The recent International Consultation on Urological Disease(ICUD)panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis,as distinct from sphin...The recent International Consultation on Urological Disease(ICUD)panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis,as distinct from sphincter stenoses and a urethral disruption injury.Whenever possible,an anastomotic urethroplasty should be performed because of the higher success rate as compared to augmentation urethroplasty.There is some debate currently regarding the critical stricture length at which an anastomotic procedure can be used,but clearly the extent of the spongiofibrosis and individual anatomical factors(the length of the penis and urethra)are important,the limitation for this being extension of dissection beyond the peno-scrotal junction and the subsequent production of chordee.More recently,there has been interest in whether to excise and anastomose or to carry out a stricturotomy and reanastomosis using a Heineke-Miculicz technique.Augmentation urethroplasty has evolved towards the more extensive use of oral mucosa grafts as compared to penile skin flaps,as both flaps and grafts have similar efficacy and certainly the use of either dorsal or ventral positioning seems to provide comparable results.It is important that the reconstructive surgeon is well versed in the full range of available repair techniques,as no single method is suitable for all cases and will enable the management of any unexpected anatomical findings discovered intra-operatively.展开更多
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 re...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.展开更多
Radiotherapy-induced urethral strictures(RIUS)decrease quality of life and present a great challenge for surgical reconstruction,especially due to proximal location,compromised vascular supply,and poor wound healing.I...Radiotherapy-induced urethral strictures(RIUS)decrease quality of life and present a great challenge for surgical reconstruction,especially due to proximal location,compromised vascular supply,and poor wound healing.It is unclear whether urethroplasty is an option in cases with stricture resulting from exposure to pelvic radiation.We review the pathophysiology,diagnostic workup,and disease-specific aspects of RIUS.Furthermore,we discuss several management alternatives such as excision and primary anastomosis,as well as techniques for open reconstruction with flaps.The most extensive techniques in the treatment of strictures include,for example,those using gracilis muscle flaps,as they can involve periurethral tissue to provide sufficient vascularity for excellent post-surgery urethral healing.In brief,RIUS represent a significant challenge.In carefully chosen patients,urethroplasty should be considered as a feasible and durable treatment.However,medical practitioners should always take into consideration that the results of urethroplasty in RIUS are not comparable to urethroplasties without a radiation background.展开更多
文摘The recent International Consultation on Urological Disease(ICUD)panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis,as distinct from sphincter stenoses and a urethral disruption injury.Whenever possible,an anastomotic urethroplasty should be performed because of the higher success rate as compared to augmentation urethroplasty.There is some debate currently regarding the critical stricture length at which an anastomotic procedure can be used,but clearly the extent of the spongiofibrosis and individual anatomical factors(the length of the penis and urethra)are important,the limitation for this being extension of dissection beyond the peno-scrotal junction and the subsequent production of chordee.More recently,there has been interest in whether to excise and anastomose or to carry out a stricturotomy and reanastomosis using a Heineke-Miculicz technique.Augmentation urethroplasty has evolved towards the more extensive use of oral mucosa grafts as compared to penile skin flaps,as both flaps and grafts have similar efficacy and certainly the use of either dorsal or ventral positioning seems to provide comparable results.It is important that the reconstructive surgeon is well versed in the full range of available repair techniques,as no single method is suitable for all cases and will enable the management of any unexpected anatomical findings discovered intra-operatively.
文摘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.
文摘Radiotherapy-induced urethral strictures(RIUS)decrease quality of life and present a great challenge for surgical reconstruction,especially due to proximal location,compromised vascular supply,and poor wound healing.It is unclear whether urethroplasty is an option in cases with stricture resulting from exposure to pelvic radiation.We review the pathophysiology,diagnostic workup,and disease-specific aspects of RIUS.Furthermore,we discuss several management alternatives such as excision and primary anastomosis,as well as techniques for open reconstruction with flaps.The most extensive techniques in the treatment of strictures include,for example,those using gracilis muscle flaps,as they can involve periurethral tissue to provide sufficient vascularity for excellent post-surgery urethral healing.In brief,RIUS represent a significant challenge.In carefully chosen patients,urethroplasty should be considered as a feasible and durable treatment.However,medical practitioners should always take into consideration that the results of urethroplasty in RIUS are not comparable to urethroplasties without a radiation background.
