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Madec FX, Karsenty G, Yiou R, Robert G, Huyghe E, Boillot B, Marcelli F, Journel NM. [Which management for anterior urethral stricture in male? 2021 guidelines from the uro-genital reconstruction urologist group (GURU) under the aegis of CAMS-AFU (Committee of Andrology and Sexual Medicine of the French Association of Urology)]. Prog Urol 2021; 31:1055-1071. [PMID: 34620544 DOI: 10.1016/j.purol.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/17/2021] [Accepted: 07/08/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this first french guideline is to provide a clinical framework for the diagnosis, treatment and follow-up of anterior urethral strictures. The statements are established by the subgroup working on uro-genital reconstruction surgery (GURU) from the CAMS-AFU (Andrology and Sexual Medicine Committee from the French Association of Urology). MATERIAL AND METHODS These guidelines are adapted from the Male Urethral Stricture : American Urological Association Guideline 2016, updated by an additional bibliography from January 2016 to December 2019. Twenty-seven main scenarios seen in clinical practice are identified: from diagnosis, to treatment and follow-up. In addition, this guidelines are powered by anatomical diagrams, treatment algorithms, summaries and follow-up tables. RESULTS Anterior urethral strictures are a common condition (0,1 à 1,4 %) in men. The diagnosis is based on a trifecta including an examination with patient reported questionnaires, urethroscopy and retrograde urethrography with voiding cystourethrography. Short meatal stenosis can be treated by dilation or meatotomy, otherwise a urethroplasty can be performed. First line treatment of penile strictures is urethroplasty. Short bulbar strictures (<2cm) may benefit from endourethral treatment (direct visual internal urethrotomy or dilation). In case of recurrence or when the stenosis measures more than 2 cm, a urethroplasty will be proposed. Repeated endourethral treatment management are no longer recommended except in case of palliative option. Urethroplasty is usually done with oral mucosa graft as the primary option, in one or two stages approach depending on the extent of the stenosis and the quality of the tissues. Excision and primary anastomosis or non-transecting techniques are discussed for bulbar urethra strictures. Follow-up by clinical monitoring with urethroscopy, or retrograde urethrography with voiding cystourethrography, is performed at least the first year and then on demand according to symptoms. CONCLUSION Anterior urethral strictures need an open surgical approach and should be treated by urethroplasty in most cases. This statement requires a major paradigm shift in practices. Training urologist through reconstructive surgery is the next challenge in order to meet the demand.
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Affiliation(s)
- F-X Madec
- Service d'urologie, hôpital Foch, 40, rue de Worth, 92150 Suresnes, France.
| | - G Karsenty
- Service d'urologie, hôpitaux universitaires de Marseille Conception, 147, boulevard Baille, 13005 Marseille, France
| | - R Yiou
- Service d'urologie, hôpital Henri-Mondor, CHU Paris est, 51, avenue du Marechal de Lattre de Tassigny, 94010 Créteil Cedex, France
| | - G Robert
- Service d'urologie, CHU de Bordeaux GH Pellegrin, 30000 Bordeaux, France
| | - E Huyghe
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 1, avenue du Professeur Jean-Poulhès, 31400 Toulouse, France
| | - B Boillot
- Service d'urologie et de la transplantation rénale, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| | - F Marcelli
- Service d'urologie, CHRU-hopital huriez, rue Michel Polonowski, 59037 Lille, France
| | - N M Journel
- Service d'urologie, Centre Hospitalier Lyon Sud (HCL), chemin du Grand Revoyet, 69310 Pierre Benite, France
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Pavletic MM. Full-thickness labial flaps to reconstruct facial defects in four dogs. Vet Surg 2021; 50:1338-1349. [PMID: 33476059 DOI: 10.1111/vsu.13571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/10/2020] [Accepted: 12/11/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the use of the upper lip for reconstruction of the external nose and closure of large facial defects in dogs. ANIMALS Four dogs with facial defects with exposure of the underlying nasal cavity. STUDY DESIGN Short case series. METHODS A variation of the lip-to-lid technique was used to reconstruct one-half of the external nose after resection of a mast cell tumor in one dog. A full-thickness labial transposition flap (upper lip) was used to reconstruct facial and nasal defects exposing the nasal cavity. A cylindrical mucosal graft was employed in the restoration of nostril patency in one dog. RESULTS The lip-to-lid variation (also known as lip-to-nose) restored the right nostril and nasal planum after mast cell tumor resection in one dog. In three dogs, the nasal defects were reconstructed with full-thickness upper labial transposition flaps. Restoration of nostril patency in one dog was also aided by the cylindrical mucosal graft. CLINICAL SIGNIFICANCE The full-thickness labial transposition flap and the lip-to-lid flap variation were successfully used to reconstruct major defects of the external nose and facial defects involving the nasal cavity. CONCLUSION Composite flaps of the upper lip should be considered to close problematic nasocutaneous fistulas and restore function to the external nose. The upper lip provides a source of mucosa to restore patency of stenotic nares or obstructed nostrils.
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Affiliation(s)
- Michael M Pavletic
- Department of Surgery, Angell Animal Medical Center, Boston, Massachusetts
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Kim SW, Lee YS, Han SW. Buccal Mucosa Tube Graft for Failed Hypospadias Repair: Worth it or Not? Urology 2020; 146:196-200. [PMID: 32910954 DOI: 10.1016/j.urology.2020.07.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/05/2020] [Accepted: 07/12/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the outcome of buccal mucosa tube graft (BMTG) over time in correcting failed hypospadias. METHODS We conducted a retrospective analysis, reviewing charts of all 69 patients who underwent BMTG to repair hypospadias between January 2005 and October 2016. Twenty-one patients were excluded, leaving 48 eligible study subjects. In patients with penile curvatures, corrective procedures (including urethral division, corporoplasty, and local skin flap) took place prior to grafting. RESULTS Mean age at surgery was 8.96 years, and mean duration of follow-up was 73.10 ± 30.31 months. A mean of 1.88 previous surgeries was recorded. During follow-up, only 7 patients (14.5%) were complication free. The other 41 patients required at least 1 additional procedure. Stricture-free rates were 50%, 35.4%, and 27% at 1, 3, and 12 months after BMTG, respectively. Among 37 patients with postoperative stricture, 25 were treated only by endoscopic procedures. Single operation prior to BMTG (P= .004) and usage of larger catheter size (>8Fr) (P = .029) were confirmed significant factors associated with better stricture-free survival after BMTG by log-rank test. After several additional procedures, 46 patients (95.8%) reported normal urination with mean maximal urinary flow of 9.55 mL/s and post-void residual of 16.08 mL for at least 12 months on last visit. CONCLUSION BMTG after failed hypospadias repair seems prone to complications, primarily urethral stricture. However, a large number of patients with postoperative stricture could be treated simply by endoscopic procedures. Given the better results of staged approach, BMTG should be only applied to highly selected patients with failed hypospadias.
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Affiliation(s)
- Sang Woon Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Seung Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Won Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Misra D, Elbourne C, Vareli A, Banerjee D, Joshi A, Friedmacher F, Skerritt C. Challenges in managing proximal hypospadias: A 17-year single-center experience. J Pediatr Surg 2019; 54:2125-2129. [PMID: 31079867 DOI: 10.1016/j.jpedsurg.2019.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are only a few publications in the medical literature reporting on complication rates in proximal hypospadias surgery, particularly with regard to long-term follow-up. METHODS Over a 17.5-year period, we operated 100 patients with penoscrotal, scrotal and perineal hypospadias. Sixty-four had a single-stage repair, including 15 who received a buccal mucosa inlay "Snodgraft" repair. Thirty-six had a two-stage Bracka repair of which 19 received buccal or lower lip grafts and 17 had preputial grafts. Overall, 34 patients received buccal grafts. The median follow-up was eight years (range 1-16 years). Three patients were operated for residual chordee years later. RESULTS Urethral fistulae occurred in a total of 26/100 (26.0%) cases, meatal stenosis in 16/100 (16.0%), wound breakdown in six (6.0%) and graft failure in one (1.0%). The fistula rate after the single-stage approach was 15/64 (23.4%), whereas it was 11/36 (30.6%) following two-stage repair (P = 0.4811). CONCLUSIONS Proximal hypospadias remains a challenging condition to treat. It is possible to perform a single-stage repair in 64.0% of cases. This brings down the median number of operations to only two. Lower lip grafts were used in 34.0% but are now used in redo-surgeries only. Our fistula rate was 26.0% but has decreased significantly in recent years. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Devesh Misra
- Department of Paediatric Urology and Paediatric Surgery, The Royal London Hospital, London, United Kingdom.
| | - Ceri Elbourne
- Department of Paediatric Urology and Paediatric Surgery, The Royal London Hospital, London, United Kingdom
| | - Anastasia Vareli
- Department of Paediatric Urology and Paediatric Surgery, The Royal London Hospital, London, United Kingdom
| | - Debasish Banerjee
- Department of Paediatric Urology and Paediatric Surgery, The Royal London Hospital, London, United Kingdom
| | - Ashwini Joshi
- Department of Paediatric Urology and Paediatric Surgery, The Royal London Hospital, London, United Kingdom
| | - Florian Friedmacher
- Department of Paediatric Urology and Paediatric Surgery, The Royal London Hospital, London, United Kingdom
| | - Clare Skerritt
- Department of Paediatric Urology and Paediatric Surgery, The Royal London Hospital, London, United Kingdom
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Rectoneovaginal Fistula in a Transgender Woman Successfully Repaired Using a Buccal Mucosa Graft. Female Pelvic Med Reconstr Surg 2019; 25:e43-e44. [DOI: 10.1097/spv.0000000000000490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Sakr A, Elkady E, Abdalla M, Fawzi A, Kamel M, Desoky E, Seleem M, Omran M, Elsayed E, Khalil S. Lingual mucosal graft two-stage Bracka technique for redo hypospadias repair. Arab J Urol 2017; 15:236-241. [PMID: 29071158 PMCID: PMC5651942 DOI: 10.1016/j.aju.2017.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/12/2017] [Accepted: 06/04/2017] [Indexed: 11/23/2022] Open
Abstract
Objectives To report our initial experience in redo hypospadias repair with a lingual mucosal graft (LMG) using a two-stage Bracka technique. Patients and methods This study was prospectively conducted and included 26 patients with hypospadias with failed previous repairs. All the patients had a LMG using a two-stage Bracka technique. In the first stage, the harvested LMG, from the ventro-lateral surface of the tongue, was implanted in a well-prepared vascularised bed in the ventral aspect of the penis. After 6 months, tubularisation of the well-taken graft was completed. Tunica vaginalis or a dartos flap was used as second-layer coverage of the neourethra. Success was defined as acceptable aesthetic and functional outcomes without any additional surgical interventions. Results The mean (SD) patient age was 5.15 (1.6) years. The mean (SD) LMG length was 3.82 (0.9) cm and the width was 1.5 (0.5) cm. The mean (SD) number of previous repairs was 2.76 (1.1). The mean (SD) follow-up was 12 (2) months. Donor-site complications included: pain in all patients, with a pain score of >3 on the visual analogue pain scale (0–10) in 10 (38%); and speech problems in 19 (73%). First-stage complications were graft loss (n = 2) and contracture (n = 1). The second stage was completed in 23 patients resulting in the following significant complications: meatal stenosis plus fistula (n = 2), breakdown (n = 1). Successful hypospadias repair was achieved in 77% (20/26) of the patients. Conclusion Lingual mucosa is a reliable and versatile graft material in the armamentarium of two-stage Bracka hypospadias repair with the merits of easy harvesting and minor donor-site complications.
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Affiliation(s)
- Ahmed Sakr
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Ehab Elkady
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Mohamed Abdalla
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Amr Fawzi
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Mostafa Kamel
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Esam Desoky
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Mohamed Seleem
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Mohamed Omran
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Ehab Elsayed
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Salem Khalil
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
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