[Arterialized penile skin flap: personal technique of reconstruction of the bulbo-membranous urethra].

In bulbar-membranous urethral strictures, the surgical choice treatment should consist on removing the stricture and performing an end to end overlap anastomosis between two flat patent surfaces (Turner-Warwick's technique), whenever possible. When this procedure cannot be used (recurrence, complex or too long strictures), we get different types of tissue in order to create a fitting neo-urethra. To this goal, in the last twenty years we performed, a wide range of urethroplastic techniques (scrotal flap, bladder mucosa free grafts, dermo-epidermal free mesh-grafts). We recently achieved a significant improvement of the post-operative results by an original procedure, which consists in using a very well-vascularized pediculed flap, taken from the complete penile dorsal skin, pulling it to the perineal area, laterally to the cavernous bodies, to be employed for the reconstruction of the neurethra. By this way, we obtain a viable and suitable tissue, reaching even 13 cm in length, so creating a very long segment of neurorethra. A free dermoepidermal mesh-graft should be used to cover the dorsal surface of the penis, in case of enlarged skin uptake. From February 1989 to April 1990, 16 patients affected with complex and relapsed bulbar-membranous urethral strictures, underwent urethroplasty with penile skin island flap. Urethrocistograms and urinary flowmetry performed 3 months from operation demonstrated effective results and all patients referred satisfactory micturation; no fistulas occurred.