Staged Bulbar Urethroplasty Using Bilateral Perineal Skin Flaps as the Urethral Plate

Objective: To assess outcomes of staged bulbar urethroplasty using bilateral perineal skin flaps as urethral plate substitutes in patients with obliterative or nearly obliterative bulbar urethral strictures. Materials and Methods:A retrospective analysis was conducted on 19 male patients with severe bulbar urethral strictures who underwent two-stage urethroplasty using scrotal or penile fasciocutaneous flaps.Inclusion criteria included urethral mucosa widths less than 3 mm and stricture length exceeding 3 cm.Initially, perineal skin flaps reconstructed the urethral plate.Six months later, a tubularized neourethra was created using scrotal or penile flaps.Patients were evaluated preoperatively and at 1 month and 6 months postoperatively using uroflowmetry and International Prostate Symptom Score (IPSS).Results: Patient ages ranged from 27 to 76 years, with a median of 60.The median stricture length was 4.6 cm.For those with cystostomy, median IPSS at six months post-surgery was 5 (range: 0-8).Postoperative Qmax values at first (Qmax-1) and sixth months (Qmax-6) were 22 ml/s (range: 14-26 ml/s) and 21 ml/s (range: 14-29 ml/s).In patients with urinary difficulties, the maximum urinary flow rate (Qmax) improved from 4.6 to 20 ml/s post-surgery (p = 0.0001), with IPSS reduction from 23 to 4 (p = 0.005).Complications were minimal, with no infections, fistulas, or penile deformities.Two patients developed circular strictures requiring internal urethrotomy, and three experienced terminal dribbling.Conclusion: Staged urethroplasty using bilateral perineal skin flaps is viable and effective for complex bulbar urethral strictures.This method shows favorable functional and cosmetic outcomes with low complications, particularly where single-stage repair is unfeasible.