured in one operation. Two patients required further treatment for recurrence and fistula. No long-term complications were noted at the graft donor sites. There was no case of intraurethral hair growth during the extended follow-up. CONCLUSION If there are contraindications for buccal mucosal grafting, a split-thickness skin can be used for dorsal inlay urethroplasty in recurrent AUS. A well-vascularized recipient bed on the corpora cavernosa is required for reliable graft take. Intra-urethral hair growth is avoided by using split-skin grafts. Although the complication rates are equivalent to those of buccal mucosa, we await the longer follow-up to assess the ultimate value of this alternative single-stage technique.