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Page 2 of 4 Djordjevic et al. Plast Aesthet Res 2023;10:4 https://dx.doi.org/10.20517/2347-9264.2023.09

the oral mucosa is the gold standard for urethral stricture repair, other options are becoming more popular,
including grafts from bowel or bladder mucosa. This paper introduces new modalities with good outcomes
and minor postoperative complications.

One of the most common congenital anomalies is hypospadias. Numerous papers have been published on
the topic in recent decades. Epispadias is a challenging congenital anomaly of the penis and urethra, and
only a few surgical procedures have been published recently. Dr. Bizic, in her paper entitled “Epispadias:
recent techniques”, summarizes the knowledge of this anomaly with special attention to urethral
reconstruction in one or two stages. One-stage primary repair is always tricky but produces the best
outcomes. Another option for staged epispadias repair presents a suitable variant, especially in cases without
available genital tissue and in severe forms. Finally, redo surgery in adults after failed primary repairs in
childhood is a new avenue for transitioning urology and offering the best possible aesthetic and functional
outcomes.

Dr. Martins and his group presented the essential elements of flap and graft tissue that are well-known for
stricture repair in “Combined grafts and flaps in urethral stricture repair”. They confirmed that various
grafts and flaps have been paramount for urethral stricture repairs and should remain an option for
reconstructive surgeons. Combined use of a graft with hairless skin flaps could be the best option for a safe,
predictable, and long-lasting approach in single-stage urethroplasty due to complex urethral stricture
disease. The authors concluded that further randomized studies would be helpful to support one technique
over another. Having a comprehensive armamentarium and choosing the best treatment for each patient is
essential.

In “Genital flaps for anterior urethral reconstruction”, the group from UCSF led by Breyer described using
genital grafts for anterior urethral strictures. They focused on genital skin flaps, particularly those derived
from penile skin, based on their vascularization, harvesting, and characteristics. The authors described all
possibilities, including longitudinal, transversal, ventral, and dorsal penile skin flaps. They concluded that
penile skin flaps play an important role in anterior urethral reconstruction in appropriately selected
patients.

“Flaps for bulbar urethral ischemic necrosis in pelvic fracture urethral injury” from the Indian group
explains the definition of bulbar urethral ischemic necrosis as an iatrogenic entity resulting from repeated
attempts at anastomotic urethroplasty for pelvic fracture urethral injuries. Vascular etiology due to
compromised blood supply of the bulbar urethra results in a compromised or complete absence of a
segment of the bulbar urethra. Urethral stricture is presented as a long narrowing, semi-obliteration, or the
absence of a segment of the bulbar urethra. The authors described the complete etiology, diagnostic
methods, and treatment options and concluded with recommendations for prevention or its management.
Special consideration should be taken for cases of urethral reconstruction in patients after phalloplasty.
Primary urethroplasty is always associated with a complex vascular supply of the neophallus derived from
anastomotic or non-anatomic flaps. This is the primary difference in urethral reconstruction between the
penis and neophallus.

In “Management of urethral strictures after masculinizing genital surgery in transgender men”, the Mount
Sinai transgender group reviewed options for urethral stricture repair after neophalloplasty urethral
reconstruction. They confirmed previously reported outcomes of high rates of urethral strictures in their
patients and recommended further research to identify better solutions.