Neourethra reconstruction using an anterior bladder wall flap for the treatment of complex urethral obliteration and absence.

Background: The optimal surgical approach for complex proximal urethral strictures remains unclear. This study evaluates the outcomes of 11 male patients with complex proximal urethral obliteration and 16 female patients with complete urethral stricture or absence, all treated with urethral reconstruction using an anterior bladder wall flap.

Methods: In this retrospective study, 11 male patients and 16 female patients with complex urethral obliteration or absence were treated from January 1990 to December 2023. Causes included traumatic urethral injury, urethral cancer, and congenital bladder exstrophy. All patients had a closed bladder neck and proximal urethral obliteration or absence, confirmed by urethrography, and underwent reconstruction with an anterior bladder wall flap. Postoperative outcomes were assessed by voiding cystourethrogram and uroflowmetry.

Results: The mean age was 29.3 (range, 4-63) years in 11 male patients and 37.1 (range, 4-73) years in 16 female patients. The mean stricture length in male patients was 7.1 (range, 5-15) and 3.6 (range, 3-5) cm in 16 female patients with complete absence of the urethra or stricture. The mean postoperative follow-up duration was 56.5 (range, 13-350) months. Urethral complications developed in 10 patients (37%), including dysuria in 4 (14.8%) cases, two in male patients and two in female patients, stress incontinence in 6 (22.2%), two in male patients and four in female patients; irregular edema or prolapse of the new urethra mucosa in the bladder neck caused obstruction in two male patients and one in female patient, while the cause was urethral external meatal stenosis in another one case. These patients could easily void after resection of the prolapsed mucosa or meatoplasty via the flap. A supplementary vaginoplasty procedure was performed in four female patients.

Conclusions: Reconstruction of the urethra using an anterior bladder wall flap is an effective technique. This treatment of urethral reconstruction can not only achieve anatomical restoration, but also restore functional urinary continence. Small bladder capacity and inflammation can prevent successful urethra reconstruction using a bladder wall flap.