Reconstruction of strictures of the fossa navicularis and meatus with transverse island fasciocutaneous penile flap

Purpose: Reconstruction of post-prostatectomy strictures involving the fossa navicularis and external urethral meatus following benign prostatic hyperplasia treatment is challenging in terms of creating a functional and cosmetically appealing penis. We reviewed our results with the use of ventral transverse island fasciocutaneous penile flap in the reconstruction of these strictures. Materials and Methods: Between 1997 and 2007 a total of 26 men (mean age 59 years, range 49 to 76) with post-prostatectomy distal urethral strictures underwent urethral reconstruction with a ventral transverse island fasciocutaneous penile flap. All patients had undergone multiple urethral dilatations. Stricture length was less than 1.5 cm in all cases. Urethral catheter was removed within 3 weeks. Followup included an initial uroflowmetry obtained 1 month after removal of the catheter followed by re-assessment at third month. The patients were followed for urinary pattern changes and/or irritative symptoms with a mean followup of 30.2 months (range 4 to 96). Results: Mean maximum urine flow rate at first month assessment was 17 ml per second. Flap necrosis and fistula developed in 1 patient 3 months after surgery. In the remaining patients stricture was not evident. A mild urinary splaying was observed in all patients which improved significantly within 6 weeks. A functional and cosmetic outcome was achieved in 96% of the patients. Conclusions: Reconstruction of post-prostatectomy strictures involving the fossa navicularis and external meatus with ventral transverse island fasciocutaneous penile flap is an efficient method for the restoration of a functional and cosmetic penis with preserved glandular integrity.