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Shaw et al. Plast Aesthet Res 2021;8:52 Plastic and
DOI: 10.20517/2347-9264.2021.53
Aesthetic Research

Review Open Access

Genital flaps for anterior urethral reconstruction

Nathan M. Shaw, Gregory Amend, Benjamin N. Breyer
Department of Urology, University of California, San Francisco, CA 94110, USA.
Correspondence to: Prof. Benjamin N. Breyer, Department of Urology, University of California, Box 0807, Floor 10, Room 20,
1001 Potrero Ave, San Francisco, CA 94110, USA. E-mail: benjamin.breyer@ucsf.edu

How to cite this article: Shaw NM, Amend G, Breyer BN. Genital flaps for anterior urethral reconstruction. Plast Aesthet Res
2021;8:52. https://dx.doi.org/10.20517/2347-9264.2021.53

Received: 27 May 2021 First Decision: 26 Jul 2021 Revised: 27 Jul 2021 Accepted: 9 Aug 2021 Published: 17 Sep 2021

Academic Editors: Miroslav L. Djordjevic, Stan M. Monstrey Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Genital flaps can provide versatile options for complex penile, genital, and urethral reconstruction. Pedicled muscle
flaps can be used in combination with grafting for urethral reconstruction, and genital skin flaps can also be utilized
as urethral augmentation or replacement. Penile skin flaps, in particular, offer versatile options for the management
of anterior urethral stricture disease. The choice of urethral reconstruction depends on surgeon expertise and
patient disease. Given its surgical complexity, flap reconstruction is equally dependent on an appropriate
understanding of patient disease and surgeon experience. It is crucial to understand the patients’ comorbid
diseases (e.g., smoking status or lichen sclerosis), potential flap tissue quality (i.e., penile/preputial skin quality),
and stricture anatomy (length, caliber, location). Of particular importance is any prior intervention that may alter
the normal vascular supply to the proposed flap. The ideal skin flap will be (1) hairless; (2) accustomed to the
aqueous environment; (3) adaptable; and (4) cosmetic. This review will cover the operative approaches and peri-
operative outcomes of genital flaps to manage urethral reconstruction. Particular attention will be paid to penile
skin flap urethroplasty.

Keywords: Urethral stricture, genital flap, penile flap, reconstructive urology

INTRODUCTION
Urethroplasty is the gold standard for the treatment of urethral stricture disease. While urethroplasty
techniques can be technically demanding and have a significantly associated learning curve, the success
[1]
rates are excellent and significantly better than endoscopic alternatives . Urethral grafting, genital skin

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
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