Comparison of continuous eversion and inverting subepithelial suture in transverse preputial island flap urethroplasty in proximal hypospadias repair: A retrospective study

ABSTRACT Introduction: Transverse preputial island flap urethroplasty (TPIFU) is one of the most frequently performed technique for single-stage repair in proximal hypospadias. It was reported that the subepithelial urethroplasty would obviously decrease urethrocutaneous fistula (UF) complication after proximal TIP. But in the process of TPIFU, it had not been reported yet. Objective: We reviewed our experience to evaluate and compare the effect of continuous eversion suture (CES) versus continuous inversion subepithelial suture (CIS) on complication rates in the TPIFU. Material and methods: A retrospective review of all patients operated with CES and CIS in our institution between January 2017 and Jun 2017 was performed. Results: A total of 161 patients were enrolled in the research. Patients were followed up for 12~17 months. Total success rate was 73.9% (119/161). No statistically difference was found between the two groups with regard to age of patients (P=0.097), catheter size (P=0.52), time of catheterization (P=0.47), length of neourethra (P=0.20), non-urethral comorbidity (P=0.44) and post-operative infection (P=1.0). The overall postoperative complications had no statistically difference between the two groups (P=0.067). There were no statistically significant differences in the incidence of urethra-cutaneous fistula (UF) (OR=0.07, 95% CI: -0.24~0.037, P=0.22), urethral diverticulum (UD) (OR=0.026, 95% CI: -0.16~-0.056, P=0.323), urethral stricture (US) (OR=0.081, 95% CI: -0.15~0.15, P=1.0) and breakdown of urethral repair (BU) (OR=0.02, 95% CI: -0.118~-0.044, P=1.0). Discussion: The comparison of two group's postoperative complications was feasible because there were no statistically differences among perioperative variables. It seemed as if continuous inversion subepithelial suture would promote healing. However, it indicated that the overall success rate and the incidences of UF, UD, US and BU complications had no statistically difference between groups. It might be accounted for the subtle differences of techniques changing the process of establishing prime and side branches vascularization. Conclusions: The CIS technique had no significantly different effect on the four complications rates when compared with CES in TPIFU. Thus, CES and CIS could be randomly adopted in TPIFU as personal preference.

The effect of urethroplasty surgery on erectile and orgasmic functions: a prospective study

ABSTRACT Objectives: to examine the effects of urethroplasty surgery on sexual functions by taking into account age, location of stenosis, length of stenosis and surgical technique parameters. Materials and Methods: The prospective study was conducted between January 2015 and August 2017 with 60 cases. Patients were categorized according to age groups (19-65 / 65-75 years), surgery technique and stricture localization and length. Before the urethroplasty operation and postoperative 6th month follow-up, the international index of erectile function (IIEF) form (15 questions), was filled, the relevant domains of sexual function; erectile function (Q1,2,3,4,5,15), orgasmic function (Q9,10) and overall satisfaction (Q13,14) were assessed. Results: The mean age of the cases is 54 ± 13. However, preoperative IIEF, sexual satisfaction and orgasmic function averages of patients with a stenosis segment length of 1-3 cm was found to be significantly higher than that of patients with a stenosis segment length of 4-7 cm. Between stenosis segment length groups, there was no statistical difference in terms of preoperative and postoperative sexual functions. And also, there was no statistically significant change in patients' preoperative and postoperative sexual function scores in terms of localization of stricture and surgery techniques. However, there were statistically significant change in the postoperative IIEF and sexual satisfaction averages according to preoperative averages. Conclusion: Our study suggests that urethroplasty surgery itself does not significantly affect erectile function, orgasmic function, and general sexual satisfaction regardless of the type of surgery, localization and length of stenosis. Besides, there was a significant decrease in erectile function in senior adults.

Is circumferential urethral mobilization an overdo? A prospective outcome analysis of dorsal onlay and dorso - lateral onlay BMGU for anterior urethral strictures

ABSTRACT Introduction For dorsal onlay graft placement, unilateral urethral mobilization is less invasive than standard circumferential urethral mobilization. Apart from success in terms of patency of urethra, other issues like sexual function, overall quality of life and patient satisfaction remain important issues while comparing outcomes of urethroplasty. Aim To prospectively compare the objective as well as subjective outcomes of two approaches. Materials and Methods Between July 2011 and January 2015, 136 adult males having anterior urethral stricture with urethral lumen ≥ 6 Fr. were prospectively assigned between two groups by alternate randomization. Operative time, complications, success rate (no obstructive symptoms, no need of any postoperative intervention, Q max > 15mL/sec), sexual functions (using Brief Male Sexual Function Inventory) were compared. Results Baseline parameters were similar in both groups (68 in each group). Overall success rate was similar in both groups (89 % and 91 % respectively). Improvement in total LUTS scores was similar in groups. Changes in overall health status (VAS and EQ 5D) was equal in both groups. Erectile function score was significantly decreased in DO than DL group while ejaculatory function and sexual desire remained stable after urethroplasty in both groups. Conclusions In anterior urethral stricture buccal mucosa graft provides satisfactory results as onlay technique. No technique whether dorsolateral and dorsal techniques is superior to other. Dorsolateral technique needs minimal urethral mobilization and should be preferred whenever feasible.

Intraoperative breakage of Sachse's knife blade: A rare complication of optical internal urethrotomy (one case managing experience)

ABSTRACT Optical internal urethrotomy (OIU) is the most common procedure performed for short segment bulbar urethral stricture worldwide. This procedure most commonly performed using Sachse’s cold knife. Various perioperative complications of internal urethrotomy have been described in literature including bleeding, urinary tract infection, extravasation of fluid, incontinence, impotence, and recurrence of stricture. Here we report a unique complication of breakage of Sachse knife blade intraoperatively and its endoscopic management.

Prophylactic effects of alpha-blockers, Tamsulosin and Alfuzosin, on postoperative urinary retention in male patients undergoing urologic surgery under spinal anaesthesia

ABSTRACT Purpose Postoperative urinary retention (POUR) is one of the most common complications after surgical procedures under spinal anaesthesia. Recent studies have shown the beneficial effects of alpha-adrenergic blockers in preventing POUR. The aim of this prospective study was to investigate and compare the prophylactic effects of tamsulosin and alfuzosin on POUR after urologic surgical procedures under spinal anaesthesia. Materials and Methods A total of 180 males who underwent elective urologic surgery were included in this study. The patients were randomly allocated into three Groups. The Group I received placebo. Patients in Group II were given 0.4mg of tamsulosin orally 14 and 2 hours before surgery. Patients in Group III were given 10mg of alfuzosin ER orally 10 and 2 hours before surgery. All patients were closely followed for 24 hours postoperatively and their episodes of urinary retentions were recorded. Results There were 60 patients in each Group. Their mean age was 35.95±15.16 years. Fifteen patients in Group I (25%), 3 patients in Group II (5%) and 4 patients in Group III (6.7%) required catheterization because of urinary retention. In tamsulosin group and alfuzosin group, there were a significantly lower proportion of patients with POUR compared with the placebo Group (p=0.002 and p=0.006). The beneficial effects of tamsulosin and alfuzosin on POUR were similar between both Groups (p=0.697). Conclusion This study suggests that the use of prophylactic tamsulosin or alfuzosin can reduce the incidence of urinary retention and the need for catheterization after urologic surgical procedures under spinal anaesthesia.

Minimally access versus conventional hydrocelectomy: a randomized trial

ABSTRACTObjective:To compare our previously published new minimally access hydrocelectomy versus Jaboulay's procedure regarding operative outcome and patient's satisfaction.Materials and Methods:A total of 124 adult patients were divided into two groups: A and B. Group A patients were subjected to conventional surgical hydrocelectomy (Jaboulay's procedure) and group B patients were subjected to the new minimal access hydrocelectomy. The primary endpoint of the study was recurrence defined as a clinically detectable characteristic swelling in the scrotum and diagnosed by the two surgeons and confirmed by ultrasound imaging study. The secondary endpoints were postoperative hematoma, wound sepsis and persistent edema and hardening.Results:The mean operative time in group B was 15.1±4.24 minutes and in group A was 32.5±4.76 minutes (P≤0.02). The mean time to return to work was 8.5±2.1 (7–10) days in group B while in group A was 12.5±3.53 (10–15) days (P=0.0001). The overall complication rate in group B was 12.88% and in group A was 37%. The parameters of the study were postoperative hematoma, degree of scrotal edema, wound infection, patients’ satisfaction and recurrence.Conclusion:Hydrocelectomy is considered the gold standard technique for the treatment of hydrocele and the minimally access maneuvers provide the best operative outcomes regarding scrotal edema and hardening and patient's satisfaction when compared to conventional eversion-excision hydrocelectomies.

Tubularized incised plate urethroplasty for hypospadias reoperation: a review and meta-analysis

Purpose Tubularized Incised Plate (TIP) urethroplasty is a technique for urethral reconstruction of hypospadias although there are some controversies for its use in recurrent cases. The aim of this study was to review the results of TIP technique in various studies and the usage of different flaps for covering the repair site. Material and Methods Extensive Search was performed for articles published between 1994 and 2013 in common electronic databases. The overall TIP complication rates were estimated by a fixed effects model meta-analysis. Results 17 articles of hypospadia repair using the TIP method were reviewed. All studies performed surgery and repair on the basis of the Snodgrass’s method; however, some introduced modifications to the method. The prevalence of complications in repeated TIP surgery was 11.1 to 33.3% and the most prevalent complication in different studies was fistula. Based on the meta-analysis, the overall estimation of complications was 21.8 % (95% CI: 18.3 to 25.5). Conclusion Most studies performed the incision of the urethral plate to create a supportive coverage upon neourethra, and confirmed its success. We recommend further investigation on using different flaps in well-designed randomized controlled trials to choose the best surgical method for repairing recurrent hypospadias. .

Estudio de la hematuria asintomática en el largo plazo de pacientes operados de hiperplasia benigna de la próstata / Asymptomatic hematuria in patients after surgery of benign prostatic hyperplasia

Introducción: La literatura no menciona la hematuria asintomática (HA), como una complicación tardía en el largo plazo de la cirugía de la Hiperplasia Benigna de la Próstata (HBP), sino más bien se le asocia con la presencia de un tumor vesical y menos frecuentemente con un tumor renal. En los últimos años hemos tenido una serie de pacientes que consultaron por HA y el antecedente común de una cirugía por HBP en el pasado. El objeto de este estudio es investigar en éstos enfermos las causas de su hematuria. Material y Métodos: Registramos desde mayo de 2003 a junio de 2007 los pacientes que consultaron por HA y tenían además el antecedente de cirugía previa por HBP. Se les realizó Anamnesis, Examen físico, Orina completa, Urocultivo, APE, Creatinina, Ecografía renal y pelviana y Cistoscopia. Resultados: Registramos 21 enfermos que consultaron por HA y tenían el antecedente de cirugía porHBP en el pasado. Edad promedio 71,4 años (53-85 años). Tiempo post-operatorio promedio 6,3años (2-15 años), 18 enfermos (85,75 por ciento) habían tenido una RTU y 3 pacientes (14,3 por ciento) una Adenomectomía prostática transvesical, 6 enfermos (28,6 por ciento) tomaban aspirina en forma permanente. En 18 de los 21 enfermos (85,7 por ciento) de los pacientes sólo encontramos la presencia de pseudopolipos y varicocidades de la logue prostática y cuello vesical como zonas originarias de la hematuria, 3 enfermos (14,3 por ciento) tenían una recidiva de la HBP parcialmente obstructiva asociada a pseudopolipos y en sólo 1 enfermo (4,8 por ciento) detectamos un tumor papilar de la vejiga. 17 pacientes (87,7 por ciento) fueron tratados en forma conservadora y 4 enfermos (19 por ciento) requirieron de una intervención quirúrgica para el control de su hematuria incluido en ellos el paciente del tumor vesical.

Introduction: The literature don´t mention the asyntomatic haemathuria (AH) as a late complication in the large follow up of the surgery of Benign hyperplasia of the prostate (BPH). Most common allude to the suspicion of a bladder neoplasm’s or kidney tumour. In the last years we had have a number of patients with AH and Surgery by BPH in the past. The object of this study is to investigate the origin of this haemathuria. Material and Methods: We recorded from May 2003 to June 2007 the patients with AH and previous surgery of BPH. We studied them with history, physical examination, urine sediment, urine culture, PSA, creatinine, renal and pelvic ultrasound, and cistoscopy. Results: We recorded 21 patients with AH and BPH surgery in the past. Average age 71,4 years (53-85 years), Average time post surgery 6.3 years (2-15 years). 18 patients (85.7 percent) had a TURP and 3 patients (14.3 percent) had an open prostatectomy. 6 patients (28.6 percent) use aspirin. In 18 of 21 patients (85.7 percent) we only fended the existence of pseudopolips and or varicose of the prostatic loge and bladder neck as the origin of the blood. 3 patients (14.3 percent) had a BPH recidive associated to the pseudopolips. In only one patient (4.8 percent) we detected a bladder tumour. 17 patients (87.5 percent) were conservativement treated and 4 patients required an surgical management for haemathuria control include them the patient with bladder tumour.

Extended complications of urethroplasty

INTRODUCTION: An extensive study of complications following urethroplasty has never been published. We present 60 urethroplasty patients who were specifically questioned to determine every possible early and late complication. MATERIALS AND METHODS: Retrospective chart review of urethroplasty patients between August 2000 and March 2004. An "open format" questioning style allowed maximal patient reporting of all complications, no matter how minor. RESULTS: 60 patients underwent 62 urethroplasties (24 anterior anastomotic, 19 buccal mucosal and 10 fasciocutaneous, 9 posterior anastomotic) with mean follow-up of 29 months. Early complications occurred in 40 percent, but only 3 percent were major (rectal injury and urosepsis). Early minor complications included scrotal swelling, scrotal ecchymosis and urinary urgency. Late complications occurred in 48 percent, but only 18 percent were significant (erectile dysfunction, chordee and fistula). Late minor complications included a feeling of wound tightness, scrotal numbness and urine spraying. Fasciocutaneous urethroplasty caused the most significant complications, and buccal mucus urethroplasty the least, while also resulting in the lowest recurrence rate (0 percent). CONCLUSIONS: Serious complications after urethroplasty (3 percent early and 18 percent late) appear similar to those reported elsewhere, but minor bothersome complications appear to occur in much higher numbers than previously published (39 percent early and 40 percent late). While all the early complications were resolved and most (97 percent) were minor, less than half of the late complications were resolved, although most (82 percent) were minor. These complication rates should be considered when counseling urethroplasty patients, and generally tend to support the use of buccal mucosal onlay urethroplasty as it had the lowest rate of serious side effects.