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Urethral reconstruction

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https://www.readbyqxmd.com/read/28088555/injury-in-pelvic-fracture-urethral-injury-is-membrano-bulbar-fact-or-myth
#1
Pankaj M Joshi, Devang J Desai, Darshan Shah, Devashree Joshi, Sanjay B Kulkarni
Pelvic fracture urethral injuries (PFUI) commonly result from motor vehicle collisions. The mechanism of injury conventionally thought was a shearing injury at the membranous urethra, which would destroy the striated sphincter. Continence would therefore depend on the bladder neck. Striated sphincter and site of injury has not been shown clearly on preoperative imaging. We demonstrate a our protocol of performing MRI whereby the membranous sphincter is seen intact and the injury is shown to be at the membrano-bulbar junction contrary to conventional belief...
January 11, 2017: Urology
https://www.readbyqxmd.com/read/28057997/male-urethral-diverticulum-uncommon-entity-our-experience
#2
Naveen Thakur, Vilas Pandurang Sabale, Deepak Mane, Abhirudra Mullay
Out pouching of the urethral wall could be congenital or acquired. Male urethral diverticulum (UD) is a rare entity. We present 2 cases of acquired and 1 case of congenital male UD. Case 1A: 40 year male presented with SPC and dribbling urine. Clinically he had hard perineal swelling. RGU revealed large diverticulum in proximal bulbar, irregular narrow distal urethra and stricture just beyond diverticulum. Managed with perineal exploration, stone removal, diverticulum repair and urethroplasty using excess diverticular wall...
October 2016: Urology Annals
https://www.readbyqxmd.com/read/28043016/flutamide-induced-hypospadias-in-rats-a-critical-assessment
#3
Adriane Watkins Sinclair, Mei Cao, Andrew Pask, Laurence Baskin, Gerald R Cunha
This paper provides the first detailed description of flutamide-induced hypospadias in the rat based upon wholemount, histologic, three-dimensional reconstruction, scanning electron microscopic, and immunocytochemical analysis. The penile malformations elicited by this potent anti-androgen include a substantial proximal shift in the urethral meatus that clearly conforms to the definition of hypospadias based upon specific morphological criteria for this malformation. Through examination of the normal penile development and flutamide-induced abnormal penile development observed in prenatally oil- and flutamide-treated rats, our analysis provides insights into the morphogenetic mechanism of development of hypospadias...
December 30, 2016: Differentiation; Research in Biological Diversity
https://www.readbyqxmd.com/read/28042624/literature-review-of-factors-affecting-continence-after-radical-prostatectomy
#4
Dalibor Pacik, Michal Fedorko
Radical prostatectomy (RP) is the most common cause of stress urinary incontinence (UI) in men. Several anatomic structures affect or may affect urinary continence - urethral sphincter, levator ani muscle, puboprostatic ligaments, bladder neck, endopelvic fascia, neurovascular bundle - and understanding of the anatomy of pelvic floor and urethra is crucial for satisfactory functional outcome of the procedure. Surgical techniques implemented to improve continence rates include nerve-sparing procedure, bladder neck preservation/plication, urethral length preservation, musculofascial reconstruction, puboprostatic ligaments preservation or seminal vesicle preservation...
January 2017: Saudi Medical Journal
https://www.readbyqxmd.com/read/28007491/a-novel-experimental-method-for-penile-augmentation-urethroplasty-with-a-combination-of-buccal-mucosa-and-amniotic-membrane-in-a-rabbit-model
#5
Mustafa Güneş, Muammer Altok, Özlem Özmen, Mehmet Umul, Alime Güneş, Ercan Baş, Zafer Özyildiz, Tolga Taha Sönmez, Hikmet Orhan
OBJECTIVES: To investigate the results of penile urethral reconstruction using amniotic membrane (AM) and buccal mucosa (BM) grafts, and the simultaneous use of both in a rabbit model. METHODS: A total of 28 male rabbits were divided into 4 groups according to grafting style:Group 1(AM), Group 2(BM), Group 3(BM+AM), and Group 4(sham). A standardized urethral defect was created in the three initial groups. The sham group underwent only a ventral vertical urethral incision and primary re-suturation...
December 19, 2016: Urology
https://www.readbyqxmd.com/read/27932079/urinary-continence-outcomes-following-vaginoplasty-in-patients-with-congenital-adrenal-hyperplasia
#6
John Stites, Kerlly J Bernabé, Denise Galan, Diane Felsen, Dix P Poppas
BACKGROUND: Feminizing genitoplasty techniques have diversified to encompass the spectrum of atypical genitalia in 46,XX congenital adrenal hyperplasia (CAH) patients. However, long-term outcomes evaluating postoperative continence following complex vaginoplasty remain scarce. OBJECTIVE: The aim was to review our surgical experience and assess postoperative urinary continence outcomes in CAH patients following complex, primary vaginoplasty. STUDY DESIGN: We retrospectively reviewed CAH patients who underwent complex, primary vaginoplasty at a single center by a single surgeon from 1996 to 2013...
November 22, 2016: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/27912972/fate-of-males-with-urethral-y-duplication-40-year-long-follow-up-in-8-patients
#7
Mario Lima, Francesca Destro, Neil Di Salvo, Tommaso Gargano, Giovanni Ruggeri
PURPOSE: The spectrum of male urethral duplication is heterogeneous and it includes the Y-duplication. The malformation is rare and there is only a few case series reported in the literature. The management of Y-forms remains challenging for the surgeon and the long-term follow-up is still scarcely investigated. We report our 40-year experience in the management of patients with Y-duplication. MATERIALS AND METHODS: We conducted a restrospective analysis collecting information of patients with urethral Y-duplication treated at our department from April 1975 to April 2015...
November 17, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27908375/treatment-of-radiation-induced-urethral-strictures
#8
REVIEW
Matthias D Hofer, Joceline S Liu, Allen F Morey
Radiation therapy may result in urethral strictures from vascular damage. Most radiation-induced urethral strictures occur in the bulbomembranous junction, and urinary incontinence may result as a consequence of treatment. Radiation therapy may compromise reconstruction due to poor tissue healing and radionecrosis. Excision and primary anastomosis is the preferred urethroplasty technique for radiation-induced urethral stricture. Principles of posterior urethroplasty for trauma may be applied to the treatment of radiation-induced urethral strictures...
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908374/effect-of-lichen-sclerosis-on-success-of-urethroplasty
#9
REVIEW
Michael A Granieri, Andrew C Peterson, Ramiro J Madden-Fuentes
Lichen sclerosis (LS) is a chronic, relapsing disease with a variable presentation. In men, genitourinary LS may affect the penile foreskin, glans, meatus, and urethra. Treatment is multifaceted, ranging from pharmacotherapy to surgery. Urethral reconstruction due to stricture disease from LS is frequently plagued by a high recurrence rate. At the authors' institution, the high recurrence rate has shifted their practice toward potent steroids and minimally invasive surgical techniques. Management of recurrence includes dilation, meatotomy/meatoplasty, 1-stage and 2-stage repairs...
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908368/endoscopic-treatment-of-urethral-stenosis
#10
REVIEW
Brittney H Cotta, Jill C Buckley
Urethral stricture disease continues to be a common problem for patients and urologists alike. Endoscopic treatment offers a simple, potentially effective treatment of primary, short, urethral strictures. For patients who recur after endoscopic management, urethral or bladder neck reconstruction should be offered with an experienced urologic reconstructionist familiar with the complexity of the situation and subtleties of the surgery. With the advent of adjunctive antifibrotic agents the durability of endoscopic repair seems to improve, but their use requires continued research and longer follow-up to determine their efficacy...
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908367/use-of-alternative-techniques-and-grafts-in-urethroplasty
#11
REVIEW
Brendan Michael Browne, Alex J Vanni
The current management for complex urethral strictures commonly uses open reconstruction with buccal mucosa urethroplasty. However, there are multiple situations whereby buccal mucosa is inadequate (eg, pan-urethral stricture or prior buccal harvest) or inappropriate for utilization (eg, heavy tobacco use or oral radiation). Multiple options exist for use as alternatives or adjuncts to buccal mucosa in complex urethral strictures. This article reviews the current state of alternate techniques for urethral stricture treatment besides buccal mucosa, including injectable antifibrotic agents, augmentation urethroplasty with skin flaps, lingual mucosa, colonic mucosa, and new developments in tissue engineering for urethral graft material...
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908363/definition-of-successful-treatment-and-optimal-follow-up-after-urethral-reconstruction-for-urethral-stricture-disease
#12
REVIEW
Bradley A Erickson, George M Ghareeb
The definition of a successful urethroplasty, the lack of need for a secondary procedure, is outdated and must be amended to incorporate objective and subjective outcomes. Success is assigned if a flexible cystoscope can traverse the reconstructed urethra without force. Functional success is assigned if patient-reported outcome measures reveal improvement in voiding symptoms and urinary quality of life. Optimal follow-up strategy allows determination of anatomic and functional outcomes, protects genitourinary health, and prevents excessive invasive testing, unnecessary cost, discomfort, anxiety, and risk...
February 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27904649/fasciocutaneous-flap-reinforcement-of-ventral-onlay-buccal-mucosa-grafts-enables-neophallus-revision-urethroplasty
#13
Stelios C Wilson, John T Stranix, Kiranpreet Khurana, Shane D Morrison, Jamie P Levine, Lee C Zhao
BACKGROUND: Urethral strictures or fistulas are common complications after phalloplasty. Neourethral defects pose a difficult reconstructive challenge using standard techniques as there is generally insufficient ventral tissue to support a graft urethroplasty. We report our experience with local fasciocutaneous flaps for support of ventrally-placed buccal mucosal grafts (BMGs) in phalloplasty. METHODS: A retrospective review of patients who underwent phalloplasty and subsequently required revision urethroplasty using BMGs between 2011 and 2015 was completed...
December 2016: Therapeutic Advances in Urology
https://www.readbyqxmd.com/read/27900223/modified-one-stage-dorsal-inlay-buccal-mucosa-graft-technique-for-ventral-penile-urethral-and-penile-skin-erosion-a-step-by-step-guide
#14
Lennert Van Putte, Gunter De Win
OBJECTIVE: To demonstrate the use of a modified single-stage technique for the repair of a ventral penile urethral erosion with involvement of the penile skin, as penile urethral erosion is a rare but potential complication of chronic indwelling catheterisation with a lack of available recommendations for reconstructive options. PATIENT AND METHODS: A 44-year-old male with paraplegia, neurogenic bladder dysfunction and chronic sacral decubitus, presented with a large mid-penile erosion of the ventral penile shaft and urethra, which was caused by chronic transurethral indwelling catheterisation while being hospitalised in an intensive care unit...
December 2016: Arab Journal of Urology
https://www.readbyqxmd.com/read/27900221/grafted-tubularised-incised-plate-urethroplasty-an-objective-assessment-of-outcome-with-lessons-learnt-from-surgical-experience-with-263-cases
#15
Vipul Gupta, Sunil Kumar Yadav, Talal Alanzi, Islam Amer, Mohmmad Salah, Mamdouh Ahmed
OBJECTIVE: Snodgrass urethroplasty remains the preferred technique in primary distal hypospadias but development of meatal stenosis often limits distal extension of the midline incision of the urethral plate (MIUP), which remains a limiting factor in reconstructing an apical neomeatus (NM). We here-in assess the cosmetic and functional outcome with distal extension of the MIUP in grafted tubularised incised-plate urethroplasty (G-TIP) repair. PATIENTS AND METHODS: This prospective study included the surgical experience of 263 cases of primary hypospadias operated upon between 2012 and 2015...
December 2016: Arab Journal of Urology
https://www.readbyqxmd.com/read/27889218/single-stage-urethroplasty-for-perineal-hypospadias-in-a-horse-a-case-report
#16
Jade Harrison, Imran Mushtaq
INTRODUCTION: Within the veterinary world, data regarding the surgical management of hypospadias is lacking. Reports within equines have documented resective phallectomy procedures rather than urethral reconstruction. This case report documents the first ever urethroplasty for an equine hypospadias, performed by a consultant paediatric surgeon. The urethroplasty was achieved by applying the same surgical principles mastered from paediatric urology to a horse. The indication for surgery was contact dermatitis of the hind-leg, which impaired the thoroughbred foal's racing potential...
November 9, 2016: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/27847256/hypospadias-repair-with-the-glanular-frenular-collar-gfc-technique
#17
Hüseyin Özbey, Şeref Etker
BACKGROUND: In the normal human penis, the glans wings merge in the midline ventrally, but are separated by the 'septum glandis' in conjunction with the frenulum. The frenulum is also included in the formation of the distal (glanular and subcoronal) urethra, which has a special part known as the 'fossa navicularis'. This has inspired a hypospadias repair technique that simulates the development of the glanular and subcoronal urethra, which can be incorporated into the repair of all cases of hypospadias...
November 3, 2016: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/27844235/robot-assisted-laparoscopic-colpectomy-in-female-to-male-transgender-patients-technique-and-outcomes-of-a-prospective-cohort-study
#18
Freek Groenman, Charlotte Nikkels, Judith Huirne, Mick van Trotsenburg, Hans Trum
BACKGROUND: Gender-affirming surgeries in female-to-male (FtM) transgender patients include mostly hysterectomy, bilateral salpingo-oophorectomy and mastectomy. Sometimes further surgery is performed, such as phalloplasty. Colpectomy may be performed to overcome gender dysphoria and disturbing vaginal discharge; furthermore, it may be important in reducing the risk of fistulas due to the phalloplasty procedure with urethral elongation. Colpectomy prior to the reconstruction of the neourethra seems to reduce fistula rates on the very first anastomosis...
November 14, 2016: Surgical Endoscopy
https://www.readbyqxmd.com/read/27822441/congenital-urethral-diverticulum-with-infertility-in-an-adult-man-and-review-of-the-literature
#19
Chen Shuzhu, Wu Min, Ye Weijing, Liu Yidong
INTRODUCTION: Congenital anterior urethral diverticula in adult males are infrequent urological diseases, which they were mainly found in women. The etiology of female diverticula is that (Mohan et al. in J Urol 123(4):592-594, 1980) women have anatomically poorly supported urethral. Clinical presentation frequently involves urinary urgency, polyuria, postmicturition dribble, and hematuria. CASE DESCRIPTION: A 37 year-old male was presented to us complaining of infertility about 6 years after marriage...
2016: SpringerPlus
https://www.readbyqxmd.com/read/27818773/transurethral-biopsy-of-the-prostatic-urethra-is-associated-with-final-apical-margin-status-at-radical-cystoprostatectomy
#20
Friedrich-Carl von Rundstedt, Douglas A Mata, Steven Shen, Yi Li, Guilherme Godoy, Seth P Lerner
PURPOSE: Biopsy of the prostatic urethra is an integral part of clinical staging in patients prior to radical cystoprostatectomy (RC) and urinary diversion. We examined whether preoperative transurethral resection (TUR) biopsy was associated with final apical urethral margin status and hypothesized that a negative biopsy could replace intraoperative frozen section for decision making regarding the feasibility of orthotopic neobladder reconstruction. METHODS: TUR biopsy, frozen section, urethrectomy, and final apical urethral margin pathologic data were extracted from the charts of men who had undergone RC at the Houston Methodist Hospital between 1987 and 2013...
November 2016: Journal of Clinical Urology
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