Tunneled tubularized bladder mucosal graft for long urethral reconstruction:is it a reliable option in selected complex cases in children and adolescents?

Aim:We analyzed the use of tubularized tunneled bladder mucosa graft(TBMG)and its application as a salvage procedure or as primary surgery for long urethroplasty in children and adolescents.Specific attention was given to a new method to harvest a long bladder mucosa graft through a minimal detrusotomy.Methods:We analyzed the files of 10 patients who underwent TBMG urethroplasty at median age of 105 months(range 20-195 months).The indications were perineal hypospadias cripple in two,masculinizing genitoplasty for ovotesticular Ovotesticular Disorder of Sex Development(DSD)in two,perineal hypospadias in four,duplicated urethra in one,and complications of circumcision in one.Staged reconstruction was performed in all patients.The first stage was removal of all fibrous tissues and efficient treatment of curvature and skin coverage.After a minimal delay of one year,a free bladder mucosa graft was harvested through a minimal detrusotomy and tubularized.Tunneling of the graft was proceeded from the perineal urethrostomy to the glans.Results:The graft was successfully harvested through the minimal detrusotomy approach for variable lengths of urethroplasty;the median length was 10.5 cm(range 8-16 cm).The median follow up was 61.7 months(range 18-160 months).TBMG was the last surgery with no redo in five cases(50%).Long stricture occurred in one case of primary perineal hypospadias and needed a redo staged surgery.Two patients performed self-dilatation for distal stenosis.Conclusion:The tunneled bladder mucosa tube graft technique represents a good alternative for a long urethroplasty in patients with a paucity of healthy skin.The minimal detrusotomy technique for graft retrieval may reduce graft harvesting morbidity.

Preliminary clinical study on non-transecting anastomotic bulbomembranous urethroplasty

This study aims to investigate the effect of non-transecting anastomotic urethroplasty for treatment of posterior urethral stricture. A total of 23 patients with traumatic posterior urethral stricture were enrolled and then divided into two groups. In one group, 12 patients underwent non-transecting anastomotic urethroplasty. In the other group, 11 patients underwent conventional posterior urethra end-to-end anastomosis. The effect of operation was evaluated using the following parameters： the bleeding amount during operation, operation time, IIEF-5 scores after operation, maximum flow rate （Qmax）, and rating scale of quality of life （QoL）. The comparison between the conventional posterior urethra end-to-end anastomosis group and the non-transecting anastomotic urethroplasty group showed no significant difference with regard to average operation time. However, a significant difference was observed between the groups with regard to the bleeding amount during operation. The patients in the group of uon-transecting anastomotic urethroplasty urinated smoothly after the removal of catheter. Meanwhile, one patient from the group of conventional posterior urethra end-to-end anastomosis had difficulty urinating after the removal of catheter. Furthermore, significant differences in the operation time, bleeding amount during operation, IIEF-5 scores after operation, and rating scale of QoL were observed, whereas no significant difference was observed between urine flow rates of the two groups after operation. Overall, non-transecting anastomotic urethroplasty is effective for posterior urethra reconstruction, and it can reduce the occurrence rate of erectile dysfunction after operation.