Difference Between Tanagho and Modified Tanagho Flap Surgery for Urethral Reconstruction
The main difference between traditional Tanagho flap and Modified Tanagho flap is that the modified version uses an anterolateral bladder wall flap rather than a midline anterior bladder wall flap, which provides improved vascular supply and decreases fistula formation at the base of the flap. 1
Traditional Tanagho Flap
- Uses a midline anterior bladder wall flap to create a tube for urethral reconstruction 1
- May result in the bladder neck being shifted anterosuperiorly, which can cause voiding issues 2
- Has a posteriorly directed suture line that increases risk of fistula formation with the vagina 2
- Creates rotational tension on the bladder that can put stress on the suture line 2
- Originally described for treatment of urinary incontinence but has been adapted for urethral stricture repair 1
Modified Tanagho Flap
- Utilizes an anterolateral bladder wall flap rather than a midline approach 3, 1
- Provides improved vascular supply to the reconstructed tissue 1
- Significantly reduces the risk of urethrovesical fistula formation 1
- Has been successfully used in patients with classic bladder exstrophy and posterior urethral strictures 3
- Shows excellent long-term success rates comparable to results reported in adult studies for post-traumatic bladder neck contractures 3
Clinical Applications and Outcomes
- Both techniques can be used for urethral reconstruction in cases of traumatic urethral loss or stricture 4
- The modified technique has shown particular success in patients with exstrophy, including those who had failed previous bladder neck surgery 1
- In a limited series of patients with classic bladder exstrophy, the modified Tanagho flap was effective in treating posterior urethral stricture disease 3
- Total continence rates of approximately 66.6% have been reported with both traditional and modified techniques 4
Surgical Considerations
- The American Urological Association recommends oral mucosa as the first choice when using grafts for urethroplasty due to higher patient satisfaction compared to skin flaps 5, 6
- Hair-bearing skin should never be used for substitution urethroplasty due to potential complications including urethral calculi and recurrent UTIs 5, 6
- Single-stage tubularized urethroplasty approaches generally have a high risk of restenosis and should be avoided when possible 5, 6
- For complex cases, surgeons may need to use a combination of techniques including oral mucosal grafts and fasciocutaneous flaps 5
Pitfalls and Caveats
- Careful patient selection is crucial as these techniques are typically reserved for complex cases where standard approaches are not feasible 3, 1
- Postoperative complications may include urethrovesical fistula, problems with catheterization, and meatal stenosis 1, 4
- Long-term follow-up is essential as urethral stricture recurrence can occur at any time in the postoperative period 5
- Monitoring should include appropriate diagnostic tests such as urethrocystoscopy, ultrasound urethrography, or retrograde urethrography to detect stricture recurrence 5