Korean J Urol.  2007 Aug;48(8):863-869. 10.4111/kju.2007.48.8.863.

The Therapeutic Effect of Perineal Urethroplasty using a Gracilis Muscle Flap in a Recurrent Complete Posterior Urethral Stricture

• Lee JH
• Lee YT

• KMID: 2061282
• DOI: http://doi.org/10.4111/kju.2007.48.8.863

Abstract

PURPOSE
To evaluate the usefulness of a gracilis muscle flap for the reconstruction of a complete posterior urethral stricture, where previous treatment had failed.
MATERIALS AND METHODS
Between March 1998 and April 2006, 56 patients, in whom previous urethroplasty or visual internal urethrotomy had failed, were treated with a gracilis muscle flap. All patients had been referred from other institutions. Of the 56 treated patients, 32(group I) underwent perineal urethroplasty, using a stepwise approach of urethral mobilization, including bulbar urethra mobilization, separation of the corporal bodies, inferior pubectomy and retrocrural urethral re-routing 24(group II) underwent perineal urethroplasty, with a gracilis muscle flap for replacement of the dead space, using a stepwise approach.
RESULTS
The mean stricture lengths were 2.7(0.5-5.5) and 3.5cm(1.0-6.5) in groups I and II, respectively(p=0.135). The success rates were 87.5 and 95.8% in groups I and II, respectively(p=0.279). The success rates of patients with urethral stricture of greater than 3cm were 71.4 and 100% in groups I and II, respectively(p=0.037). The success rates of patients who had undergone previous perineal urethroplasty were 82.6 and 100% in groups I and II, respectively(p=0.045). A gracilis muscle flap made no difference to the incidences of erectile dysfunction and incontinence. The incidences of restricture were 15.6 and 0% in groups I and II, respectively (p=0.042).
CONCLUSIONS
Our results showed that a gracilis muscle flap can be useful method with a stricture greater than 3cm in length and in patients having undergone previous perineal urethroplasty.

Keyword

Urethral stricture; Urethroplasty; Gracilis muscle; Complications

MeSH Terms

Constriction, Pathologic
Erectile Dysfunction
Humans
Incidence
Male
Urethra
Urethral Stricture*

Figure

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  Fig. 1 The thigh skin incisions and gracilis muscle mobilization.

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  Fig. 2 Schematic drawing of the technique for the transfer of the gracilis muscle: (A) origin of the gracilis muscle at the pubis symphysis, (B) branch of the medial circumflex femoral artery, (C) medial circumflex branch of the profundal femoral artery, (D) profundal femoral artery, (E) insertion of the gracilis muscle at the medial tibial condyle.

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  Fig. 3 Transposition of the gracilis muscle around an end to end urethral anastomosis.

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