Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 34
Filter
1.
Int. braz. j. urol ; 46(1): 83-89, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1056362

ABSTRACT

ABSTRACT Purpose: Obliterative urethral stenosis is a type of urethral lesion that compromises the whole corpus spongiosum's circumference. We present our experience in resolving complex long segment urethral obliteration in a single procedure using a combination of dorsal onlay oral mucosa graft (OMG) and ventral fasciocutaneous penile skin flap. Materials and methods: A prospectively maintained database was reviewed, which included data of men presenting long, obliterative strictures. Patients were excluded if they were lost to follow-up before one year. Failure was defined as need for further urethral instrumentation. The surgical technique used consisted on the fixation of OMG to the tunica albuginea of the corpus cavernosum, thus creating a new urethral plate. Penile or foreskin flaps were employed to complete the ventral aspect. Postoperative follow-up was done with a voiding cystourethrography at week 3. Results: A total of 21 patients were included with a median age of 49 years. Mean follow-up was 25 months. Failure was found for 3 patients (2 of them needing dilations and only one required a new urethral reconstruction). Conclusion: Single stage combination of dorsal OMG with ventral fasciocutaneous penile flap showed good results for selected patients affected with obliterative urethral stenosis.


Subject(s)
Humans , Male , Penis/surgery , Surgical Flaps/transplantation , Urethral Stricture/surgery , Reconstructive Surgical Procedures/methods , Mouth Mucosa/transplantation , Prospective Studies , Reproducibility of Results , Follow-Up Studies , Treatment Outcome , Kaplan-Meier Estimate , Operative Time , Middle Aged
2.
Int. braz. j. urol ; 45(5): 981-988, Sept.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1040089

ABSTRACT

ABSTRACT Objectives To compare and assess various outcomes and success of buccal mucosal graft urethroplasty (BMGU) in patients with CKD versus patients having normal renal function. Material and Methods This was a retrospective, single centre study, during period 2013 to 2017. Patients were grouped into two groups. Group 1 had patients with estimated Glomerular Filtration Rate (eGFR)>60mL/min/1.73m2 while group 2 had patients with eGFR <60mL/min/1.73m2. eGFR was calculated according to the MDRD equation. The two groups were compared with regard to various outcomes like length, location of stricture, technique of graft placement, intra-operative blood loss (haemoglobin drop), duration of hospital stay, post-operative complications and recurrence. Results A total of 223 patients were included in study with group 1 had 130 patients and group 2 had 93 patients. Mean age of patients with CKD were higher (47.49 years versus 29.13 years). The mean follow-up period was comparable between both groups (23.29 months and 22.54 months respectively). Patients with CKD had more post-operative Clavien Grade 2 or higher complications (p=0.01) and a greater recurrence rates (p<0.001) than in non-CKD patients. On multivariate analysis, age and CKD status was significant predictor of urethroplasty success (p=0.004) (OR= 14.98 (1.952-114.94, 95% CI). Conclusions CKD patients are more prone to post-operative complications in terms of wound infection, graft uptake and graft failure and higher recurrence rates following BMGU.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Urologic Surgical Procedures/methods , Urethra/surgery , Urethral Stricture/surgery , Renal Insufficiency, Chronic/physiopathology , Mouth Mucosa/transplantation , Postoperative Complications/etiology , Recurrence , Urologic Surgical Procedures/adverse effects , Multivariate Analysis , Retrospective Studies , Risk Factors , Treatment Outcome , Renal Insufficiency, Chronic/complications , Glomerular Filtration Rate , Middle Aged
4.
Int. braz. j. urol ; 44(4): 838-839, July-Aug. 2018.
Article in English | LILACS | ID: biblio-1040041

ABSTRACT

ABSTRACT Objectives: Buccal mucosa grafts and fascio-cutaneous flaps are frequently used in long anterior urethral strictures (1). The inlay and onlay buccal mucosa grafts are easier to perform, do not need urethral mobilization and generally have good long-term results (2-4). In the present video, we present a case where we used a double buccal mucosa graft technique in a simultaneous penile and bulbar urethral stricture. Materials and Methods: A 54 year-old male patient was submitted to appendectomy where a urethral catheter was used for two days in May 2015. Three months after surgery, the patient complained of acute urinary retention and a supra-pubic tube was indicated. Urethrocystography was performed two weeks later and showed strictures in penile and bulbar urethra with 3.5 cm and 3 cm in length respectively. Urethroplasty was proposed for the surgical treatment in this case. We used a perineal approach with a ventral sagittal urethrotomy in both strictures. Penile urethra stricture measuring 3.5 cm in length was observed and a free graft from the buccal mucosa was harvested and placed into the longitudinal incision in the dorsal urethra and fixed with interrupted suture as dorsal inlay. Bulbar urethra stricture measuring 3 cm was observed and a free graft from the buccal mucosa was harvested and placed into the longitudinal incision in the ventral urethra and fixed with interrupted suture as ventral onlay. The ventral urethrotomy was closed over a 16Fr Foley catheter and the skin incision was then closed in layers. Results: No intraoperative or postoperative complications occurred. The patient could achieve satisfactory voiding and no complication was seen during the six-month follow-up. Postoperative imaging demonstrated a widely patent urethra, and the mean peak flow was 12 mL/s. Conclusion: The BMG placement can be ventral, dorsal, lateral or combined dorsal and ventral BMG in the meeting of stricture but the first two are most common (5, 6). Ventral location provides the advantages of ease of exposure and good vascular supply by avoiding circumferential rotation of the urethra (7). Early success rates of dorsal and ventral onlay with BMG were 96 and 85%, respectively. However, long-term follow-up revealed essentially no difference in success rates (8-11). Anterior urethral stricture treatments are various, and comprehensive consideration should be given in selecting individualized treatment programs, which must be combined with the patient's stricture, length, complexity, and other factors. Traditionally, anastomotic procedures with transection and urethral excision are suggested for short bulbar strictures, while longer strictures are treated by patch graft urethroplasty preferably using the buccal mucosa as gold-standard material due to its histological characteristics. The current management for complex urethral strictures commonly uses open reconstruction with buccal mucosa urethroplasty. However, there are multiple situations whereby buccal mucosa is inadequate (pan-urethral stricture or prior buccal harvest) or inappropriate for utilization (heavy tobacco use or oral radiation). Multiple options exist for use as alternatives or adjuncts to buccal mucosa in complex urethral strictures (injectable antifibrotic agents, augmentation urethroplasty with skin flaps, lingual mucosa, colonic mucosa, and new developments in tissue engineering for urethral graft material). In the present case, our patient had two strictures and we chose to correct the first stricture with a dorsal graft and the bulbar stricture with a ventral graft because of our personal expertise. We can conclude that the double buccal mucosa graft is easier to perform and can be an option to repair multiple urethral strictures.


Subject(s)
Humans , Male , Penile Diseases/surgery , Urethral Stricture/surgery , Skin Transplantation/methods , Mouth Mucosa/transplantation , Urologic Surgical Procedures, Male/methods , Surgical Flaps/transplantation , Reproducibility of Results , Treatment Outcome , Constriction, Pathologic/surgery , Middle Aged
5.
Int. braz. j. urol ; 44(1): 163-171, Jan.-Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-892955

ABSTRACT

ABSTRACT Purpose To evaluate the surgical outcome and predictors of failure of substitution urethroplasty using either dorsal onlay buccal mucosal (BM) graft or ventral onlay penile skin flap (PS) for anterior urethral stricture ≥ 8cm. Patients and methods Between March 2010 and January 2016, 50 patients with anterior urethral stricture ≥ 8 cm were treated at our hospital. The surgical outcome and success rate were assessed. The predictors of failure were analyzed using multivariate analysis. Failure was considered when subsequent urethrotomy or urethroplasty were needed. Results Dorsal onlay BM graft was carried out in 24 patients, while PS urethroplasty in 26 patients. There was no significant difference between both groups regarding patients demographics, stricture characteristics or follow-up period. One case in the BM group was lost during follow-up. Stricture recurrence was detected in 7 (30.4%) patients out of BM group while in 6 (23.1%) patients out of PS group (p value= 0.5). No significant differences between both groups regarding overall early and late complications were observed. Occurrence of early complications and the stricture length were the only predictors of failure in univariate analysis, while in multivariate analysis the occurrence of early complications was only significant. Conclusion On short-term follow-up, both dorsal onlay BM graft and ventral onlay PS flap urethroplasty have similar success rates. However, BM graft has a potential advantage to reduce operative time and is also technically easier. The surgeon should avoid early local complications as they represent a higher risk for failure.


Subject(s)
Humans , Male , Adult , Penis , Urologic Surgical Procedures, Male , Surgical Flaps/transplantation , Urethral Stricture/surgery , Skin Transplantation/methods , Mouth Mucosa/transplantation , Urethral Stricture/pathology , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Middle Aged
7.
Int. braz. j. urol ; 42(3): 564-570, tab, graf
Article in English | LILACS | ID: lil-785720

ABSTRACT

ABSTRACT Objective To assess the outcome of single stage dorsolateral onlay buccal mucosal urethroplasty for long anterior urethral strictures (>4cm long) using a perineal incision. Materials and Methods From August 2010 to August 2013, 20 patients underwent BMG urethroplasty. The cause of stricture was Lichen sclerosis in 12 cases (60%), Instrumentation in 5 cases (25%), and unknown in 3 cases (15%). Strictures were approached through a perineal skin incision and penis was invaginated into it to access the entire urethra. All the grafts were placed dorsolaterally, preserving the bulbospongiosus muscle, central tendon of perineum and one-sided attachement of corpus spongiosum. Procedure was considered to be failure if the patient required instrumentation postoperatively. Results Mean stricture length was 8.5cm (range 4 to 12cm). Mean follow-up was 22.7 months (range 12 to 36 months). Overall success rate was 85%. There were 3 failures (meatal stenosis in 1, proximal stricture in 1 and whole length recurrent stricture in 1). Other complications included wound infection, urethrocutaneous fistula, brownish discharge per urethra and scrotal oedema. Conclusion Dorsolateral buccal mucosal urethroplasty for long anterior urethral strictures using a single perineal incision is simple, safe and easily reproducible by urologists with a good outcome.


Subject(s)
Humans , Adolescent , Adult , Young Adult , Perineum/surgery , Urologic Surgical Procedures, Male/methods , Urethral Stricture/surgery , Mouth Mucosa/transplantation , Postoperative Complications , Urethra/surgery , Reproducibility of Results , Treatment Outcome , Operative Time , Length of Stay , Medical Illustration , Middle Aged
8.
Belo Horizonte; s.n; 2015. 34 p.
Thesis in Portuguese | LILACS | ID: lil-790300

ABSTRACT

A excelência estética nas reabilitações implanto-suportadas deve associar aspectos da restauração com as características dos tecidos moles adjacentes, a fim de obter resultados que se assemelham aos dentes naturais. Tem sido afirmado na literatura que a mucosa periimplantar promove um selamento sobre a superfície do pilar, de forma a estabelecer uma importante barreira biológica, entre o ambiente bucal e o osso, podendo garantir o sucesso do implante. Além disso, a presença do tecido ceratinizado confere maior resistência e estabilidade ao epitélio para a manutenção da mucosa...


Subject(s)
Dental Implants , Mucous Membrane/transplantation , Mouth Mucosa/transplantation , Gingiva/transplantation , Oral Health
9.
Korean Journal of Urology ; : 478-486, 2015.
Article in English | WPRIM | ID: wpr-171072

ABSTRACT

Tissue transfer techniques are an essential part of the reconstructive urologist's armamentarium. Flaps and graft techniques are widely used in genital and urethral reconstruction. A graft is tissue that is moved from a donor site to a recipient site without its native blood supply. The main types of grafts used in urology are full thickness grafts, split thickness skin grafts and buccal mucosa grafts. Flaps are transferred from the donor site to the recipient site on a pedicle containing its native blood supply. Flaps can be classified based on blood supply, elevation methods or the method of transfer. The most used flaps in urology include penile, preputial, and scrotal skin. We review the various techniques used in reconstructive urology and the outcomes of these techniques.


Subject(s)
Genitalia/surgery , Humans , Mouth Mucosa/transplantation , Reconstructive Surgical Procedures/methods , Skin Transplantation/methods , Surgical Flaps , Tissue Transplantation/methods , Ureter/surgery , Urethra/surgery , Urologic Surgical Procedures/methods
10.
Korean Journal of Urology ; : 164-167, 2015.
Article in English | WPRIM | ID: wpr-109958

ABSTRACT

To describe the novel technique of ventral inlay substitution urethroplasty for the management of male anterior urethral stricture disease. A 58-year-old gentleman with multifocal bulbar stricture disease measuring 7 cm in length was treated using a ventral inlay substitution urethroplasty. A dorsal urethrotomy was created, and the ventral urethral plated was incised. The edges of the urethral plate were mobilized without violation of the ventral corpus spongiosum. A buccal mucosa graft was harvested and affixed as a ventral inlay to augment the caliber of the urethra. The dorsal urethrotomy was closed over a foley catheter. No intraoperative or postoperative complications occurred. Postoperative imaging demonstrated a widely patent urethra. After three years of follow-up, the patient continues to do well with no voiding complaints and low postvoid residuals. Ventral inlay substitution urethroplasty appears to be a safe and feasible technique for the management of bulbar urethral strictures.


Subject(s)
Cystoscopy/methods , Humans , Male , Middle Aged , Mouth Mucosa/transplantation , Urethra/surgery , Urethral Stricture/diagnosis , Urologic Surgical Procedures, Male/methods
11.
Korean Journal of Urology ; : 841-843, 2014.
Article in English | WPRIM | ID: wpr-187585

ABSTRACT

Penile amputation is a rare catastrophe and a serious complication of circumcision. Reconstruction of the glans penis may be indicated following amputation. Our report discusses a novel technique for reconfiguration of an amputated glans penis 1 year after a complicated circumcision. A 2-year-old male infant presented to us with glans penis amputation that had occurred during circumcision 1 year previously. The parents complained of severe meatal stenosis with disfigurement of the penis. Penis length was 3 cm. Complete penile degloving was performed. The distal part of the remaining penis was prepared by removing fibrous tissue. A buccal mucosal graft was applied to the distal part of the penis associated with meatotomy. The use of a buccal mucosal graft is a successful and simple procedure with acceptable cosmetic and functional results for late reconfiguration of the glans penis after amputation when penile size is suitable.


Subject(s)
Amputation, Traumatic/surgery , Child, Preschool , Circumcision, Male/adverse effects , Humans , Male , Mouth Mucosa/transplantation , Penis/injuries , Reconstructive Surgical Procedures/methods
12.
Belo Horizonte; s.n; 2013. 21 p. ilus.
Thesis in Portuguese | LILACS, BBO | ID: lil-790346

ABSTRACT

Depois do surgimento dos implantes a quantidade de tratamentos odontológicos através de próteses implantossuportadas cada dia torna-se mais elevada e para maior longevidade dessas reabilitações deu-se uma busca nos fatores que podem levar a perda de implantes dentários. Um desses fatores ainda um pouco controverso, seria ter ou não mucosa queratinizada ao redor de implantes...


Subject(s)
Gingiva , Dental Implants , Mucous Membrane/transplantation , Mouth Mucosa/transplantation , Prostheses and Implants
13.
Int. braz. j. urol ; 38(6): 825-832, Nov-Dec/2012. tab, graf
Article in English | LILACS | ID: lil-666023

ABSTRACT

Objective

To histologically evaluate, in an experimental study in rabbits, the integration process of the buccal mucosa fenestrated graft applied in the corpora cavernosa for Bracka first stage urethroplasty. Materials and Methods

A urethral defect was surgically created in 16 male rabbits of the New Zealand breed through the excision of the penile urethra. The urethral defect was corrected by applying buccal mucosa fenestrated graft through two cruciform incisions in the distal portions of its longitudinal axis. The animals were sacrificed at 2, 4, 8 and 12 weeks post surgery and their genitals were subjected to clinical and histological assessment. Results

The buccal mucosa fenestrated graft showed complete uptake in all groups, with keratinization squamous metaplasia and mucosal proliferation of the fenestrated areas. The fenestrated graft area represented an increase in length of 25% in length in relation to the original standard graft. Conclusions

The fenestrated buccal mucosa graft presented total integration to the adjacent epithelia with re-epithelization of the incision areas of the graft (fenestrations) and no significant inflammatory or scarring reactions when compared to other mucosa transplanted areas; therefore its application is viable in cases of extensive urethral defect whenever the donating area might be insufficient. .


Subject(s)
Animals , Male , Rabbits , Mouth Mucosa/transplantation , Urethra/surgery , Urethral Stricture/surgery , Models, Animal , Reproducibility of Results , Time Factors , Treatment Outcome , Urethra/pathology
14.
Rev. chil. urol ; 75(1): 15-18, 20100000.
Article in Spanish | LILACS | ID: lil-574231

ABSTRACT

Objetivo: Evaluar la eficacia y recidiva de la Uretroplastía de aumento (UA) con mucosa oral en el tratamiento de la estenosis uretral secundaria a Liquen Escleroso (LE).Material y Método: Un total de 10 pacientes operados por EU secundaria a LE desde enero de 2001a febrero de 2008. Edad promedio 43 años (rango, 34-78 años). Seguimiento promedio 37 meses (12-84 meses).Ubicación de la estenosis: meatal 2, fosa navicular 7 y pan uretral 1. Se planificó uretroplastía en 2 tiempos con injerto de mucosa oral. Se describe a continuación técnica quirúrgica. Posteriormente los pacientes se controlaron periódicamente con evaluación clínica, uroflujometría y uretrocistografía cuando fue necesario. Se considera fracaso la re estenosis uretral o la recidiva del LE. Resultados: La tasa de éxito global de la serie es de 90 por ciento (9/10) considerando la reaparición de EU y/o recidiva del LE. No hubo complicaciones mayores Conclusiones: La estenosis uretral secundaria a LE es una patología de difícil manejo. La reparación en 2 tiempos, utilizando mucosa bucal parece ser un buen sustituto a los injertos o colgajos de piel, con resultados promisorios en el tiempo y sin recidiva reportada del LE.


Objective: To evaluate the efficacy and recurrence rate of augmentation urethroplasty (AU) using oral mucosa for the treatment of urethral stenosis (US) secondary to Lichen Sclerosus (LS).Material and method: The study included a total of 10 patients submitted to surgery of US secondary LS, from January 2001 to February 2008. Average age was 43 years (34-78 yrs). Average follow up was 37 months (12-84).The stenosis was meatal in two cases, panurethral in one case and in the navicular fossa in seven cases. EU in two stages with oral mucosal graft was planned. Surgical technique is described. Afterwards, patients were followed with clinical evaluation, uroflowmetry and urethrocistography when necessary. A recurrence of US or LS was considered a failure. Results: The overall success rate of the series was 90 percent (9/10). There were no major complications. Conclusions: The treatment of US secondary to LS is difficult. Repair in two stages using oral mucosa seems to be a good substitute for skin grafts with promising results and without the recurrence rates elsewhere reported for LS.


Subject(s)
Humans , Male , Adult , Middle Aged , Urethral Stricture/surgery , Mouth Mucosa/transplantation , Urethra/surgery
15.
Rev. chil. urol ; 74(4): 370-372, 2009. ilus
Article in Spanish | LILACS | ID: lil-572116

ABSTRACT

La reconstrucción de la estrechez uretral requiere la eliminación del tejido fibroso patológico y el aporte de tejido sano que reemplace la pared uretral dañada. En las últimas décadas, el uso de injertos de mucosa oral se ha consolidado como la técnica de primera elección en la mayoría de los casos. La mucosa oral está fácilmente disponible y es de sencillo procuramiento. Su textura es muy apropiada y los injertos “toman” con facilidad, prácticamente sin retracción. En este artículo se describe en detalle la técnica que usamos en nuestro hospital para el procuramiento de mucosa oral.


Urethral stricture reconstruction requires replacement of the pathologic fibrous urethral tissue with healthy, normal tissue. In the last decades, oral mucosa graft has become the preferred alternative inmost cases. Oral mucosa is readily available, simple to use and has a high success rate. In this communication we describe in detail the technique we use in our hospital for oral mucosa procurement.


Subject(s)
Humans , Male , Urethral Stricture/surgery , Mouth Mucosa/transplantation , Reconstructive Surgical Procedures/methods , Urologic Surgical Procedures/methods , Urethra/surgery
16.
Int. braz. j. urol ; 34(3): 345-354, May-June 2008. ilus
Article in English | LILACS | ID: lil-489594

ABSTRACT

PURPOSE: Buccal mucosa is a widely accepted tissue for urethroplasty. The exact healing and tissue integration process, mainly the histological characteristics of dorsal buccal mucosa graft urethroplasty when used dorsally to reconstruct the urethral plate has not previously been assessed, and thus we developed an experimental model to address this question. MATERIALS AND METHODS: In 12 New Zealand rabbits (weight 2.5 kg) we surgically created a dorsal penile urethral defect. A buccal mucosa graft was sutured to the corpora and tunica albuginea, and the ventral urethra anastomosed to this new urethral plate. The animals were divided in three groups and sacrificed 1, 3 and 6 weeks after surgery (groups 1, 2 and 3). A retrograde urethrogram was obtained at autopsy in the last group and the penis analyzed histologically with hematoxylin-eosin and Masson's staining. RESULTS: The urethrograms showed no evidence of fistula or stricture. In group 1 the histopathological analysis showed submucosal lymph-mononuclear inflammatory edema, numerous eosinophils and squamous epithelium integrated into the adjacent urothelium. In group 2 there was no evidence of an inflammatory response but rather complete subepithelial hyaline healing, which was more marked in group 3. CONCLUSION: Healing of buccal mucosa grafts to reconstruct the urethral plate can be achieved by total integration of the squamous epithelium with the urothelium, maintaining the original histological properties of the graft with no fibrosis or retraction.


Subject(s)
Animals , Male , Rabbits , Mouth Mucosa/transplantation , Urethra/surgery , Urethral Stricture/surgery , Urologic Surgical Procedures, Male/methods , Wound Healing/physiology , Disease Models, Animal , Epithelial Cells/pathology , Penis/surgery , Reconstructive Surgical Procedures , Surgical Flaps , Time Factors , Urethra/pathology
17.
Int. braz. j. urol ; 33(4): 461-469, July-Aug. 2007.
Article in English | LILACS | ID: lil-465781

ABSTRACT

We performed an up-to-date review of the surgical techniques suggested for the treatment of anterior urethral strictures. References for this review were identified by searching PubMed and MEDLINE using the search terms "urethral stricture" or "urethroplasty" from 1995 to 2006. Descriptive statistics of the articles were provided. Meta-analyses or other multivariate designs were not employed. Out of 327 articles, 50 (15 percent) were determined to be germane to this review. Eight abstracts were referenced as the authors of this review attended the meetings where the abstract results were presented, thus it was possible to collect additional information on such abstracts. Urethrotomy continues to be the most commonly used technique, but it does have a high failure rate and many patients progress to surgical repair. Buccal mucosa has become the most popular substitute material in urethroplasty; however, the skin appears to have a longer follow-up. Free grafts have been making a comeback, with fewer surgeons using genital flaps. Short bulbar strictures are amenable using primary anastomosis, with a high success rate. Longer strictures are repaired using ventral or dorsal graft urethroplasty, with the same success rate. New tools such as fibrin glue or engineered material will become a standard in future treatment. In reconstructive urethral surgery, the superiority of one approach over another is not yet clearly defined. The surgeon must be competent in the use of various techniques to deal with any condition of the urethra presented at the time of surgery.


Subject(s)
Humans , Male , Mouth Mucosa/transplantation , Surgical Flaps , Urethra/surgery , Urethral Stricture/surgery , Anastomosis, Surgical , Follow-Up Studies , Penis/surgery , Skin Transplantation , Tissue and Organ Harvesting , Tissue Engineering , Urologic Surgical Procedures, Male/methods
18.
Int. braz. j. urol ; 33(4): 523-531, July-Aug. 2007. ilus, tab
Article in English | LILACS | ID: lil-465790

ABSTRACT

INTRODUCTION: Nowadays, buccal mucosa grafts are the most successful method to reconstruct bulbar urethral strictures. Dorsal placement of the graft has been recently proposed, allowing the graft to be spread fixed on the tunica albuginea of the corporal bodies overlying the stricture. The dorsal graft is ingenious and represents a useful addition to the surgical armamentarium, since it offers a better chance for graft take than does the spongiosum when the urethra is diseased and poorly vascularized. We developed an additional reconstructive option using tunica vaginalis grafts, placed dorsally, for the treatment of anterior urethral strictures. SURGICAL TECHNIQUE: A total of 11 patients with anterior urethral strictures were treated with a tunica vaginalis graft urethroplasty. The surgical technique was done as described by Barbagli. The urethra was dissected from the corpora cavernosa and rotated 180 degrees. The dorsal urethral surface was exposed and fully opened. Both the distal and proximal lumina were calibrated. The tunica vaginalis graft was sutured, splayed and quilted over the corpora cavernosa using 6-0 PDS running stitches. The left side of the urethral mucosa was sutured to the graft using 6-0 PDS sutures. A 18F silicone Foley catheter was inserted at this point. The urethra was rotated back to its original position and sutured laterally to the right side of the graft. At the end of the procedure, the graft was completely covered by the urethra. With a follow-up ranging from 7 weeks to 5 months, all patients were voiding well (uroflowmetry > 14 mL per second). CONCLUSION: This initial experience in 11 patients indicates that tunica vaginalis dorsal graft urethroplasty may be considered within the reconstructive armamentarium of genitourinary surgeons.


Subject(s)
Adult , Aged , Humans , Male , Middle Aged , Mouth Mucosa/transplantation , Surgical Flaps , Serous Membrane/transplantation , Urethra/surgery , Urethral Stricture/surgery , Anastomosis, Surgical , Follow-Up Studies , Urologic Surgical Procedures, Male/methods
20.
Int. braz. j. urol ; 33(2): 181-187, Mar.-Apr. 2007. tab
Article in English | LILACS | ID: lil-455592

ABSTRACT

OBJECTIVE: To assess the success of buccal mucosal graft (BMG) urethroplasty by the dorsal onlay technique in long anterior urethral stricture (> 2 cm long) through the midline perineal incision. MATERIALS AND METHODS: From January 1998 to December 2003, 43 patients with long anterior urethral strictures were managed by dorsal onlay BMG urethroplasty. After voiding trial, they were followed up at 3 months with uroflowmetry, retrograde urethrogram (RGU) and American Urological Association symptoms score (AUA symptoms scores). Successful outcome was defined as normal voiding with a maximum one attempt of VIU after catheter removal. Patients were further followed-up with uroflowmetry at 3 months interval and RGU every 6 months interval. RESULTS: Mean stricture length was 4.8 cm (range 3 to 9 cm) and mean follow up was 48 months (range 12 to 84 months). Only five patients were found to develop stricture at anastomotic site, during follow-up. Two of them voided normally after single attempt of VIU. Other three patients (6.9 percent) required further open surgery or repeat VIU during follow up and were considered as failure. CONCLUSION: Dorsal onlay BMG urethroplasty is a simple technique with good surgical outcome.


Subject(s)
Adult , Humans , Male , Middle Aged , Mouth Mucosa/transplantation , Surgical Flaps , Ureter/surgery , Urethral Stricture/surgery , Follow-Up Studies , Treatment Outcome
SELECTION OF CITATIONS
SEARCH DETAIL