Introduction: Management of panurethral stricture is challenging .Etiology is usually either Lichen Sclerosus or Iatrogenic. Single stage dorsal onlay with Kulkarni Technique is a preferred approach. In lichen sclerosus, local genital skin cannot be used. We describe a new spiral preputial graft dorsal onlay single stage Urethroplasty for non LS Panurethral strictures.
Methods: Ours is a tertiary care referral center for urethroplasty with experience of more than 6000 Urethroplasties in last 2 decades. This is a prospective study from Jan 2020-July 2021.9 patients of Panurethral stricture were included. None of them had LS. Stricture length was 14 cm .Urethrogram was performed prior to Urethroplasty. Perineal incision ,penile invagination, dorsal onlay approach was performed .A outer circumcision incision was made just deep to the skin. The prepuce was harvested with dissection above the dartos .This was continued to the inner prepuce. Inner circumcision incision was made. The prepuce was harvested like a cylinder. The prepuce was then slided over a 20 cc disposable syringe .A spiral incision was made and a long continuous 1.5 cm wide and 20 cm long graft was made. This was described by Anderson et el. This graft was applied as dorsal onlay like Kulkarni technique from meatus till proximal bulbar urethra. Catheter was removed after 4 weeks.
Results: At follow up, all the patient passed urine within normal uroflow. At 6 months follow up, uroflow remained excellent with a Qmax of 22.3ml/sec. 1 patient had proximal narrowing
There was no chordee, urinary tract infections or sexual dysfunction. There were no local complications
Conclusions: BMG Urethroplasty is the preferred augmentation material for strictures. The results of Penile skin and BMG are almost comparable. In Asian subcontinent ,many men have an intact prepuce. By harvesting a spiral long graft, we avoid junctional strictures (which can take place at the site of 2 BMG).The graft is long and there is no need to harvest another graft .There is no oral morbidity. We also preserve the preputial dartos ,which preserves the neurovascular supply.
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