Urethroplasty in a post irradiation urethral stricture-a review

Radiotherapy-induced urethral strictures(RIUS)decrease quality of life and present a great challenge for surgical reconstruction,especially due to proximal location,compromised vascular supply,and poor wound healing.It is unclear whether urethroplasty is an option in cases with stricture resulting from exposure to pelvic radiation.We review the pathophysiology,diagnostic workup,and disease-specific aspects of RIUS.Furthermore,we discuss several management alternatives such as excision and primary anastomosis,as well as techniques for open reconstruction with flaps.The most extensive techniques in the treatment of strictures include,for example,those using gracilis muscle flaps,as they can involve periurethral tissue to provide sufficient vascularity for excellent post-surgery urethral healing.In brief,RIUS represent a significant challenge.In carefully chosen patients,urethroplasty should be considered as a feasible and durable treatment.However,medical practitioners should always take into consideration that the results of urethroplasty in RIUS are not comparable to urethroplasties without a radiation background.

Penoscrotal defect:a functional,esthetic,and psychological challenge

Aim:Penoscrotal defects may be caused by a variety of events.Reconstruction of the penoscrotal region is required not only for aesthetic appearance but also for functional and psychological reasons.Numerous techniques have been described for penoscrotal reconstruction reflecting the challenge and complexity of the region involved.This suggests that no single method is satisfactory for all types and degrees of tissue defects.This prospective study was conducted in a tertiary care hospital in India,over a period of 5 years.Methods:Eighteen patients with penoscrotal defects of varying etiology were included in the study and underwent different surgical techniques.Age of the patients ranged from 20 to 60 years.The etiology of penoscrotal defect was Fournier’s gangrene in 12 cases,trauma in 4 cases,and burn in 2 cases.The patients with Fournier’s gangrene were initially treated by debridement,drainage,and antibiotics.The penoscrotal defects were treated with local flap advancement with skin grafting(n=7),pedicled anterolateral thigh flap(n=4),gracilis muscle flap with split skin grafting(n=4),and medial thigh flap(n=3).Results:There was complete healing in 16 patients with minor complications in the form of partial skin graft loss(n=1)and wound dehiscence(n=1).Results were highly satisfactory in 6 patients,satisfactory in 8 patients,and not satisfactory in 4 patients.Scarring at the donor site was limited and acceptable.Conclusion:The vast arsenal of options for penoscrotal defect coverage ranges from skin grafting to flaps,and every case needs a customized approach with regard to its feasibility,outcome,and complication rate.Flaps should be the preferred choice over the skin grafts because of the superior functional and aesthetic results and better compliance.