ABSTRACT
There are many indications for flaps in urethral reconstruction. For the purpose of this discussion, the posterior urethra will include the bulbar and the true anatomic posterior urethra (prostatomembranous urethra). It is common to find that posterior urethral strictures involve the proximal bulb as well as a portion of the membranous urethra and therefore we look at these structures together. A stricture longer than 3 cm is the most common indication for flap urethral reconstruction. A large urethral defect, as seen in erosion injuries, is another common indication for a flap. Recipient wounds that are chronically inflamed are best reconstructed with flaps and this is true for urethral reconstruction as well. Buccal mucosa grafts have become very popular in recent years, but we have seen these procedures fail when applied to a severely scarred perineal wound for urethral reconstruction. Extremely long defects are also reparable with scrotal and perineal flaps. A scrotal flap onlay procedure can be used in combination with grafts for longer urethral defects by using the graft for the urethral plate and then the flap for the onlay as either a one-or two-stage procedure.
