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Ruiz-Graña S, Ramos JL, Arance I, Angulo JC. Transanal minimally invasive surgery for rectal mucosa extraction in the treatment of panurethral stenosis associated with lichen sclerosus using Kulkarni urethroplasty. Cir Esp 2022; 100:598-600. [PMID: 35700891 DOI: 10.1016/j.cireng.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/11/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Sonia Ruiz-Graña
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain; Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
| | - José Luis Ramos
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain; Servicio de Cirugía General y Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Ignacio Arance
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain; Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Javier C Angulo
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain; Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
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Sahin C, Yesildal C. Female urethral stricture: which one is stronger? Labial vs buccal graft. Int Urogynecol J 2022; 33:731-735. [PMID: 35039917 DOI: 10.1007/s00192-021-05052-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to compare labial and buccal mucosa graft methods in female urethroplasty. METHODS Female urethroplasty surgeries performed between March 2016 and October 2020 were retrospectively reviewed. Labial and buccal mucosa graft surgeries were listed. RESULTS Between March 2016 and October 2020, a total of 28 patients had graft urethroplasty surgery in our center. Fourteen had labial, 14 had buccal onlay graft urethroplasty. The pre-treatment Qmax values were 13 ml/s in the labia major onlay graft (LMOG) group and 12.5 ml/s in the buccal mucosa onlay graft (BMOG) group. The Qmax values after the treatment were remeasured at the 1st, 3rd, and 12th months. They were 20 ml/s, 24 ml/s, and 24 ml/s in the LMOG group and 23 ml/s, 25 ml/s, and 28 ml/s in the BMOG group. The operation times were 65 min (55-90) in the LMOG group; in the BMOG group, it was 70.35 min (65-90). CONCLUSIONS In female urethral strictures, especially in long segments and recurrent strictures, graft urethroplasty is a successful and safe method. Dorsal buccal onlay mucosal graft and labia major grafts show similar results in the early period to complications and success. In the long term, buccal onlay mucosal graft gives better results.
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Affiliation(s)
- Coskun Sahin
- Private Ada Tip Hospital Istanbul Turkiye, İstanbul, Pendik, Turkey
| | - Cumhur Yesildal
- Universty of Health and Science Sultan Abdulhamid Han Training and Research Hospital Istanbul Turkiye, Selimiye, Tıbbiye Cd, 34668, İstanbul, Üsküdar, Turkey.
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Favorito LA, da Silva FS, de Resende JA. A new option to prevent fistulas in anterior urethroplasty in patients with kippered urethra: the tunica vaginalis flap. Int Braz J Urol 2021; 47:1032-1036. [PMID: 34260180 PMCID: PMC8321442 DOI: 10.1590/s1677-5538.ibju.2020.1058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/09/2021] [Indexed: 11/22/2022] Open
Abstract
The objective of this study is describing a technique with the use of a tunica vaginalis flap (TVF) to cover the suture line during anterior urethroplasty in patients with kippered urethra due to chronic indwelling catheterization (CIC). We studied 5 patients (mean age=50.2) with a neurogenic bladder that developed urethral erosion after a long period of CIC. Foley catheter was removed on the 14th postoperative day. One patient developed wound infection and utethrocutaneous fistula, which was conservatively managed and after 12 months of follow-up all the patients didn't report difficulties in intermittent self-catheterization. In conclusion, a urethroplasty with TVF technique may be a viable method for repairing penile urethral erosions, but further studies are required with a bigger sample to confirm our results.
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Affiliation(s)
- Luciano A Favorito
- Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil.,Unidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro, UERJ, Rio de Janeiro, RJ, Brasil
| | | | - José Anacleto de Resende
- Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil.,Departamento de Urologia, Universidade do Estado do Rio de Janeiro, UERJ, Rio de Janeiro, RJ, Brasil
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Ruiz-Graña S, Ramos JL, Arance I, C Angulo J. Transanal minimally invasive surgery for rectal mucosa extraction in the treatment of panurethral stenosis associated with lichen sclerosus using Kulkarni urethroplasty. Cir Esp 2021; 100:S0009-739X(21)00213-X. [PMID: 34344518 DOI: 10.1016/j.ciresp.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Sonia Ruiz-Graña
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España; Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, España.
| | - José Luis Ramos
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España; Servicio de Cirugía General y Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - Ignacio Arance
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España; Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - Javier C Angulo
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España; Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, España
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Policastro CG, Simhan J, Martins FE, Lumen N, Venkatesan K, Angulo JC, Gupta S, Rusilko P, Ramírez Pérez EA, Redger K, Flynn BJ, Hughes M, Blakely S, Nikolavsky D. A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis. World J Urol 2020; 39:2669-2675. [PMID: 32944804 DOI: 10.1007/s00345-020-03446-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/05/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To critically evaluate a multi-institutional patient cohort undergoing Dorsal-Onlay Buccal Mucosal Graft Urethroplasty (D-BMGU) for recurrent post-radiation posterior urethral stenosis. METHODS Retrospective multi-institutional review of patients with posterior urethral stenosis from 10 institutions between 2010-2019 was performed. Patients with at least 1-year follow-up were assessed. Patient demographics, stenosis characteristics, peri-operative outcomes, and post-operative clinical and patient-reported outcomes were analyzed. The primary outcomes were stenosis recurrence and de-novo stress urinary incontinence (SUI). Secondary outcomes were changes in voiding, sexual function, and patient-reported satisfaction. RESULTS Seventy-nine men with post-radiation urethral stenosis treated with D-BMGU met inclusion criteria. Median age and stenosis length were 72 years, (IQR 66-75), and 3.0 cm (IQR 2.5-4 cm), respectively. Radiation modalities included: 36 (45.6%) external beam radiotherapy (EBRT), 13 (16.5%) brachytherapy (BT), 10 (12.7%) combination EBRT/BT, and 20 (25.3%) EBRT/radical prostatectomy. At a median follow-up of 21 months (IQR 13-40), 14 patients (17.7%) had stenosis recurrence. Among 37 preoperatively-continent patients, 3 men (8.1%) developed de-novo SUI following dorsal onlay urethroplasty. Of 29 patients with preoperative SUI all but one remained incontinent post-operatively (96.6%). Following repair, patients experienced significant improvement in PVR (92.5 to 26 cc, p = 0.001) and Uroflow (4.6 to 15.9 cc/s, p = 0.001), and high overall satisfaction, with 91.9% reporting a GRA of + 2 or better). CONCLUSION Dorsal onlay buccal mucosa graft urethroplasty is a safe and feasible technique in patients with post-radiation posterior urethral stenosis. This non-transecting approach may confer low rates of de-novo SUI. Further research is needed to compare this technique with excisional urethroplasty.
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Affiliation(s)
- Connor G Policastro
- Department of Urology, SUNY Upstate Medical University, 750 E Adams St, CWB 2nd Floor, Syracuse, NY, 13210, USA
| | - Jay Simhan
- Einstein Medical Center/Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | | | - Krishnan Venkatesan
- Georgetown University, Washington, DC, USA.,MedStar Washington Hospital Center, Washington, DC, USA
| | - Javier C Angulo
- Departemento Clinico, Universidad Europea de Madrid, Hospital Universitario de Getafe, Madrid, Spain
| | | | | | | | | | | | - Michael Hughes
- Department of Urology, SUNY Upstate Medical University, 750 E Adams St, CWB 2nd Floor, Syracuse, NY, 13210, USA
| | - Stephen Blakely
- Department of Urology, SUNY Upstate Medical University, 750 E Adams St, CWB 2nd Floor, Syracuse, NY, 13210, USA
| | - Dmitriy Nikolavsky
- Department of Urology, SUNY Upstate Medical University, 750 E Adams St, CWB 2nd Floor, Syracuse, NY, 13210, USA.
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Straddle injuries to the bulbar urethra: What is the best choice for immediate management? J Trauma Acute Care Surg 2019; 87:892-897. [DOI: 10.1097/ta.0000000000002388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Morán E, Bonillo MA, Fernández-Estevan L, Martínez-Cuenca E, Arlandis S, Broseta E, Boronat F. Oral quality of life after buccal mucosal graft harvest for substitution urethroplasty. More than a bite? World J Urol 2018; 37:385-389. [PMID: 29931527 DOI: 10.1007/s00345-018-2381-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/15/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The aim of our study was to analyze the oral quality of life (QoL) in patients with urethral stricture treated with BMG by using a validated questionnaire (OIDP). MATERIALS AND METHODS A prospective, single-arm, observational single-centre study of a cohort of patients scheduled for BMG Urethroplasty was conducted. OIDP assesses the impact of oral conditions on daily activities including an oral QoL question (0-10). The questionnaire was self-administered before, 3 months postoperatively and at the end of the study. Means, pre- and postoperatively, were compared. Multivariate analysis was performed to analyze the risk factors for a low quality of life (<8) after surgery. RESULTS We included 41 patients (2013-2017). The mean preoperative oral QoL was 9.33 points (SD1.16). Preoperative mean OIDP dimensional score and global score were 0,5 (SD:0.02) and 0,8%. The most frequently preoperative altered aspect was hygiene. Mean oral QoL, 3 months after surgery, was 8,56 (SD1.89) and OIDP dimensional score and global score were 0,67 (SD0.21) and 1,1%. Mean oral QoL at the end of the study (mean 3,12 years) was 8,50 (SD1.13). OIDP dimensional score and global score were 0,7 (SD 0.16) and 1,1%.The most frequently altered aspect at the end of the study was eating. No statistical (p = 0.07) decrease in oral QoL was found. The increase in OIDP dimensional and global score was also not statistically significant. Neither age nor smoking, diabetes mellitus, cardiovascular morbidity, previous OIDP score, width, length of the graft, or surgery success could explain a low oral QoL alter graft harvesting. CONCLUSIONS BMG harvesting is not free of problems at the donor site. Eating seems to be the most affected aspect after surgery. Nevertheless, those sequelae do not induce a reduction in oral QoL.
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Affiliation(s)
- E Morán
- Department of Urology, La Fe University Hospital, Valencia, Spain.
| | - M A Bonillo
- Department of Urology, La Fe University Hospital, Valencia, Spain
| | - L Fernández-Estevan
- Department of Dental Medicine, School of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | | | - S Arlandis
- Department of Urology, La Fe University Hospital, Valencia, Spain
| | - E Broseta
- Department of Urology, La Fe University Hospital, Valencia, Spain
| | - F Boronat
- Department of Urology, La Fe University Hospital, Valencia, Spain
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