The penis transposed to the perineum with penile-prostatic anastomotic urethroplasty for the treatment of a long segment complex urethral strictures

BackgroundTo present our experience of transposing the penis to the perineum, with penile-prostatic anastomotic urethroplasty, for the treatment of complex bulbo-membranous urethral strictures.MethodsBetween January 2002 and December 2018, 20 patients with long segment urethral strictures (mean 8.6 cm, range 7.5 to 11 cm) and scarred perineoscrotal skin underwent a procedure of transposition of the penis to the perineum and the penile urethra was anastomosed to the prostatic urethra. Before admission 20 patients had unsuccessful repairs (mean 4.5, range 2 to 12); five patients were associated urethrorectal fistula; 16 patients reported severe penile erectile dysfunction (PED) or no penile erectile at any time and four reported partial erections.ResultsThe mean follow-up period was 45.9 (range 12 to 131) months. Nineteen patients could void normally with a mean Qmax of 22.48 (range 15.6 to 31.4) mL/s. One patient developed postoperative urethral stenosis. After 1 to 10 years of the procedure, nine patients underwent the second procedure. Of the nine patients, four underwent straightening the penis and one-stage anterior urethral reconstruction using a penile circular fasciocutaneous skin flap, and five underwent straightening the penis and staged Johanson urethroplasty. Seven patients could void normally, one developed urethrocutaneous fistula and one developed urethral stenosis.ConclusionsTransposition of the penis to the perineum with pendulous-prostatic anastomotic urethroplasty may be considered as a salvage option for patients with complex long segment posterior urethral strictures.