Split-thickness thigh skin grafts for extended urethroplasty: Retrospective assessment of surgical and functional outcomes.

Abstract

Introduction: The objective of this study was to evaluate the feasibility and clinical outcomes of single-stage dorsal onlay urethroplasty using thigh-harvested split-thickness skin grafts (STSGs) for the treatment of panurethral strictures.

Methods: Between July 2019 and November 2023, 17 patients with urethral strictures ≥8 cm underwent single-stage dorsal onlay STSG urethroplasty at a single center. Grafts were harvested using an electric dermatome. Follow-up included uroflowmetry at 1, 6, 12, 24, and 36 months, alongside 5-item International Index of Erectile Function (IIEF-5) and International Prostate Symptom Score quality of life questionnaires at 48 months.

Results: The mean patient age was 55.6 years, and the median stricture length was 10 cm. Etiology was primarily iatrogenic (70.6%), followed by lichen sclerosus (23.5%) and infection (5.9%). Median operative time and hospital stay were 249 min (interquartile ranges [IQR]: 79) and 5 days (IQR: 2.5), respectively. The overall complication rate was 11.8%. Median Qmax remained stable over time: 22.3 mL/s at 1 month, 25 mL/s at 6 months, 22 mL/s at 12 months, and 19 mL/s at 48 months. At the 3-year assessment, the median post-void residual measured by bladder scan and confirmed with uroflowmetry was 30 mL (IQR: 30). At 48 months, median IIEF-5 was 23 (IQR: 12), indicated preserved erectile function. One recurrence occurred within 24 months, with five total recurrences by 48 months. Regarding patient satisfaction (Likert scale), 14 out of 17 patients reported being "satisfied" or "very satisfied."

Conclusions: Single-stage panurethroplasty with STSG is a feasible, effective, and durable surgical option for long-segment strictures. Larger studies are needed to validate these findings.