What is Tubularized Urethroplasty?
Tubularized urethroplasty is a surgical technique where a graft or flap is rolled into a tube over a catheter to completely replace a segment of urethra, but this approach should be avoided when attempted as a single-stage procedure due to high risk of restenosis. 1
Definition and Technical Description
Tubularized urethroplasty represents a specific reconstructive approach in which tissue (either a graft or flap) is fashioned into a tubular configuration around a urethral catheter to create a neo-urethra that completely substitutes for a diseased urethral segment. 1
Critical Clinical Caveat
The American Urological Association explicitly states that single-stage tubularized urethroplasty has a high risk of restenosis and should be avoided. 1 This represents a fundamental principle in urethral reconstruction—while the technique is technically feasible, outcomes are poor compared to alternative approaches.
Preferred Alternative Techniques
When urethral reconstruction requires tissue substitution, surgeons should instead utilize:
Onlay grafts (dorsal or ventral placement) rather than tubularized configurations for bulbar strictures, which demonstrate success rates greater than 80% for strictures up to 10 cm. 1
Oral mucosa as first-choice graft material due to higher patient satisfaction compared to skin flaps and grafts, with less post-void dribbling and fewer penile skin problems. 1
Two-stage procedures for complex penile urethral strictures, which provide better results than single-stage tubularized approaches. 2
Augmented anastomotic urethroplasty for strictures with particularly narrow/fibrotic segments, which combines partial excision with onlay grafting and achieves 90% success rates. 3
Materials That Must Be Avoided
Hair-bearing skin should never be used for substitution urethroplasty, as it results in urethral calculi, recurrent UTI, and urinary stream obstruction from hair in the lumen. 1
Allograft, xenograft, or synthetic materials should not be used except under experimental protocols, as long-term success rates are unknown. 1
When Tubularized Approaches May Be Considered
The only scenario where tubularized reconstruction has documented utility is in staged procedures (such as Johanson's staged urethroplasty) for salvage treatment of complex, long, or multiple strictures, particularly in patients with war-related injuries or unhealthy perineal/genital skin. 4 Even in these cases, the tubularization occurs as part of a multi-stage approach rather than a single-stage procedure.
Key Clinical Pitfall
The fundamental error is attempting single-stage tubularized urethroplasty when superior alternatives exist. For strictures requiring complete urethral replacement, surgeons should employ fasciocutaneous flaps, oral mucosal grafts, or combinations of these techniques in either onlay or staged configurations. 1