Single‐Stage Combined Buccal Mucosal Graft and Penile Skin Flap Urethroplasty for Gunshot Anterior Urethral Stricture in a Sudanese War Zone: A Case Report

Gunshot injuries to the external genitalia are rare but may lead to urethral strictures, significantly affecting quality of life. Treating anterior urethral strictures from such trauma is challenging, particularly when delayed, due to tissue loss and fibrosis. Historically, staged urethroplasty using buccal mucosa graft (BMG) or penile skin grafts was the standard. However, single-stage urethroplasty using a combination of BMG and penile skin flap is gaining attention as a viable alternative. A 30-year-old male soldier from eastern Sudan sustained a gunshot wound to the genital area 3 months ago, resulting in distal penile and right testicular injuries. Initial management included right scrotal exploration, testicular repair, and suprapubic catheter. Upon presentation, he reported mild penile pain, inability to achieve erection, and normal scrotal wound healing. Examination revealed a 3-cm hard nodule in the distal penile shaft. Retrograde urethrogram (RGU) showed a 2-cm tight distal penile urethral stricture. The patient underwent single-stage urethroplasty. A circumferential incision was made, and the fibrotic urethra and corpora cavernosa were excised. A 4-cm BMG was harvested and quilted to the corpora cavernosa, and a 6-cm vascularized dorsal penile skin flap was rotated to reconstruct the urethra. At 2-month follow-up, the patient exhibited satisfactory urine flow (Q max 23 mL/s), mild post-void dribbling, and subjectively experienced a progressive improvement in potency. Postoperative RGU confirmed the restoration of normal urethral caliber. This case demonstrated that single-stage urethroplasty using a penile skin flap and buccal mucosa graft is a practical and effective approach for traumatic distal penile urethral strictures, even in low-resource, conflict settings and where advanced surgical expertise is unavailable.