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Joshi et al. Plast Aesthet Res 2022;9:22 https://dx.doi.org/10.20517/2347-9264.2021.98 Page 5 of 10
Figure 1. RGU and MCUG suggestive of bulbar urethral stenosis. RGU: Retrograde urethrogram; MCUG: micturating cystourethrogram.
Figure 2. RGU and MCUG depicting bulbar urethral ischemic necrosis (BUIN). RGU: Retrograde urethrogram; MCUG: micturating
cystourethrogram.
Figure 3. Our algorithm for managing Bulbar urethral ischemia.
1. Pedicle preputial flap/tube:
In cases of BUIN, it is important to note preoperatively whether the patient is circumcised or not. In non-
circumcised patients, our preferred approach is to use the prepuce to harvest a pedicle preputial tube for
repair. Two parallel circumcision incisions are made. The outer circumcision is deep to the skin and
superficial to dartos fascia. This dissection is carried forward until the base of the penis. The inner
circumcision is performed deep to dartos and superficial to the Bucks fascia. The entire prepuce is then
