Objective: To describe a salvage procedure for bulbo-membranous stricture disease or trauma.
Patients and methods: Over a 10-year period 11 patients with otherwise unsalvageable strictures of the bulbo-membranous urethra or defects after trauma were treated by interposition of a tailored intestinal flap. An intestinal flap, on average 8 cm in length, was harvested from the ileum, the stomach, the right colon or (preferably) the sigmoid colon, and tailored to a calibre of 26-30 F. It was then sutured between the stump of the prostate and the distal bulbar or proximal pendulous urethra either following the normal perineal route for the urethra or a more direct route through a trench cut in the superior pubic ramus.
Results: Three patients developed proximal anastomotic contractures requiring interval dilatation in one and revision in two. Two patients developed a stone in the gut segment one of which was removed traumatically causing irreparable damage to the neourethra. The results were otherwise satisfactory.
Conclusion: For an otherwise unsalvageable bulbo-membranous stricture or defect, a tailored flap of intestine, preferably sigmoid colon, gives satisfactory results. Of the two potential routes for the neourethra, we have more experience with the normal route but the direct route has several advantages.