Use of the
Koyanagi repair is determined from the outset of the operation based on the
surgeon’s impression that VC will lead to urethral plate excision. The
Koyanagi repair updates the Russell operation (Russell, 1900), primarily by
maintaining blood supply to the flaps as illustrated in Figure 1. These flaps are brought
together ventrally, sewn into a single strip, and then tubularized proximally
to distally.
Figure 1: Koyanagi flap. A, Proposed
lines of incisions to create flap. B, The flap can be divided into
two wings as shown or maintained in one piece with a central buttonhole to transpose
it ventrally. C, The urethral plate in the center of the flap is
dissected from the corpora to near the meatus, and the glanular portion of the
plate is excised as glans wings are made. D, Inner flap margins are reapproximated,
and excess flap skin is excised. E, The outer margins are closed
to complete tubularization using 7-0 polyglactin or polydioxanone subepithelial
interrupted or running sutures. Glansplasty and skin closure are as described
for other preputial flaps.
Outcomes: Proponents
offer varied opinions for managing the dartos vascular pedicle to the lateral
skin flaps. Koyanagi and colleagues (1994) split the contiguous flap into a Y at the 12-o’clock position. Others attribute
complications to devascularization of the distal region and instead maintain
the loop, passing the glans dorsally through a 12-o’clock buttonhole in the dartos
pedicle. Alternatively, in the largest reported series the pedicle was removed
from the distal 2 cm of the flap, which was treated as a tubularized graft
(Sugita et al, 2001).
Complications: 47%
Fistulas:
15/77
Meatal Stenosis:
0
Stricture:
6/77
Dehiscence:
12/77
Diverticulum:
0
Recurrent VC:
0
