Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug;28(8):806-811.
doi: 10.1111/iju.14582. Epub 2021 May 6.

Triangular extension of hinge flaps: A novel technique to resolve stomal stenosis and prevent restenosis in staged buccal mucosal urethroplasty

Ryuichi Azuma  1 , Akio Horiguchi  2 , Kenichiro Ojima  2 , Masayuki Shinchi  3 , Tetsushi Aizawa  1 , Masato Tsuchiya  1 , Eiko Nakayama  1 , Hisato Nagano  1 , Keiichi Ito  2 , Tomohiko Asano  2 , Tomoharu Kiyosawa  1
Affiliations

Triangular extension of hinge flaps: A novel technique to resolve stomal stenosis and prevent restenosis in staged buccal mucosal urethroplasty

Ryuichi Azuma et al. Int J Urol. 2021 Aug.

Abstract

Objectives: To verify the utility of triangular extension of a hinge flap in buccal mucosal staged urethroplasty to resolve stomal stenosis after the first stage and ultimately prevent restenosis.

Methods: A total of 23 patients (triangular extension group) were studied in 2013-2019. In the first stage, buccal mucosa was transplanted, and an extended triangle portion of the mucosa was placed beside the proximal and/or distal stoma that was created when the stricture segment of the urethra was resected. In the second stage, during tubularization of the urethral plate, an incision was made at the stoma to increase the caliber to which the triangular extension was inserted. The procedure was considered successful when a 17-Fr flexible cystoscope passed through the reconstructed urethra at 6 months after the second-stage urethroplasty and no additional surgery or bougie dilation required. The clinical course of the triangular extension group was compared with 24 patients who underwent conventional staged urethroplasty (control group).

Results: In total, 20 patients from each group underwent second-stage surgery. No patients in the triangular extension group required additional revision surgery because of stomal stenosis after first-stage surgery, whereas five (20%) control patients did. Urethroplasty was successful in 19 patients (95%) in the triangular extension group and in 19 patients (95%) in the control group. Uroflowmetry after the second-stage surgery indicated that the mean maximum urinary flow rate was 21.5 and 15.8 mL/s after triangular extension and the control procedure, respectively (P = 0.027).

Conclusions: The triangular extension technique reduces the need for revision surgery and prevents postoperative restenosis.

Keywords: hinge flap; mucosal graft; stenosis; triangular extension; urethroplasty.

PubMed Disclaimer

Comment in

References

    1. Palminteri E, Lazzeri M, Guazzoni G, Turini D, Barbagli G. New 2-stage buccal mucosal graft urethroplasty. J. Urol. 2002; 167: 130-2.
    1. Andrich D, Greenwell T, Mundy A. The problems of penile urethroplasty with particular reference to 2-stage reconstructions. J. Urol. 2003; 170: 87-9.
    1. Snodgrass W, Elmore J. Initial experience with staged buccal graft (Bracka) hypospadias reoperations. J. Urol. 2004; 172: 1720-4.
    1. Andrich DE, Mundy AR. What is the best technique for urethroplasty? Eur. Urol. 2008; 54: 1031-41.
    1. Kulkarni S, Barbagli G, Kirpekar D, Mirri F, Lazzeri M. Lichen sclerosus of the male genitalia and urethra: surgical options and results in a multicenter international experience with 215 patients. Eur. Urol. 2009; 55: 945-56.

Publication types

MeSH terms

LinkOut - more resources