INTRODUCTION AND PURPOSE: The management of of extensive urethral strictures represents one of the most challenging clinical problems in uroplastic surgery. We report our experience with one-stage reconstruction of long urethral strictures using a longitudinal ventral tubed flap of penile skin.      PATIENTS AND METHODS: Between 1997 and 2001, two men underwent one-stage urethroplasty using a penile tubed skin island flap which was developed in the immediately beneath Buck's fascia. All men had multiple or extensive strictures involving the long segment of anterior urethra (at least 7 cm). None had undergone prior open urethroplasty.   RESULTS: The longitudinal ventral tubed flap of penile skin provided a pedicled strip of penile skin measuring an average of 9 cm (range 8-10 cm). Additional graft materials were not necessary for reconstruction in any patient. Mean follow-up was 26.5 months (range 3 to 50 months). Postoperative imaging included a VCUG at 2 weeks, which was repeated at follow-up if there was clinical evidence of stricture recurrence. There were no urethral strictures.   CONCLUSIONS: We have successfully performed one-stage reconstruction of long urethral strictures using a longitudinal ventral tubed flap of penile skin. Long-term evaluation reveals stable performance characteristics without any complication. Fig 1.Preoperative urethrogram Note severe strictures on the whole anterior urethra. Fig 2. 50 months after surgery.  Note well-delineated urethral passage on urethrogram.     Fig 3. Neourethra formation after insertion of 18-French Foley catheter.   Fig 4. Thirty months after surgery, showing the active urination.

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