The Problems of Penile Urethroplasty with Particular Reference to 2-Stage Reconstructions

Andrich, Daniela E.; Greenwell, Tamsin; Mundy, Anthony R.

doi:10.1097/01.ju.0000069721.20193.fd

Cited by 86 publications

(93 citation statements)

References 7 publications

(5 reference statements)

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“…Urethroplasty in patients with failed hypospadias repair is one of the most challenging and difficult procedures to perform in the field of reconstructive urological surgery, characterized by a high percentage of post-operative complications mainly due to local urethral mucosa conditions which, in this group of patients, is commonly atrophic or dystrophic (1)(2). This mucosa also commonly has abnormal healing.…”

Section: Discussionmentioning

confidence: 99%

“…Repair of navicularis and penile urethral strictures in adult patients is one of the most challenging and difficult problems to deal with in the field of reconstructive urological surgery (1). Moreover, many patients with failed hypospadias repair may require two-stage urethroplasty using an oral mucosa graft (1)(2).…”

mentioning

confidence: 99%

“…Moreover, many patients with failed hypospadias repair may require two-stage urethroplasty using an oral mucosa graft (1)(2). In the standard two-stage surgical procedure, the oral mucosa graft is sutured to the corpora cavernosa with the aim of building up a sufficiently large urethral plate (first-stage oral mucosa graft urethroplasty) and then is tubularized to the neo-urethra in a second step (second-stage oral mucosa graft urethroplasty), commonly performed one year later.…”

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confidence: 99%

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The Use of Topical Hyaluronic Acid and Silver Sulfadiazine (Altergen®) in Patients Undergoing Two-Stage Anterior Urethroplasty with Oral Mucosal Graft

Romano

Barbagli

Lazzeri³

2011

Eur J Inflamm

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This investigative pilot study was conducted with the objective of evaluating the therapeutic effect of a cream containing hyaluronic acid (HA) and silver-sulfadiazine (Altergen", IBSA Farmaceutici Italia, Sir.l.) in adult patients undergoing two-stage urethroplasty using an oral mucosal graft for anterior urethral strictures due to failed hypospadias repair. We used a cream (Altergen") containing the following active ingredients: 100 g HA, 0.20 mg sodium salt, and 1 g silver-sulfadiazine. During the period of January 2009 -May 2010, 40 patients, mean age 24 years, who had undergone hypospadias surgery during childhood were enrolled in the study, according to some inclusion and exclusion criteria (age >18 years, with the absence of diabetes, neurovascular disease, lichen sclerosus or other dermatological lesions). All 40 patients had navicularis or penile urethral strictures and underwent twostage urethroplasty using an oral mucosa graft. Post-operatively, 20 patients (50%) were treated with a cream containing HA and silver-sulfadiazine (Altergen") and 20 patients (50%) were treated using a standard topical treatment (iodopovidone 10% gel). All patients underwent a follow-up at 6, 15,30,60 and 120 days after surgery. Out of the 20 patients treated with the HA and silver-sulfadiazine-containing cream (Altergen"), 18 (90%) showed good and complete healing of the graft implant 30 days after surgery. Of the 20 patients not treated with the HA and silver-sulfadiazine-contaning cream (Altergen"), 13 (65%) showed good and complete healing of the graft implant 30 days after surgery. These results were constant in all follow-ups in both patient groups. In patients who underwent a navicularis or penile two-stage oral mucosal graft urethroplasty, the use of a HA and silver-sulfadiazine-containing cream was associated with a higher success rate of the graft implant and a lower incidence of post-surgical complications compared to the controls.Repair of navicularis and penile urethral strictures in adult patients is one of the most challenging and difficult problems to deal with in the field of reconstructive urological surgery (1). Moreover, many patients with failed hypospadias repair may require two-stage urethroplasty using an oral mucosa graft (1-2). In the standard two-stage surgical procedure, the oral mucosa graft is sutured to the corpora cavernosa with the aim of building up a sufficiently large urethral plate (first-stage oral mucosa graft urethroplasty) and then is tubularized to the neo-urethra in a second step (second-stage oral

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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The Use of Topical Hyaluronic Acid and Silver Sulfadiazine (Altergen®) in Patients Undergoing Two-Stage Anterior Urethroplasty with Oral Mucosal Graft

Romano

Barbagli

Lazzeri³

2011

Eur J Inflamm

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“…5,6,7 Excision of the involved urethra and substitution urethroplasty is the modality of choice. 8 The currently most widely accepted recommendation is the use of non-genital mucosal grafts of which buccal mucosal graft is the most popular. 8,9 Controversies exist in the literature about advantages and disadvantages of one stage versus two-stage repairs.…”

Section: Introductionmentioning

confidence: 99%

“…8 The currently most widely accepted recommendation is the use of non-genital mucosal grafts of which buccal mucosal graft is the most popular. 8,9 Controversies exist in the literature about advantages and disadvantages of one stage versus two-stage repairs. 10 However, many published studies have recently confirmed equally good results with one-stage mucosal graft substitution urethroplasty .…”

Section: Introductionmentioning

confidence: 99%

Ventral Onlay Buccal Mucosal Graft Urethroplasty Based on Tunica Vaginalis Flap for Balanitis Xerotica Obliterans Related Urethral Strictures: The Outcome of Single- Stage Reconstruction

Singh¹

2017

jmscr

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Fossa Navicularis and Meatal Reconstruction

Armenakas

2013

Advanced Male Urethral and Genital Reconstructive Surgery

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SummaryThe correction of strictures involving the fossa navicularis and meatus poses a distinct challenge. Unlike surgical repair of strictures involving other urethral segments where the primary concern is restoration of urethral patency, management of glanular urethral strictures also requires particular attention to cosmesis. Various options are available, the choice of which depends on the etiology and characteristics of the stricture, prior failed procedures, the patient's expectations, and the surgeon's operative familiarity and preference. No single technique is applicable to all strictures. In general, minimally invasive procedures are usually palliative, whereas reconstructive procedures should be performed with a curative intent. Paramount to the success of any reconstructive procedure is the careful selection of non-diseased tissue for urethral substitution. If the penile skin is healthy and the glans is not extensively involved with LSA, our preferred urethral substitute is the fasciocutaneous ventral penile transverse island fl ap. In cases of extensive LSA or penile scarring, extragenital tissue transfer techniques should be considered, preferably in one stage, using the versatile buccal mucosal graft. Equally important is the choice of glanuloplasty. Where possible, a glans-cap repair is preferred because of the limited dissection required with this relatively simple technique.The careful selection of the optimal urethral tissue substitute and glanuloplasty technique, as well as meticulous attention to surgical principles, are mandatory in achieving a satisfactory functional and aesthetic outcome when reconstructing strictures of the fossa navicularis and meatus.

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The Problems of Penile Urethroplasty with Particular Reference to 2-Stage Reconstructions

Abstract: Although 2-stage has a significantly lower re-stricture rate than 1-stage urethroplasty for complex strictures in the penile urethra, it does so at the expense of a significantly higher revision rate particularly of the penile urethra.

Cited by 86 publications

References 7 publications

The Use of Topical Hyaluronic Acid and Silver Sulfadiazine (Altergen®) in Patients Undergoing Two-Stage Anterior Urethroplasty with Oral Mucosal Graft

The Use of Topical Hyaluronic Acid and Silver Sulfadiazine (Altergen®) in Patients Undergoing Two-Stage Anterior Urethroplasty with Oral Mucosal Graft

Ventral Onlay Buccal Mucosal Graft Urethroplasty Based on Tunica Vaginalis Flap for Balanitis Xerotica Obliterans Related Urethral Strictures: The Outcome of Single- Stage Reconstruction

Fossa Navicularis and Meatal Reconstruction

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