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Urethral stricture disease is one of the commonest diseases treated by Urologists. No two forms of the disease can be assumed to be the same because of the varied aetiologies and modalities of management. Choice of treatment modality depends on location of the stricture, available facilities and the experience of the managing surgeon. Urethral dilatation and internal urethrotomy as modalities of treatment have limited usage in current day practice because when there is associated spongiofibrosis, they are not curative. Urethral reconstruction has therefore become the mainstay treatment of urethral stricture disease when the aim is to cure the patient of such a crippling ailment. (Rosen et al., 1994) Anastomotic urethroplasty is considered the best form of reconstruction when possible because no tissue can replace the urethra better then the urethra itself. (Santucci et al., 2002) However, anastomotic urethroplasty has limited application in urethral reconstruction because it can cause abnormal penile curvature (chordee) due to shortening of the urethra relative to the spongy tissues during penile erection. This may result in painful erection and disturbance of sexual function with resultant psychological disturbances. Anastomotic urethroplasty is therefore better avoided in reconstruction of some urethral stricture like those located in the penile urethra or long segment stricture (>2cm) located in the bulbar urethra. In such cases, substitution urethroplasty is considered most appropriate. (Kellner et al., 2004) Since its introduction, substitution urethroplasty has remained one of the standard methods for urethral reconstruction especially in difficult urethral stricture or where other modalities of treatment have failed. (Olajide et al., 2010) Several tissues have been used to replace diseased urethra and the best tissue to use is an area of controversy. Buccal mucosa, bladder mucosa, intestinal mucosa, scrotal skin, perineal skin and penile skin are some of the tissues that have been used. Some are used as graft while others are used as flaps. However, one incontrovertible finding is the fact that flaps have an obvious advantage over grafts because it does not depend on the blood supply of the recipient tissue which may be non dependable in some situation because of associated severe spongiofibrosis and precarious blood supply. (MacDonald & Santucci, 2005) |
