Anatomical and Functional Outcome of Penile Skin Graft for Urethral Substitution in Long Segment Anterior Urethral Strictures Using One-sided Dorsal Perineal Approach: A Prospective Study

Document Type : Original Article

Authors

Urology, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt

10.21608/aimj.2025.446616

Abstract

Objectives: To assess the outcomes of penile skin graft (PSG) in repairing long anterior urethral strictures using a unilateral dorsal perineal approach.
Methods: This prospective study involved 31 patients diagnosed with long anterior urethral strictures (>2 cm) between June 2022 and July 2024. All patients underwent PSG urethroplasty and were followed for 12 months. The primary endpoint was urethral patency at 12 months, evaluated by retrograde urethrography (RUG). Secondary outcomes included improvements in lower urinary tract symptoms (LUTS), sexual function, and patient satisfaction, assessed through IPSS, IIEF-5, MSHQ-EJD, and satisfaction questionnaires. Success was defined as symptom improvement by 50%, a Q-max ≥ 10 mL/s, and no recurrent stricture on RUG.
Results: The mean age of the patients was 40.9 ± 14 years, with 22 (71.0%) having prior urethral interventions. The mean stricture length was 6.4 ± 2.3 cm, and the mean operative time was 115.6 ± 18.9 minutes. At 12 months, the success rate was 87.1% (95% CI: 70.2% – 96.4%). Significant improvements were noted in Q-max, IPSS, and patient satisfaction (all p < 0.001). No significant differences were observed in IIEF-5 (p = 0.460) and MSHQ-EJD scores (p = 0.500). Postoperative complications occurred in 2 patients (6.45%), both with urethrocutaneous fistulas.
Conclusion: PSG for long anterior urethral strictures demonstrates high success rates, significant improvement in urinary symptoms, preservation of sexual and ejaculatory functions, and a low incidence of complications.

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