E-learning Bedah FK UNS

RECONSTRUCTION OF URETHRAL DEFECT POST URETHROPLASTY : RE-URETHROPLASTY AND WOUND CLOSURE USING ADVANCEMENT FLAP (A CASE REPORT)

Bagus Aris Madani1, Amru Sungkar2

1 Sebelas Maret University,Resident of General Surgeon,Solo;

2 Sebelas Maret University, Plasticsurgeon,Solo

ABSTRACT

Introduction : Urethral defect is rare and usually a result of infectious complications, trauma or surgery. Even after complex hypospadia repair, it is reported in no more than 10% of cases. Repair of the defect is individualized, it may involve the tehniques employed in hypospadias surgery or more complex reconstruction of the distal urethra and glans.

A Case Report : Male patient, 12 years old, came with his family with chief complaints of urination not from the tip of the genital. History of uretroplasty at Private Hospital in Surakarta at age of 6 years. From physical examination, the penis region had been circumcised. On the ventral side, there was a defect of ± 4 mm from distal of coronary sulcus with the measurement of 1x0.5 cm.

Discussion : Urethroplasty is generally well tolerated with a high rate of success, serious complications occur in fewer than ten percent of patients. Urethral defect is rare complication of penile and urethral surgery. Literally hundred of techniques have been reported over the years. Penile skin flaps, when used correctly, are a reliable for urethral reconstruction. In case of an isolated defect with intact spongiosum, repair with local flaps is sufficient. Flap provides the advantage of rich vascularity and flexibility. A flap refers to the tissue transferred with the original intact blood supply, while the graft refers to the tissue removed from the donor site without the original blood supply and relies on the formation of a new circulation through a process called "take. This becomes an option for the improvement of urethral defect. The flap maintains postoperative flexibility with little tendency to shrinkage and re-stricture.

Conclusion : We reported a boy 12 years old was diagnosed urethral defect post urethroplasty. We performed urethroplasty and closed the wound using local advancement flap. Post operation follow up the wound healed without presence any fistula anymore.