Urethroplasty:current techniques and management of complications

Urethroplasty has always been a challenge in genitourinary surgery;urethral reconstruction(primary or redo)is one of the most critical functional requests.In recent decades,many urethroplasty techniques and their modifications have been published.Primary repair is indicated for congenital abnormalities of the urethra,such as hypospadias or epispadias,the most frequent anomalies with urethral defects.One of the essential aspects of urethroplasty is urethral stricture disease,and there is much discussion about the etiology,location,length,and management.Despite recent improvements,the management of urethral stricture disease remains a challenging problem.Successful management is based on detailed knowledge of the anatomy,pathophysiology,and proper procedure selection tailored for each case.

Epispadias:recent techniques

Aim:This paper presents the latest surgical approaches for epispadias treatment in the pediatric population,as well as those for adolescent and adult populations after initial failed repair in childhood.Methods:The retrospective study was conducted between March 2005 and May 2020 and included 18 patients with the mean age of 21 months(range 11-48 months)(Group A),who underwent primary epispadias repair and 15 patients with the mean age of 18 years(range 13-29 years)(Group B),who underwent redo surgery after failed epispadias repair in childhood.In Group A,the surgery was performed as a one-stage procedure using complete penile disassembly technique,while,in Group B,the surgery was done as a two-stage procedure and included complete straightening and lengthening of the penis,followed by urethral reconstruction.Penile straightening and lengthening were achieved by tunica albuginea incision and grafting.In Group A,the urethral plate was mobilized,transposed ventrally,and tubularized and augmented with vascularized preputial skin flap where needed.In Group B,the urethra was reconstructed either using the buccal mucosa graft and genital skin flaps or with tubularization of genital skin flaps.Successful treatment was defined as a functional and esthetically acceptable penis without complications.Results:The mean follow-up was 88 months(range 15-197 months).Satisfactory results were achieved in 26/33 patients.Urethral fistula occurred in 4/18 patients from Group A and in 3/15 patients in Group B and was surgically repaired after four months.Skin dehiscence occurred in eight patients,five from Group A and three from Group B.Recurrent penile curvature was observed in 2/18 patients from Group A and required surgical correction and in 2/15 patients from Group B and was mild and did not need surgical repair.Eleven patients from Group B who filled out the International Index for Erectile Function reported satisfying erectile function,sexual desire,intercourse,and overall satisfaction.Conclusion:Primary or redo epispadias repair is challenging even for experienced reconstructive urologists.Only radical surgical approach can lead to complete correction of all deformities and provide successful outcome.