Use of Buccal Mucosa in Hypospadias Repair

Cruz-Diaz, Omar; Castellán, Miguel; Gosálbez, Rafael

doi:10.1007/s11934-013-0334-9

Cited by 9 publications

(4 citation statements)

References 39 publications

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“…Clinical experience in this area is still relatively scarce, and further research is needed before tissue-engineered urethral repair will become daily practice. Meanwhile, due to the above-mentioned characteristics, for over 20 years, oral mucosa is considered by most surgeons as the best and therefore the primary source of alternative tissue in complex hypospadias [13]. …”

Section: Current Opinion: Future Perspectivesmentioning

confidence: 99%

Hypospadias, all there is to know

2017

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Hypospadias is one of the most common congenital anomalies in men. The condition is typically characterized by proximal displacement of the urethral opening, penile curvature, and a ventrally deficient hooded foreskin. In about 70%, the urethral meatus is located distally on the penile shaft; this is considered a mild form that is not associated with other urogenital deformities. The remaining 30% are proximal and often more complex. In these cases, endocrinological evaluation is advised to exclude disorders of sexual differentiation, especially in case of concomitant unilateral or bilateral undescended testis. Although the etiology of hypospadias is largely unknown, many hypotheses exist about genetic predisposition and hormonal influences. The goal of hypospadias repair is to achieve cosmetic and functional normality, and currently, surgery is recommended between 6 and 18 months of age. Hypospadias can be corrected at any age with comparable complication risk, functional, and cosmetic outcome; however, the optimal age of repair remains conclusive. Although long-term overall outcome concerning cosmetic appearance and sexual function is fairly good, after correction, men may more often be inhibited in seeking sexual contact. Moreover, lower urinary tract symptoms occur twice as often in patients undergoing hypospadias repair and can still occur many years after the initial repair. Conclusion: This study explores the most recent insights into the management of hypospadias. What is Known: • Guidelines advise referral for treatment between 6 and 18 months of age.• Cosmetic outcome is considered satisfactory in over 70% of all patients. What is New: • Long-term complications include urinary tract symptoms and sexual and cosmetic issues.• New developments allow a more individualized approach, hopefully leading to less complications and more patient satisfaction.

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Section: Current Opinion: Future Perspectivesmentioning

confidence: 99%

Hypospadias, all there is to know

2017

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“…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. 12 Preclinical studies aimed at improving hypospadias repair outcomes by applying novel biomaterials and tissue-engineering techniques have met limited success (reviewed 2 ).…”

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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“…гіпоспадіями першим етапом проводиться операція Брокка з використанням букального лоскута, при безуспішності такої тактики проводиться пластика шкірно-фасціальним лоскутом із крайньої плоті або шкіри статевого члена на судинній ніжці [10]. За даними таблиці, довжина стриктур/облітерацій уретри у групі A становила 2,8±2,1 см, що достовірно менше середньої довжини СУ у групі В -6,1±3,2 см (р=0,0001).…”

Section: розподіл пацієнтів за видом корекції стриктур уретри по рокамunclassified

Early and Long-term Results of Open Urethroplasty and Changes in Surgical Approaches to the Choice of Surgical Techniques: an 18-year Experience

Vozianov,

Shamrayev,

Ridchenko

et al. 2023

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The objective: to determine tactical approaches to the selection of treatment methods and to evaluate the results of various types of urethroplasty in patients with urethral strictures and obliterations. Materials and methods. The results of 1362 surgical interventions in patients with strictures and obliterations of the urethra of various etiologies and complexity were analyzed from 2003 to 2020. The clinical data of the medical histories of 173 (12.7%) patients with long strictures and obliterations of the urethra were retrospectively evaluated. The age of the patients ranged from 13 to 85 years (average age – 44.6±1.2 years). For a detailed study of the results of surgical corrections of long strictures and obliterations of the urethra, patients were divided into two groups: group A – 50 (28.9%) patients who were operated on in 2003-2014 and group B – 123 (71.1%) patients who were operated on in 2015–2020. The localization and length of the stricture, the degree of spongiofibrosis were evaluated according to the results of ultrasonography and retrograde or micturition urethrocystography, as well as in some patients according to the data of spiral computed tomography in the angiomode. According to the types of surgical operations, the patients were divided into three groups: buccal plastic urethra, urethrourethral or urethro-prostatic anastomosis (UUA) and replacement plastic with a skin-fascial flap. The digital material was mathematically processed and the probability of difference was assessed using the Chi-square test for qualitative features and the t-test for quantitative features. Results. A retrospective analysis of the 18-year experience of surgical treatment of patients with urethral strictures and obliterations at the SI “Acad. O.F. Vozianov Institute of Urology NAMS of Ukraine” revealed a change in the percentage of various types of urethroplasty in the direction of methods with proven better results. During the analysis of the results of operations in 173 patients, an increased number of replacement and augmentation buccal plastics over the years and a decreased rate of urethro-urethral and urethro-prostatic anastomoses were found. This indicates an increase in the frequency of successful results in the second period of the study (accumulated experience) from 68.0% to 86.2%. Due to the change in the management of the treatment of patients with urethral strictures a probable improvement in the results of surgical treatment of patients with urethral strictures is determined by 2.9 times, accordingly, a probable decrease of treatment recurrences by 18.2% is also observed. Conclusions. The number of urethro-urethroanastomoses decreased by 20.0%, and the number of performed buccal urethral plastics increased by 91.6%. The obtained data correspond to the world research results.

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Use of Buccal Mucosa in Hypospadias Repair

Cited by 9 publications

References 39 publications

Hypospadias, all there is to know

Hypospadias, all there is to know

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

Early and Long-term Results of Open Urethroplasty and Changes in Surgical Approaches to the Choice of Surgical Techniques: an 18-year Experience

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