scholarly journals Reconstructing forked corpus spongiosum to correct glans droop in distal/midshaft hypospadias repair

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092569
Author(s):  
Bin Zhang ◽  
Yunli Bi ◽  
Shuangsui Ruan
Keyword(s):  
Postoperative Complications ◽  
Urethral Stricture ◽  
Urethral Diverticulum ◽  
Mometasone Furoate ◽  
Corpus Spongiosum ◽  
Hypospadias Repair ◽  
Postoperative Residual

Purpose We reviewed our experience and efficacy of reconstruction of a forked corpus spongiosum (FCS) to correct glans droop in distal/midshaft hypospadias repair. Methods Eighty-five consecutive patients who underwent distal/midshaft hypospadias repair by the same surgeon in our center from October 2015 to June 2018 were retrospectively analyzed. All cases were accompanied by different degrees of glans droop, which we corrected by cutting off and reconstructing the FCS along the plate. We recorded the degrees of glans droop, development of the FCS, and postoperative complications including residual chordee, fistula, diverticulum, glans dehiscence, meatus stenosis, and urethral stricture. Results The follow-up period ranged from 5 to 37 months (mean, 19.7 months). Two patients (2.3%) developed a coronal fistula and underwent a second repair. Two patients (2.3%) developed a mild urethral diverticulum and underwent continued observation. One patient (1.2%) developed a meatus stenosis that resolved after 1 month of meatus expansion combined with external mometasone furoate. No patients developed postoperative residual chordee or urethral stricture. Conclusions The degree of glans droop is closely associated with the development of an FCS. Reconstructing the FCS to correct the glans droop can yield satisfactory outcomes and should be popularized in distal/midshaft hypospadias repair.

scholarly journals Severe Penile Curvature following Otis Urethrotomy

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Ersagun Karaguzel ◽  
Metin Gur ◽  
Dogan S. Tok ◽  
İlke O. Kazaz ◽  
Huseyin Eren ◽  
...  
Keyword(s):  
Urethral Stricture ◽  
Tunica Albuginea ◽  
High Recurrence Rate ◽  
Penile Curvature ◽  
Corpus Spongiosum ◽  
Tunica Vaginalis ◽  
Internal Urethrotomy ◽  
Urethral Catheterization ◽  
Cold Knife

Urethral stricture is a common urological pathology with a high recurrence rate after treatment. Urethral manipulations are among its main causes. In this paper, urethral stricture developed secondary to urethral catheterization and was treated with cold-knife internal urethrotomy and the Otis urethrotomy procedure. During the follow-up period, severe ventral penile curvature preventing sexual intercourse developed due to fibrosis of the corpus spongiosum and tunica albuginea of the penis. This ventral penile curvature was corrected with a separate operation using a tunica vaginalis flap harvested from the left scrotum.

Penile urethral stricture disease

2018 ◽  
Vol 12 (2) ◽  
pp. 145-157
Author(s):  
Marco Spilotros ◽  
Suzie Venn ◽  
Paul Anderson ◽  
Tamsin Greenwell
Keyword(s):  
Urethral Stricture ◽  
Lichen Sclerosus ◽  
Corpus Spongiosum ◽  
Hypospadias Repair ◽  
Internal Urethrotomy ◽  
Level Of Evidence ◽  
Urethral Stricture Disease ◽  
Urethral Strictures ◽  
Considerable Cost ◽  
The Uk

Patients affected by a urethral stricture account for a considerable cost to all healthcare systems. The estimated prevalence of all urethral stricture in the UK is 10/100,000 men during youth, increasing to about 40/100,000 by age 65 years and to more than 100/100,000 thereafter. A penile urethral stricture is a narrowing of the lumen of the urethra due to ischaemic fibrosis of the urethral epithelium and/or spongiofibrosis of the corpus spongiosum occurring within the penile urethra. Its aetiology is largely idiopathic but other important causes are failed hypospadias repair and lichen sclerosus, which account for 60% of all cases. Strictures of the anterior urethra account for 92% of cases: bulbar strictures are more frequent (46.9%), followed by penile (30.5%) and combined bulbar/penile (9.9%), that is, 40.4% of all men presenting with stricture will have a penile urethral stricture alone or in combination with a bulbar urethral stricture. There are several options for the treatment of penile urethral strictures ranging from less invasive treatments, including urethral dilatation and direct vision internal urethrotomy, to more complex augmentation graft and flap urethroplasty. The aim of the present review is to describe the aetiology and epidemiology of anterior urethral strictures and the available options reported in literature for their treatment. Level of evidence: 1a

scholarly journals Tunneled Tunica Vaginalis Flap for Recurrent Urethrocutaneous Fistulae

2008 ◽  
Vol 2008 ◽  
pp. 1-3 ◽  
Author(s):  
Jonathan C. Routh ◽  
James J. Wolpert ◽  
Yuri Reinberg
Keyword(s):  
Postoperative Complications ◽  
Hypospadias Repair ◽  
Urethrocutaneous Fistula ◽  
Tunica Vaginalis ◽  
Surgical Time ◽  
Tubularized Incised Plate ◽  
Successful Technique ◽  
Surgical Setting

The tubularized incised plate (TIP) hypospadias repair is currently the most widely used urethroplasty technique. The most significant post-TIP complication is urethrocutaneous fistula (UCF) development. Tunneled tunica vaginalis flap (TVF) is a well-described technique for the repair of UCF. We retrospectively reviewed all patients undergoing repeat repair of UCF after TIP repair from 2001 to 2005. Twelve boys underwent TVF repair at our institution for recurrent UCF. Fistulae ranged from distal penile to penoscrotal in location. Median surgical time was 45 minutes and no postoperative complications occurred. After a median follow-up of 32 months (range 16–48 months), no patient has yet had a recurrence of UCF. In conclusion, TVF repair is a successful technique for the treatment of UCF after previous failed repair. TVF is technically simple to perform and should be considered for treating UCF following TIP urethroplasty, particularly in a repeat surgical setting.

scholarly journals Transanal fistulectomy for postoperative persistent rectourethral fistula in patients with ARM: is simple resection enough?

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xinjie Huang ◽  
Yajun Chen ◽  
Wenbo Pang ◽  
Chunhui Peng ◽  
Dongyang Wu
Keyword(s):  
Postoperative Complications ◽  
Operative Time ◽  
Revisional Surgery ◽  
Urethral Diverticulum ◽  
Rectourethral Fistula ◽  
Closure Rate ◽  
Sphincter Function ◽  
Average Operative Time ◽  
Safe Approach

Abstract Background Postoperative rectourethral fistula (RUF) in patients with congenital anorectal malformation (ARM) remains a challenge for paediatric surgeons, among them persistent fistula is the most common. Various techniques have been proposed, only a few reports based on different causes are available, and there is no consensus so far. This study is to evaluate the application, advantages and limitations of transanal fistulectomy approach in repairing persistent RUF in ARM patients. Methods From January 2007 to July 2019, 78 ARM patients who received revisional surgery for RUF were reviewed, 34 persistent fistulas were identified. Examination under anaesthesia included patients with fistulas that were located within 3 cm from the anus verge, good appearance of the anus and sphincter function, and no urethral and rectoanal obstruction. Three patients were excluded because of complex urologic pathologic defects. In total, thirty-one patients underwent transanal fistulectomy to repair RUF. Results All cases were approached with transanal incision and fistulectomy to repair RUF. The average operative time was 91 ± 35 min. At a minimum six-month follow-up, 29 patients healed after the first attempt, the success closure rate was 93.5%. Two patients received redo transanal fistulectomy and healed. Two patients had postoperative complications: one patient had urethral stenosis and it was managed by dilation; one patient had urethral diverticulum but it did not require revisional surgery. No patient in this study was incontinent because of the surgery. Conclusions Transanal fistulectomy provides a simple, straightforward, and safe approach to repair persistent RUF in ARM patients, especially in those with a low-lying fistula, good anus appearance and sphincter function without obstruction in the rectum or urethra. Trial registration: Retrospectively registered.

Outcome of Single Stage OMG Urethroplasty by Kulkarni Technique in Comparison With Johanson’s Staged Urethroplasty for Management of Pan-Urethral Stricture

2020 ◽  
Vol 19 (2) ◽  
pp. 78-84
Author(s):  
Md Shariful Islam ◽  
Md Asaduzzamman ◽  
Kaiser Ahmed ◽  
MA Salam ◽  
Md Shawkat Alam
Keyword(s):  
Postoperative Complications ◽  
Clinical Outcome ◽  
Urethral Stricture ◽  
Operative Procedure ◽  
Single Stage ◽  
Buccal Mucosal Graft ◽  
Group A ◽  
Group B ◽  
Final Calculation

Purpose: To observe the outcome of single stage buccal mucosal graft and Johanson’s staged urethroplasty for treatment of pan- urethral stricture. Materials and Methods: A total of 60 patients with an average age of 42 years (21-55) underwent OMG urethroplasty and Johanson’s staged urethroplasty between March 2008 to September 2015 for pan-urethral stricture of different etiology. OMG was always harvested from cheek using 2 team approaches. Graft was placed using Kulkarni technique. Clinical outcome was considered success or failure if any post operative procedure needed. Mean follow up was 45 month (6-95) Results: Total 60 patients were included for final calculation, 31 patients with buccal mucosal graft (Group A) and 29 patients with Johanson’s staged urethroplasty (Group B) were followed up for average 45 months. Success rate of group A was 93.5% at 3 months and 77.4% at 3 years and in group B 65.5% at 3 months and 44.8% at 3 years follow up which is statiscally significant (p <.05). Postoperative complications were significantly higher in group-B. Conclusion: Repair of pan-urethral stricture in a single-stage OMG by Kulkarni technique is simple, fast, safe, effective and reproducible in the hand of any surgeon. Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.78-84

scholarly journals Adult Urethral Stricture Disease after Childhood Hypospadias Repair

2008 ◽  
Vol 2008 ◽  
pp. 1-4 ◽  
Author(s):  
Shou-Hung Tang ◽  
Clarisa C. Hammer ◽  
Leo Doumanian ◽  
Richard A. Santucci
Keyword(s):  
Urethral Stricture ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Severe Form ◽  
Adult Patients ◽  
Hypospadias Repair ◽  
Urethral Stricture Disease ◽  
Urethral Strictures ◽  
Hypospadias Surgery

Background. Adult patients with urethral stricture after childhood hypospadias surgeries are infrequently discussed in the literature. We report our experience in treating such patients.Materials and Methods. A retrospective chart review was performed. From 2002 through 2007, nine consecutive adult patients who had current urethral stricture and had undergone childhood hypospadias surgeries were included. All adult urethral strictures were managed by a single surgeon.Results. Mean patient age was 38.9 years old. The lag time of urethral stricture presentation ranged from 25 to 57 years after primary hypospadias surgery, with an average of 36 years. Stricture length ranged from 1 to 17 cm (mean: 10.3 cm). Open graft-based urethroplasties were performed in 4/9 cases. Salvage perineal urethrostomy was performed in 2/9 cases. Another 3 cases chose to undergo repeat urethrotomy or dilatations—none of these patients was cured by such treatment. Complications included one urethrostomy stenosis and one urinary tract infection.Conclusion. Urethral stricture may occur decades after initial hypospadias surgery. It can be the most severe form of anterior urethral stricture, and may eventually require salvage treatment such as a perineal urethrostomy. Patients undergoing hypospadias surgery should receive lifelong follow-up protocol to detect latent urethral strictures.

Outcome of Buccal Mucosal Graft Urethroplasty in Long Segment Anterior Urethral Stricture

2020 ◽  
Vol 19 (2) ◽  
pp. 64-68
Author(s):  
Mrinmoy Biswas ◽  
Sudip Das Gupta ◽  
Mohammed Mizanur Rahman ◽  
Sharif Mohammad Wasimuddin
Keyword(s):  
Urethral Stricture ◽  
Flow Rate ◽  
Surgical Outcome ◽  
Simple Technique ◽  
Anterior Segment ◽  
Maximum Flow ◽  
Anastomotic Site ◽  
Buccal Mucosal Graft ◽  
Male Patients

Objective: To assess the success of BMG urethroplasty in long segment anterior urethral stricture. Method: From January 2014 to December 2015, twenty male patients with long anterior segment urethral stricture were managed by BMG urethroplasty. After voiding trial they were followed up at 3 month with Uroflowmetry, RGU & MCU and PVR measurement by USG. Patients were further followed up with Uroflowmetry and PVR at 6 months interval.Successful outcome was defined as normal voiding with a maximum flow rate >15ml /sec and PVR<50 ml with consideration of maximum one attempt of OIU after catheter removal. Results: Mean stricture length was 5.2 cm (range 3-9 cm) and mean follow-up was 15.55 months (range 6-23 months). Only two patients developed stricture at proximal anastomotic site during follow-up. One of them voided normally after single attempt of OIU. Other one required second attempt of OIU and was considered as failure (5%). Conclusion: BMG urethroplasty is a simple technique with good surgical outcome. Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.64-68

The impact of increasing interbody fusion levels at the fractional curve on lordosis, curve correction, and complications in adult patients with scoliosis

2020 ◽  
pp. 1-10
Author(s):  
Dominic Amara ◽  
Praveen V. Mummaneni ◽  
Shane Burch ◽  
Vedat Deviren ◽  
Christopher P. Ames ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Revision Surgery ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Pelvic Incidence ◽  
Secondary Analysis ◽  
Lumbar Interbody Fusion ◽  
Curve Correction ◽  
Surgery Rates

OBJECTIVERadiculopathy from the fractional curve, usually from L3 to S1, can create severe disability. However, treatment methods of the curve vary. The authors evaluated the effect of adding more levels of interbody fusion during treatment of the fractional curve.METHODSA single-institution retrospective review of adult patients treated for scoliosis between 2006 and 2016 was performed. Inclusion criteria were as follows: fractional curves from L3 to S1 > 10°, ipsilateral radicular symptoms concordant on the fractional curve concavity side, patients who underwent at least 1 interbody fusion at the level of the fractional curve, and a minimum 1-year follow-up. Primary outcomes included changes in fractional curve correction, lumbar lordosis change, pelvic incidence − lumbar lordosis mismatch change, scoliosis major curve correction, and rates of revision surgery and postoperative complications. Secondary analysis compared the same outcomes among patients undergoing posterior, anterior, and lateral approaches for their interbody fusion.RESULTSA total of 78 patients were included. There were no significant differences in age, sex, BMI, prior surgery, fractional curve degree, pelvic tilt, pelvic incidence, pelvic incidence − lumbar lordosis mismatch, sagittal vertical axis, coronal balance, scoliotic curve magnitude, proportion of patients undergoing an osteotomy, or average number of levels fused among the groups. The mean follow-up was 35.8 months (range 12–150 months). Patients undergoing more levels of interbody fusion had more fractional curve correction (7.4° vs 12.3° vs 12.1° for 1, 2, and 3 levels; p = 0.009); greater increase in lumbar lordosis (−1.8° vs 6.2° vs 13.7°, p = 0.003); and more scoliosis major curve correction (13.0° vs 13.7° vs 24.4°, p = 0.01). There were no statistically significant differences among the groups with regard to postoperative complications (overall rate 47.4%, p = 0.85) or need for revision surgery (overall rate 30.7%, p = 0.25). In the secondary analysis, patients undergoing anterior lumbar interbody fusion (ALIF) had a greater increase in lumbar lordosis (9.1° vs −0.87° for ALIF vs transforaminal lumbar interbody fusion [TLIF], p = 0.028), but also higher revision surgery rates unrelated to adjacent-segment pathology (25% vs 4.3%, p = 0.046). Higher ALIF revision surgery rates were driven by rod fracture in the majority (55%) of cases.CONCLUSIONSMore levels of interbody fusion resulted in increased lordosis, scoliosis curve correction, and fractional curve correction. However, additional levels of interbody fusion up to 3 levels did not result in more postoperative complications or morbidity. ALIF resulted in a greater lumbar lordosis increase than TLIF, but ALIF had higher revision surgery rates.

scholarly journals Impact of distance on postoperative follow-up in patients of pediatric surgery: a retrospective review

2020 ◽  
Vol 3 (4) ◽  
pp. e000195
Author(s):  
Meagan E Wiebe ◽  
Anna C Shawyer
Keyword(s):  
Postoperative Complications ◽  
Pediatric Surgery ◽  
Descriptive Statistics ◽  
Attendance Rates ◽  
Urban Center ◽  
Children's Hospital ◽  
Median Distance ◽  
Equivalent Rate ◽  
Children’S Hospital

ObjectiveCentralization of medical services in Canada has resulted in patients travelling long distances for healthcare, which may compromise their health. We hypothesized that children living farther from a children’s hospital were offered and attended fewer follow-up appointments.MethodsWe reviewed children less than 17 years of age referred to the general surgery clinic at a tertiary children’s hospital during a 2-year period who underwent surgery. Descriptive statistics were performed.ResultsWe identified 723 patients. The majority were male (61%) with a median age of 7 years (range 18 days to16 years) and were from the major urban center (MUC) (56.3%). The median distance travelled to hospital for MUC patients was 8.9 km (range 0.9–22 km) vs 119.5 km (range 20.3–1950 km) for non-MUC patients. MUC children were offered more follow-up appointments (72.7% vs 60.8%, p<0.05). No significant differences existed in follow-up attendance rates (MUC 88.5% vs non-MUC 89.1%, p=0.84) or postoperative complications (9.8% vs 9.2%, p=0.78). There were no deaths.ConclusionsPatients living farther from a hospital were offered fewer follow-up appointments, but attended an equivalent rate of follow-ups when offered one. Telemedicine and remote follow-up are underused approaches that can permit follow-up appointments while reducing associated travel time and expenses.

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