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Joshi et al. Plast Aesthet Res 2022;9:22 Plastic and
DOI: 10.20517/2347-9264.2021.98
Aesthetic Research

Perspective Open Access

Flaps for bulbar urethral ischemic necrosis in pelvic
fracture urethral injury

1,#
1
1
1,#
Pankaj M. Joshi , Marco Bandini 1,2,3,# , Christian Yepes , Sandeep Bafna , Shreyas Bhadranavar , Vipin
2
1
Sharma , Giuseppe Ottone Cirulli , Sanjay B. Kulkarni 1
1
Kulkarni Endo Surgery Institute and Reconstructive Urology Center, Pune, Maharashtra 411038, India.
2
Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan 20132, Italy.
3
Centro Chirurgico Toscano, Arezzo 52100, Italy.
#
Authors contributed equally.
Correspondence to: Dr. Pankaj M. Joshi, Kulkarni Endo Surgery Institute and Reconstructive Urology Center, Rajpat Society Opp,
Vanazengg Paud Road, Pune, Maharashtra 411038, India. E-mail: drpankajmjoshi@gmail.com
How to cite this article: Joshi PM, Bandini M, Yepes C, Bafna S, Bhadranavar S, Sharma V, Cirulli GO, Kulkarni SB. Flaps for
bulbar urethral ischemic necrosis in pelvic fracture urethral injury. Plast Aesthet Res 2022;9:22.
https://dx.doi.org/10.20517/2347-9264.2021.98
Received: 27 Aug 2021 First Decision: 14 Dec 2021 Revised: 20 Dec 2021 Accepted: 16 Feb 2022 Published: 26 Mar 2022
Academic Editor: Stan Monstrey Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Bulbar urethral ischemic necrosis (BUIN) is an iatrogenic entity resulting from repeated attempts at performing
anastomotic urethroplasty for pelvic fracture urethral injuries. Etiologically speaking, BUIN is related to a
compromised blood supply of the bulbar urethra, which normally relies on anterograde supply from bulbar arteries
and retrograde supply from recurrent branches of dorsal penile arteries, through the glans. At each transection of
the bulbar urethra, both the anterograde and retrograde supplies are compromised, increasing the risk of BUIN.
Even though this term is widely used among reconstructive urologists, BUIN is orphan of an accepted scientific
definition. We aim to report our personal perspective on BUIN, to identify factors associated with its occurrence,
and to describe the management options in these patients.

Keywords: Bulbar urethral ischemic necrosis, inferior pubectomy, pedicled preputial tube, Q-flap

INTRODUCTION
Pelvic fracture urethral injury (PFUI) occurs in 10% of those who suffer from pelvic fractures. The most

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