Feasibility and short-term outcomes of the dorsal inlay skin flap for challenging distal penile urethral strictures—a novel case series

Background: Distal penile +/- meatus and fossa navicularis urethral stricture disease (USD) presents major reconstructive challenges owing to poor local vascularity and a high risk of dorsal graft failure. This study describes the novel Dorsal External Skin Augmented Inlay (DESAI) flap urethroplasty, a single-stage technique designed to achieve durable patency in distal ischemic urethral strictures while preserving glans morphology and cosmesis. Case Description: A prospective case series of seven men (mean age 54.7±13.9 years) with distal penile USD and impaired local vascularity underwent DESAI flap urethroplasty by a single reconstructive urologist between 2020 and 2025. Four patients (57.1%) had previous failed reconstructions and one (14.3%) had prior pelvic radiotherapy (RT). Functional outcomes were assessed using maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and disease-specific quality-of-life (QoL) measures pre- and post-operatively. Statistical significance was defined as P