Orandi flap—A versatile option for anterior urethral stricture disease and experience in a regional Australian centre

Objective

In regards to the treatment of anterior urethral stricture disease, a Urologist must possess diverse techniques tailored to address the varied clinical presentations of the entity. The Orandi flap, a longitudinal ventral penile skin flap with a vascular lateral pedicle lends its utilisation in tackling challenging ischemic strictures and re-do urethroplasty [1]. The technique is elucidated in the accompanying video providing a demonstration and discussion of its application. The study also presents the outcomes achieved at a regional centre, demonstrating its efficacy in clinical practice.

Methods and surgical procedure

A 77 year old male with a non-obliterative anterior urethral stricture, had failed clean intermittent self cathterisation and urethral dilatation. He has a three piece penile prosthesis inserted for erectile dysfunction therefore precluding a dorsal approach to urethroplasty. Retrograde urethrography revealed a 6 cm stricture extending proximally from the meatus.

The urethra is opened dorsally through the length of the stricture and the medial edge of the skin flap which has been dissected in sutured onto the left edge of the urethral plate. The skin flap is then rotated over the IDC and sutured onto the right edge of the urethral plate. Glans is re-approximated and the skin is closed overlying. The patient had no post operative complications and experienced improvement in voiding. The patient did not continue clean intermittent self-catheterisation or further urethral dilatation post operatively. A prospective study was conducted to evaluate the effectiveness of the Orandi flap procedure in reestablishing urinary function and its influence on patients' sexual function and quality of life. All surgeries were performed by a single reconstructive fellowship-trained consultant urologist at a regional centre. Pre and post operative assessments included uroflowmetry and modified patient reported outcomes measures survey.

Results

The favourable outcomes elicited in the presented patient was reproduced in the other patients treated at our regional centre. Prospective data collected on all patients undergoing Orandi flap (n = 4), demonstrated that no complications were recorded and no further interventions such as urethral dilatation or urethroplasty is required. Analysis of this patient cohort revealed an average improvement in maximum flow rate (Qmax) of 316 % at 3 months post procedure affirming the efficacy and reproducibility of the outcomes. 100 % of all patients were satisfied at 3,6 and 12 months.

Conclusion

The Orandi flap stands as a versatile and efficacious option for anterior urethral stricture disease. Its durability enables its application in challenging scenarios such as those of re-do urethroplasty and ischemic stricture. The flap yields favourable outcomes such as those evidenced at our regional centre.