V01-04: Pedicle preputial tube for bulbar urethral necrosis in failed urethroplasty for PFUDD
Bulbomembranous anatastamosis for Pelvic Fracture Urethra Defect (PFUD) has great success. However, some cases have bulbar urethral ischemia due to inadequate retrograde blood supply. Anastomotic urethroplasty is not possible and substitution urethroplasty using a perineal or abdominoperineal approach is required. Various techniques of flaps,gracilis,radial free forearm flap have been described for this complex issue.The simplest flap are always locally available .We present our description of substitution urethroplasty with a Pedicle Preputial Tube (PPT) for such cases of inadequate bulbar urethral length.
A unique video of a stepwise approach to a difficult case, with accompanying narration of surgical management with PPT. Perineal dissection is performed in a standard stepwise format. Two circumcision incisions are made .The outer circumcision is done beneath the skin and above the dartos.The inner cricumcision is done deep to darts and above the Bucks fascia.Eventually the prepuce is mobilised based on the penile darts.The flap is incised in midline ventrally.Blood supply to this flap comes from dorsal vessels. The prepuce is mobilized into the perineum on the dartos flap. The Inner Prepuce is tubularized and utilized to bridge the long gap between the anterior and posterior urethra.The outer prepuce is excised.
We have performed PPT for 51 patients. It is common for these patients to have post micturition dribble due to diverticulum formation of the skin-lined urethra.The success rate of peddled preputial tube in our unit is 86.4%.
Pedicle Preputial Tube is a viable option for patients in patients with bulbar urethral ischemia .It can be used as a flap onlay or tubularised on its pedicle.This technique can be also performed using distal penile skin in case patient has had circumcision.This technique of pedicled preputial tube is simpler than other complex flaps like the radial free forum flap and gracilis flap with buccal graft .