V1-11: Staged Urethroplasty for Penile Urethral Strictures after Hypospadias Repair and Lichen Sclerosus
Staged urethroplasty with oral mucosa graft is a versatile and reliable technique that allows patients with severe penile urethral strictures from lichen sclerosus, repeated failed urethroplasties and trauma to resume standing physiologic voiding. We present our technique for staged urethroplasty in this patient population.
From 2013-2016, staged urethroplasty was performed by a single surgeon (BF) on 20 men. During first-stage surgery, the urethra is divided in the midline and lateralized. Oral mucosa graft is applied to the exposed corpora cavernosa. A bolster dressing and urethral catheter are left in place for 5-7 days. Second-stage urethroplasty is performed 6-9 months later. The urethra is tubularized over a urethral stent, which remains in place for 10 days.
Stricture etiology was lichen sclerosus (9, 45%), failed hypospadias surgery (8, 40%), trauma (2, 10%), and penile calciphylaxis (1, 5%). Twelve men (60%) underwent second stage urethroplasty at a median of 277 days (range 167-738). No patient required additional grafting after first stage. Complications after second stage surgery included wound dehiscence (2, 17%), fistula (1,8%), and stricture (1, 8%).
Staged urethroplasty is an effective treatment for patients with severe penile urethral strictures from lichen sclerosus, repeated failed urethroplasties and trauma.