Plastic and Reconstructive Surgery

doi: 10.25005/2074-0581-2020-22-2-253-261
URETHROPLASTY OF EXTENDED URETHRA STRICTURES BY VASCULARIZED FLAPS

G.M. Khodzhamuradov1, K.P. Artykov2, M.M. Ismoilov1, S.S. Ziyozoda2, M.F. Odinaev1, M.S. Saidov1

1Department of Reconstructive Surgery, Republican Scientific Center for Cardiovascular Surgery, Dushanbe, Republic of Tajikistan
2Department of Surgical Diseases № 2, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: Optimization of urethroplasty results in extended urethral stricture by using vascularized flaps.

Methods: The experience of treatment of 12 patients with extended urethral stricture were presented. The clinical material includes the patients with extended strictures of 7 to 18 cm with the average size of 13±3.67 cm of urethra and skin defects. Operations were performed 4-6 months after the epicystostomy application. The results were evaluated by the anamnestic, clinical, dopplerography and retrograde urethrography data.

Results: In 9 cases extended urethral strictures were replaced by free revascularized single (6 cases) or double (3 cases) radial flaps. In 3 other cases urethral strictures were replaced by local skin tissues and volar defect of the penis was covered by axial groin flap. In all cases autotransplants were survived with restoration of natural urination, ejaculation and optimal aesthetic outcome were obtained. In one case the infiltration of wound and in another case urethral fistula were developed as the complication.

Conclusion: In extended urethral stricture, the size which exceeds 7 cm of using the additional vascularized transplants of soft tissues (free, axial) is the method of the choice for adequate covering urethra tissues and accompanying skin defects of the penis.

Keywords: Extended urethral stricture, free vascularized radial flap, axial groin flap, urethroplasty, plasty of penis skin defects.

Download file:


References
  1. Beloborodova VA, Vorobyov VA. Khirurgicheskaya rekonstruktsiya zadney chasti uretry [Surgical reconstruction of the back of the urethra]. Sibirskoe meditsinskoe obozrenie. 2017;3:13-20.
  2. Kotov SV. Striktury uretry u muzhchin – sovremennoe sostoyanie problemy [Urethral strictures in men – the current state of the problem]. Meditsinskiy vestnik Bashkortostana. 2015;10(3):266-70.
  3. Özkan Ö, Özkan Ö. The prefabricated pedicled anterolateral thigh flap for reconstruction of a full-thickness defect of the urethra. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2009;62(3):380-4.
  4. Pushkar DYu, Zhivov AV, Loran OB, Karpovich AV, Bagaudinov MR, Ismailov MR. Sravnitel’naya chastota i faktory riska retsidiva striktury uretry pri razlichnykh metodakh operativnogo lecheniya [Comparative frequency and risk factors for recurrence of urethral stricture with various methods of surgical treatment]. Andrologiya i genital’naya khirurgiya. 2012;4:37-44.
  5. Kurbanov UA, Davlatov AA, Dzhanobilova SM, Kholov ShI. Opyt khirurgicheskogo lecheniya gipospadii s primeneniem pretsizionnoy tekhniki [The experience of surgical treatment of hypospadias with the use of precision technology]. Vestnik Avitsenny [Avicenna Bulletin]. 2013;1:7-14.
  6. Wisenbaugh ES, Gelman J. The use of flaps and grafts in the treatment of urethral stricture disease. Adv Urol. 2015;2015:979868. Available from: https:// doi.org/10.1155/2015/979868
  7. Vasyutin IA, Lyundup AV, Vinarov AZ, Butnaru DV, Kuznetsov SL. Rekonstruktsiya uretry s pomoshch’yu tekhnologiy tkanevoy inzhenerii [Reconstruction of the urethra using tissue engineering techniques]. Vestnik RAMN. 2017;72(1):17-25. Available from: https://doi.org/10.15690/vramn771
  8. Palmer DA, Buckley JC, Zinman LN, Vanni AJ. Urethroplasty for high risk, long segment urethral strictures with ventral buccal mucosa graft and gracilis muscle flap. J Urol. 2015;193(3):902-5. Available from: https://doi.org/10.1016/j. juro.2014.09.093
  9. Favorito LA, Conte PP, Sobrinho UG, Martins RG, Accioly T. Double inlay plus ventral onlay buccal mucosa graft for simultaneous penile and bulbar urethral stricture. Int Braz J Urol. 2018;44(4):838-9. Available from: https://doi. org/10.1590/S1677-5538.IBJU.2017.0067
  10. Kotov SV. Novye metody uretroplastiki pri strikturakh uretry u muzhchin [New methods of urethroplasty for urethral strictures in men]. Annaly khirurgii. 2015;4:9-11.
  11. Sheplev PA, Plutnitskiy AN, Al’-Gazo A. Odnomomentnaya plastika peredney i zadney chasti uretry razdvoennym preputsial’nym loskutom (modifikatsiya operatsii McAninch) [Simultaneous plastic surgery of the anterior and posterior urethra with a bifurcated prepuce flap (modification of the McAninch operation)]. Andrologiya i genital’naya khirurgiya. 2003;3-4:82-3.
  12. Palminteri E, Berdondini E, Verze P, De Nunzio C, Vitarelli A, Carmignani L. Contemporary urethral stricture characteristics in the developed world. Urology. 2013;81(1):191-6.
  13. Vijayganapathy S, Mallya A, Karthikeyan VS, Sreenivas J. Penile circular fasciocutaneous (McAninch) flap as an option for complex anterior urethral stricture in case of non-viable buccal mucosal graft. J Clin Diagn Res. 2016;10(7):PD09- PD11. Available from: https://doi.org/10.7860/JCDR/2016/20404.8117
  14. Zheng D, Xie M, Fu S, Guo J, Li W, Yao H, et al. Staged male genital reconstruction with a local flap and free oral graft: a case report and literature review. BMC Urol. 2019;19:104-9. Available from: https://doi.org/10.1186/ s12894-019-0537-6
  15. Milanov NO, Adamyan RT, Lipskiy KB, Gulyaev I. Podgotovka luchevogo kozhno-fastsial’nogo autotransplantata dlya protyazhyonnoy uretroplastiki [Preparation of a radiation skin-fascial autograft for long urethroplasty]. Annaly plasticheskoy, rekonstruktivnoy i esteticheskoy khirurgii. 2007;4:70-3.
  16. Nelson AK, Wessells H, Friedrich JB. Review of microsurgical posterior urethral reconstruction. J Reconstr Microsurg. 2011;27(3):179-86. Available from: https://doi.org/10.1055/s-0030-1270535
  17. Hmida W, Othmen MB, Bako A, Jaidane M, Mosbah F. Penile skin flap: a versatile substitute for anterior urethral stricture. Int Braz J Urol. 2019;45(5):1057- 63. Available from: https://doi.org/10.1590/S1677-5538.IBJU.2018.0652
  18. Rizoev KhKh. Rezul’taty primeneniya bukal’noy uretroplastiki pri strikturakh uretry [Results of the use of buccal urethroplasty for urethral strictures]. Zdravookhranenie Tadzhikistana. 2009;3:55-9.
  19. Guo H, Jia Z, Wang L, Bao X, Huang Y, Zhou J, et al. Tubularized urethral reconstruction using a prevascularized capsular tissue prelaminated with buccal mucosa graft in a rabbit model. Asian Journal of Andrology. 2019;21(4):381- 6. Available from: https://doi.org/10.4103/aja.aja_43_19
  20. Horiguchi A. Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews. Int J Urol. 2017;24(7):493-503. Available from: https://doi.org/10.1111/iju.13356
  21. Verla W, Oosterlinck W, Spinoit AF, Waterloos M. A comprehensive review emphasizing anatomy, etiology, diagnosis, and treatment of male urethral stricture disease. Biomed Res Int. 2019;2019:9046430. Available from: https://doi.org/10.1155/2019/9046430
  22. Khodzhamuradov GM, Saidov MS, Ismoilov MM. Sravnitel’nye kharakteristiki rezul’tatov khirurgicheskogo lecheniya bol’nykh s gipospadiey [Comparative characteristics of the results of surgical treatment of patients with hypospadias]. Nauchno-prakticheskiy zhurnal TIPPMK. 2013;2:205-7.
  23. Khodzhamuradov GM, Ismoilov MM, Ziyozoda SS, Shaymonov AKh. Gipospadiya: problemy vedeniya i lecheniya bol’nykh [Hypospadias: the problems of management and treatment of patients]. Vestnik Avitsenny [Avicenna Bulletin]. 2018;20(4):473-8. Available from: http://dx.doi.org/10.25005/2074- 0581-2018-20-4-473-478
  24. Korshunov MYu, Zhivov AV, Plekhanov AYu. Sozdanie neouretry posle povrezhdeniya mocheispuskatel’nogo kanala prolenovym slingom – etapy i 5-letnie rezul’taty [Constructing neourethra after urethral damage by a prolene mesh sling – stages and 5-year outcomes]. Urologicheskie vedomosti. 2019;9(4):73-76. Available from: https://doi.org/10.17816/uroved9473-76

Authors informations:

Khodzhamuradov Gafur Мukhammadmukhsinovich
Doctor of Medical Sciences, Senior Researcher, Department of Reconstructive Surgery, Republican Scientific Center for Cardiovascular Surgery
Researcher ID: F-4112-2018
ORCID ID: 0000-0002-7095
SPIN: 1726-7169
E-mail: gafur@tojikiston.com

Artykov Karimdzhon Pulatovich
Doctor of Medical Sciences, Full Professor, Professor of the Department of Surgical Diseases № 2, Avicenna State Medical University
Scopus ID: 6506551678
ORCID ID: 0000-0002-6346-0851
Author ID: 909829
SPIN: 2480-6526
E-mail: artikov53@mail.ru

Ismoilov Mukhtordzhon Marufovich
Candidate of Medical Sciences, Head of the Department of Reconstructive Surgery, Republican Scientific Center for Cardiovascular Surgery
ORCID ID: 0000-0002-6344-1810
SPIN: 4699-1871
E-mail: m.ismoilov@mail.ru

Ziyozoda Sorboni Sayburkhondzhon
Postgraduate Student, Department of Surgical Diseases № 2, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-5228-0994
SPIN: 7764-2892
E-mail: ziyozodasorbon@gmail.com

Odinaev Mirali Fayzulloevich
Researcher, Department of Reconstructive Surgery, Republican Scientific Center for Cardiovascular Surgery
Researcher ID: C-5172-2019
ORCID ID: 0000-0002-5361-1724
SPIN: 5388-9704
E-mail: mirali67@mail.ru

Saidov Makhmadullo Sayfulloevich
Researcher, Department of Reconstructive Surgery, Republican Scientific Center for Cardiovascular Surgery
Researcher ID: E-8505-2018
ORCID ID: 0000-0001-9003-1609
SPIN: 6838-1053
E-mail: mahmad_jon1974@mail.ru

Information about the source of support in the form of grants, equipment, and drugs

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflict of interest: No conflict

Address for correspondence:

Saidov Makhmadullo Sayfulloevich
Researcher, Department of Reconstructive Surgery, Republican Scientific Center for Cardiovascular Surgery

734003, Republic of Tajikistan, Dushanbe, Sanoi str., 33

Tel.: +992 (918) 626332

E-mail: mahmad_jon1974@mail.ru

Materials on the topic: