PREPUCIAL SKIN TUBE URETHROPLASTY

Whenever urethra requires replacing (substitution) pedicled prepucial skin tube was the primary choice.  Harvesting of inner prepucial skin with the blood supply is done as explained by Asopa and Ducket. 

A stay suture is extracted from the glans dorsal to the meatus.  A circumcision cut or incision was made in the inner layer of the prepuce which is 5mm away from coronal sulcus.  This cut or incision was based upon the Bucks facia at this certain level the entire penis was degloved upto the base.  

This dissection may leave the dorsal neurovascular bundle integral on the penis.  A 2^nd cut or incision was made on the outer surface of the prepuce on the level of the glans.  Here the penile skin is degloved once again which was just below the skin. 

Now the prepuce with the blood supply forms a round tube in between the Bucks facia and penile skin. 

This prepucial skin and facia tube was cut or incised at 6 O’clock towards the penis base.  Now stay sutures was taken at the joint of the inner & outer prepucial skin at the both ends.  A cut or incision was made with the help of a sharp scissors in between these 2 skin layers. 

The outer skin may be used like a free graft or as a pedicled graft if necessary.  But in most of the times, it will be discarded. 

The inner prepucial skin with the blood supply will be rotated around the penile base and was used to construct a tube surrounding a 14 Foley catheter.  Now this tube was anastomosed distally and proximally to the urethra. 

The most common use of bulbar urethral necrosis following the posterior urethral trauma.  The proximal end of the prepucial tube was anastomosed apex of prostatic urethra.  The distal end was anastomosed to urethra at the level of distal bulbar portion.  The disadvantage of pedicle prepucial tube are that it will forms a diverticulam and that can leads to post micturition dribble.  The patient can get anastomotic stricture at two ends of the prepucial tube.