Pedicled rectus abdominis muscle flap wrapped around the penis for enhanced urethral pressure: an experimental study in dogs

PURPOSE: It was the aim of this study to investigate the possibility of pedicled rectus abdominis muscle fascial flap wrapped around the penis for enhanced urethral pressure in dogs. MATERIALS AND METHODS: Ten adult male Beagle dogs underwent a procedure in which surrounding tissue of the penis at the site of the bulbomembranous urethra was dissected and a pedicled rectus abdominis muscle fascial flap was wrapped around the penis. Profilometry of the urethral pressure was carried out before, during and after the operation in all dogs. RESULTS: Before the operation, the mean maximal urethral pressure (MUP) was 48.9 +/- 11 cm H(2)O, and the mean MUP was 78.3 +/- 20.5 cm H(2)O after the penis was surrounded by a rectus muscle flap. There was a significant difference (t = 4.99, p = 0.0007). Ten weeks after the operation, the mean MUP was 88.3 +/- 22.4 cm H(2)O, which was significantly higher than that before the operation (t = 6.0584, p = 0.0002). CONCLUSIONS: A pedicled rectus abdominis muscle fascial flap wrapped around the penis can raise the urethral pressure. This provided an experiment basis for treating male urinary incontinence with a pedicled rectus muscle flap.     

Oral mucosal grafts urethroplasty for the treatment of long segmented anterior urethral strictures

Objective  To evaluate the efficacy and safety of using oral mucosal grafts for urethroplasty in the treatment of complex segmented urethral strictures. Methods  Between January 2002 and January 2008, 25 cases of long or multi-segmented urethral strictures (10–18 cm, mean 11.72) were treated using combined two oral mucosal graft urethroplasty. Of the 25 patients, combined double buccal mucosal graft (BMG) urethroplasty was performed in nine patients, double lingual mucosal graft (LMG) urethroplasty in seven patients and combined lingual and buccal mucosal graft urethroplasty in nine patients. Results  Follow-up was obtained for 6–72 months (mean 26.83) post-operatively. Urethrocutaneous fistulas developed in two patients. Urethral strictures developed in one patient undergoing BMG urethroplasty; the patient underwent five urethral dilations, after which he voided well with a urinary peak flow of 26.4 ml/s. Meatal stenosis developed in one patient undergoing LMG and a second operation was required, after which the patient voided well (urinary peak flow of 28.7 ml/s). The other patients voided well and urinary peak flow rates ranged from 16.8 to 49.2 ml/s (mean 28.65 ml/s). Conclusion  Combined two oral mucosal grafts substitution urethroplasty is an effective technique for the treatment of long, segmented urethral strictures.