urethral plate
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2022 ◽  
Vol 48 (1) ◽  
pp. 74-81
Author(s):  
Mohamed Abdalla ◽  
◽  
Ahmed Sakr ◽  
Hazem Elgalaly ◽  
Ehab Elsayed ◽  
...  

2022 ◽  
Vol 5 (1) ◽  
pp. e000225
Author(s):  
M Reza Roshandel ◽  
Tannaz Aghaei Badr ◽  
Fahimeh Kazemi Rashed ◽  
Samantha Salomon ◽  
Seyyed Mohammad Ghahestani ◽  
...  

BackgroundTubularized incised plate urethroplasty is the most common hypospadias repair technique. However, there are unanswered questions and debates about the anatomical prognostic factors affecting the repair outcomes. This study tried to address some of the problems in the studies compromising the results of the current body of literature.MethodsA prospective cohort of 101 males aged 1–3 years undergoing primary distal to mid-shaft hypospadias repair were enrolled in the study. Complications including edema, erection, inadvertent removal of the urethral stent, surgical wound infection, bladder spasm, hematoma, and hemorrhage were evaluated. Studies in the current literature were reviewed to achieve a better perspective for future investigations.ResultsPersistent complications were found in 16 cases (15.8%) including fistula formation, the persistence of chordee, meatal stenosis, glans, and urethral dehiscence. The mean follow-up time was 6.6±3.4 months. In the single-variable analysis, the meatal location, the length and width of the urethral plate, and the reversible acute postoperative events were significantly associated with the complications. Furthermore, fistula formation was associated with acute surgical site infection (p<0.001). However, the multivariable regression study revealed the presurgical meatal location to be the only statistically significant factor (p=0.03). Notably, the glans diameter or glanular groove shape, urethral plate dimensions, or presence of mild chordee were not independently associated with the outcomes (p>0.05).ConclusionsOur study on the toddlers with hypospadias surgery revealed that the location of urethral meatal was the main predicting factor in the development of major complications. Furthermore, the fistula formation at the infected surgical site emphasizes the importance of postsurgical care.


Materials ◽  
2021 ◽  
Vol 14 (24) ◽  
pp. 7648
Author(s):  
Nunzia Gallo ◽  
Maria Lucia Natali ◽  
Claudia Curci ◽  
Angela Picerno ◽  
Anna Gallone ◽  
...  

Urethral stenosis is a pathological condition that consists in the narrowing of the urethral lumen because of the formation of scar tissue. Unfortunately, none of the current surgical approaches represent an optimal solution because of the high stricture recurrence rate. In this context, we preliminarily explored the potential of an insoluble type-I collagen from horse tendon as scaffolding material for the development of innovative devices for the regeneration of injured urethral tracts. Non-porous collagen-based substrates were produced and optimized, in terms of crosslinking density of the macromolecular structure, to either provide mechanical properties compliant with the urinary tract physiological stress and better sustain tissue regeneration. The effect of the adopted crosslinking strategy on the protein integrity and on the substrate physical–chemical, mechanical and biological properties was investigated in comparison with a decellularized matrix from porcine small intestinal submucosa (SIS patch), an extensively used xenograft licensed for clinical use in urology. The optimized production protocols allowed the preservation of the type I collagen native structure and the realization of a substrate with appealing end-use properties. The biological response, preliminarily investigated by immunofluorescence experiments on human adult renal stem/progenitor cells until 28 days, showed the formation of a stem-cell monolayer within 14 days and the onset of spheroids within 28 days. These results suggested the great potential of the collagen-based material for the development of scaffolds for urethral plate regeneration and for in vitro cellular studies.


2021 ◽  
Vol 9 ◽  
Author(s):  
Yuan Ding ◽  
Shengli Gu ◽  
Xingrong Xia ◽  
Zhengbo Yu

Objective: To compare the effect of prefabricated urethra and pre-implanted urethral plate in the treatment of severe hypospadias in children.Methods: We retrospectively analyzed the clinical data of 53 patients who diagnosed as severe hypospadias underwent staging urethroplasty from January 2015 to January 2018 in the Department of Pediatric Surgery, First People's Hospital, Zunyi City. The patients were divided into two groups: group A (n = 25) were treated with prefabricated urethra and group B (n = 28) were treated with pre-implanted urethral plate. After the second stage surgery, the ratios of complications such as urethral fistula, urethral stenosis, urethrocele, and recurrence chordee were compared. The penis was scored from meatus, glans, shaft skin, general appearance by the parents, blinded urologists according to The Pediatric Penile Perception Score, and the scores were compared too.Results: All patients were followed up after two stage operations for an average of 28 months. Glans dehiscence occurred in two patients (8%), urethral orifice stenosis occurred in one (4%) and urethral fistula occurred in three (12%) in group A. No urethral stenosis, urethrocele and recurrence chordee was observed. One patient presented urethral plate inactivation (3.6%), two patients presented urethral fistula (7.1%) and one patient presented urethral stenosis (3.6%) in group B. No urethrocele, glans dehiscence and recurrence chordee was observed. The total complication rate in group A was 24 and 14.3% in group B, respectively, and the difference was not statistically significant (P = 0.582). The differences between two groups scored by parents in glans (P = 0.030) was statistically significant. The differences between two groups scored by operators in meatus (P = 0.041), shaft skin (P = 0.000), glans (P = 0.001), and general appearance (P = 0.007) were statistically significant. The differences between two groups scored by counterparts in meatus (P = 0.006), shaft skin (P = 0.003), glans (P = 0.010), and general appearance (P = 0.014) were statistically significant.Conclusion: Both prefabricated urethra and pre-implanted urethral plate methods are suitable for correction of severe hypospadias as staging surgery in children. In general, pre-implanted urethral plate is more worthy of spread because it is much more applied in patients with small glans and achieve good appearance of penis.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Naeem M ◽  
◽  
Khan MK ◽  
Shah G ◽  
Izhar M ◽  
...  

Objective: To compare the outcomes of modified Mathieu versus standard tubularised incised-plate urethroplasty for distal hypospadias repair. Materials and Methods: This prospective comparative study was conducted on 54 cases affected by distal hypospadias presenting to Institute of Kidney Disease, Hayatabad, Peshawar form February 2015 to June 2020. The inclusion criteria was patients with distal hypospadias (coronal, sub-coronal, or distal penile), age range of 15 to 60 months. Cases with severe chordee/ventral curvature, history of previous hypospadias repair, and poorly developed urethral plate were excluded. The patients with distal hypospadias were divided into two equal groups: in-group I repair done with Mathieu procedure plus incision of the urethral plate (modified Mathieu) and in-group II repair was performed with Tubularized Incised Plate (TIP). The principal author performed functional and cosmetic assessment at follow up visits which includes; denvo meatus; size and pressure of the stream; and complications like meatal stenosis, urethral cutaneous fistula. Fisher Exact test was used to compare categorical variables between the two groups and student t test for continuous variables. Results: The mean age of the study was 38.13±12.55 months. The operating time was less in TIP than modified Mathieu procedure statistically (P=0.036, 95% CI=0.315, 9.02). In modified Mathieu procedure the sprayed stream of micturition was higher (n=4, 14.8%) while in TIP procedure the frequency of narrow stream was higher (n=4, 14.8%). The difference was statistically significant (P=0.054). Only in modified Mathieu procedure the meatus shape was round in 4 (14.8%) cases and the results were statistically different (P=0.038). Post-operative fistula was higher TIP (n=6, 22.2%) than modified Mathieu (n=1, 3.7%) statistically (P=0.043). Only in TIP procedure postoperative meatal stenosis was found in 5 (18.5%) and the difference was statistically significant (P=0.019). Conclusion: The modified Mathieu technique can improve the cosmetic outcome through creation of slit-like meatus, low incidence of fistula and meatal stenosis than tubularized incised plate urethroplasty in the repair of distal hypospadias.


2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Ahmed Shoukry ◽  
Ahmed Abbas ◽  
Mohamed Abdelwahab ◽  
Waleed Ghoneima ◽  
Ahmed Shouman ◽  
...  

Abstract Background Our prospective study aims to assess if penile parameters and GMS score can predict the postoperative outcome of patients with hypospadias repaired with the TIP technique. Methods This prospective study included patients (6 months–11 years old) with coronal, distal or mid penile hypospadias who underwent Tubularized incised plate (TIP) urethroplasty technique from 2015 to 2017. All patients were assessed preoperatively using GMS score. GMS score included a scale for each component, with the more unfavorable characteristics assigned higher scores. Penile length, urethral plate length, and penoscrotal length were measured using a ruler. Glans width was measured by using a caliper ruler. Demographics and complications were assessed within 3 months of the procedure. Results There was a statistically significant difference between complicated and non-complicated patients regarding GMS score, glans width, penoscrotal length, penile length, and urethral plate length/penile length ratio. According to the ROC curve, the cutoff values for GMS score, glans width and penoscrotal length were 6, 14 mm and 5 cm, respectively. The area under the ROC curve for penile length and for urethral plate/penile length ratio was poor and so we could not get a specific cutoff value for either parameters. According to Stepwise logistic regression, the GMS score was the only significant independent parameter while controlling all the other factors. Any increase in the GMS score by one unit would increase the risk of complications 3 times. Conclusion GMS score and penile parameters are good predictors and complete each other in preoperative assessment for hypospadias patients. Patients with a high GMS score (above 6) have a higher risk of complication and patients with a Glans width of 14 mm or more and a penoscrotal length of 5 cm or more are associated with less risk of complication.


2021 ◽  
Vol 22 (1) ◽  
pp. 62-70
Author(s):  
Yu. E. Rudin ◽  
D. V. Maruhnenko ◽  
A. Yu. Rudin ◽  
D. К. Aliev ◽  
G. V. Lagutin ◽  
...  

Background. Important causes of complications of hypospadias repair are the deficit of tissues for plastic surgery, grooveless and small size of glans, obliteration of the urethral platewith varying degrees of scarring. The coronal urethral fistula  is the most common complication of urethroplasty. Surgeons continue to search for reliable methods of correction of complications.Materials and methods. Between 2011 and 2019, 85 children aged 2 and 17 years presented with coronal fistula  of urethra after hypospadias repair. (TIP) Snodgrass – 78 (91.7 %) and Mathiue – 7 (8.2 %) procedures have been performed them earlier. In our clinic previously operated 28 (32 %) boys, primary surgery of the remaining 57 (67 %) was performed in other medical institutions.Results. All patients (85), conditionally, were divided into two groups. The first group included 39 children (45.8 %), with stitching a fistula, the second group consisted of 46 patients (54.1 %), with augmentation of the urethral plate of the glans and distal urethra with the implantation of a rectangular preputial or oral mucosa free graft. Recurrent urethral fistula after stitching was observed in 10 boys (25.6 %) of the first group, and only in 2 cases (4.3 %) in children with the augmentation of the urethral plate (p <0.05). The decrease of urine flow according to the data of uroflowmetry was observed  in 15 patients (52 %) the first group, the children of the second group did not have a decrease in the flow of urine.Discussion. The shape, size of the glans and the condition of the urethral plate affect to the result of urethroplasty. The connection of the wings of the glans in accordance with normal anatomy, avoid obstruction in the distal part of urethra. A wide urethra in the glans and meatal area improves urine flow. Conclusion. The augmentation of the urethral plate of the penile glans and the distal urethra with the implantation of a wide rectangular free flap in to the meatus, in our opinion, an advantage over the implantation of diamond-shaped grafts using the GTIP or TIP graft technique. 


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