Proximal hypospadias repair with bladder mucosal graft: Our 10 years experience

Lanciotti, Michele; Betti, Marta; Elia, Antonio; Landi, L.; Taverna, Maria; Cini, Chiara; Masieri, Lorenzo

doi:10.1016/j.jpurol.2017.01.011

Cited by 10 publications

(5 citation statements)

References 24 publications

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“…Skin grafts are not preferred as the first choice due to complications such as infection, hair growth, fistula and stone formation, development of diverticula and stenosis (10). The most important problem encountered when the bladder mucosa is used as a replacement material in urethral defect repair is the hypertrophy and stickiness of the mucosa in the part of the newly formed urethra exposed to air at the tip of the penis as seen in bladder exstrophy (11). Prolapsed bladder mucosa at the newly formed meatus level often requires revision.…”

Section: Discussionmentioning

confidence: 99%

Autologous Free Reverse Inlay Vein Graft in the Treatment of Cripple Hypospadias; an experimental rabbit model

Çalışkan¹,

SÜRER

GÜNHAN>

2023

Türkiye Çocuk Hast Derg

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Objective: The aim of this study is using the autologous reverse inlay jugular vein graft as a substitute for defective urethral plate and the incorporation of the graft to the urethral plate. Cripple hypospadias are the patients who have a history of previous multiple unsuccessful hypospadias surgery and still having anatomical and functional complications. Insufficient local or support tissue for the repair of defective urethral plate is always a problem. Material and Methods: In the study fourteen male 8-10 months old which is weighting four kg, New Zealand type rabbit are divided into two equal groups. Juguler vein graft (1st group) and buccal mucosal graft (2nd group) harvested and transferred to defective area in the urethral plate as a free flap. Results: In the histopatologic examination, epithelization, fibrosis and inflammation degrees were evaluated between the groups and in-groups. In the histopatological examination of the 1st group, uroepithelization is complete or nearly complete, fibrotic activity is (+) and the inflammation was found minimal. In the second group after 21st day, the uroepithelization on the graft is nearly thirty percent, fibrotic activity is (++) and the inflammation is also found minimal. Conclusion: From the results of the study, in the treatment of defective urethra in cripple hypospadias cases, reverse free juguler vein graft can be used as an alternative for buccal mucosa graft as a substitution material which has been used for a long time.

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Section: Discussionmentioning

confidence: 99%

Autologous Free Reverse Inlay Vein Graft in the Treatment of Cripple Hypospadias; an experimental rabbit model

Çalışkan¹,

SÜRER

GÜNHAN>

2023

Türkiye Çocuk Hast Derg

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“…The vascular anastomosis is extremely challenging and prone to complications. Buccal mucosal urethroplasty [4] and bladder mucosa urethroplasty [5] operations are also described in the literature of hypospadias surgery for hypospadias with bad quality of urethral plate. The results of these operations are generally poor and are as follows.…”

Section: Discussionmentioning

confidence: 99%

“…The results of these operations are generally poor and are as follows. In a series of 50 cases of proximal hypospadias, treated with bladder mucosal urethroplasty [5] the long-term complications observed were, urethra-cutaneous fistula in nine patients (18%), urethral stricture in 15 patients (30%), meatal stricture in four patients (8%), and prolapse of meatus in seven patients (14%).…”

Section: Discussionmentioning

confidence: 99%

Appendicular Mucosal Tube Implant with Dartos Wrap Operation for Hypospadias

Jawale¹

2020

OJU

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Aims and Objective: To develop a better operation for hypospadias patients with poor and bad quality urethral plate and damaged urethral plate as in hypospadias cripples. Materials and Methods: I operated 21 cases of hypospadias with Appendicular mucosal tube implant with Dartos wrap operation from 17/04/2017 to 03/03/2019, in Jawale Institute of pediatric Surgery, and that group was labeled as group A. 27 cases of hypospadias were operated in same time span with conventional techniques such as extended Snodgrass operation and Byar's two-stage operation (group B), kept as control. 7 patients (33.33%) were cases of hypospadias cripples with multiple surgeries done in the past. 4 patients (9.52%) patients had congenital short urethra. Remaining 10 patients (50%) were fresh cases with no operation done in past but with bad and fibrotic urethral plate. The longest follow up was 3 years and the shortest of 1 year. Technique of Operation: Appendicectomy performed by open technique and the serosa of Appendix cut longitudinally and stripped off the mucosal tube. The proximal hypospadias opening sutured with the appendicular mucosal tube with 6 sutures of 5-0 Vicryl. Dartos fascia is raised from the scrotum wrapped over the tube and 8-10 interrupted stitches taken with 5-0 Vicryl. Glanuloplasty performed over it. Suprapubic diversion did and kept for 3 weeks postoperatively. Results: In group A, 3 patients developed fistula and only 1 (4.76%) required repair at the end of 6 weeks. 2 (9.52%) patients developed grade 3 infection and settled with conservative treatment. UFR was normal at the end of 12 weeks (12.85 Ml/sec. In group B, 11 patients developed fistula and 9 (33.33%) required repaired. 9 (33.33%) patients developed strictures and all of them required multiple urethral dilatation under GA. 7 (25.92%) patients developed meatal stenosis.UFR was badly reduced with average of 5.78 ML/Sec. Conclusion: The operation proves to be a much better option compared to the conventional for group A patients. We need a series with longer follow up and larger number of patients.

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“…Bladder mucosa has many favorable properties including inherent tolerance of urine exposure and large graft segment harvest without significant harvest site morbidity. 73 , 74 However, it classically requires open surgical harvest and suffers from higher-than-average complication rates, making it a last resort typically reserved for severe proximal hypospadias and other major congenital malformations. 67 , 75 Colonic and rectal mucosa, harvested after either sigmoid resection or transanal endoscopic mucosal resection, offers another excellent graft choice for long, complex USD that has failed previous management attempts with long-term success rates comparable to other graft sources at ~85%.…”

Section: Alternative Graft Optionsmentioning

confidence: 99%

Recurrent Anterior Urethral Stricture: Challenges and Solutions

Mershon¹,

Baradaran²

2021

RRU

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Recurrent male anterior urethral stricture disease is a complex surgical challenge that should be managed by reconstructive urologists with experience in stricture management. Diagnosis of recurrence requires both anatomic narrowing and patient symptoms identified on validated questionnaires, with limited role for intervention in asymptomatic treatment "failures". Endoscopic management has a very specific role in recurrence, and the choice of technique for urethroplasty depends on pre-operative urethrography and cystoscopy. Surgical success depends on addressing patient concerns, complete stricture excision, tissue quality optimization, and the use of multi-stage repair when indicated. Augmentation with genital skin flaps and/or grafts is often required, with buccal mucosa as the ideal graft source if local tissue is compromised. Salvage options including urinary diversion and perineal urethrostomy must also be considered in debilitated patients with severe disease or repeated treatment failures. Unique patient populations including patients with hypospadias and lichen sclerosis are among the highest risk for repeated recurrence and require special care in surgical technique, graft selection, and post-operative management.

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Proximal hypospadias repair with bladder mucosal graft: Our 10 years experience

Cited by 10 publications

References 24 publications

Autologous Free Reverse Inlay Vein Graft in the Treatment of Cripple Hypospadias; an experimental rabbit model

Autologous Free Reverse Inlay Vein Graft in the Treatment of Cripple Hypospadias; an experimental rabbit model

Appendicular Mucosal Tube Implant with Dartos Wrap Operation for Hypospadias

Recurrent Anterior Urethral Stricture: Challenges and Solutions

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