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Xu AJ, Mishra K, Zhao LC. Heineke-Mikulicz Preputioplasty: Surgical Technique and Outcomes. Urology 2022; 166:271-276. [PMID: 35430235 DOI: 10.1016/j.urology.2022.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To provide a summary of surgical technique and outcomes for Heineke-Mikulicz preputioplasty (HMP), a foreskin-preserving surgical treatment for phimosis in the adult population. METHODS We retrospectively reviewed 7 patients who underwent HMP by a single surgeon from May 2017 to May 2021. Variables included patient demographics, intraoperative considerations, and post-operative course. HMP is performed using a 2-3 cm vertical incision over the phimotic band on the dorsal surface to just above Buck's fascia. Additional incisions are made on the ventral surface if phimosis remains persistent after dorsal release. The incision is closed horizontally in 2 layers. RESULTS Seven patients underwent HMP. Median age was 47.3 and median BMI was 24.3. Five patients reported bothersome phimosis and 1 each reported paraphimosis and frenular tethering. Six patients requested foreskin sparing surgery as a personal preference and 1 patient was an intraoperative consult. Topical betamethasone was attempted in 3 of 7 patients. The median time from diagnosis to surgery was 2 months. Median operative time was 45.5 minutes and median estimated blood loss was 5 mL. Two patients required both dorsal and ventral incisions. No intraoperative complications were reported and all patients were discharged the same day. At median follow-up of 1.8 months, 1 patient reported bothersome phimosis secondary to scar formation treated successfully with triamcinolone. CONCLUSION HMP is a safe and effective method of treating even very significant phimosis in patients trying to avoid circumcision or intraoperative consults where preferences may be unclear. Our method takes less time than traditional circumcision with a comparable recovery and complication profile.
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Affiliation(s)
- Alex J Xu
- Department of Urology, NYU Langone Health, New York, NY.
| | | | - Lee C Zhao
- Department of Urology, NYU Langone Health, New York, NY
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2
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Calleja Hermosa P, Campos-Juanatey F, Varea Malo R, Correas Gómez MÁ, Gutiérrez Baños JL. Sexual function after anterior urethroplasty: a systematic review. Transl Androl Urol 2021; 10:2554-2573. [PMID: 34295743 PMCID: PMC8261436 DOI: 10.21037/tau-20-1307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/27/2021] [Indexed: 11/09/2022] Open
Abstract
Background Urethral surgery outcomes are often evaluated by assessing urinary flow and urethral patency. However, sexual consequences may appear after urethroplasty, impairing quality of life and patient’s perception of success. The aim of this study is to assess the relationship between anterior urethral reconstruction and postoperative sexual dysfunction, including the proposed factors predicting sexual outcomes. Methods We searched in PubMed database using the terms: “anterior urethroplasty”, bulbar urethroplasty” or “penile urethroplasty”, and “sexual dysfunction”, “erectile function” or “ejaculation”. Articles were independently evaluated for inclusion based on predetermined criteria. Systematic data extraction was followed by a comprehensive summary of evidence. Results Thirty-eight studies were included for final analysis. No randomised trial on the topic was found. Urethral surgery might affect different aspects of sexual function: erectile function, ejaculatory function, penile shape and length, and genital sensitivity, leading to severe sexual dysfunction. Patient perception of sexual impairment was related to post-operative satisfaction. Conclusions Sexual dysfunction after anterior urethral reconstruction is an important issue that must be appropriately discussed during preoperative patient counselling. Reported outcomes after anterior urethroplasty should include sexual consequences and relevance, evaluated using validated tools.
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Affiliation(s)
| | - Felix Campos-Juanatey
- Urology Department, Marques de Valdecilla University Hospital, Santander, Spain.,Valdecilla Research Institute (IDIVAL), Santander, Spain
| | - Raquel Varea Malo
- Urology Department, Marques de Valdecilla University Hospital, Santander, Spain
| | - Miguel Ángel Correas Gómez
- Urology Department, Marques de Valdecilla University Hospital, Santander, Spain.,Medical and Surgical Sciences Department, School of Medicine, University of Cantabria, Santander, Spain
| | - Jose Luis Gutiérrez Baños
- Urology Department, Marques de Valdecilla University Hospital, Santander, Spain.,Medical and Surgical Sciences Department, School of Medicine, University of Cantabria, Santander, Spain
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3
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de Rooij FPW, Peters FRM, Ronkes BL, van der Sluis WB, Al-Tamimi M, van Moorselaar RJA, Bouman MB, Pigot GLS. Surgical outcomes and proposal for a treatment algorithm for urethral strictures in transgender men. BJU Int 2021; 129:63-71. [PMID: 34046987 PMCID: PMC9291467 DOI: 10.1111/bju.15500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/30/2021] [Accepted: 05/23/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess our results of surgical treatment for urethral strictures in transgender men, and to provide a surgical treatment algorithm. PATIENTS AND METHODS A single centre, retrospective cohort study was conducted of transgender men who underwent surgical correction of their urethral stricture(s) between January 2013 and March 2020. The medical charts of 72 transgender men with 147 urethral strictures were reviewed. The primary outcomes were the success and recurrence rates after surgical treatment for urethral strictures. RESULTS The median (interquartile range [IQR]) follow-up was 61 (25-202) months. At last follow-up, 50/72 (69%) were able to void while standing (after one [60%], two [20%], three [6%], four [8%], five [4%], or seven [2%] procedures), 10/72 (14%) await further treatment, two of the 72 (3%) sat to void despite good urodynamic function, and 10/72 (14%) had a definitive urethrostomy. Of 104 surgical treatments included in separate success rate analysis, 65 (63%) were successful (43/75 [57%] after phalloplasty, 22/29 [76%] after metoidioplasty). The highest success rates in short urethral strictures were seen after a Heineke-Mikulicz procedure (six of seven cases), and in longer or more complicated urethral strictures after two-stage with graft (four of six), two-stage without graft (10/12), pedicled flap (11/15, 73%), and single-stage graft (seven of seven) urethroplasties. Grafts used were buccal mucosa or full-thickness skin grafts. Success rates improved over time, with success rates of 38% and 36% in 2013 and 2014, to 71% and 73% in 2018 and 2019, respectively. We concluded with a surgical treatment algorithm based on previous literature, stricture characteristics, and our surgical outcomes. CONCLUSION The highest success rates were seen after a Heineke-Mikulicz procedure in short urethral strictures; and after graft, pedicled flap, or two-stage urethroplasties in longer or more complicated urethral strictures. Finally, most of the transgender men were able to void while standing, although in some multiple surgical procedures were necessary to accomplish this.
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Affiliation(s)
- Freek P W de Rooij
- Department of Urology, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands.,Center of Expertise on Gender Dysphoria at the Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
| | - Femke R M Peters
- Department of Urology, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
| | - Brechje L Ronkes
- Department of Urology, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands.,Center of Expertise on Gender Dysphoria at the Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
| | - Wouter B van der Sluis
- Center of Expertise on Gender Dysphoria at the Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
| | - Muhammed Al-Tamimi
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
| | - R Jeroen A van Moorselaar
- Department of Urology, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
| | - Mark-Bram Bouman
- Center of Expertise on Gender Dysphoria at the Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
| | - Garry L S Pigot
- Department of Urology, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands.,Center of Expertise on Gender Dysphoria at the Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
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4
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Lane VA, Calisto J, deBlaauw I, Calkins CM, Samuk I, Avansino JR. Assessing the previously repaired patient with an anorectal malformation who is not doing well. Semin Pediatr Surg 2020; 29:150995. [PMID: 33288142 DOI: 10.1016/j.sempedsurg.2020.150995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In this review, the care of children with a previously repaired anorectal malformation is explored. We know that the surgical care of children with anorectal malformations is complex; however, despite an increased understanding of the congenital anomaly and significant technical advances in the operative repair, many of these children continue to have poor functional outcomes. In this article we focus on the common surgical complications, discuss typical presentations, consider appropriate investigations, and review the risks and benefits of revisional surgery in those patients that are 'not doing well' following their primary reconstruction.
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Affiliation(s)
- Victoria A Lane
- Department of Paediatric Surgery, Great North Children's Hospital, Newcastle-Upon-Tyne, UK.
| | - Juan Calisto
- Colorectal Center, Nicklaus Children's Hospital, Miami, FL, USA
| | - Ivo deBlaauw
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - Casey M Calkins
- The Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Inbal Samuk
- Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Jeffrey R Avansino
- Reconstructive Pelvic Medicine Program, Seattle Children's Hospital, Seattle, WA, USA; Department of Surgery, University of Washington, USA
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5
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Surgical repair of urethral complications after metoidioplasty for genital gender affirming surgery. Int J Impot Res 2020; 33:771-778. [DOI: 10.1038/s41443-020-0328-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/22/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
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Abstract
Objective To report the outcomes of surgical correction of post-circumcision webbed penis using two previously described techniques: the Heineke-Mikulicz (HM) scrotoplasty and the multiple Z-plasty. Patients and methods A prospective study of children with post-circumcision webbed penis was conducted. The patients were classified into two groups according to the degree of web and the remaining ventral penile skin as to whether adequate or short after circumcision. Group I was repaired by HM scrotoplasty and in Group II the multiple Z-plasty technique was used. Results This study included 86 patients of whom 71 maintained follow-up; 44 (62%) in Group I and 27 (38%) in Group II. The median (range) operative time was 45 (30–55) min in Group I and 75 (60–90) min in Group II. Wound infection occurred in two (4.5%) patients in Group I. In Group II postoperative mild self-limited penile oedema was present in three patients (11.1%). A self-limited scrotal haematoma developed in two (7.4%) patients. Conclusion Correction of post-circumcision webbed penis in children can be done by one of two techniques: HM scrotoplasty in Grade 1 and multiple Z-plasty in Grade 2 and Grade 3, with favourable outcomes. Abbreviations HM: Heineke-Mikulicz; IQR: interquartile range
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Affiliation(s)
- Mohamed A Negm
- Pediatric Surgery Unit, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Salah A Nagla
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Li Y, Zhu X, Feng D, Gong J, Sun G, Zhang X, Hu D, Sha S, Han T. A Modified Scrotoplasty for Treating Severe Penoscrotal Webbing in Children. Front Pediatr 2020; 8:551. [PMID: 33072658 PMCID: PMC7533638 DOI: 10.3389/fped.2020.00551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 07/30/2020] [Indexed: 11/13/2022] Open
Abstract
To compare a novel modified W-incision scrotoplasty (MWS) operation method with the conventional V-Y scrotoplasty for treatment of severe penoscrotal webbing (PSW) in children a retrospective study was conducted on 26 children. Circumcision combined with modified scrotoplasty was used to repair the webbed penis and phimosis of children and another 32 patients undergoing V-Y scrotoplasty served as the control group. There was a statistically significant difference of angle improvements of penis and scrotum in a horizontal position (-66 ± 10; -57 ± 6, P < 0.001) and the parent satisfaction score (Five Likert Scale) (4.7 ± 0.56; 3.8 ± 0.47, P < 0.001) between the two groups. All 26 children who underwent MWS presented with no serious postoperative complications, and there was no significant difference in surgical complications compared to children treated with V-Y scrotoplasty.
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Affiliation(s)
- Yuan Li
- Department of Urology Surgery, The Affiliated Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xiaoyu Zhu
- Department of Urology Surgery, The Affiliated Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Dongchuan Feng
- Department of Urology Surgery, The Affiliated Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jinchao Gong
- Department of Urology Surgery, The Affiliated Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Guangyao Sun
- Department of Urology Surgery, The Affiliated Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xilun Zhang
- Department of Urology Surgery, The Affiliated Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Dianhe Hu
- Department of Urology Surgery, The Affiliated Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Suoyou Sha
- Department of Urology Surgery, The Affiliated Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
| | - Tao Han
- Department of Urology Surgery, The Affiliated Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
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A Comprehensive Review Emphasizing Anatomy, Etiology, Diagnosis, and Treatment of Male Urethral Stricture Disease. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9046430. [PMID: 31139658 PMCID: PMC6500724 DOI: 10.1155/2019/9046430] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/31/2019] [Indexed: 12/21/2022]
Abstract
To date, urethral stricture disease in men, though relatively common, represents an often poorly managed condition. Therefore, this article is dedicated to encompassing the currently existing data upon anatomy, etiology, symptoms, diagnosis, and treatment of the disease, based on more than 40 years of experience at a tertiary referral center and a PubMed literature review enclosing publications until September 2018.
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9
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Halleran DR, Sanchez AV, Rentea RM, Ahmad H, Weaver L, Reck C, Gasior AC, Levitt MA, Wood RJ. Assessment of the Heineke-Mikulicz anoplasty for skin level postoperative anal strictures and congenital anal stenosis. J Pediatr Surg 2019; 54:118-122. [PMID: 30366721 DOI: 10.1016/j.jpedsurg.2018.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/01/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Acquired skin-level strictures following posterior sagittal anorectoplasty (PSARP) and some rare cases of congenital anal stenosis can be managed using a Heineke-Mikulicz like anoplasty (HMA). We hypothesized that this procedure was an effective, safe, and durable outpatient procedure in select patients. METHODS We retrospectively reviewed all patients who underwent HMA for skin level strictures following PSARP or for certain congenital anal stenoses from 2014 to 2017. RESULTS Twenty-eight patients (19 males, 9 females) with a mean age of 5.8 years (range 0.5-24.4) underwent HMA. Twenty-six had a prior PSARP, of which 18 were redo, and 8 were primary procedures. Two patients had congenital skin level anal stenosis. The mean follow up was 1.0 years (range 0.4-2.9). The average preprocedure anal size was Hegar 8, which after HMA increased 8 Hegar sizes to 16 (95% CI 7-9, p < 0.001). There were no operative complications. One patient restenosed and required a secondary procedure. CONCLUSION HMA is a safe procedure for skin-level anal strictures following PSARP (primary and redo) and can also be used in some rare cases of congenital anal stenosis. Long-term follow up to determine the restricture rate is ongoing. A plan to do an HMA if a stricture develops may offer an alternative to routine anal dilations, particularly after a redo PSARP in an older child. TYPE OF STUDY Case series. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Devin R Halleran
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH.
| | | | - Rebecca M Rentea
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Hira Ahmad
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Laura Weaver
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Carlos Reck
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Alessandra C Gasior
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Marc A Levitt
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
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10
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11
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Wilson SC, Stranix JT, Khurana K, Morrison SD, Levine JP, Zhao LC. Fasciocutaneous flap reinforcement of ventral onlay buccal mucosa grafts enables neophallus revision urethroplasty. Ther Adv Urol 2016; 8:331-337. [PMID: 27904649 DOI: 10.1177/1756287216673959] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Urethral strictures or fistulas are common complications after phalloplasty. Neourethral defects pose a difficult reconstructive challenge using standard techniques as there is generally insufficient ventral tissue to support a graft urethroplasty. We report our experience with local fasciocutaneous flaps for support of ventrally-placed buccal mucosal grafts (BMGs) in phalloplasty. METHODS A retrospective review of patients who underwent phalloplasty and subsequently required revision urethroplasty using BMGs between 2011 and 2015 was completed. Techniques, complications, additional procedures, and outcomes were examined. RESULTS A total of three patients previously underwent phalloplasty with sensate radial forearm free flaps (RFFFs): two female-to-male (FTM) gender reassignment, and one oncologic penectomy. Mean age at revision urethroplasty was 41 years (range 31-47). Indications for surgery were: one meatal stenosis, four urethral strictures (mean length 3.6 ± 2.9 cm), and two urethrocutaneous fistulas. The urethral anastomosis at the base of the neophallus was the predominant location for complications: 3/4 strictures, and 2/2 fistulas. Medial thigh (2) or scrotal (1) fasciocutaneous flaps were used to support the BMG for urethroplasty. One stricture recurrence at 3 years required single-stage ventral BMG urethroplasty supported by a gracilis musculocutaneous flap. All patients were able to void from standing at mean follow up of 8.7 months (range 6-13). A total of two patients (66%) subsequently had successful placement of a penile prosthesis. CONCLUSIONS Our early results indicate that local or regional fasciocutaneous flaps enable ventral placement of BMGs for revision urethroplasty after phalloplasty.
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Affiliation(s)
- Stelios C Wilson
- Wyss Department of Plastic Surgery, New York University Langone Medical Center, NY, USA
| | - John T Stranix
- Wyss Department of Plastic Surgery, New York University Langone Medical Center, NY, USA
| | - Kiranpreet Khurana
- Department of Urology, New York University Langone Medical Center, NY, USA
| | - Shane D Morrison
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Jamie P Levine
- Wyss Department of Plastic Surgery, New York University Langone Medical Center, NY, USA
| | - Lee C Zhao
- Department of Urology, New York University, School of Medicine, 150 East 32nd Street, Second Floor,New York, NY 10016, USA
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12
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Lawal TA, Reck CA, Wood RJ, Lane VA, Gasior A, Levitt MA. Use of a Heineke-Mikulicz like stricturoplasty for intractable skin level anal strictures following anoplasty in children with anorectal malformations. J Pediatr Surg 2016; 51:1743-5. [PMID: 27516175 DOI: 10.1016/j.jpedsurg.2016.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/06/2016] [Accepted: 07/15/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We introduced a modification of the Heineke-Mikulicz technique to treat intractable skin level anal strictures post posterior sagittal anorectoplasty (PSARP). The aim of this article is to describe the technique and outcome in a series of patients. METHODS This was a retrospective evaluation of patients who had Heineke-Mikulicz like stricturoplasty performed for a post PSARP skin level stricture over a one-year period. RESULTS Five patients who were operated using the technique were reviewed. All had severe anal strictures that could admit Hegar dilator sizes 6 to 9 at 16months to 5years after PSARP. All underwent routine dilatations, which became increasingly painful. As an alternative to continued dilatations, an operative procedure was offered. The surgery was done as a day case and lasted 10 to 30min. The anus at the end of the procedure could comfortably accept a Hegar dilator size 14 to 17. None of the patients had a colostomy after the procedure and there were no complications. CONCLUSIONS The Heineke-Mikulicz like stricturoplasty is a simple surgical procedure that can be done in an ambulatory setting to treat children with intractable skin level anal stricture if this develops following definitive surgery for anorectal malformations.
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Affiliation(s)
- Taiwo A Lawal
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Carlos A Reck
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA
| | - Victoria A Lane
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA
| | - Alessandra Gasior
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA
| | - Marc A Levitt
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA
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13
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Bonitz RP, Hanna MK. Correction of congenital penoscrotal webbing in children: A retrospective review of three surgical techniques. J Pediatr Urol 2016; 12:161.e1-5. [PMID: 27020468 DOI: 10.1016/j.jpurol.2016.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/04/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Congenital penoscrotal webbing (PSW) is a condition that leads to penile shortening and is a common cause of delayed circumcision. While various techniques for PSW repair have been described, no comparative studies are currently available. OBJECTIVE The goal of this study was to validate and critique three commonly utilized techniques for PSW repair. SUBJECTS AND METHODS A retrospective chart review was performed on all patients who underwent repair for PSW, with or without concomitant surgical procedure, by a single surgeon (MKH) over a 7-year period. Inclusion criteria were: aged <5 years, diagnosis of PSW, documented surgical approach undertaken to correct the PSW, and follow-up for a minimum of 6 months. A total of 196 patients aged 6 months-3.4 years (average 7.8 months) were included, and underwent three different types of procedure: Heineke-Mikulicz (HM) scrotoplasty, VY scrotoplasty or Z scrotoplasty. RESULTS Out of 196 patients, 10 (6.7%) had complications, with four (2.7%) requiring surgical revision or correction. Two patients had excision of 'dog-ear' skin tags, one required excision of a suture tract, and the fourth required revision of skin contraction after HM repair with Z scrotoplasty. DISCUSSION Congenital penoscrotal webbing is a common condition that often requires pediatric urology consultation. Although it is felt that the severity of the defect may not impact on the operative technique for repair of PSW, data comparing these techniques is lacking. This single-surgeon series highlighted that amongst the patients who underwent one of the three described techniques (HM, VY or Z scrotoplasty), there were no significant postoperative differences in complications or parent satisfaction. Although the ease of the HM repair for minor webbing is acknowledged, Z scrotoplasty is the authors' preference for repair given its ability to address the most severe webbing. CONCLUSIONS In this comparison of three surgical techniques for the correction of PSW, it was demonstrated that each choice is safe, with no option showing a significant difference in complication rate. Surgeon preference should therefore weigh heavily when choosing the surgical approach for PSW repair.
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Affiliation(s)
- R P Bonitz
- Urology Division, Rutgers-New Jersey Medical School, Newark, NJ, USA; Children's Hospital of New Jersey, Saint Barnabas Health System, Livingston, NJ, USA.
| | - M K Hanna
- Urology Division, Rutgers-New Jersey Medical School, Newark, NJ, USA; Children's Hospital of New Jersey, Saint Barnabas Health System, Livingston, NJ, USA; Division of Pediatric Urology, Cohen Children's Medical Center, North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA; New York Presbyterian-Weill Cornell Medical Center, New York, NY, USA
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14
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Stephenson R, Carnell S, Johnson N, Brown R, Wilkinson J, Mundy A, Payne S, Watkin N, N'Dow J, Sinclair A, Rees R, Barclay S, Cook JA, Goulao B, MacLennan G, McPherson G, Jackson M, Rapley T, Shen J, Vale L, Norrie J, McColl E, Pickard R. Open urethroplasty versus endoscopic urethrotomy--clarifying the management of men with recurrent urethral stricture (the OPEN trial): study protocol for a randomised controlled trial. Trials 2015; 16:600. [PMID: 26718754 PMCID: PMC4697334 DOI: 10.1186/s13063-015-1120-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 12/14/2015] [Indexed: 12/03/2022] Open
Abstract
Background Urethral stricture is a common cause of difficulty passing urine in men with prevalence of 0.5 %; about 62,000 men in the UK. The stricture is usually sited in the bulbar part of the urethra causing symptoms such as reduced urine flow. Initial treatment is typically by endoscopic urethrotomy but recurrence occurs in about 60 % of men within 2 years. The best treatment for men with recurrent bulbar stricture is uncertain. Repeat endoscopic urethrotomy opens the narrowing but it usually scars up again within 2 years requiring repeated procedures. The alternative of open urethroplasty involves surgically reconstructing the urethra, which may need an oral mucosal graft. It is a specialist procedure with a longer recovery period but may give lower risk of recurrence. In the absence of firm evidence as to which is best, individual men have to trade off the invasiveness and possible benefit of each option. Their preference will be influenced by individual social circumstances, availability of local expertise and clinician guidance. The open urethroplasty versus endoscopic urethrotomy (OPEN) trial aims to better guide the choice of treatment for men with recurrent urethral strictures by comparing benefit over 2 years in terms of symptom control and need for further treatment. Methods/Design OPEN is a pragmatic, UK multicentre, randomised trial. Men with recurrent bulbar urethral strictures (at least one previous treatment) will be randomised to undergo endoscopic urethrotomy or open urethroplasty. Participants will be followed for 24 months after randomisation, measuring symptoms, flow rate, the need for re-intervention, health-related quality of life, and costs. The primary clinical outcome is the difference in symptom control over 24 months measured by the area under the curve (AUC) of a validated score. The trial has been powered at 90 % with a type I error rate of 5 % to detect a 0.1 difference in AUC measured on a 0–1 scale. The analysis will be based on all participants as randomised (intention-to-treat). The primary economic outcome is the incremental cost per quality-adjusted life year. A qualitative study will assess willingness to be randomised and hence ability to recruit to the trial. Discussion The OPEN Trial seeks to clarify relative benefit of the current options for surgical treatment of recurrent bulbar urethral stricture which differ in their invasiveness and resources required. Our feasibility study identified that participation would be limited by patient preference and differing recruitment styles of general and specialist urologists. We formulated and implemented effective strategies to address these issues in particular by inviting participation as close as possible to diagnosis. In addition re-calculation of sample size as recruitment progressed allowed more efficient design given the limited target population and funding constraints. Recruitment is now to target. Trial registration ISRCTN98009168 Date of registration: 29 November 2012. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1120-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachel Stephenson
- Newcastle Clinical Trials Unit, Newcastle University, 1-2 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, UK.
| | - Sonya Carnell
- Newcastle Clinical Trials Unit, Newcastle University, 1-2 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, UK.
| | - Nicola Johnson
- Newcastle Clinical Trials Unit, Newcastle University, 1-2 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, UK.
| | - Robbie Brown
- Newcastle Clinical Trials Unit, Newcastle University, 1-2 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, UK.
| | - Jennifer Wilkinson
- Newcastle Clinical Trials Unit, Newcastle University, 1-2 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, UK.
| | - Anthony Mundy
- University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.
| | - Steven Payne
- Central Manchester Foundation Trust, Oxford Road, Manchester, M13 9WL, UK.
| | - Nick Watkin
- St George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Andrew Sinclair
- Stepping Hill Hospital, Hazel Grove, Stockport, SK2 7JE, UK.
| | - Rowland Rees
- Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | | | - Jonathan A Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7HE, UK.
| | - Beatriz Goulao
- Centre for Healthcare and Randomised Trials, Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Graeme MacLennan
- Centre for Healthcare and Randomised Trials, Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Gladys McPherson
- Centre for Healthcare and Randomised Trials, Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Matthew Jackson
- Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
| | - Tim Rapley
- Institute of Health & Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - Jing Shen
- Institute of Health & Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - Luke Vale
- Institute of Health & Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - John Norrie
- Centre for Healthcare and Randomised Trials, Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Elaine McColl
- Newcastle Clinical Trials Unit, Newcastle University, 1-2 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, UK.
| | - Robert Pickard
- Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK. .,The Medical School, Newcastle University, 3rd Floor William Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
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Tricard T, Padja E, Story F, Saeedi Y, Mouracade P, Saussine C. [Benefit of clean intermittent self-catheterization in the management of urethral strictures]. Prog Urol 2015; 25:705-10. [PMID: 26381320 DOI: 10.1016/j.purol.2015.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Urethral stenosis has a recurrent character. The urethroplasty is often proposed for repeat stenosis. This study seeks to explore the interest of clean intermittent self-catheterization in the evolution of urethral stenosis after urethrotomy. METHODS Single-center retrospective study from 2008 to 2013, concerning patients who received urethrotomy to treat urethral stenosis which was confirmed by endoscopy and a flow chart. Some accomplished self-catheterization in addition to urethrotomy to prevent recurrence. The monitoring was provided during consultation by a subjective assessment (patient and surgeon) and a flow chart. The restenosis were confirmed by endoscopy and flow chart. RESULTS Ninety-three patients treated with urethrotomy alone (50 patients) or associated with self-catheterization (43) was included. Urethral stenosis were mostly iatrogenic (75%), short <10mm (84%), single (74%) and primary (50.5%). Mean follow-up was 99.3±72.8 weeks. Eighteen patients (19%) had symptomatic recurrence suspected by flow chart with a mean Qmax at recurrence was 6.25±2.8mL/s (P<0.001), 8 in urethrotomy group and 10 in the urethrotomy+self-catheterization group. Recurrence rates were comparable in the 2 groups, urethrotomy (16%) urethrotomy+self-catheterization (23%) (P=0.46). The mean time to recurrence was 81.1±87 weeks and was different in the 2 groups: 76.8±76.3 weeks in urethrotomy group, 83.3±93.9 in urethrotomy+self-catheterization group (P=0.014). An analysis recurrence for the primitive urethral stenosis showed that the recurrence rate was not statistically different: 18% for urethrotomy+self-catheterization group vs 14% for urethrotomy group. An analysis of recurrent relapses for urethral stenosis showed a rate of 26%, comparable in the 2 groups (P=1). CONCLUSION After urethrotomy, urethral stenosis recurs in 1 patient over 5, after 18 months especially if they were complicated (multiple, recurrent, extended). Self-catheterization do not provide benefit in terms of recurrence (for the general population and for primitive urethral stenosis) compared to only urethrotomy but seem to extend the time without recurrence (76.8 weeks vs 83.3 weeks). LEVEL OF EVIDENCE 5.
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Affiliation(s)
- T Tricard
- Service d'urologie, nouvel hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg, France.
| | - E Padja
- Service d'urologie, nouvel hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - F Story
- Service d'urologie, nouvel hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - Y Saeedi
- Service d'urologie, nouvel hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - P Mouracade
- Service d'urologie, nouvel hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - C Saussine
- Service d'urologie, nouvel hôpital civil, 1, place de l'Hôpital, 67091 Strasbourg, France
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16
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Current trends in urethral stricture management. Asian J Urol 2015; 1:46-54. [PMID: 29511637 PMCID: PMC5832879 DOI: 10.1016/j.ajur.2015.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/19/2014] [Accepted: 08/26/2014] [Indexed: 01/16/2023] Open
Abstract
The recent International Consultation on Urological Disease (ICUD) panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis, as distinct from sphincter stenoses and a urethral disruption injury. Whenever possible, an anastomotic urethroplasty should be performed because of the higher success rate as compared to augmentation urethroplasty. There is some debate currently regarding the critical stricture length at which an anastomotic procedure can be used, but clearly the extent of the spongiofibrosis and individual anatomical factors (the length of the penis and urethra) are important, the limitation for this being extension of dissection beyond the peno-scrotal junction and the subsequent production of chordee. More recently, there has been interest in whether to excise and anastomose or to carry out a stricturotomy and reanastomosis using a Heineke-Miculicz technique. Augmentation urethroplasty has evolved towards the more extensive use of oral mucosa grafts as compared to penile skin flaps, as both flaps and grafts have similar efficacy and certainly the use of either dorsal or ventral positioning seems to provide comparable results. It is important that the reconstructive surgeon is well versed in the full range of available repair techniques, as no single method is suitable for all cases and will enable the management of any unexpected anatomical findings discovered intra-operatively.
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Kovell RC, Terlecki RP. Ventral inlay buccal mucosal graft urethroplasty: a novel surgical technique for the management of urethral stricture disease. Korean J Urol 2015; 56:164-7. [PMID: 25685305 PMCID: PMC4325122 DOI: 10.4111/kju.2015.56.2.164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/10/2014] [Indexed: 11/25/2022] Open
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.
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Affiliation(s)
- Robert Caleb Kovell
- Department of Urology, Wake Forest Baptist Medical Center, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Ryan Patrick Terlecki
- Department of Urology, Wake Forest Baptist Medical Center, Wake Forest School of Medicine, Winston Salem, NC, USA
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18
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Hillary CJ, Osman NI, Chapple CR. WITHDRAWN: Current trends in urethral stricture management. Asian J Urol 2014. [DOI: 10.1016/j.ajur.2014.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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19
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Stricture Excision and Primary Anastomosis for Anterior Urethral Strictures. ADVANCED MALE URETHRAL AND GENITAL RECONSTRUCTIVE SURGERY 2014. [DOI: 10.1007/978-1-4614-7708-2_12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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20
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Blaschko SD, Sanford MT, Cinman NM, McAninch JW, Breyer BN. De novo erectile dysfunction after anterior urethroplasty: a systematic review and meta-analysis. BJU Int 2013; 112:655-63. [PMID: 23924424 PMCID: PMC3740455 DOI: 10.1111/j.1464-410x.2012.11741.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the likelihood of developing de novo erectile dysfunction (ED) after anterior urethroplasty and to determine if this likelihood is influenced by age, stricture length, number of previous procedures or timing of evaluation. MATERIALS AND METHODS PubMed, Embase, Cochrane, and Google Scholar databases were searched for the terms 'urethroplasty', 'urethral obstruction', 'urethral stricture', 'sexual function', 'erection', 'erectile function', 'erectile dysfunction', 'impotence' and 'sexual dysfunction'. Two reviewers evaluated articles for inclusion based on predetermined criteria. RESULTS In a meta-analysis of 36 studies with a total of 2323 patients, de novo ED was rare, with an incidence of 1%. In studies that assessed postoperative erectile function at more than one time point, ED was transient and resolved at between 6 and 12 months in 86% of cases. CONCLUSIONS Men should be counselled regarding the possibility of transient or permanent de novo ED after anterior urethroplasty procedures. Increasing mean age was associated with an increased likelihood of de novo ED, but this was not statistically significant.
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Affiliation(s)
- Sarah D Blaschko
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
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21
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Lumen N, Spiers S, De Backer S, Pieters R, Oosterlinck W. Assessment of the short-term functional outcome after urethroplasty: a prospective analysis. Int Braz J Urol 2012; 37:712-8. [PMID: 22234005 DOI: 10.1590/s1677-55382011000600005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2011] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To assess the short-term functional outcomes on urinary symptoms, erectile function, urinary continence and patient's satisfaction after urethroplasty. MATERIALS AND METHODS A prospective analysis was done in 21 patients who underwent urethroplasty. An assessment of the urinary flow, urinary symptoms (International Prostate Symptoms Score <IPSS>), erectile function (International Index of Erectile Function-5 <IIEF-5>) and urinary continence International Consultation Committee on Incontinence Questionnaire male Short Form <ICI-Q-SF>) was done before urethroplasty and 6 weeks and 6 months after urethroplasty. Patients were also asked to score their satisfaction with the urethroplasty after 6 weeks and 6 months. RESULTS Mean patient's age was 48 years range: 26-80 years). Mean stricture length was 4.2 cm (range: 1-12 cm). Three patients suffered a stricture recurrence. Mean maximum urinary flow increased from 5.83 mL/s to 24.92 mL/s (p < 0.001). Mean IPSS preoperative, 6 weeks and 6 months postoperative was respectively 15.86, 4.60 and 6.41(p < 0.001). The mean IIEF-5 score preoperative, 6 weeks and 6 months postoperative was respectively 15, 12.13 and 11.62 (not significant). The mean ICI-Q-SF score preoperative, 6 weeks and 6 months postoperative was respectively 10.47, 8.33 (p = 0.04) and 9.47 (p = 0.31). Patient's satisfaction 6 weeks and 6 months postoperative was respectively 17.14/20 and 17.12/20. CONCLUSIONS Urethroplasty leads to a significant improvement in urinary flow and IPSS and urinary continence is tending to improve. Although not significant, erectile function was slightly diminished after urethroplasty. Functional outcome should be assessed when urethroplasty is performed.
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Affiliation(s)
- N Lumen
- Department of Urology, Ghent University Hospital, Ghent and University of Ghent, Belgium.
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The heineke-mikulicz principle for hepaticojejunostomy stricture. Case Rep Surg 2012; 2012:454975. [PMID: 22919532 PMCID: PMC3420084 DOI: 10.1155/2012/454975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 07/10/2012] [Indexed: 11/25/2022] Open
Abstract
Benign anastomotic stricture after hepaticojejunostomy is one of the serious complications of biliary surgery. If left untreated, jaundice, cholangitis, or cirrhosis may develop. A 58-year-old male patient was admitted with benign hepaticojejunostomy stricture. The patient initially underwent an endoscopic retrograde cholangiography using double-balloon enteroscope, which was unsuccessful due to the sharp angle between the jejunal limb and the biliary tree. It was decided to perform surgery. During the operation, we performed Heineke-Mikulicz strictureplasty to the narrowed anastomosis. Patient's postoperative course was uneventful. At the end of followup, for 18 months, his liver enzymes were within normal ranges, and the ultrasound examination showed a patent hepaticojejunostomy anastomosis. The simplicity of the technique and the promising result support the applicability of the Heineke-Mikulicz principle in suitable cases as an alternative treatment approach for hepaticojejunostomy strictures.
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Current world literature. Curr Opin Urol 2011; 21:535-40. [PMID: 21975510 DOI: 10.1097/mou.0b013e32834c87d0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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