1/19. Free vascularized appendix transfer for reconstruction of penile urethras with severe fibrosis.Despite the development of newer techniques with a free radial forearm tube flaps for phallus reconstruction, severe urethral strictures are still seen in such cases after irradiation or repeated infection because of the paucity of healthy, well-vascularized tissue. For urethral reconstruction in cases with poorly vascularized tissue as well as for total penile creation, a new technique involving a free vascularized appendix transfer combined with a radial forearm osteocutaneous flap was successfully used in two cases. The appendix provides a normal tube structure composed of a muscular tubular layer lined with mucosal epithelium. It has no hair and has rich vascularization. This results in little stricture at the junction with the original urethra, no occurrence of urethral stones, and possible postoperative enlargement of the diameter with changes in catheters. This method will allow a patient with severe fibrosis around the urethra to undergo one-stage phallus reconstruction with minimal complications.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
2/19. Urethral plate salvage with dorsal graft promotes successful penile flap onlay reconstruction of severe pendulous strictures.PURPOSE: A modified 1-stage penile flap onlay reconstruction is presented for patients with a long stricture in whom the urethral plate is deficient or absent. MATERIALS AND methods: Of 37 patients who underwent transverse penile island flap onlay urethroplasty 3 men and 1 boy required simultaneous augmentation (2) or replacement (2) of an inadequate urethral plate. The 15-year-old boy had persistent severe chordee after multiple hypospadias procedures. A dorsal buccal mucosal graft was used in 3 cases and cadaveric dermal graft was used in 1. The goal of dorsal graft application in each case was to create a uniform urethral plate 1 cm. wide to promote successful 1-stage penile flap onlay reconstruction. RESULTS: No patient has required further instrumentation and all void without difficulty. In the 15-year-old boy chordee has completely resolved. CONCLUSIONS: Using dorsal grafts to salvage an inadequate urethral plate during 1-stage penile island flap onlay reconstruction obviates flap tubularization.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
3/19. The use of pedicled appendix graft for substitution of urethra in recurrent urethral stricture.BACKGROUND: Recurrent posterior urethral strictures after failed urethroplasty may need urethral substitution. skin or mucosal grafts, currently used for this purpose, have a high complication rate. The authors describe the use of pedicled appendix for posterior urethral substitution. methods: Two boys with pelvic fracture urethral distraction injuries were treated for recurrent posterior urethral strictures after a failed perineal anastomotic urethroplasty. Through a perineal-transpubic approach the stricture tissue was excised, which resulted in a gap of 5 to 7 cm between the healthy ends. The vermiform appendix was mobilised on its own pedicle and transposed to the perineum; the proximal end of appendix was anastomosed to the prostatic urethra and the distal end (tip discarded) to the bulbar/penile urethra. omentum was transposed to wrap the anastomosis and fill the dead space. RESULTS: Normal micturition was restored in both patients. No further treatment was required after 1 dilatation in the first case. Both patients are continent. Potency status remains unchanged from the preoperative period with normal erections in 1 case. Follow-up (1 to 3 years) has been satisfactory with no complications. CONCLUSIONS: The appendix is a promising organ for posterior urethral replacement. It can be brought to the perineum on its own vascular pedicle.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
4/19. Watering can perineum--a forgotten complication of gonorrhoea.In the modern era of broad spectrum antibiotics, urethral fistulae (watering can perineum) is one of the forgotten sequelae of chronic gonococcal infection. We report a 20-year-old unmarried male with gonococcal urethritis and two sinuses in the scrotum (watering can perineum). The micturating and retrograde urethrogram revealed mucosal irregularity and extravasation of contrast medium at the junction of bulbous and membranous urethra. Recent worldwide emergence of multidrug resistant strains of gonococci give rise to alarm. In the present scenario of hiv pandemic, ineffective treatment of patient or partner with gonorrhoea may result in development of these complications.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
5/19. Transpubic-perineal urethral reconstruction in boys using a substitution graft.A combined transpubic-perineal 1-stage approach was used for urethral replacement and proximal urethral repair in 6 boys: 4 were treated for a long proximal urethral stricture secondary to trauma and 2 with urethral atresia underwent replacement of the entire anterior urethra. All patients underwent a urethral substitution graft of either skin or bladder mucosa. Followup ranged from 2 to 8 years with all patients continent.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
6/19. Reconstructive urethroplasty using porcine acellular matrix.Long tract urethral reconstruction nowadays still has no other resolution than two-stage techniques or graft and flap procedures that are neither simple nor trouble-free both for the patient and the surgeon. tissue engineering simplifies this surgery using "porcine acellular matrix", obtained from small intestine submucosa. It is thin but strong, just ready for grafting, without rejection, because it is not immunogenic, being deprivated of cells. It serves as biological bridging of the reconstruction, promoting the generation of surrounding tissue in which it is completely transformed. We report the first use of porcine intestine submucosa in urethroplastic surgery.The up to date follow up is sixteen months with satisfactory urodynamic and subjective outcome.- - - - - - - - - - ranking = 2keywords = mucosa (Clic here for more details about this article) |
7/19. urethral stricture after pancreas-kidney transplantation due to polypoid urethritis.Urologic complications are common after pancreas-kidney transplantation using bladder drainage. We report a case of urethral stricture caused by polypoid urethritis occurring 4 years after simultaneous pancreas-kidney transplantation. Endoscopic exploration revealed irregular, ragged-appearing urethral mucosa. The diagnosis of polypoid urethritis was confirmed histopathologically.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
8/19. Urethral reconstruction using buccal mucosa urethroplasty in the treatment of urethral injury.A 52-year-old Japanese man was referred to us with a urethral injury caused by masturbation. His penis was swollen and about one and a half times its size due to urine extravasation and infection. foreign bodies were surgically removed, and debridement and excision of necrotic tissue were performed. After confirming that the infection was under control, we planned the reconstruction of the urethra and penis, following endoscopic urethrotomy for the bulbous urethra stricture. A free graft from the buccal mucosa was harvested, placed over the defect and fixed with interrupted suture as ventral onlay. The patient could achieve satisfactory voiding and no complication was seen during the 18-month follow up. In our experience, buccal mucosa is a useful source of urethral grafting material and excellent results can be expected in case of urethral injury.- - - - - - - - - - ranking = 6keywords = mucosa (Clic here for more details about this article) |
9/19. Successful closure of a bladder neck fistula complicated by urethral and vaginal stenosis, using oxidized cellulose (Surgicel) for reinforcement.We describe a case of a bladder neck fistula in a 25-year-old lady presenting with true urinary incontinence, vaginal constriction and induration, with vaginal length reduced to only 1.5 cm. There was an 8-mm fistula involving upper urethra and bladder neck, with fibrosis all around. Using Schuchardt incision, the fistula was reached and mobilization tried. As there was less available tissue, a 3 x 2-cm layer of oxidized cellulose was stitched between the bladder and the vaginal mucosa for reinforcement and to achieve a watertight closure of fistula.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
10/19. Rectourethral fistula associated with two short segment urethral strictures in the anterior and posterior urethra: single-stage reconstruction using buccal mucosa and a radial forearm fasciocutaneous free flap.INTRODUCTION: We report a novel surgical technique used to repair a rectourethral fistula associated with two short-segment urethral strictures located in the anterior and posterior segments of the urethra in a patient with prior unsuccessful repairs. TECHNICAL CONSIDERATIONS: The anterior urethral stricture was reconstructed with a ventral onlay of buccal mucosa in the exaggerated lithotomy position. In a modified prone position, the rectourethral fistula was repaired using the transrectal transsphincteric (York-Mason) technique and the posterior urethral stricture with a radial forearm fasciocutaneous free flap which was anastomosed to the inferior gluteal artery and vein. The coexistence of a rectourethral fistula and distal urethral stricture requires simultaneous repair, because the urethral pressure from the distal obstruction may compromise fistula closure. Reconstructive efforts should be tailored to minimize disruption of the urethral blood supply in patients with previous pelvic trauma. Rectal and urethral repairs should be separated by well-vascularized tissue to prevent fistula recurrence. CONCLUSIONS: The radial fasciocutaneous flap may offer the reconstructive surgeon another surgical option for complex urethral stricture and rectourethral fistula reconstruction when the local blood supply is in question. Longer follow-up and more cases are needed to further evaluate the continued use of this technique.- - - - - - - - - - ranking = 5keywords = mucosa (Clic here for more details about this article) |
| | Next -> |