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Wayne G, Perez A, Demus T, Nolte A, Mallory C, Boyer J, Cordon B. Ventral onlay glanuloplasty for treatment of fossa navicularis strictures. Int Braz J Urol 2022; 48:798-804. [PMID: 35838505 PMCID: PMC9388189 DOI: 10.1590/s1677-5538.ibju.2022.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/30/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose: Management of fossa navicularis (FN) strictures balances restoring urethral patency with adequate cosmesis. Historically, FN strictures are managed via glans cap or glans wings, and in severe cases, multi-stage procedures. Ventral onlay glanuloplasty (VOG) is an easily reproducible technique that involves a single-stage augmentation with buccal mucosal graft. We have been applying this technique for several years and present early promising outcomes of this novel approach. Materials and Methods: We retrospectively reviewed all patients with FN strictures who underwent VOG at our institution. Treatment success was designated by the absence of extravasation on voiding cystourethrogram and no need for further urethral instrumentation on follow up. Glans cosmesis was assessed by patients providing binary (yes/no) response to the satisfaction in their appearance. We also noted stricture length, stricture etiology, demographic characteristics and any post-operative complications and reported median, interquartile range (IQR) and count, frequency (%), accordingly. Results: Ten patients underwent VOG and fit our inclusion criteria. Median stricture length was 2.0 cm (IQR 1.6 -2). Success rate was 90% (9/10) with a median follow up of 30 months (IQR 24.3 – 36.8). The one recurrence was treated by dilation combined with triamcinolone injection at 419 days post-op. Stricture etiology included primarily iatrogenic causes such as transurethral prostate resection (4/10), greenlight laser vaporization (2/10), cystolitholapaxy (1/10), and traumatic catheterization (3/10). All patients were satisfied with penile cosmesis. Conclusion: VOG is a simple technique for treating FN strictures. Based on our preliminary series, VOG provides sustained distal urethral patency and patients are pleased with the appearance.
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Affiliation(s)
- George Wayne
- Division of Urology, Columbia University at Mount Sinai Medical Center, Miami Beach, Fl, USA
| | - Alejandra Perez
- Division of Urology, Columbia University at Mount Sinai Medical Center, Miami Beach, Fl, USA
| | - Timothy Demus
- Division of Urology, Columbia University at Mount Sinai Medical Center, Miami Beach, Fl, USA
| | - Adam Nolte
- Division of Urology, Columbia University at Mount Sinai Medical Center, Miami Beach, Fl, USA
| | - Chase Mallory
- Florida International University School of Medicine, Fl, USA
| | - Jessica Boyer
- Division of Urology, Columbia University at Mount Sinai Medical Center, Miami Beach, Fl, USA
| | - Billy Cordon
- Division of Urology, Columbia University at Mount Sinai Medical Center, Miami Beach, Fl, USA
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2
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Yagi K, Horiguchi A, Shinchi M, Ojima K, Hirano Y, Takahashi E, Kimura F, Ito K, Azuma R. Urethral reconstruction for iatrogenic urethral stricture after transurethral prostate surgery: An analysis of surgical and patient‐reported outcomes. Int J Urol 2022; 29:995-1001. [DOI: 10.1111/iju.14923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Kota Yagi
- Department of Urology National Defense Medical College Saitama Japan
| | - Akio Horiguchi
- Department of Urology National Defense Medical College Saitama Japan
| | - Masayuki Shinchi
- Department of Urology National Defense Medical College Saitama Japan
- Department of Urology, National Hospital Organization Nishisaitama‐Chuo Hospital Saitama Japan
| | - Kenichiro Ojima
- Department of Urology National Defense Medical College Saitama Japan
| | - Yusuke Hirano
- Department of Urology National Defense Medical College Saitama Japan
| | - Eiji Takahashi
- Department of Urology, National Hospital Organization Nishisaitama‐Chuo Hospital Saitama Japan
| | - Fumihiro Kimura
- Department of Urology, National Hospital Organization Nishisaitama‐Chuo Hospital Saitama Japan
| | - Keiichi Ito
- Department of Urology National Defense Medical College Saitama Japan
| | - Ryuichi Azuma
- Department of Plastic Surgery National Defense Medical College, Tokorozawa Saitama Japan
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3
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Wang Y, Liu M, Song LJ, Yang RX, Zhang KL, Jin SB, Fu Q. Novel strategy using a spiral embedded flap for meatal stenosis after post-penile cancer amputation surgery: a single-center experience. Asian J Androl 2022; 24:591-593. [PMID: 35435337 PMCID: PMC9809499 DOI: 10.4103/aja20227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
This study aimed to investigate the curative effect of spiral embedded flap urethroplasty for the treatment of meatal stenosis after penile carcinoma surgery. From January 2015 to January 2021, we used our technique to treat strictures of the external urethral orifice in seven patients, including four cases of meatal stenosis after partial penile resection and three cases of meatal stenosis after perineal stoma. All patients had previously undergone repeat urethral dilatation. The patients underwent spiral embedded flap urethroplasty to enlarge the outer urethral opening. The patients' mean age at the time of surgery was 60 (range: 42-71) years, the mean operative time was 43 min, and the median follow-up period was 18 months. The patients voided well post-operatively, and urinary peak flow rates ranged from 18.3 ml s-1 to 30.4 ml s-1. All patients were successful with absence of urethral meatus stricture. The present study showed that using spiral embedded flap urethroplasty to treat meatal stenosis after penile carcinoma surgery is an effective surgical technique with good long-term outcomes.
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Affiliation(s)
- Ying Wang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Meng Liu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Lu-Jie Song
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Ran-Xing Yang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Kai-Le Zhang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai 200233, China
| | - San-Bao Jin
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Qiang Fu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai 200233, China,
Correspondence: Dr. Q Fu ()
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4
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Al-Hajjar B. Tubularized preputial free graft one-stage repair for proximal hypospadias. MEDICAL JOURNAL OF BABYLON 2022. [DOI: 10.4103/mjbl.mjbl_14_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Gn M, Sterling J, Sinkin J, Cancian M, Elsamra S. The Expanding Use of Buccal Mucosal Grafts in Urologic Surgery. Urology 2021; 156:e58-e65. [PMID: 34097942 DOI: 10.1016/j.urology.2021.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/07/2021] [Accepted: 05/27/2021] [Indexed: 12/21/2022]
Abstract
The advent and success of buccal mucosal grafts as a substitution material in the urinary tract has changed the landscape of reconstructive urology. Due to its ease to harvest, low morbidity, and advantageous properties, there has been a growing number of applications for buccal mucosal grafts in upper and lower urinary tract reconstruction as well as genital reconstruction. In this article, we review the historical application and the evolution of buccal mucosal grafts and provide an up-to-date review on its utilization in urologic procedures.
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Affiliation(s)
- Martus Gn
- Department of Urology, Warren Alpert Medical School, Providence, RI.
| | - Joshua Sterling
- Department of Urology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jeremy Sinkin
- Department of Plastic Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Madeline Cancian
- Department of Urology, Warren Alpert Medical School, Providence, RI
| | - Sammy Elsamra
- Department of Urology, Robert Wood Johnson Medical School, New Brunswick, NJ
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Campos-Juanatey F, Bugeja S, Dragova M, Frost AV, Ivaz SL, Andrich DE, Mundy AR. Single-stage tubular urethral reconstruction using oral grafts is an alternative to classical staged approach for selected penile urethral strictures. Asian J Androl 2021; 22:134-139. [PMID: 31441450 PMCID: PMC7155792 DOI: 10.4103/aja.aja_78_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Penile urethral strictures have been managed by a staged surgical approach. In selected cases, spongiofibrosis can be excised, a neo-urethral plate created using buccal mucosa graft (BMG) and tubularized during the same procedure, performing a “two-in-one” stage approach. We aim to identify stricture factors which indicate suitability for this two-in-one stage approach. We assess surgical outcome and compare with staged reconstruction. We conducted an observational descriptive study. The data were prospectively collected from two-in-one stage and staged penile urethroplasties using BMG in a single center between 2007 and 2017. The minimum follow-up was 6 months. Outcomes were assessed clinically, radiologically, and by flow-rate analysis. Failure was defined as recurrent stricture or any subsequent surgical or endoscopic intervention. Descriptive analysis of stricture characteristics and statistical comparison was made between groups. Of 425 penile urethroplasties, 139 met the inclusion criteria: 59 two-in-one stage and 80 staged. The mean stricture length was 2.8 cm (single stage) and 4.5 cm (staged). Etiology was lichen sclerosus (LS) 52.5% (single stage) and 73.8% hypospadias related (staged). 40.7% of patients had previous failed urethroplasties in the single-stage group and 81.2% in the staged. The most common stricture locations were navicular fossa (39.0%) and distal penile urethra (59.3%) in the single-stage group and mid or proximal penile urethra (58.7%) in the staged group. Success rates were 89.8% (single stage) and 81.3% (staged). A trend toward a single-stage approach for select penile urethral strictures was noted. We conclude that a single-stage substitution penile urethroplasty using BMG as a “two-in-one” approach is associated with excellent functional outcomes. The most suitable strictures for this approach are distal, primary, and LS-related strictures.
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Affiliation(s)
- Felix Campos-Juanatey
- Reconstructive Urology Unit, Institute of Urology, University College London Hospitals, London W1G 8PH, UK.,Department of Urology, Marques de Valdecilla University Hospital, Institute of Investigation Valdecilla (IDIVAL), Santander 39008, Spain
| | - Simon Bugeja
- Reconstructive Urology Unit, Institute of Urology, University College London Hospitals, London W1G 8PH, UK.,Urology Unit, Mater Dei Hospital, Msida MSD 2090, Malta
| | - Mariya Dragova
- Reconstructive Urology Unit, Institute of Urology, University College London Hospitals, London W1G 8PH, UK
| | - Anastasia V Frost
- Reconstructive Urology Unit, Institute of Urology, University College London Hospitals, London W1G 8PH, UK
| | - Stella L Ivaz
- Reconstructive Urology Unit, Institute of Urology, University College London Hospitals, London W1G 8PH, UK
| | - Daniela E Andrich
- Reconstructive Urology Unit, Institute of Urology, University College London Hospitals, London W1G 8PH, UK
| | - Anthony R Mundy
- Reconstructive Urology Unit, Institute of Urology, University College London Hospitals, London W1G 8PH, UK
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Favre GA, Villa SG, Scherñuk J, Tobia IP, Giudice CR. Glans Preservation in Surgical Treatment of Distal Urethral Strictures With Dorsal Buccal Mucosa Graft Onlay by Subcoronal Approach. Urology 2020; 152:148-152. [PMID: 33359490 DOI: 10.1016/j.urology.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe dorsal onlay buccal mucosa graft urethroplasty technique by subcoronal approach and glans preservation in distal penile urethral strictures with fossa navicularis involvement and to report safety, effectiveness, and cosmetic outcomes. METHODS Retrospective review of a prospective database of patients treated at Hospital Italiano de Buenos Aires between January 2011 and December 2019. Main surgical steps: ventral subcoronal incision, dorsal dissection of glandelar urethra until piercing the tip of the glans, dorsal urethrotomy, and graft transposition. Low urinary tract symptoms, uroflowmetry, and urinalysis were assessed at follow-up. Simplified International Index Erectile Function and Hypospadias Objective Scoring Evaluation were applied 1 year after surgery. RESULTS Sixteen patients with a median age of 56.5 years (IQR 35.7-66.7) were included. Median stricture length was 5.5 cm (IQR 4-8.7). In 3 patients, Clavien-Dindo grade I-II complications were reported. At 1 year, median peak flow was 18 mL/seg (IQR 12.7-27.4) and median mean flow 7.8 mL/seg (IQR 6.1-9.9). At 41.5 months follow-up (IQR 13.2-74), all patients were stricture free and had no changes in erectile function. Hypospadias Objective Scoring Evaluation score ≥14 points was achieved by 14 patients (87.5%). CONCLUSION For treatment of distal penile urethral strictures with fossa navicularis involvement, dorsal onlay buccal mucosa graft by subcoronal approach and glans preservation is a feasible technique with excellent functional outcomes, minimal complications, and substantial cosmetic results.
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Affiliation(s)
- Gabriel Andrés Favre
- Genitourinary Reconstructive Surgery Division, Department of Urology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Sergio Gil Villa
- Genitourinary Reconstructive Surgery Division, Department of Urology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Jordán Scherñuk
- Genitourinary Reconstructive Surgery Division, Department of Urology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
| | - Ignacio Pablo Tobia
- Genitourinary Reconstructive Surgery Division, Department of Urology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Carlos Roberto Giudice
- Genitourinary Reconstructive Surgery Division, Department of Urology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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8
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Chung ASJ, Suarez OA. Current treatment of lichen sclerosus and stricture. World J Urol 2019; 38:3061-3067. [DOI: 10.1007/s00345-019-03030-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022] Open
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9
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Single-stage buccal mucosal graft urethroplasty for meatal stenoses and fossa navicularis strictures: a monocentric outcome analysis and literature review on alternative treatment options. World J Urol 2019; 38:2609-2620. [DOI: 10.1007/s00345-019-03035-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022] Open
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10
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11
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Friel BJ, Skokan AJ, Kovell RC. Historical and Current Practices in the Management of Fossa Navicularis Strictures. Curr Urol Rep 2019; 20:30. [PMID: 31020487 DOI: 10.1007/s11934-019-0897-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW Fossa navicularis strictures represent a surgically challenging disease process that requires detailed preoperative planning and an understanding of each patient's goals in order to achieve a satisfactory long-term outcome. This review summarizes the various approaches used in the management of fossa navicularis strictures over the past several decades. RECENT FINDINGS In addition to existing evidence to support open flap- and graft-based reconstruction, recent studies suggest a potential role for limited open repair via a transurethral approach. Open repair of fossa navicularis strictures has become the standard of care with high success rates using local skin flaps or tissue grafts. There remains a very limited role for minimally invasive techniques in definitive management of this disease.
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Affiliation(s)
- Brian J Friel
- The University of Pennsylvania System, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexander J Skokan
- The University of Pennsylvania System, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Caleb Kovell
- The University of Pennsylvania System, University of Pennsylvania, Philadelphia, PA, USA.
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