A Case of Recurrent Bulbar Urethral Stricture Salvaged by Penile Skin Tube Flap Urethroplasty

A 47-year-old male had previously undergone internal urethrotomy three times for bulbar urethral stricture. During the third internal urethrotomy, the iatrogenic rectal injury occurred and resulted in the rectourethral fistula. Subsequently, the urethral stricture became obliterative, and the patient voided through the fistula via the rectum. Twelve years after the initial diagnosis of bulbar urethral stricture, he was referred to our hospital for urethral reconstruction. We performed excision and primary anastomosis along with fistula closure. However, shortly after initiating voiding, stricture recurred at the anastomosis site. Six years after the initial surgery, we performed a re-do excision and primary anastomosis, but stricture recurred again. He was managed with intermittent self-dilation, but the stricture progressed to involve a longer urethral segment. Five years after the second surgery, we performed salvage penile skin flap tube urethroplasty. A 3 cm circumferential incision was made to harvest the foreskin flap, which was transferred to the perineum and tubularized. After complete excision of the scarred bulbar urethra, the tubularized foreskin flap was interposed to the urethral defect. The patient could void on postoperative day 24 and remains stricture-free with good voiding sixteen months postoperatively. While transurethral treatment is a simple and widely used for urethral strictures, it is essential to recognize that repeated procedures can lead to increase stricture complexity and negatively impact subsequent urethroplasty outcome.