Evaluation of a new technical change: using a pedicled flap of perineal subcutaneous fat tissue to fill up the retro-urethral space after anastomotic posterior urethroplasty

Abstract

Urinary tract impairments are a common condition in society, with a reported prevalence between 0.22 to 0.62 percent among different communities. Generally, the term "urinary obstruction" mostly refers to anterior urethra obstruction, often secondary to scarring in its spongy tissue. Nowadays, the leading cause of urinary obstruction is trauma or accidents and iatrogenic factors. Inflammation, infections, malignancies, and congenital causes are less common. Nearly 30% of urinary obstructions, are idiopathic. Method: The study is conducted as case series. Prior to surgery, it's not easy to determine which patients will require this specific aspect of the procedure, and the decision to use the subcutaneous fat flap during surgery is made. Therefore, the procedure operates as follows: any patient meeting at least one of the inclusion criteria, provided they don’t meet any of the exclusion criteria and with informed consent, will be included in the study (total of 12 patients). Between days 4 to 7 post-surgery, all patients will undergo grayscale ultrasonography for assessing the fat flap and, additionally, between days 7 to 21 after surgery, MRI with and without contrast will be conducted to confirm proper blood supply, tissue viability, and absence of necrosis in the flap. Results: Based on the obtained results, among the 8 patients whose ultrasound results were analyzed: 1. Collection and fluid accumulation were observed in the ultrasound images of 4 patients. 2. Collection was not observed in the ultrasound images of the other 4 patients. Consequently, the surgical technique of embedding the flap was successful in 50% of the patients, while no effect was observed in the remaining 50%. Regarding tissue sensitivity results: 1. a relatively high percentage of tissue necrosis and damage was observed in only one out of seven cases. 2. Tissue necrosis was not observed in one case. 3. In the remaining cases, a relatively low percentage (10-20%) of tissue exhibited necrosis.