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      Double breasting repair of urethral fistula in a patient with perineal abscess secondary to a large urethral stone

      case-report

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          Abstract

          We report here a case of urethral fistula managed successfully following incision and drainage for the urethral abscess secondary to a large urethral stone leading to a large diverticulum (another rare condition) by using the technique of double breasting, where we used the redundant urethra and overlying skin.

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          Combined buccal mucosa graft and genital skin flap for reconstruction of extensive anterior urethral strictures.

          Kenneth Angermeier, Staffan Berglund (2006)
          Buccal mucosa has become the graft material of choice for substitution urethroplasty, but the tissue may be insufficient to completely reconstruct an extensive or panurethral stricture. We reviewed our experience with the combination of buccal mucosa and a genital skin flap to assess the efficacy of this approach in this setting. Eighteen patients underwent single-stage urethral reconstruction at our institution from November 1997 to May 2003 using a buccal mucosa onlay graft and a penile and/or scrotal island flap. After surgery, patients were evaluated with voiding urethrography at 3 weeks, followed by flexible cystoscopy at 6 and 12 months and as needed thereafter. The mean stricture length was 15.1 cm (range 9.5 to 22), with an average graft length of 6.3 cm and flap of 8.5 cm. The stricture etiology included multiple hypospadias repair failures in 4 (22.2%), prior instrumentation in 4 (22.2%), pelvic trauma in 3 (16.7%), balanitis xerotica obliterans in 3 (16.7%), and unknown in 4 (22.2%) of the 18 patients. At the last follow-up visit, 3 patients (16.7%) had had recurrent stricture noted on follow-up cystoscopy. In this series, the combination of buccal mucosa and a genital skin flap proved to be a reliable and durable method of single-stage repair for extensive and panurethral stricture disease. The use of longitudinal island flaps and patient repositioning during surgery seemed to contribute to a decreased incidence of local and systemic morbidity.
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            Dorsal double-layer dartos flap for preventing fistulae formation in the Snodgrass technique.

            Vedat Bakan, Abdullah Yıldız (2006)
            The Snodgrass technique and its modifications have become a preferred method for all varieties of hypospadias in the past decade. However, fistula is the most common complication of this technique. The aim of this study was to investigate the importance of the single and double flap to prevent fistula formation in the Snodgrass procedure. Tubularized incised plate urethroplasty, using a single or the double flap, was undertaken in 74 consecutive boys (median age 6.6 years old, range 1-15) within the last 4 years. In the first 29 patients (group 1), a dorsolateral flap was rotated laterally for covering the neourethra and in the remaining 45 patients (group 2) the neourethra was covered with dorsal double dartos flaps. In group 1, fistula in 4 patients and partial glanular dehiscence in 1 patient were detected. There was no fistula formation in group 2. For preventing fistula formation, urethral covering by a well-vascularized dorsal double-layer dartos flap should be the basic part of the Snodgrass procedure. Copyright 2007 S. Karger AG, Basel.
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              Giant calculus of the posterior urethra following recurrent penile urethral stricture.

              P Olbert, A. Hegele, Paul A Heidenreich … (2001)
              A case of an unusually large, proximal urethral calculus located very close to the external sphincter and caused by recurrent urethral stricture is presented. Copyright 2002 S. Karger AG, Basel
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Plast Surg
                Journal ID (publisher-id): IJPS
                Title: Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India
                Publisher: Medknow Publication (India )
                ISSN (Print): 0970-0358
                ISSN (Electronic): 1998-376X
                Publication date (Print): Jul-Dec 2008
                Volume: 41
                Issue: 2
                Pages: 226-228
                Affiliations
                Department of Surgery, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, India
                Author notes
                Address for Correspondence: Dr. Sankalp Dwivedi, Department of Surgery, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India. E-mail- sankalpdwivedi@ 123456yahoo.com
                Article
                Publisher ID: IJPS-41-226
                DOI: 10.4103/0970-0358.44938
                PMC ID: 2740513
                PubMed ID: 19753271
                SO-VID: 4afa01ae-a148-41b8-aeb5-bda7ed198f57
                Copyright © © Indian Journal of Plastic Surgery
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: urethra,urethral fistula,urethral diverticulum,double breasting
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: urethra, urethral fistula, urethral diverticulum, double breasting

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