Bovine Graft Research Articles

Durability of Bovine Carotid Artery Graft for Revisions of Arteriovenous Fistula Aneurysms and Associated Complications

Durability of Bovine Carotid Artery Graft for Revisions of Arteriovenous Fistula Aneurysms and Associated Complications

(405) Penile Prosthesis Implantation and Peyronie's Disease: How to Approach the Residual Curvature – A Detailed Demonstration of Moulding Technique and Grafting Procedure

Abstract Introduction Insertion of a penile prosthesis is the treatment of choice in men with Peyronie’s disease and concomitant erectile dysfunction. The aim of surgery is to straighten the penis and allow adequate rigidity for sexual intercourse. A conundrum arises when there is residual curvature during device testing. Objective This video highlights strategies that will aid the implanter when faced with these intraoperative challenges. Methods This video illustrates three different scenarios and suggests strategies that can be used when there is a residual penile curvature following inflatable penile prosthesis insertion: 1) Manual moulding – In this scenario, a persistent left lateral curvature is successfully straightened by moulding the plaque following device insertion. The cylinders are fully inflated and the tubes to the pump are double clamped. One hand is positioned distal to the apex of the curvature while the other is proximal. The penis is manipulated in the opposite direction to the curvature. 2) Residual curvature after manual moulding – The plaque can be incised at the point of maximal curvature and grafted If there is a significant persistent curvature (>30 degrees) following moulding. A fibrin sealant patch was used in this patient and it offers a quick and effective choice for grafting the tunical defect. 3) Upfront plaque incision and grafting - Some patients are not suitable for moulding following penile prosthesis insertion. Examples include ventral penile curvature and ossified plaques. In this patient with a ventral curvature, the plaque was incised and the tunical defect grafted with bovine pericardial graft prior to corporal dilatation. Results All three patients had an uneventful post-operative outcome. They were encouraged to cycle the device from 3 weeks and allowed to commence sexual intercourse after 6 weeks post-surgery. Conclusions Manual moulding is a safe and effective first line option for residual penile curvature following inflatable penile prosthesis insertion. Plaque incision and grafting can be considered if moulding fails or where manual moulding is contraindicated. There are several choices for graft material including fibrin sealant patch or bovine pericardium. Disclosure No

A Multicenter Analysis of Revision of Aneurysmal Dialysis Access Using Bovine Carotid Artery Conduit

Dialysis access complications and failure requiring revision are common. Understanding which methods of revision yield the optimal patency rates and lowest complications remain in evolution. Revision of native vessels is preferred, with revision using expanded polytetrafluoroethylene (ePTFE) graft as an alternative. Revision with Bovine Carotid Artery Graft (Artegraft) has historically been indicated when other options have been exhausted. While earlier studies demonstrated lower patency and higher infection rates compared to ePTFE, more recent studies have suggested otherwise. We describe our experience with patients who underwent arteriovenous access revision with Artegraft, and present this as a viable alternative. A multicenter analysis was conducted over 6years of 25 patients with arteriovenous access complications requiring revision. Complications included aneurysmal degeneration, bleeding, recurrent thrombosis, and sclerotic outflow. Patients were grouped into 2 groups based on the complication. The first group included aneurysm-only complication and the second group included aneurysm and all other complications. All patients underwent revision of their arteriovenous fistula with excision of diseased segment of the arteriovenous fistula and interposition placement of Artegraft. All patients were followed long term and assessed for postop complications, patency, and any reintervention. Of 25 patients, 13 were male and 12 female. Average age was 57 (range 27-83). Sixteen of the 25 patients had follow-up. Of the 16, 10 patients had primary patency (62.5%), 3 with primary-assisted patency (18.75%), and 3 with failure of grafts (18.75%). Ten of the 16 had at least 1year or greater follow-up (5 with primary patency, 3 primary-assisted patency, and 2 with failure both of which failed after 1year). Those that required intervention to maintain patency were from thrombosis requiring declot or anastomotic stenosis requiring angioplasty. None of the followed patients were found to have neither postoperative surgical site nor graft infections. This case series supports that arteriovenous access revision with Artegraft is a viable option that has acceptable patency rates (81% overall functional patency rate at 1.5years), with an observed 0% infection rate, and is comparable to ePTFE. With more recent studies suggesting Artegraft may have superior outcomes, further study and consideration should be given to using Artegraft as a conduit for arteriovenous fistula revision.

Bovine Grafting: An Effective Alternative after Curettage of Benign Bone Tumors

We retrospectively reviewed 28 patients (15 women and 13 men) with benign bone tumors or pseudotumors treated with curettage and filling with freeze-dried bovine bone graft Orthogen (Baumer S/A, São Paulo, Brazil). The aim of the study was to evaluate the rate of incorporation of Orthogen into the host bone, as well as to describe the outcomes of bone healing (quality, time, and complications). General characteristics, tumor volume, size, site, complications, percent filled, and healing quality at 6 and 12 months were assessed through radiographs. Mean patient age was 20.5 (range 4.7-75.1) years. The most common lesion type was simple bone cyst (12/28), and the most common sites were the tibia (7/28) and humerus (7/28). There were no postoperative pathologic fractures. Two cases (7.1%) of serous fluid leakage through the wound occurred. Mean cavity volume was 20.1 (range 2.7-101.4) cm3. At 6 and 12 months, 75% and 77.8% of cavities, respectively, showed complete bone healing. At 12 months, 81% of cavities filled >90% with graft showed complete bone healing vs. only 19% of those filled <90%. Filling with bovine bone graft resulted in few complications and excellent healing after curettage of benign bone tumors or pseudotumors. Complete healing occurred in most cases by 12 months. Cavities with a higher percentage of filling had a higher rate of complete radiographic incorporation.

Self-Made Bovine Pericardial Tube Grafts for the Treatment of Abdominal Aortic Infections

Aortic infections are an uncommon but life-threatening disease. The material of choice for aortic reconstruction is still a matter of debate. The aim of this study is to examine the short and mid-term outcomes in the treatment of abdominal aortic infections using self-made bovine pericardium tube grafts. This retrospective, single-center study collected all patients who underwent in situ abdominal aortic reconstruction using self-made bovine pericardial tube grafts between February 2020 and December 2021 in a tertiary care center. Patient comorbidities, symptoms, radiological, bacteriological and peri-operative findings, as well as postoperative outcomes were analyzed. Bovine pericardial aortic tube grafts were used in 11 patients (10 male, median age 68.7 years). Two patients presented a native aortic infection and nine had graft infections (four bypass grafts, four endografts and a plurioperated patient who had undergone both endovascular and open procedures). There were two emergent surgeries due to infectious aneurysm ruptures. All patients were symptomatic and the most frequent clinical finding was lumbar or abdominal pain (36%), followed by wound infection (27%) and fever (18%). Seven bifurcated and four straight pericardial tube grafts were needed. Purulent drainage was obtained around the previous graft or in the aneurysmal sac in 7 cases; intraoperative cultures were positive in 6 cases (Gram + bacteria). Two patients died in the immediate postoperative period (perioperative mortality 18%; urgent procedures 50%; scheduled procedures 11%). One patient had a major complication due to bilateral SARS-CoV2 pneumonia. There was one single reintervention to control hemostasis due to bleeding non-graft-related. The median follow-up was 14.1 months (3-24 months). Our preliminary experience in the treatment of abdominal aortic infections by in situ reconstrucción with self-made bovine pericardial tube grafts shows promising results. These should be confirmed in the long term.

A Retrospective Review of Bovine Artery Graft Patency: A Single-Site Study

The hemodialysis-dependent population is increasing in the United States. Dialysis access complications are a significant source of morbidity and mortality for patients with end-stage renal disease. A surgically created autogenous arteriovenous fistula has been the gold standard for dialysis access. However, for patients who are not candidates for arteriovenous fistula, arteriovenous grafts using various conduits have widely been used. In this study, we report the outcomes of bovine carotid artery (BCA) grafts for dialysis access at a single institution and compare these results to those for polytetrafluoroethylene (PTFE) grafts. A single-institution, retrospective review of all patients undergoing surgical placement of a bovine carotid artery graft for dialysis access from 2017-2018 was performed under an institutional review board-approved protocol. The primary, primary-assisted, and secondary patency were calculated for the whole cohort and results determined based on gender, body mass index (BMI), and indication for use. Comparison was performed to PTFE grafts at same institution from 2013 to2016. One hundred and twenty two patients were included in this study. Seventy four patients had a BCA graft placed while 48 had a PTFE graft placed. . The mean age was 59.7±13.5years in the BCA group, 55.8±14.5 in the PTFE group, and the mean BMI was 29.8±9.2kg/m2 in the BCA group and 28.1±9.7 in the PTFE group. Comparison of the comorbidities present in BCA/PTFE groups included hypertension (92%/100%), diabetes (57%/54%), congestive heart failure (28%/10%), lupus (5%/7%), and chronic obstructive pulmonary disease (4%/8%). The various configurations were reviewed (BCA/PTFE): interposition/access salvage (40.5%/13%), axillary-axillary (18.9%, 7%), brachial-basilic (5.4%, 6%), brachial-brachial (4.1%, 4%), brachial-cephalic (1.4%, 0%), axillary-brachial (1.4%, 0%), brachial-axillary (23%, 62%), and femoral-femoral (5.4%, 6%). Overall, 12-month primary patency was 50% in the BCA group and 18% in the PTFE group (P=0.001). Twelve-month primary-assisted patency was 66% in the BCA group and 37% in the PTFE group (P=0.003). Twelve-month secondary patency was 81% in the BCA group and 36% in the PTFE group (P=0.07). When comparing BCA graft survival probability among male and female gender, males had better primary-assisted patency (P=0.042). Secondary patency among the 2 genders was similar. There was no statistically significant difference in primary, primary-assisted, and secondary patency of BCA grafts between different BMI groups and indication for use. The average patency of a bovine graft was 17.8±8months. Sixty one percent of the BCA grafts needed intervention with 24% needing multiple interventions. There was an average of 7±5months to first intervention. The infection rate was 8.1% in the BCA group and 10.4% in the PTFE group with no statistical difference. Primary and primary-assisted patency rates at 12months in our study were higher than those for PTFE at our institution. There was higher primary-assisted patency of BCA grafts among males at 12months compared to PTFE. Obesity and indication for BCA graft use did not appear to affect patency in our population.

Treatment of infected hybrid arch prosthesis with self-assembled bovine elephant trunk grafts.

Graft infections are associated with severe morbidity and mortality. The widespread use of the frozen elephant technique increases the incidence of complex aortic patients to suffer from graft infections. Surgery of these patients is challenging. Removal of the stent graft portion of the frozen elephant technique prosthesis via sternotomy carries the risk of irreparable damage to the descending aorta. There is currently no single-stage surgical strategy that allows for the removal of all infected material apart from a hemi-clamshell approach. This approach is technically demanding and associated with significant morbidity and mortality. This results in conservative treatment in a substantial number of patients. Pericardial tube grafts have shown to be an excellent option in treating graft infections in various aortic segments with promising results concerning freedom of re-infection and survival. We report a single-stage, trans-sternal approach to remove all infected materials and simultaneously treat the descending aorta to prevent aortic catastrophe in 2 consecutive cases.

Sinus Mucosal Damage Triggered by Synthetic or Xenogeneic Bone Substitutes: A Histological Analysis in Rabbits.

Background: It has been shown in rabbit models that the sinus mucosa in contact with graft particles might experience a progressive thinning and perforations. The phenomenon depends on the graft used. Hence, the aim of the present study was to compare the damaging effects of a synthetic of a xenogeneic graft. Methods: Forty New Zealand rabbits received a bilateral sinus elevation. Both sinuses of twenty rabbits were grafted with a biphasic 60% hydroxyapatite and 40% β-tricalcium phosphate while the other twenty received a deproteinized bovine bone mineral graft. Thinned sites (<40 µm) and perforations on the mucosa in contact with graft particles were evaluated after 2 and 10 weeks (ten animals each period). The width of the pseudostratified epithelium was also measured as control. Results: After 2 weeks of healing, 61 thinned sites were detected in the Synthetic group and 49 in the Xenogeneic group. After 10 weeks, the number of thinned mucosae increased to 79 sites in the Synthetic group (p = 0.222 between periods), and to 114 sites in the Xenogeneic group (p = 0.030 between groups; p = 0.001 between periods). Perforations were few in the 2-week period, two in two sinuses out of 20 in the Synthetic group, and four in two sinuses out of 20 in the Xenogeneic group (p = 0.721). In the 10-week period, the perforations increased to eight in the Synthetic group, distributed in six sinuses out of 20, and to sixteen in the Xenogeneic group, distributed in 11 sinuses out of 20 (p = 0.082). The pseudostratified epithelium presented a reduced width at the thinned sites. Conclusions: The contact with synthetic or xenogeneic grafts will induce thinning and possible perforations of the sinus mucosa. This effect will increase over time, and it is stronger at the xenogeneic than the synthetic graft.

The pattern of osteocyte in dental socket bone regenerative induced by hydroxyapatite bovine tooth graft

Background: Tooth extraction is a procedure with the highest prevalence of causing alveolar bone damage. After extraction, the dimension will change. This procedure needs a balance of bone formation and resorption. Osteocytes are the most common cells in bone and have an essential role in bone formation. This study explores the effect of bovine tooth grafts on the number of osteocytes in the socket preservation process post-dental extraction. Methods: A total of 28 Wistar rats, 14 control and 14 treatment groups, were extracted on the lower left incisor. Control group with PEG without induction and treatment group with bovine tooth graft and PEG induction. On the 14th and 28th days, the rats were euthanized. Then perform histological examination with HE staining and cell counting using a light microscope Results: We found the treatment group had higher the average number of the osteocyte, which was 146.43±11.41 on 14th day and 288.14±161.91 on 28th day. There was a significant increase in osteocytes among the treatment group compared to the control (p=0.000). Conclusion: Bovine tooth graft application as dental socket preservation was proven to increase the number of osteocyte cells in the alveolar bone of Wistar rats after extraction. Bovine tooth grafts as dental socket preservation materials increased the number of osteocytes at a peak at 28 days.

The effect of the structural transition within a direct hexagonal (HI) mesophase on the internal lipid mobility

The current study analyzes the cause of the extreme change in dermal permeation resulting from a minute structural transformation within a temperature-sensitive direct hexagonal mesophase by a multiple-method approach. The evaluated mesophase is composed of Tween 80, propylene glycol, isopropyl myristate, benzyl alcohol, and water. 1 wt% ketoconazole (KCZ) was loaded in the concentrate as a model lipophilic drug. Evaluation of the mesophase at 25 °C indicated that the hexagonal mesophase region (33.0–42.5 wt% water along water dilution line N91) consists of two distinct structures. At water content below 39.0 wt%, the mesophase is structured as a bidiscontinuous hexagonal mesophase (BHM) consisting of occluded hydration centers and hexagonally oriented direct micelles. Above 39.5 wt% water, dilution of the BHM obstructs the hydration centers, transforming the mesophase to a water continuous hexagonal mesophase (CHM). FTIR evaluation indicated that the both the added water upon dilution and the water molecules released from the hydration centers bind to the surfactant's non-hydrated ethoxylates. Evaluation of the structural transition by PGSE-NMR and DSC indicated that the binding of water to the surfactant's heads immobilizes the inner core of the solubilized lipids. The reduction of the lipid core’s mobility prevents its crystallization at cryogenic temperatures. SAXS and rheological evaluations pointed out that both BHM and CHM are temperature-sensitive mesophases, which lose their range order and storage modulus at 32 °C. Obstruction of the hexagonal mesophase enhances KCZ's diffusion from both mesophases’ via cellulose acetate at 35 °C. Despite the similarity of both mesophases at elevated temperatures (35 °C), the lipidic inner core’s rotational correlation time for deformed CHM micelles remains substantially lower than from the deformed BHM. Franz cell evaluation indicated that the lipidic core mobility substantially influences KCZ's distribution upon dermal application, whereas from CHM KCZ's transdermal flux via a dermatome bovine graft at 35 °C, was 1.60 ± 0.28 µg/cm2 h, no flux was detected from BHM. On the other hand, KCZ's dermal accumulation from BHM, at 35 °C, was found to be more than double than that from CHM, indicating that the decrease in the lipidic inner core’s mobility of direct micelles prevents the accumulation of lipophilic compounds in the dermis, thereby enhancing their transdermal flux.

The Osteogenesis Mechanisms of Dental Alveolar Bone Socket Post Induction with Hydroxyapatite Bovine Tooth Graft: An Animal Experimental in Rattus norvegicus Strain Wistar.

Surgical endodontics (hemisection) commonly involves the alveolar bone socket and the periradicular tissue. In today's era, optimizing the bone healing process is updated by using bone graft induction. This study explores the mechanisms of bone healing of the alveolar bone socket post-dental extraction of Wistar rats after administration of a bovine tooth graft (hydroxyapatite bovine tooth graft [HAp-BTG]). Fifty Wistar rats were randomly selected into two groups, control and treatment, and into five subgroups on days 3, 7, 14, 21, and 28. The postextraction socket was filled with polyethylene glycol (PEG) as the control and PEG + HAp-BTG as the treatment group. On days 3, 7, 14, 21, and 28, Wistar rats were sacrificed, mandibles were taken, paraffin blocks were made, cut 4 µm thick, and made into glass preparations for microscopic examination. The variable analysis was performed by staining hematoxylin-eosin for osteoblasts (OBs) and osteoclasts (OCs) and immunohistochemistry for runt-related transcription factor 2 (RUNX2), osterix (OSX), osteocalcin (OCN), bone morphogenic protein (BMP) 2. We analyzed the expressed cell count per microscope field. In general, the number of cell expressions in the treatment group was significantly higher and faster, except for significantly lower OC. The high variables peak occurred on day 14 for RUNX2 and OCN, on day 7 for OSX, while OB significantly increased on day 21 and remained until day 28. The decrease of OC cells occurred on day 7 and remained low until 28 days. BMP2 was first dominantly induced by HAp-BTG, then the others. HAp-BTG can induce higher and faster bone healing biomarkers. BMP2 is the dominant first impacted. On the 28th day, it did not significantly express the suppression of OC by OB, which entered the bone formation and remodeling step.

A technical note on anterolateral mobilization in vertebrobasilar dolichoectasia for relief of brainstem compression.

Vascular compression of neural tissue causing neurological symptoms is a wellknown phenomenon. This is commonly seen in trigeminal neuralgia and, less commonly, in hemifacial spasm by small arteries, which can be treated by microvascular decompression. Rarely, larger arteries, such as the vertebral arteries, may compress the brainstem. This can lead to symptoms of pontine or medullary distress like hemiparesis, dysphagia, or respiratory distress. This is treated by macrovascular decompression. Due to the rare and heterogenous nature of this disease, there is no standardized approach. We describe a novel technique whereby the vertebrobasilar system is mobilized anterolaterally towards the occipital condyle with a sling to decompress the brainstem.We report two cases of vertebrobasilar dolichoectasia causing brainstem compression. A carotid patch graft sling with anterolateral mobilization to the occipital condyle is described as a surgical nuance to macrovascular decompressive surgery. Briefly, the vertebral artery was identified and dissected away from the brainstem and the bulbar cranial nerves. Bovine pericardium graft was used to create a sling around the artery by suturing the two ends together. The sling was then fixed either to the occipital condyle using cranial plating screws or suturing to the dura of the occipital condyle.A novel surgical technique for management of vertebrobasilar dolichoectasia causing brainstem compression with progressive neurological deterioration is reported. Anatomical location and the offending vessel should guide neurosurgeons to select the best surgical option to achieve complete decompression of the involved neural structures.

Horizontal Bone Augmentation in the Pre-Maxilla Region with Used the Bone Block Xenogeneic Origin - Clinical and Tomographic Analysis

Tooth loss, especially in the anterior region, generates a loss of local bone structure affecting the aesthetics and function for the patient and a viable tactic is the use of deproteinized bovine bone block graft. This reconstructive method allows the possibility of partial or total reconstruction of the maxilla and mandible in a safe and predictable way, where it seeks the maintenance of the three-dimensional structure, viability of bone neoformation and favoring implant-supported rehabilitation. This case report aims to reveal and support the longitudinal follow-up of 5 years of a horizontal alveolar reconstruction in the anterior maxillary region with heterogeneous bone block and subsequent implantation and rehabilitation with metal-ceramic crown.

Evaluation of a New Porcine Bone Graft on the Repair of Surgically Created Critical Bone Defects in Rat Calvaria: Histomorphometric and Microtomographic Study.

The aim of this study was to evaluate the use of a new porcine bone graft in rat calvaria bone defects. Critical defects were surgically created in 24 rats that were divided into four experimental groups according to defect filling (n = 6): Control Group (CG)—blood clot; Porcine Bone Group (PG)—porcine-derived bone substitute; (BG): Bio-Oss Group (BG)–chemically and heat-treated bovine graft; Bonefill Group (BFG)—chemically treated bovine bone substitute. Euthanasia of the animals occurred 30 days after the surgery, and the area of the original surgical defect and the surrounding tissues were removed for micro-CT and histomorphometric analysis. In the micro-CT evaluation, the PG presented statistically significant differences (p < 0.05) in comparison to the CG, BG and BFG, for the parameters percentage of Bone Volume (BV/TV), Surface Bone Density (BS/TV), Number of Trabeculae (Tb.N) and Bone Connectivity (Conn), but not for Total Porosity (Po.tot) and Trabecular Thickness (Tb.Th). The histomorphometric analysis showed that the PG presented similar results to the BG regarding newly formed bone extension and to the BG and BFG regarding newly formed bone area. The porcine-derived graft presented superior microtomographic and histomorphometric results when compared to the two bovine bone substitutes.

Custom Bone Regeneration (CBR): An Alternative Method of Bone Augmentation-A Case Series Study.

We performed this clinical study in order to evaluate the reliability of the Guided Bone Regeneration (GBR) surgical technique through the use of customized CAD CAM titanium meshes (Yxoss CBR® Reoss) in order to show an alternative method of bone augmentation. Materials and methods: Nine patients presenting 10 bone defects were referred to solve oral dysfunction due to edentulous atrophic ridges. Guided bone regeneration was performed with titanium meshes combined with autogenous bone grafting and heterologous bovine bone mineral grafting, and exclusively a “poncho technique” soft tissue approach for all the cases. After a mean 9 months of graft healing (range 6–12 months), titanium meshes were removed, and implant surgery was subsequently performed. The results we obtained were positive in terms of volumetric increases in height, length and thickness of the atrophic ridges without biological complications detectable before implant surgery. Results: Out of nine, one site met titanium mesh exposure: however, in all 10 sites a three-dimensional volumetric bone implementation was obtained. The statistical results were estimated by uploading and superimposing cbct scans before and after CBR surgery for each patient, so it was possible evaluate the maximum linear vertical and horizontal bone gain through dedicated Cad Cam software (Exocad GmbH®). The average horizontal gain was 6.37 ± 2.17 mm (range 2.78–9.12 mm) and vertical gain was 5.95 ± 2.06 mm (range 2.68–9.02 mm). A total of 18 implants were placed into the grafted sites with a 100% survival rate (clearly they are relative percentages to be compared to the short time elapsed). Conclusions: The results we obtained in this study suggest that this CBR procedure (Yxoss® by Reoss) is reliable and safe for bone regeneration to allow implant-prosthetic restoration in horizontal, vertical and combined bone defects. The soft tissue management is diriment: all the cases were managed with a “poncho” flap approach to decrease exposure complication.

Will previous palliative surgery for congenital heart disease be detrimental to subsequent pig heart xenotransplantation?

IntroductionPig heart xenotransplantation might act as a bridge in infants with complex congenital heart disease (CHD) until a deceased human donor heart becomes available. Infants develop antibodies to wild-type (WT, i.e., genetically-unmodified) pig cells, but rarely to cells in which expression of the 3 known carbohydrate xenoantigens has been deleted by genetic engineering (triple-knockout [TKO] pigs). Our objective was to test sera from children who had undergone palliative surgery for complex CHD (and who potentially might need a pig heart transplant) to determine whether they had serum cytotoxic antibodies against TKO pig cells. MethodsSera were obtained from children with CHD undergoing Glenn or Fontan operation (n = 14) and healthy adults (n = 8, as controls). All of the children had complex CHD and had undergone some form of cardiac surgery. Seven had received human blood transfusions and 3 bovine pericardial patch grafts. IgM and IgG binding to WT and TKO pig red blood cells (RBCs) and peripheral blood mononuclear cells (PBMCs) were measured by flow cytometry, and killing of PBMCs by a complement-dependent cytotoxicity assay. ResultsAlmost all children and adults demonstrated relatively high IgM/IgG binding to WT RBCs, but minimal binding to TKO RBCs (p < 0.0001 vs WT), although IgG binding was greater in children than adults (p < 0.01). All sera showed IgM/IgG binding to WT PBMCs, but this was much lower to TKO PBMCs (p < 0.0001 vs WT) and was greater in children than in adults (p < 0.05). Binding to both WT and TKO PBMCs was greater than to RBCs. Mean serum cytotoxicity to WT PBMCs was 90% in both children and adults, whereas to TKO PBMCs it was only 20% and < 5%, respectively. The sera from 6/14 (43%) children were cytotoxic to TKO PBMCs, but no adult sera were cytotoxic. ConclusionsAlthough no children had high levels of antibodies to TKO RBCs, 13/14 demonstrated antibodies to TKO PBMCs, in 6 of these showed mild cytotoxicity. As no adults had cytotoxic antibodies to TKO PBMCs, the higher incidence in children may possibly be associated with their exposure to previous cardiac surgery and biological products. However, the numbers were too small to determine the influence of such past exposures. Before considering pig heart xenotransplantation for children with CHD, testing for antibody binding may be warranted.

Fertility preservation: improved neovascularization and follicle viability in cryopreserved bovine ovarian cortex transplants by remaining medulla tissue

To investigate the advantages of cryopreserved medulla-containing ovarian cortex grafts with those of commonly used sole cortex grafts for fertility preservation by analyzing tissue quality, neovascularization processes, and the number of vital follicles. Experimental setting of cryopreserved bovine ovarian cortex tissue grafts with or without medulla tissue. Laboratory animal research at Ulm University, Ulm, Germany. Bovine ovaries and fertilized chicken eggs. Experimental setting of bovine ovarian tissue samples grafted on the chicken chorioallantoic membrane (CAM) after cryopreservation and thawing to examine histologic tissue integrity, apoptosis and proliferation immunohistochemically, blood vessel counts and determine the presence of neutral red-stained vital follicles. We used hematoxylin and eosin staining to visualize tissue structures, immunohistochemistry with anti-caspase 3 to detect apoptosis, anti-Ki67 to examine proliferation, blood vessel count on the chicken CAM to investigate neovascularization processes, and neutral red staining to evaluate vital follicles. We demonstrated that in all analyzed tissue samples, after cryopreservation, thawing, and grafting on the chicken CAM, there was excellent tissue integrity and quality, as shown by extremely rare apoptosis processes analyzed using immunohistochemical caspase 3 staining (sole cortex, 0.54%; thin medulla-containing cortex, 0.43%; thick medulla-containing cortex, 0.13%; and sole medulla, 2.82%). Moreover, we detected increased neovascularization in the vicinity of medulla and medulla-containing grafts (small blood vessels: cortex 8.7, thin medulla-containing cortex 9.9, thick medulla-containing cortex 9.7, and medulla 9.8; very small blood vessels: cortex 7.0, thin medulla-containing cortex 13.0, thick medulla-containing cortex 12.0, and medulla 15.0), with higher Ki67-detected proliferation (cortex, 17.58%; thin medulla-containing cortex, 20.28%; thick medulla-containing cortex, 20.56%; and medulla, 29.9%). Additionally, we identified an increased number of vital follicles in medulla-containing cortex grafts compared with the number of vital follicles in sole cortex tissue (cortex, 256.1; thin medulla-containing cortex, 338.2; thick medulla-containing cortex, 346.6; and medulla, 8.1). In this experimental setting, bovine medulla-containing cortex tissue had excellent tissue structure and quality after cryopreservation and thawing and increased neovascularization and an augmented vital follicle count after grafting than the commonly used sole cortex tissue. Therefore, we suggest reconsidering the current cryopreservation and grafting processes in humans for fertility preservation by favoring retain medulla tissue at the ovarian cortex.

Thirty-six-month Prospective Study of Transvaginal Bovine Graft vs Native Tissue Repair for the Treatment of Pelvic Organ Prolapse

Objective(s)To compare the safety and effectiveness of dermal bovine transvaginal graft, Xenform, to native tissue in the surgical treatment of anterior and/or apical pelvic organ prolapse. This study was designed in conjunction with Food and Drug Administration requirements. MethodsThis was a prospective, non-randomized, parallel cohort, multi-center trial. The primary objective was to demonstrate noninferiority between transvaginal graft and native tissue repair at 36 months compared to baseline. Treatment success was based on a composite of objective and subjective measures. The co-primary outcome was the rate of serious device- or procedure-related adverse events. A total of 228 patients at 25 sites were included in the study arm and 485 patients underwent native tissue repair. Propensity score stratification was applied to achieve balance between treatment groups. Study outcomes were compared in per protocol and intent-to-treat analysis. ResultsThe primary outcome, treatment success at 36 months, was 83.6% (191/228) for transvaginal graft and 80.5% (390/485) native tissue repair (0.2%, 90% confidence interval [–5.6% to 5.9%]), demonstrating noninferiority at a preset margin of -12%. The overall rate of severe adverse events was 5.3% (12/228) in transvaginal graft vs 2.7% (13/485) in native tissue repair groups. The study group demonstrated noninferiority in serious adverse events at the preset margin of 11.6% (2.0%, 90% confidence interval [–0.8% to 4.7%]). There were no reports of graft erosion, and graft exposure rates were low (0.9% [2/228]). ConclusionsTransvaginal repair of anterior and/or apical prolapse with a biological graft is noninferior to traditional native tissue repair in effectiveness and safety at 36 months.

Robot-Assisted Laparoscopic IVC Treatment Strategy in Retroperitoneal Tumors.

ObjectivesTo show the practice of robot-assisted laparoscopic inferior vena cava (IVC) treatment strategies in patients with retroperitoneal tumors.Patients and MethodsFrom October 2020 to July 2021, 17 patients with retroperitoneal tumors successfully underwent robot-assisted laparoscopic tumor resection with IVC management. The patient details, tumor characteristics, intraoperative data, pathological features and severe complications were assessed. The IVC treatment strategies were divided into 4 ways: ①local resection and primary repair of the IVC; ②IVC ligation; ③ IVC reconstruction by bovine pericardial grafts; and ④ IVC transection and anastomosis.ResultsIn terms of IVC management, 5 cases had conventional total occlusion of the IVC and its branches, 3 cases had delayed occlusion of the proximal IVC technique, 2 cases had IVC resection by Satinsky clamp, 5 cases had IVC ligation, 1 case had IVC reconstruction by bovine pericardial grafts and 1 case had IVC transection and anastomosis. The median operation time was 151 min, and blood loss was 500 ml. There was no severe complication perioperatively. The follow-up time of 17 patients was 8 to 17 months (median: 12 months). No local recurrence or overall death was found during follow-up.ConclusionsThese robot-assisted laparoscopic IVC treatment strategies were considered to be safe and feasible in experienced centers, as well as helpful to completely remove the tumor for better oncological prognosis and restore the blood reflux of IVC as much as possible to ensure fewer postoperative complications.

V04-12 A SINGLE STAGE URETHROPLASTY FOR PRIMARY PENOSCROTAL ADULT HYPOSPADIAS

You have accessJournal of UrologyCME1 May 2022V04-12 A SINGLE STAGE URETHROPLASTY FOR PRIMARY PENOSCROTAL ADULT HYPOSPADIAS Pankaj Joshi, Vipin Sharma, Sandeep Bafna, Shreyas Bhadranawar, Marco Bandini, and Sanjay Kulkarni Pankaj JoshiPankaj Joshi More articles by this author , Vipin SharmaVipin Sharma More articles by this author , Sandeep BafnaSandeep Bafna More articles by this author , Shreyas BhadranawarShreyas Bhadranawar More articles by this author , Marco BandiniMarco Bandini More articles by this author , and Sanjay KulkarniSanjay Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002560.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of hypospadias is challenging. This is due to the variable presentations and guarded healing. Majority get treated in childhood. Some progress as hypospadias cripple. But there are few that we see, uncorrected hypospadias who present as adults. This could be due to Scio economic conditions or lack of awareness that such patients remain uncorrected till adolescence or adults. These patients need a single stage surgery. We present our experience of such group of patients. METHODS: Ours is a tertiary care referral center for urethroplasty with experience of more than 6000 Urethroplasties in last 2 decades. We have performed over 500 failed hypospadias surgeries over past 2 decades. This is a prospective study from Jan 2010-July 2020.11 patients were adults who presented with primary penoscrotal hypospadias with chordee. Single stage surgery was performed. Standard progressive steps are penile degloving, ventral corporotomies, urethral transection, chordee correction with corporal grafting (BMG or bovine pericardium), pedicled preputial tube for urethra. RESULTS: Mean age 24 years. Operative time was 110 minutes. Catheter was kept for 6 weeks.2 developed UTI requiring antibiotics.3 patients had Urethrocutaneous fistula and all at the proximal level.1 patient with bovine pericardial graft had complete dehiscence. All those with BMG performed well. No residual chordee was seen. Patients were evaluated with PROMS. They were most happy with the shape of Glans. Follow up was 16 months. Common complaint was post micturition dribble and need to massage penis for ejaculation. CONCLUSIONS: Few patients present with primary uncorrected hypospadias in adulthood. Such patient’s merit chordee correction and single stage surgery. Corporal grafting offers improved penile length as compared to plication. Pedicled preputial tube helps performing a single stage surgery. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e370 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pankaj Joshi More articles by this author Vipin Sharma More articles by this author Sandeep Bafna More articles by this author Shreyas Bhadranawar More articles by this author Marco Bandini More articles by this author Sanjay Kulkarni More articles by this author Expand All Advertisement PDF downloadLoading ...