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Altieri VM, Greco F, Lisanti RC, Altieri B, Esperto F, Cindolo L, Castellucci R, Della Camera PA, Sangiorgi GM, Verratti V. Clinical and penile Doppler outcomes using a modified, tourniquet free, Nesbit plication for severe Peyronie's disease. Transl Androl Urol 2021; 10:2857-2870. [PMID: 34430388 PMCID: PMC8350228 DOI: 10.21037/tau-20-1338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 05/10/2021] [Indexed: 11/21/2022] Open
Abstract
Background Penile curvature (PC) can be surgically corrected by plication techniques or Nesbit corporoplasty. These shortening techniques can be complicated by post-operative: penile shortening, recurrent PC, palpable suture knots and erectile dysfunction. Furthermore, Nesbit procedures require the use of a penile tourniquet to avoid intraoperative bleeding. This observational study aims to assess the results of Nesbit modified corporoplasty, avoiding intraoperative use of tourniquet without risk of bleeding. The objective is to reduce penile ischemic anatomical and functional damages such as long-term erectile dysfunction. Methods Between January 2010 and March 2019, a total of 64 patients with congenital penile curvature (CPC) and Peyronie’s disease (PD) underwent surgical correction with a Nesbit modified technique first time described by Rolle et al., with minimal technical differences. The operation notes were retrospectively reviewed. In particular, we evaluated pre- and post-operative erectile functions using IIEF-5 score, penile Doppler ultrasonography and overall patient satisfaction. Results During operations, no intraoperative bleeding was noted, and no short-term complications such as hematomas or neurovascular bundle lesions were reported. At 6 months, no palpable subcutaneous indurations and no sensory change were detected. Post-operative penile shortening was reported in 38 (59.4%) patients (mean 0.83±0.79 cm), but it did not influence the high overall satisfaction rate of 91.4%. Only 2 patients reported a slightly partial recurrence of curvature (<15%) with no need for a redo surgery. Mean IIEF-5 score increased from 17.1±5.2 to 20.8±3.9 at 6 months and 21.8±3.4 at 12 months (P<0.001 in both cases). Mean PSV also significantly increased at the end of follow-up (28.5±6.1 at baseline vs. 31.0±7.1 at 12 months, P=0.03). Conclusions Considering the optimal results in terms of erectile functions increasing and absence of PC recurrence (>15°), we think that Nesbit modified corporoplasty without tourniquet application during reconstruction is a safe and effective surgical procedure for all kind of shortening corporoplasty to reduce the time of penile ischemia, preventing even serious consequences for the normal physiology of erection.
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Affiliation(s)
| | | | | | - Barbara Altieri
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Francesco Esperto
- Department of Urology, Campus Biomedico, University of Rome, Rome, Italy
| | - Luca Cindolo
- Department of Urology, "Villa Stuart" Private Hospital, Rome, Italy
| | | | | | | | - Vittore Verratti
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
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Gulburun MA, Karabulut R, Turkyilmaz Z, Eryilmaz S, Kaya C, Arslan B, Gulbahar O, Poyraz A, Sonmez K. Protective effects of hydrogen rich saline solution on ventral penile mathieu type flap with penile tourniquet application in rats. J Pediatr Urol 2021; 17:292.e1-292.e7. [PMID: 33608226 DOI: 10.1016/j.jpurol.2021.01.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/17/2020] [Accepted: 01/31/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Penile tourniquet (Pt) application aims to work in a bloodless field in penile surgery. When the tourniquet is released, reperfusion injury occurs with the resumption of blood flow. Molecular hydrogen can easily attach to biomembranes and enter cytosol, mitochondria and other organelles of the cell and convert the formed OH- to H₂O to prevent cell and tissue damage. AIM We investigated the effects of hydrogen rich saline solution (HRSS) on penile Mathieu type flap tissue with Pt application in rats. STUDY DESIGN Thirty-six Wistar-albino male rats were randomly divided into six groups. No operations were performed in the Sham group. Ventral penile Mathieu type flap was prepared and Pt was applied to the root of the penis with a plastic band in other groups. Pt was applied 10 and 30 min in the PT1⁰ and PT³⁰ groups. HRSS was injected intraperitoneally (ip) 5 ml/kg just before Pt was released in the HRSS1⁰ and HRSS³⁰ groups. In the HRSSB group, HRSS was injected 1 h before 10 min of Pt application. At the 4th hour of experiments the rats were sacrificed and tissue samples were taken for biochemical and histopathological studies. Tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), myeloperoxidase (MPO), malondialdehyde (MDA) and glutathione (GSH) levels were determined in the penile tissue. The results were analyzed with one-way ANOVA and Pearson's Chi-Squared test. RESULTS Tissue MDA, MPO, IL-6 and TNF-α values were significantly lower in all HRSS groups compared to PT1⁰ and PT³⁰ groups. Tissue GSH levels of HRSS groups were higher compared to PT groups. Histopathologically, inflammation was found to be higher in PT groups compared to HRSS groups. Interestingly, in the HRSSB group with HRSS administration prior to Pt, the damage was less in grade, but not statistically different than the other HRSS groups (p > 0.05). DISCUSSION In previous studies, damage in histopathological examinations after Pt could only be demonstrated long after tourniquet applications such as 24 h and with longer duration of Pt such as 30 min. Structural changes in different Pt application times could be demonstrated at 60 min by electron microscopy and 48 h by light microscopy. In this study, the histopathological effect of Pt application could be demonstrated at the 4th hour after release and HRSS was observed to reduce the damage histopathologically as well as biochemically with its anti-inflammatory and antioxidant effects. It was observed that administration of HRSS either before or following Pt did not cause an alteration statistically. CONCLUSION HRSS reduces tissue oxidative stress and inflammation on the flap tissue and has a protective effect in Pt applied to the hypospadias model created with a penile flap.
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Affiliation(s)
- Merve Altin Gulburun
- Gazi University Faculty of Medicine, Departments of Pediatric Surgery, Biochemistry Pathology, Ankara, Turkey
| | - Ramazan Karabulut
- Gazi University Faculty of Medicine, Departments of Pediatric Surgery, Biochemistry Pathology, Ankara, Turkey.
| | - Zafer Turkyilmaz
- Gazi University Faculty of Medicine, Departments of Pediatric Surgery, Biochemistry Pathology, Ankara, Turkey
| | - Sibel Eryilmaz
- Gazi University Faculty of Medicine, Departments of Pediatric Surgery, Biochemistry Pathology, Ankara, Turkey
| | - Cem Kaya
- Gazi University Faculty of Medicine, Departments of Pediatric Surgery, Biochemistry Pathology, Ankara, Turkey
| | | | | | | | - Kaan Sonmez
- Gazi University Faculty of Medicine, Departments of Pediatric Surgery, Biochemistry Pathology, Ankara, Turkey
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Weng C, Lan K, Li T, Zhang L, Wang J, Lai X. Regional hypothermia attenuates secondary-injury caused by time-out application of tourniquets following limb fragments injury combined with hemorrhagic shock. Scand J Trauma Resusc Emerg Med 2019; 27:104. [PMID: 31752982 PMCID: PMC6873525 DOI: 10.1186/s13049-019-0678-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 10/10/2019] [Indexed: 01/04/2023] Open
Abstract
Background Tourniquet is the most widely used and effective first-aid equipment for controlling hemorrhage of injured limb in battlefield. However, time-out application of tourniquets leads to ischemic-necrosis of skeletal muscles and ischemia-reperfusion injury. Regional hypothermia (RH) on wounded limb can relieve the injury on local tissue and distant organs. We aimed to investigate the protective effects of RH on rabbits’ limbs injured by a steel-ball combined with hemorrhagic-shock, and then employed tourniquet over-time, tried to identify the optimal treatment RH. Methods Thirty rabbits were randomly divided into 5 groups. All rabbits were anesthetized, intubated femoral artery and vein in right-hind limbs. Sham operation group (Sham): only femoral arteriovenous cannula in right-hind limb. None RH group (NRH): rabbits were intubated as Sham group, then the soft tissues of rabbits’ left-hinds were injured by a steel-ball shooting, and were exsanguinated until shock, then bundled with rubber tourniquets for 4 h. Three RH subgroups: rabbits were injured as mentioned above, the injured limbs were bundled with rubber tourniquets and treated with different temperature (5 ± 1 °C, 10 ± 1 °C, and 20 ± 1 °C, respectively) for 4 h. The injury severity of lung and regional muscle was assessed by histologic examination. Activity of adenosine triphosphatase (ATPase) and content of malondialdehyde (MDA) in muscle, inflammatory cytokines, myoglobin, creatine kinase-MM (CK-MM), Heme, Heme oxygenase 1 (HO-1), lactic acid (Lac), and lectrolyte ion in serum were detected. Results Following with RH treatment, the injury of lung and local muscle tissue was alleviated evidencing by mitigation of histopathological changes, significant decrease of water-content and MDA content, and increase of ATPase activity. Lower level of Lac, Potassium (K+), inflammatory cytokines, Heme, CK-MM, myoglobin content, and higher level of Calcium (Ca2+), HO-1 content were shown in RH treatment. 10 °C was the most effective RH to increase ATPase activity, and decrease MDA, myoglobin, CK-MM content. Conclusion Transient RH (4 h) had a “long-term mitigation effects” (continued for 6 h) on time-out application of tourniquet with the fluid resuscitation and core temperature maintenance, and the most effective temperature for reducing the side effects on tourniquet time-out application was 10 °C.
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Affiliation(s)
- Changmei Weng
- Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.,State Key Laboratory of Trauma, Burn and Combined Injury Research Institute, Third Military Medical University, Chongqing, 400042, China
| | - Kai Lan
- State Key Laboratory of Trauma and Burns, Surgery Research Institute; Research Institute of Surgery, Daping Hospital, Third Military Medical University, 10 Changjiang Road, Chongqing, 400042, China
| | - Tao Li
- Joint Surgery Center, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Liangchao Zhang
- Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.,State Key Laboratory of Trauma, Burn and Combined Injury Research Institute, Third Military Medical University, Chongqing, 400042, China
| | - Jianmin Wang
- Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.,State Key Laboratory of Trauma, Burn and Combined Injury Research Institute, Third Military Medical University, Chongqing, 400042, China
| | - Xinan Lai
- Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, 400042, China. .,State Key Laboratory of Trauma, Burn and Combined Injury Research Institute, Third Military Medical University, Chongqing, 400042, China.
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Ateş U, Ekberli G, Taştekin NY, Göllü G, Çakmak M. Tourniquet and adrenaline use in hypospadias surgery: a survey on the current practice in Turkey. Turk J Urol 2018; 45:218-222. [PMID: 30468426 DOI: 10.5152/tud.2018.94412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 07/24/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Aim of the study is to determine the hemostatic techniques among pediatric urologists in Turkey. MATERIAL AND METHODS Questionnaire forms were sent to 459 pediatric urologist by e-mail. RESULTS Ninety eight of 459 participants answered the questionnaire forms. Eighty-one (84.4%) of the participants were using tourniquet. The participants who didn't use tourniquet stated their justifications as follows: lack of need (n=10: 66.7%), development of edema, ischemia, delay of wound-graft healing and fistula risk (n=5: 33.3%). The indications of tourniquet use were stated as follows: penile (91.4%: n=74), distal (72.8%: n=59), penoscrotal (55.6%: n=45) hypospadias; fistula repair (33.3%: n=27), cripple hypospadias (33.3%: n=27), repair with flaps (30.9%: n=25), repair with grafts (27.2%: n=22), and isolated penile curvature (21%: n=17). Most commonly used tourniquet material (49.9%) was latex glove. Erection test was applied by 43.8% of participants. Scalp vein set was the most commonly (54.8%) used injector during erection test. Only 9.4% of participants were using adrenaline. Adrenaline dosages used at 1/100.000 dilution by 55.6%, lidocaine with 1/100.000 adrenaline by 44.4% of participants. CONCLUSION Beside a few experimental ones there is a paucity of studies that can serve as a guideline for using these techniques in the literature. There is a necessity of realizing prospective, randomized studies with long-term follow up to evidence that postoperative complications could develop secondary to hemostatic techniques and also to facilitate safe use of these techniques.
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Affiliation(s)
- Ufuk Ateş
- Department of Pediatric Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Günay Ekberli
- Department of Pediatric Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Nil Yaşam Taştekin
- Department of Pediatric Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Gülnür Göllü
- Department of Pediatric Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Murat Çakmak
- Department of Pediatric Surgery, Ankara University School of Medicine, Ankara, Turkey
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Boybeyi-Turer O, Kacmaz B, Arat E, Atasoy P, Kisa U, Gunal YD, Aslan MK, Soyer T. Does penile tourniquet application alter bacterial adhesion to rat urethral cells: an in vitro study. J Pediatr Surg 2018; 53:818-824. [PMID: 28693848 DOI: 10.1016/j.jpedsurg.2017.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/18/2017] [Accepted: 06/11/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the effects of penile tourniquet (PT) application on bacterial adhesion to urothelium. METHODS Fifty-six rats were allocated into control group (CG), sham group (SG), PT group (PTG). No intervention was applied in CG. A 5mm-length urethral repair was performed in SG and PTG. In PTG, a 10-min duration of PT was applied during the procedure and the tissue oxygenation monitor was used to adjust the same degree of ischemia in all subjects. Samples were examined for wound healing parameters and tissue levels of inflammatory markers, eNOS, e-selectin, and ICAM-1antibodies. The adhesion of Escherichia coli to urothelium was investigated with in vitro adhesion assay. RESULTS Inflammation was higher and wound healing was worse in SG than CG and in PTG in comparison to CG and SG (p<0.05). The endothelial damage, as shown by eNOS expression, was significantly higher in PTG compared to CG and SG (p<0.05). The staining with ICAM-1 and e-selectin antibodies, showing increased inflammatory response to bacterial adhesion, was significantly higher in PTG compared to CG and SG (p<0.05). In vitro urethral cell proliferation was achieved only in CG and SG revealing significantly increased adhesion in SG compared to CG (p<0.05). The PT application caused endothelial corruption and prevented cell proliferation in cell culture. CONCLUSION The PT application does not improve wound healing and increases bacterial adhesion molecules in penile tissue. The in vitro assays showed that PT causes severe endothelial damage and inhibits endothelial cell proliferation.
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Affiliation(s)
- Ozlem Boybeyi-Turer
- Hacettepe University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey.
| | - Birgul Kacmaz
- Kirikkale University, Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Kirikkale, Turkey
| | - Esra Arat
- Kirikkale University, Faculty of Science, Department of Biology, Kirikkale, Turkey
| | - Pınar Atasoy
- Kirikkale University, Faculty of Medicine, Department of Pathology, Kirikkale, Turkey
| | - Ucler Kisa
- Kirikkale University, Faculty of Medicine, Department of Biochemistry, Kirikkale, Turkey
| | - Yasemin Dere Gunal
- Kirikkale University, Faculty of Medicine, Department of Pediatric Surgery, Kirikkale, Turkey
| | - Mustafa Kemal Aslan
- Kirikkale University, Faculty of Medicine, Department of Pediatric Surgery, Kirikkale, Turkey
| | - Tutku Soyer
- Hacettepe University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
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ZakiEldahshoury M, Gamal W, Salem E, Rashed E, Mamdouh A. Is approximated de-epithelized glanuloplasty beneficial for hypospadiologist? Actas Urol Esp 2016; 40:258-62. [PMID: 26781549 DOI: 10.1016/j.acuro.2015.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Further evaluation of the cosmetic and functional results of approximated de-epithelized glanuloplasty in different degree of hypospadias. MATERIAL AND METHODS This study included 96 male patients (DPH=68 & MPH=28). Patients selected for repair with glans approximation should have wide urethral plate & grooved glans. All cases were repaired with the classic TIP and glans approximation technique. Follow up was for one year by clinical examination of the meatal shape, size & site, glans shape, skin covering, suture line, urethral catheter, edema & fistula in addition to parent satisfaction. RESULTS Mean operative time was 49±9minutes. As regards the functional and cosmetic outcomes, success was reported in 95.8%, while failure was in 4.16% in the form of glanular disruption in two patients and subcoronal urethrocutaneous fistula in another two patients. CONCLUSION Glans approximation has many advantages, good cosmetic and functional results, short operative time, less blood loss, no need for tourniquet. Study of a large number of cases and comparing glans approximation with the classic TIP technique.
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Abstract
Tourniquets are commonly used in penile surgery to achieve a bloodless operating field or produce artificial erections intraoperatively. Several techniques have been described, but there is a paucity of data and a lack of guidelines to direct their safe use. In penile surgery, it is the local rather than systemic effects of tourniquet use that are the main concern. Tourniquet time should be kept to a minimum, as the limited data available suggests that reperfusion injury can occur even after short periods of ischaemia. High risk groups such as diabetics and arteriopaths are at particular risk. Further studies are needed to determine safe tourniquet times and pressures.
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