Staged buccal mucosa graft Bracka urethroplasty in children with proximal hypospadias

2020 ◽  
Vol 8 (1) ◽  
pp. 15-20
Author(s):  
G.V. Kozyrev ◽  
◽  
D.Т. Manasherova ◽  
G.А. Аbdulkarimov ◽  
F.K. Аbdullaev ◽  
...  
Keyword(s):  
Buccal Mucosa ◽  
Penile Curvature ◽  
Urinary Flow ◽  
Proximal Hypospadias ◽  
Buccal Mucosa Graft ◽  
Primary Surgery ◽  
History Of ◽  
Key Words Hypospadias ◽  
Cosmetic Outcomes

For management of proximal hypospadias in children both one-stage (Hodgson, Ducket), and two-stage (Bracka) technieuqa are used. The staged Bracka repair is preferable because of fewer complications. The objective of the study was to assess and improve the outcomes of treating children with proximal hypospadias by improving the staged buccal mucosa graft Bracka repair. Patients and methods. In the department of uroandrology of the National Children’s Clinical Hospital in the period from 2013 to 2019 126 boys with proximal hypospadias received operative treatment according to the methos of buccal mucosa graft Bracka repair. Depending on whether it was primary surgery or an operation after failed repair, all patients were divided into 2 groups. Results. Both functional and cosmetic outcomes of treatment were assessed in the near and long-term post-operative periods. The assessment of the functional outcomes was based on the following criteria: recovery of free passage of urine with a wide stream (average urinary flow rate) and absence of penile curvature. Cosmetic outcomes were analysed by the HOPE score. Conclusion. Staged buccal mucosa graft urethroplasty permits to obtain positive functional and cosmetic outcomes of treatment in 60% (51% good and 9% satisfactory) of patients in the near and long-term periods. The percentage of complications is 41% and they are mainly presented by urethral fistulae. In patients with a history of failed surgery the risk for developing complications is practically the same as in primary patients. Key words: hypospadias, curvature correction

scholarly journals Scrotal Hypospadias with Severe Chordee, Micropenis, and Bifid Scrotum in A Child Treated with Multi Stage Repair and Hormonal Therapy

2019 ◽  
Vol 2 (3) ◽  
Author(s):  
Paulina Magdalena ◽  
Gede Wirya Kusuma Duarsa
Keyword(s):  
Therapeutic Option ◽  
Surgical Correction ◽  
Surgical Reconstruction ◽  
Penile Curvature ◽  
Corpus Spongiosum ◽  
Proximal Hypospadias ◽  
Multi Stage ◽  
Good Cosmetic ◽  
Cosmetic Outcomes

Proximal hypospadias, include proximal penile, penoscrotal, scrotal and perineal types, are a less common occurrence and correspond to 20% of total hypospadias. Surgical reconstruction is the only possible therapeutic option for hypospadias. The primary objectives of the reconstruction are to create a vertically slit orthotopic meatus, straighten the penis and establish good cosmetic results that include a conically shaped glans. Other important aspects for the reconstruction are to avoid shortening the penis and optimal skin coverage. A 9 years old male presented with abnormal spraying during urination. The parents said that the opening of his urethra is located under the penis. Everytime he urinates, the urine flowing along the thighs. In physical examination, the opening of urethra is in the scrotum. The penis was uncircumcised while the scrotum was bifid in the normal position, and bilateral testes were fully descended in the well-developed scrotum. Repair of proximal hypospadias involves correction of several components of the hypospadias complex with the intent of optimizing long-term functional and cosmetic outcomes. These components include ventral penile curvature, proximal location of the urethral meatus, ventral skin deficiency, glans morphology abnormality, abnormal division of the corpus spongiosum, penile torsion and penoscrotal transposition. Surgical correction of several components divide into five sequential steps. Severe forms of hypospadia are typically accompanied by an abnormal ventral curvature of the penis (chordee). Surgical correction of both chordee and hypospadias is recommended. When properly corrected, it does not cause long-term problems, and a natural appearance of the penis is usually restored.

scholarly journals Urethroplasty with dorsal buccal mucosa graft. Is it still the method of choice in long term urethral stenosis?

2017 ◽  
Vol 89 (1) ◽  
pp. 42 ◽  
Author(s):  
Carlo Pavone ◽  
Dario Fontana ◽  
Ninfa Giacalone ◽  
Nino Dispensa ◽  
Marco Vella ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Buccal Mucosa ◽  
Maximum Flow ◽  
Screening Tests ◽  
Life Questionnaire ◽  
Urethral Stenosis ◽  
Buccal Mucosa Graft

The aim of our work was to evaluate the long-term changes in symptoms (median 42 months) and to analyze data for any negative predictive factors for the application of the procedure, in patients who underwent to urethroplasty with dorsal buccal mucosa graft. During the period from 2010 to 2015 27 patients were examined. Than they underwent urethroplasty using dorsal buccal mucosa graft (graft of 4 x 2.5 cm). The evaluation of symptoms has been addressed through the application of the IPSS Quality of Life Questionnaire (International Prostatic Symptoms Score) and the evaluation of urinary flow has been carried out by a comparative analysis between the pre- and post-operative uroflowmetry. As our study has shown, data obtained by the screening tests in the post-operative follow-up indicate that there is an increase in the maximum flow of urine until 1 month after surgery. The results in the long-term follow-up are different because they show a partial reduction of the maximum flow although it is maintained around an average value of 23 ml/s being still higher than the maximum flow in the pre-operative period. According to our results it follows that there is a low failure rate of the procedure after a median of 42 months. Only in patients with urethral stenosis longer than 2 cm, a lower long term success is achieved. From what we could observe, this length of the stenosis seems to be the only negative predictive factor for long-term maintenance of a good Quality of Life in patients undergoing the procedure. The results obtained from our study confirm literature data according to which, the gold standard for 2-cm long bulbar urethral stricture whose lumen is well preserved with circumferential spongiofibrosis limited to 1-2 mm is the dorsal graft urethroplasty with buccal mucosa that in our study showed success rates higher of 80% after a median follow up of 42 months and a percentage of relapse-free patients of 82.1% ( median 3.5 years).

The article contains the analysis of the literature devoted to the correction of hypospadias in children. Parallels are drawn between classical works and modern trends in the treatment of this malformation. New surgical techniques (with reference to the history of their appearance) and developments are described. There is a discussion about the use of single and staged surgical interventions in the proximal hypospadias, the analysis of literary data about the complications, results of operations. New classification parameters of hypospadias, methods of assessing the severity of the defect before surgery, functional and cosmetic results after surgery are described. Attention is paid to such direction as standardization of approaches to surgical treatment of hypospadias, unification of methods of urethroplasty and correction of penile curvature. The data of clinical studies on the use of various operational techniques are presented.

2019 ◽  
pp. 82-86
Author(s):  
A. Z. Tibilov ◽  
N. B. Kireeva
Keyword(s):  
Surgical Treatment ◽  
Clinical Studies ◽  
Surgical Techniques ◽  
Penile Curvature ◽  
New Classification ◽  
Surgical Interventions ◽  
Cosmetic Results ◽  
Proximal Hypospadias ◽  
History Of

The article contains the analysis of the literature devoted to the correction of hypospadias in children. Parallels are drawn between classical works and modern trends in the treatment of this malformation. New surgical techniques (with reference to the history of their appearance) and developments are described. There is a discussion about the use of single and staged surgical interventions in the proximal hypospadias, the analysis of literary data about the complications, results of operations. New classification parameters of hypospadias, methods of assessing the severity of the defect before surgery, functional and cosmetic results after surgery are described. Attention is paid to such direction as standardization of approaches to surgical treatment of hypospadias, unification of methods of urethroplasty and correction of penile curvature. The data of clinical studies on the use of various operational techniques are presented.

Proximal hypospadias treated with a transverse preputial island tube: long-term functional, sexual, and cosmetic outcomes

2018 ◽  
Vol 122 (3) ◽  
pp. 463-471 ◽  
Author(s):  
Sybren P. Rynja ◽  
Tom P.V.M. de Jong ◽  
J.L.H. Ruud Bosch ◽  
Laetitia M.O. de Kort
Keyword(s):  
Proximal Hypospadias ◽  
Cosmetic Outcomes

scholarly journals Grinspan’s Syndrome: A Rare Case with Malignant Transformation

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Numan Kökten ◽  
Lokman Uzun ◽  
Ayşe Serap Karadağ ◽  
Tülay Zenginkinet ◽  
M. Tayyar Kalcıoğlu
Keyword(s):  
Malignant Transformation ◽  
Lichen Planus ◽  
Buccal Mucosa ◽  
Histopathological Examination ◽  
Split Thickness Skin Graft ◽  
Thickness Skin ◽  
Exophytic Tumor ◽  
History Of ◽  
Stratified Squamous Epithelium

Aim. Oral lichen planus (OLP) is one of the common chronic inflammatory, noninfectious, and precancerous oral mucosal diseases that affect the stratified squamous epithelium in adults. Grinspan et al. reported an association of OLP with diabetes mellitus and vascular hypertension and called that Grinspan’s syndrome in 1966. We aim to present a case of Grinspan’s syndrome with malignant transformation. Case Presentation. A 60-year-old man who presented with a ten-year history of OLP diagnosed clinically and histologically was referred to our otolaryngology department with a painless swallowing in the left buccal mucosa for 3 months. Clinical examination revealed several plaques, striated white lesions in the buccal mucosa bilaterally, and an exophytic tumor in the left buccal mucosa. Histopathological examination showed lichen planus bilaterally and oral squamous cell carcinoma in the left buccal mucosa. The tumor had been developed on the preexisting areas of lichen planus which had been histologically proven before. The tumor was removed completely, and the tissue defect on the buccal mucosa was repaired with a split-thickness skin graft. Conclusion. Patients with OLP should be followed up periodically in a long term at close intervals for early diagnosis of malignant transformation.

Staged Buccal Mucosa Graft Urethroplasty for Proximal Hypospadias in Children: A Short- to Mid-Term Follow-Up Retrospective Study

2020 ◽  
Author(s):  
Sen Chen ◽  
Yangqun Li ◽  
Ning Ma ◽  
Weixin Wang ◽  
Lisi Xu ◽  
...  
Keyword(s):  
Buccal Mucosa ◽  
Complication Rate ◽  
Maximum Flow ◽  
Previous Treatment ◽  
Tanner Stage ◽  
Complication Rates ◽  
Flow Rates ◽  
Proximal Hypospadias ◽  
Buccal Mucosa Graft ◽  
Buccal Mucosa Graft Urethroplasty

Abstract Introduction The aim of this study is to report our experience with modified staged buccal mucosa graft urethroplasty for the repair of proximal hypospadias in children and adolescents. Materials and Methods A total of 183 patients were treated at the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between 2010 and 2019. The patients were grouped according to age: (1) within 1.5-year-old group, (2) prepuberty group (Tanner stage 1), and (3) puberty group. Results In total, 153 patients were included in this study. Thirty-six patients had complications: seven after stage one; 29 after stage two; one patient had two complications. Maximum flow rates were 11.80 ± 1.46 mL/s in the 1.5-year-old group, 13.24 ± 2.61 mL/s in the prepuberty group, and 13.60 ± 2.20 mL/s in the puberty group (p = 0.199). Average flow rates were 6.86 ± 1.37, 7.94 ± 1.74, and 7.88 ± 1.22 mL/s, respectively (p = 0.203). The optimal hypospadias objective scoring evaluation score of 16 was seen in 117 patients (76%), the score of 15 in 23 patients (15%), 14 in 10 (7%), and 13 in 3 patients (2%). Patients with an uncomplicated treatment (no complication) had a higher clinical outcome than patients with a complication (15.8 ± 0.53 vs. 15.3 ± 0.97, with or without complication, p = 0.000). Multivariable analyses showed that previous treatment was closely related to the complication rate (p = 0.016). Conclusion The modified procedure allows for two-stage repair of proximal hypospadias with good results with a low complication rate and good functional results. Delaying operation did not increase complication rates in our research.

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