Two‐stage hypospadias repair with inner preputial layer Wolfe graft (Aivar Bracka repair)

Altarac, Silvio; Papeš, Dino; Bracka, Aivar

doi:10.1111/j.1464-410x.2012.11304.x

Cited by 21 publications

(6 citation statements)

References 6 publications

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“…Post-operative complications increase with the severity of the anomaly 6 and patients with severe hypospadias often require extra tissue to repair the urethra (reviewed 1 ). Autologous free tissue grafts have been used clinically for urethral reconstruction, including skin from genital and extra-genital regions, 7,8 with buccal mucosa the most commonly used. [9][10][11] Problems most commonly associated with the use of autologous free tissue grafts include graft size, donor site morbidity and graft contracture.…”

Section: Introductionmentioning

confidence: 99%

Augmentation of the insufficient tissue bed for surgical repair of hypospadias using acellular matrix grafts: A proof of concept study

et al. 2021

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Acellular matrices produced by tissue decellularisation are reported to have tissue integrative properties. We examined the potential for incorporating acellular matrix grafts during procedures where there is an inadequate natural tissue bed to support an enduring surgical repair. Hypospadias is a common congenital defect requiring surgery, but associated with long-term complications due to deficiencies in the quality and quantity of the host tissue bed at the repair site. Biomaterials were implanted as single on-lay grafts in a peri-urethral position in male pigs. Two acellular tissue matrices were compared: full-thickness porcine acellular bladder matrix (PABM) and commercially-sourced cross-linked acellular matrix from porcine dermis (Permacol™). Anatomical and immunohistological outcomes were assessed 3 months post-surgery. There were no complications and surgical sites underwent full cosmetic repair. PABM grafts were fully incorporated, whilst Permacol™ grafts remained palpable. Immunohistochemical analysis indicated a non-inflammatory, remodelling-type response to both biomaterials. PABM implants showed extensive stromal cell infiltration and neovascularisation, with a significantly higher density of cells ( p < 0.001) than Permacol™, which showed poor cellularisation and partial encapsulation. This study supports the anti-inflammatory and tissue-integrative nature of non-crosslinked acellular matrices and provides proof-of-principle for incorporating acellular matrices during surgical procedures, such as in primary complex hypospadias repair.

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Section: Introductionmentioning

confidence: 99%

Augmentation of the insufficient tissue bed for surgical repair of hypospadias using acellular matrix grafts: A proof of concept study

et al. 2021

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“…Others have argued that a staged operation has a lower complication rate. For example, following the principles described by Bracka et al ( 13 ), Pfistermüller et al had an impressively low reoperation rate of 6.25% after the second stage of a staged repair in 208 patients ( 12 ). Nevertheless, their group of patients required 429 procedures under general anesthesia until resolution of the problem or 2.07 procedures per child.…”

Section: Discussionmentioning

confidence: 99%

Results of Onlay Preputial Flap Urethroplasty for the Single-Stage Repair of Mid- and Proximal Hypospadias

2018

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AimsTo report current results of preputial flap onlay urethroplasty using the principle of the total preputial flap (TPF) for the one-stage repair of mid- and proximal hypospadias.MethodsThis study was a retrospective chart review of patients in a prospectively kept database of all hypospadias operations performed at two institutions from January 1 2011 to August 2017. Inclusion criteria: all patients who underwent hypospadias repair using a preputial only flap urethroplasty based on the principle of the TPF. Demographic data, duration of follow-up, complications, and reoperations were recorded. A successful result was considered to be a straight penis, a glanular meatus, and absence of voiding symptoms. Whenever possible an uroflow was obtained during the follow-up visits.ResultsForty-nine children met the inclusion criteria. All patients had marked penile curvature. Three patients had chromosomal abnormalities. The mean age at the time of surgery was 22 months (11–110) and the mean duration of follow-up 23.4 months (1–79). In 48 cases, the urethral plate could be preserved without dividing it. The penile curvature was corrected with chordectomy alone in 10 patients, 38 required a dorsal plication of the tunica albuginea, and 1 required an additional ventral dermal graft. In 38 patients (77.5%), the initial operation was successful, and no further operations were needed. There were eight urethrocutaneous fistulas, three dehiscences of the glans approximation. One patient suffered a wound infection and partial loss of the flap.ConclusionOne-stage repair of mid- and proximal hypospadias preserving the urethral plate and using a TPF for the urethroplasty and coverage of the ventral penis is successful in 77.5% of cases. Complications in the remaining patients were easily managed or did not require treatment. Compared to a planned two-stage approach, the technique described in this report resulted in significantly fewer procedures till complete resolution of the problem.

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“…In the case of severe hypospadias, extra tissue is frequently required to restore the missing urethra. Autologous sources for urethral replacement usually involve skin from the genital areas or extragenital regions [ 44 , 45 , 46 ]. In fact, the most widely used replacements are preputial skin graft/flaps when available, or buccal mucosa (BM) free grafts [ 47 , 48 ], when considered appropriate.…”

Section: Requirements For Tissue Engineering In the Case Of Pediatric...mentioning

confidence: 99%

“…In particular, the outcome of the urethroplasty depends on the quality of the anatomical structures and the surgical approach, but it is also dependent on the availability of the appropriate graft source as patients with severe hypospadias frequently need extra tissue to restore the missing urethra [ 2 ]. Usually, the autologous graft sources used for urethral replacement are skin from the genital areas or extragenital regions [ 44 , 45 , 46 ] or, more recently, buccal mucosa free skin [ 47 ], because of its easier harvesting procedure, which causes minimal discomfort for the patient, and because of its acceptable degree of morbidity [ 78 ].…”

Section: Tissue-engineered Urethra In the Case Of Hypospadiasmentioning

confidence: 99%

Tissue Engineering and Regenerative Medicine in Pediatric Urology: Urethral and Urinary Bladder Reconstruction

Casarin¹,

Morlacco²,

Moro³

2022

IJMS

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In the case of pediatric urology there are several congenital conditions, such as hypospadias and neurogenic bladder, which affect, respectively, the urethra and the urinary bladder. In fact, the gold standard consists of a urethroplasty procedure in the case of urethral malformations and enterocystoplasty in the case of urinary bladder disorders. However, both surgical procedures are associated with severe complications, such as fistulas, urethral strictures, and dehiscence of the repair or recurrence of chordee in the case of urethroplasty, and metabolic disturbances, stone formation, urine leakage, and chronic infections in the case of enterocystoplasty. With the aim of overcoming the issue related to the lack of sufficient and appropriate autologous tissue, increasing attention has been focused on tissue engineering. In this review, both the urethral and the urinary bladder reconstruction strategies were summarized, focusing on pediatric applications and evaluating all the biomaterials tested in both animal models and patients. Particular attention was paid to the capability for tissue regeneration in dependence on the eventual presence of seeded cell and growth factor combinations in several types of scaffolds. Moreover, the main critical features needed for urinary tissue engineering have been highlighted and specifically focused on for pediatric application.

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Two‐stage hypospadias repair with inner preputial layer Wolfe graft (Aivar Bracka repair)

Cited by 21 publications

References 6 publications

Augmentation of the insufficient tissue bed for surgical repair of hypospadias using acellular matrix grafts: A proof of concept study

Augmentation of the insufficient tissue bed for surgical repair of hypospadias using acellular matrix grafts: A proof of concept study

Results of Onlay Preputial Flap Urethroplasty for the Single-Stage Repair of Mid- and Proximal Hypospadias

Tissue Engineering and Regenerative Medicine in Pediatric Urology: Urethral and Urinary Bladder Reconstruction

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