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Objective <p>To evaluate the feasibility and clinical effectiveness of urethroplasty using a perineum-based scrotal flap (PBSF) for complex bulbomembranous urethral strictures (BMUS ≥ 5&#xa0;cm with severe scarring).</p> Methods <p>We retrospectively analyzed 26 patients with complex BMUS treated at Shanghai Sixth People’s Hospital between January 2015 and June 2024. The median stricture length was 7.0&#xa0;cm (IQR: 5.8–8.5). The preoperative maximum urinary flow rate (Qmax) was 2.8 ± 2.5&#xa0;ml/s. Standard posterior urethroplasty steps were performed, and when tension-free anastomosis was not possible, a full-thickness pedicled perineal flap was harvested and tubularized to bridge the defect. A silicone catheter was left in place for 4 weeks. All patients underwent uroflowmetry, retrograde urethrography (RUG) and voiding cystourethrography (VCUG) to determine the stricture length, location and recurrence. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5).</p> Results <p>Postoperative Qmax significantly improved to 18.1 ± 11.3&#xa0;ml/s (<i>P</i> &lt; 0.001). Nineteen patients (73.1%) achieved both anatomical and functional success. Seven patients experienced Clavien–Dindo grade III complications (26.9%). Anastomotic strictures (4 patients, 15.4%): two treated with internal urethrotomy, two underwent cystostomy). Hair growth with stone formation (2 patients, 7.7%): Both experienced recurrence after endoscopic lithotripsy. Urethral skin fistula (1 patient, 3.8%): successfully managed with re-urethroplasty. No significant change in erectile function was observed (<i>P</i> = 0.396).</p> Conclusion <p>PBSF urethroplasty provides well-vascularized tissue, flexible dimensions, and reliable tubularization. It is a viable option for long-segment BMUS, especially in patients with hairless perineal skin and when end-to-end anastomosis is not feasible.</p>

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Application of perineal pedicled tubular flap in the treatment of complex bulbomembranous urethral strictures

  • 期刊论文

  • 发表日期：

    2025年10月8日

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  • Chao Deng,
  • Wenzhuo Fang,
  • Lujie Song,
  • Yuemin Xu,
  • Yinglong Sa,
  • Hang Guo,
  • Tao Liang,
  • Qiang Fu

摘要

Objective

To evaluate the feasibility and clinical effectiveness of urethroplasty using a perineum-based scrotal flap (PBSF) for complex bulbomembranous urethral strictures (BMUS ≥ 5 cm with severe scarring).

Methods

We retrospectively analyzed 26 patients with complex BMUS treated at Shanghai Sixth People’s Hospital between January 2015 and June 2024. The median stricture length was 7.0 cm (IQR: 5.8–8.5). The preoperative maximum urinary flow rate (Qmax) was 2.8 ± 2.5 ml/s. Standard posterior urethroplasty steps were performed, and when tension-free anastomosis was not possible, a full-thickness pedicled perineal flap was harvested and tubularized to bridge the defect. A silicone catheter was left in place for 4 weeks. All patients underwent uroflowmetry, retrograde urethrography (RUG) and voiding cystourethrography (VCUG) to determine the stricture length, location and recurrence. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5).

Results

Postoperative Qmax significantly improved to 18.1 ± 11.3 ml/s (P < 0.001). Nineteen patients (73.1%) achieved both anatomical and functional success. Seven patients experienced Clavien–Dindo grade III complications (26.9%). Anastomotic strictures (4 patients, 15.4%): two treated with internal urethrotomy, two underwent cystostomy). Hair growth with stone formation (2 patients, 7.7%): Both experienced recurrence after endoscopic lithotripsy. Urethral skin fistula (1 patient, 3.8%): successfully managed with re-urethroplasty. No significant change in erectile function was observed (P = 0.396).

Conclusion

PBSF urethroplasty provides well-vascularized tissue, flexible dimensions, and reliable tubularization. It is a viable option for long-segment BMUS, especially in patients with hairless perineal skin and when end-to-end anastomosis is not feasible.