Penile Enhancement Using Biodegradable Scaffolds Covered with Platelet-rich Plasma-Fibrin Glue, Mesenchymal Stem Cells for Micropenis.

PURPOSE: Evaluation of preliminary cosmetic and functional outcomes of biodegradable scaffolds covered with platelet-rich plasma in penile girth augmentation. MATERIALS AND METHODS: Between June 2016 and June 2018, 36 males who had a mean age of 28.91 years (range 20 - 48 years) with micropenis underwent this procedure. A mixture of platelets-fibrin glue and mesenchymal cells obtained from dermal fat tissue were prepared. Then the mixture was seeded on the pretreated tube-shaped poly lactic-co-glycolic acid scaffold and underwent a whole day of incubation. Following penile degloving, scaffolds were surgically implanted within the interface region of dartos and Buck's fascia. The 5-point Likert scoring scale was used to evaluate the patients' satisfaction with surgery. RESULTS: Patients followed up for 6-12 (8 ± 2.86) months. The penile length in an erected state before surgery was 6.5 - 12.5 cm (9.08 ± 1.6) which enhanced to 7 - 14 cm (10.59 ± 1.71) after surgery (P < .0001). The penile girth before and after surgery were 8.49 ± 1.53 and 10.91 ± 1.96 cm, respectively (P < .0001). An augment in penile length and girth of 1.5 and 2.6 cm were achieved, respectively. Patients appraised surgical intervention on a rating of one to five. The highest possible score (5) was assigned by 27 %, 33 % expressed a very good mark (4), and 19 % gave a good mark (3). CONCLUSION: Covering the scaffold with a mixture of Platelets-Fibrin glue and mesenchymal cells seems a safe and feasible method for penile reconstruction surgery. More studies should be done to determine the effect of platelets- fibrin glue and mesenchymal cells for treating micropenis.

Autologous Platelet-Rich Plasma Injection and Platelet-Rich Fibrin Glue Insertion for the Treatment of Extensive Supralevator Anorectal Fistula: A Case Report.

Supralevator fistula stays a challenge in general surgery. We present a case with supralevator anorectal fistula and subsequent retroperitoneal necrotizing fasciitis in which autologous platelet-rich plasma and platelet-rich fibrin glue were used for fistula closure. A 59-year-old man was admitted with pelvic pain and fever. Abdominopelvic sonography and CT scan reported a deep horseshoe-shaped anorectal abscess with extension to the pelvic floor, supralevator, psoas, retroperitoneal muscles, and kidneys. He was managed with antibiotics, abscess drainage, repeated radical surgical debridement, and necrosectomy. After 30 days, he was discharged, but he returned to the office with the complaint of purulent discharge from the hypogastric region and a diagnosis of fistula formation. Platelet-rich plasma was injected around the fistula into the tissue, and platelet-rich fibrin glue was introduced to the fistula tract. At the 11-month follow-up, the patient did not have voiding dysfunction, constipation, diarrhea, or fistula tract infection. Autologous platelet-rich plasma injection and platelet-rich fibrin glue insertion suggest a secure and effective approach for treating supralevator anorectal fistula.

Application of urethral injection of calcium hydroxyapatite as a natural bulking agent for improvement of urinary incontinence in children with spinal dysraphism.

PURPOSE: The aim of this report is to evaluate the efficacy of endoscopic injection of calcium hydroxyapatite (CaHA) into the bladder neck and posterior urethra in children with refractory urinary incontinence due to spinal dysraphism. METHODS: A retrospective study was performed on patients with neuropathic bladder due to spinal dysraphism who had undergone submucosal urethral injections of CaHA from 2010 until 2019. All patients were totally incontinent without voiding per urethra and did not respond to 1-year standard pharmacotherapy with anticholinergic drugs. All children underwent a precise physical exam and urodynamic studies. Patients underwent urethrocystoscopy and injection of pure soluble CaHA into the bladder neck and posterior urethra except for the verumontanum. The outcomes were determined as no change, improvement (social continent), or cure (total continent). RESULTS: Fifteen children (ten boys, five girls, mean age of 7.6 years) with a history of spinal dysraphism and refractory urinary incontinence were included. Endoscopic injections of CaHA were performed one or two times for each patient. At the median follow-up of 2 years (interquartile range = 6), seven (46.7%), three (20.0%), and five (33.3%) of the patients were total continent, social continent, and total incontinent, respectively. In four patients, intradetrusor botulinum toxin injection was performed simultaneously with CaHA injection. Also, one patient experienced a febrile urinary tract infection between two CaHA injections. Among 15 patients, 9 had atonic/hypotonic bladders both before and after CaHA injections; at the last follow-up, 4 of these children (44.4%) were totally continent. No injection-related or other complications were observed in the patients. CONCLUSION: Injection of CaHA into the bladder neck is relatively safe, reproducible, and effective for total dribbling urinary incontinence in children with spinal dysraphism. The bladder neck reconstruction with or without a urethral sling or other surgical procedures could be postponed until puberty in selected cases. However, further multicenter clinical trials are highly recommended.

Prevalence of Vesicoureteral Reflux in Children with Urinary Tract Infection.

Vesicoureteral reflux (VUR) is reported in 30%-50% of children affected by urinary tract infection (UTI). We aimed to investigate the frequency of VUR in children presenting with UTI and the changes in its prevalence from birth up to 18 years. This research was an observational retrospective study in the nephrology clinic of an academic tertiary hospital during 2003-2016. Patients with UTI subjected to direct cystourethrography were enrolled (908 patients, 86.23% of girls and 13.77% of boys). They were aged from 3 days to 214 months (33 ± 33.2 months). VUR was observed in 419 of 908 (46.14%) cases. High-grade VUR (VUR Grades IV-V) and VUR were significantly more prevalent in boys (P = 0.001 for both). Only 9.2% of the VUR subjects were diagnosed after 5 years of age. The patients with VUR developed UTI at a significantly younger age compared with those without VUR (P = 0.0001). Abnormal kidney ultrasound results were significantly more common in patients with VUR than in those without VUR (P = 0.0001). The prevalence of VUR in the 1st, 2nd, 3rd, 4th, and 5th years of life was estimated to be 56.64%, 48.2%, 49.46%, 35.8%, and 45.07%, respectively. The highest and lowest VUR prevalence was 56.64% (1st year of life) and 0% (13-18 years). In addition, severe VUR was not an uncommon finding, and affected 10.7% of the total population. The results indicated a decrease in the prevalence of VUR with increased age when considering the five main age subgroups of childhood.

Diagnostic Values of Kidney Ultrasonography for Vesicoureteral Reflux (VUR) and High Grade VUR.

INTRODUCTION: Vesicoureteral reflux (VUR) is a well-known risk factor for urinary tract infection (UTI). We aim to define diagnostic values of kidney ultrasonography (US) as a predictor of VUR and high grades VUR in children presented by UTI. METHODS: This retrospective study was conducted during October 2003 to 2016. Children aged ≤ 18 years with history of UTI who had underwent kidney US and direct cystography [voiding cystourethrography (VCUG) or radionuclide cystography (RNC)] enrolled in the study. Diagnostic values of hydronephrosis, hydro ureter, renal scaring, hydroureteronephrosis, decreased kidney size and abnormal kidney US for diagnosis of VUR and high grades VUR (grades IV-V) were evaluated. RESULTS: Hydro-ureter, renal scaring, and hydroureteronephrosis were significantly more prevalent in VUR+ versus VUR- cases, also in higher grades compared with lower grades (grades I-III) VUR (P < .05 for all). Additionally, hydronephrosis was more common in VUR+ compared with VUR- patients (P < .0001). As a predictor of VUR and higher grades of VUR, abnormal kidney US had the highest sensitivity (24.87% and 40.84%, respectively), abnormal kidney US and hydro ureter reached the highest NPV (70.42% and 81.27%, respectively), hydroureteronephrosis and hydro ureter showed the highest accuracy (68.51% and 82.21%, respectively) . CONCLUSION: Kidney US is a valuable screening test, abnormal renal US significantly increases the probability of VUR and high grades VUR , but if used as the only screening test , about 2/3 and 1/3 and 20% of VUR , high grades VUR and grade V VURs will be missed. DOI: 10.52547/ijkd.5966.