Tunica vaginalis: An aid in hypospadias fistula repair: Our experience of 14 cases

Kadian, Yogender Singh; Rattan, Kamal Nain; Singh, Jagjit; Singh, Mahavir; Kajal, Pradeep; Parihar, Dheeraj

doi:10.4103/0189-6725.86054

Cited by 16 publications

(10 citation statements)

References 20 publications

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“…End-to-end anastomosis is frequently used to repair short, non complex urethral defects wherein organ continuity is surgically restored by aligning and joining normal tissue segments [8]. In circumstances in which there is a lack of patient urethral tissue, extragenital skin flaps [9], [10], buccal mucosa [11], bladder mucosa [12], [13], and tunica vaginalis [14] have been utilized clinically as autologous tissue grafts for urethroplasty procedures. In addition to the risk of donor site morbidity, the long-term success of these implants is often suboptimal due to significant complications such as fistula formation [15], recurrent strictures [16], hair growth [17], stone formation [18], diverticula [19], and meatal stenosis [20].…”

Section: Introductionmentioning

confidence: 99%

Acellular Bi-Layer Silk Fibroin Scaffolds Support Tissue Regeneration in a Rabbit Model of Onlay Urethroplasty

Chung

Franck

et al. 2014

PLoS ONE

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Acellular scaffolds derived from Bombyx mori silk fibroin were investigated for their ability to support functional tissue regeneration in a rabbit model of urethra repair. A bi-layer silk fibroin matrix was fabricated by a solvent-casting/salt leaching process in combination with silk fibroin film casting to generate porous foams buttressed by homogeneous silk fibroin films. Ventral onlay urethroplasty was performed with silk fibroin grafts (Group 1, N = 4) (Width×Length, 1×2 cm2) in adult male rabbits for 3 m of implantation. Parallel control groups consisted of animals receiving small intestinal submucosa (SIS) implants (Group 2, N = 4) or urethrotomy alone (Group 3, N = 3). Animals in all groups exhibited 100% survival prior to scheduled euthanasia and achieved voluntary voiding following 7 d of initial catheterization. Retrograde urethrography of each implant group at 3 m post-op revealed wide urethral calibers and preservation of organ continuity similar to pre-operative and urethrotomy controls with no evidence of contrast extravasation, strictures, fistulas, or stone formation. Histological (hematoxylin and eosin and Masson's trichrome), immunohistochemical, and histomorphometric analyses demonstrated that both silk fibroin and SIS scaffolds promoted similar extents of smooth muscle and epithelial tissue regeneration throughout the original defect sites with prominent contractile protein (α-smooth muscle actin and SM22α) and cytokeratin expression, respectively. De novo innervation and vascularization were also evident in all regenerated tissues indicated by synaptophysin-positive neuronal cells and vessels lined with CD31 expressing endothelial cells. Following 3 m post-op, minimal acute inflammatory reactions were elicited by silk fibroin scaffolds characterized by the presence of eosinophil granulocytes while SIS matrices promoted chronic inflammatory responses indicated by mobilization of mononuclear cell infiltrates. The results of this study demonstrate that bi-layer silk fibroin scaffolds represent promising biomaterials for onlay urethroplasty, capable of promoting similar degrees of tissue regeneration in comparison to conventional SIS scaffolds, but with reduced immunogenicity.

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Section: Introductionmentioning

confidence: 99%

Acellular Bi-Layer Silk Fibroin Scaffolds Support Tissue Regeneration in a Rabbit Model of Onlay Urethroplasty

Chung

Franck

et al. 2014

PLoS ONE

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“…11 Local fascial tissue around the UCF, such as a de-epithelialized scrotal advancement flap, 3,4 a pure dartos flap or a tunica vaginalis flap, was transferred to form an effective vascularized waterproof barriers. [5][6][7][8] Then a preputial or scrotal flap was transferred to cover the cutaneous wound. The three layers are fabricated using different tissues from different flaps, which make the procedure complex and time-consuming.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, it has been reported that an extra waterproof layer between the urethra and skin is able to improve the success rate and reduce the recurrence of the fistula. [3][4][5][6][7][8] Therefore, three-layer reconstruction, including outer cutaneous coverage, waterproof layer and inner urethral layer, has gained popularity in fistula repair.…”

Section: Introductionmentioning

confidence: 99%

Three-layer reconstruction of large urethrocutaneous fistulas using scrotal-septal flaps

Zhou¹,

Lu²,

Zhou³

et al. 2014

CUAJ

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Cite as: Can Urol Assoc J 2014;8(11-12):e828-31. http://dx.doi.org/10.5489/cuaj.1983 Published online November 24, 2014. AbstractIntroduction: The repair of large urethrocutaneous fistulas (UCFs) commonly involves reconstruction of the urethra, waterproof layer and skin coverage, which deploy different tissues from different flaps. To simplify the multiple procedures, we explored to use one flap (a scrotal-septal flap) to reconstruct three layers in UCF repairing in one stage. Methods: Between January 2011 and July 2012, 29 patients with large UCFs (ranging from 1.0 to 2.0 cm) were treated using scrotal-septal flaps for three-layer reconstruction. Every patient has an unbroken scrotum. The hair follicles in the donor site were destroyed using a radiosurgical knife 2 months before the operation. The flap was divided into three zones, which were flipped, folded, and extended respectively to form the urethra, waterproof layer and skin coverage. Results: The patients were followed up between 6 to 12 months. No fistula recurrence was observed. All flaps survived, except in one case, in which the distal skin flap was lost but stenosis or fistula did not develop. Two patients underwent second operations to refine the aesthetic results. Conclusions: The scrotal-septal flap can be transferred in an overturning-folding-advancement fashion and can simultaneously involve the reconstruction of the urethra, waterproof barrier and skin coverage. This is a simple and reliable alternative for large UCFs (≤2 cm) repairing at the penoscrotal junction; however, it cannot be used in patients with a damaged scrotal septum.

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“…Subtle abnormalities in the hypothalamic-pituitary-testis hormonal axis have been reported, although subsequent pubertal development appears unaffected. (3) Similarly, minor defects in testosterone formation, 5-alpha reductase activity and androgen receptor function have been detected. Altered molecular process normally resulting from androgen stimulation also may play a role.…”

Section: Pathogenesismentioning

confidence: 98%

“…Less often complete prepuce conceals the urethral defect that is detected only during circumcision . (3) Figure 1.Varieties of hypospadias. A.…”

Section: Introductionmentioning

confidence: 99%

Tunica Vaginalis Flap as a second layer for Tubularized incised plate urethroplasty (Snodgrass method) in reoperation for hypospadias

Akal¹

2014

iosrphr

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Tunica vaginalis: An aid in hypospadias fistula repair: Our experience of 14 cases

Cited by 16 publications

References 20 publications

Acellular Bi-Layer Silk Fibroin Scaffolds Support Tissue Regeneration in a Rabbit Model of Onlay Urethroplasty

Acellular Bi-Layer Silk Fibroin Scaffolds Support Tissue Regeneration in a Rabbit Model of Onlay Urethroplasty

Three-layer reconstruction of large urethrocutaneous fistulas using scrotal-septal flaps

Tunica Vaginalis Flap as a second layer for Tubularized incised plate urethroplasty (Snodgrass method) in reoperation for hypospadias

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