Bovine Graft Research Articles

V12-05 WHAT TREATMENT OPTIONS ARE THERE FOR PEYRONIE'S DISEASE?

You have accessJournal of UrologyCME1 May 2022V12-05 WHAT TREATMENT OPTIONS ARE THERE FOR PEYRONIE'S DISEASE? Consuelo Conde Redondo, Alejandro García Viña, María Núñez, Ana Ruano Mayo, Álvaro Zamora Horcajada, Fernando Natal Rodriguez, and Luis Cuellar Martín Consuelo Conde RedondoConsuelo Conde Redondo More articles by this author , Alejandro García ViñaAlejandro García Viña More articles by this author , María NúñezMaría Núñez More articles by this author , Ana Ruano MayoAna Ruano Mayo More articles by this author , Álvaro Zamora HorcajadaÁlvaro Zamora Horcajada More articles by this author , Fernando Natal RodriguezFernando Natal Rodriguez More articles by this author , and Luis Cuellar MartínLuis Cuellar Martín More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002638.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peyronie’s disease (PD) is a relatively common progressive fibrotic disorder that affects the tunica albuginea. Traditionally, men will present with a new penile curvature, which may be associated with pain in the acute phase. Prevalence is 0.4–20%, increasing in cases of diabetes mellitus. The treatment must be carried out when the plate is stabilized. METHODS: In this video we present a review of the different therapeutic approaches to Peyronie's disease. RESULTS: Non-surgical treatment. Non-surgical therapies include the penile extender, The reduction in curvature was enhanced when increasing the usage time. Greater than 6 hours ’use daily resulted in a 36.2 ° reduction compared to baseline (51.4%), whilst less than 4 hours produced a 19.7 ° improvement (28.8%). Intraplaque therapy with clostridium histoliticum collagenase which is used to dissolve the plaques. The therapy is based on four cycles with two injections per cycle. Under local anesthesia we perform an erection and a controlled fracture of the plaque. Treatment with xiapex has a cost of eight times the treatment of simple plication, the use of 6 to 7 months of treatment of 8 vials and 14 consultations, the success rate is 34 to 40%. Treatment of Peyronie's disease with bovine pericardium. Corporoplasty with a bovine pericardium graft with a total or partial incision of the plaque is a technique that shortens the surgical time by avoiding obtaining autologous tissue. The published success rate is 41-93% with a satisfaction rate close to 100% if a residual curvature rate of less than 10% is obtained. Treatment of Peyronie's disease with tachosil patch. The advancement of the surgery leads us to look for alternatives that are easy to perform and that shorten surgical times, the total or partial incision of the peyronie plate plus tachosil graft leads us to obtain surgical results with a success rate of 83.8%. Tachosil is a sealing fibrin patch that is placed over the wound made, then covered with a compress moistened with warm saline for three minutes. Treatment of Peyronie's disease with Vivostat. Activated autologous fibrin is also being used as a sealant. During anesthetic induction, 120 ml of blood from the patient is obtained to which citrate is added, subsequently it is put for 25 minutes in the processor unit and a solution of 5 to 6 ml of autologous fibrin is obtained ready for use. We make some transverse incisions in the plate without having to resect it, later with the help of the vivostat applicator we fill the incisions made with the autologous fibrin solution we have obtained. Regardless of the surgical technique used, all patients should undergo penile rehabilitation with the help of vacuum device or an extender, to avoid shrinkage and shortening. CONCLUSIONS: There is no single approach to peyronie disease, it depends on the surgical skills of the surgeon and the involvement of the patient to achieve success Source of Funding: anyone © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e968 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Consuelo Conde Redondo More articles by this author Alejandro García Viña More articles by this author María Núñez More articles by this author Ana Ruano Mayo More articles by this author Álvaro Zamora Horcajada More articles by this author Fernando Natal Rodriguez More articles by this author Luis Cuellar Martín More articles by this author Expand All Advertisement PDF DownloadLoading ...

Time-series biological responses toward decellularized bovine tendon graft and autograft for 52 consecutive weeks after rat anterior cruciate ligament reconstruction

There is an essential demand for developing biocompatible grafts for knee anterior cruciate ligament reconstruction (ACLR). This study investigated cell infiltration into decellularized bovine tendon xenografts using a rat knee ACLR model. Twelve-week-old Sprague–Dawley rats were used. At weeks 1, 2, 4, 8, 16, 26, and 52 (each period, n = 6) after ACLR, rats receiving decellularized bovine tendon (group D, n = 42) or autologous tendon (group A, n = 42) as grafts underwent peritibial bone tunnel bone mineral density (BMD), histological, and immunohistological assessments. BMD increased over time in both the groups until week 16 and then remained unchanged without exhibiting significant differences between the groups. Initially, cellularity in group D was lower than that in group A; however, by weeks 4–8, both the groups were comparable to the native anterior cruciate ligament group and cellularity remained unchanged until week 52. Initially, group A had more M1 macrophages, indicating inflammation, whereas group D had more M2 macrophages, indicating tissue regeneration. Nonetheless, the M1 and M2 macrophage counts of both the groups were comparable at most times. This study revealed the excellent recellularization and tendon–bone integration abilities of decellularized tendons using a cross-species model.

Wound healing ability of acellular fish skin and bovine collagen grafts for split-thickness donor sites in burn patients: Characterization of acellular grafts and clinical application.

Due to its high polyunsaturated fatty acid content, acellular fish skin has emerged as a dermal substitute for the promotion of wound healing as it decreases scar formation while providing pain relief. However, various systematic studies on acellular fish skin, such as its biophysical analysis, in vitro activities, and clinical application, have not been sufficiently investigated. In this study, we conducted a comparative study to evaluate the wound-healing ability of acellular fish skin graft (Kerecis®) with that of the widely used bovine collagen skin graft (ProHeal®). The skin grafts were evaluated not only in terms of their biophysical properties, but also their in vitro cellular activities, using fibroblasts, keratinocytes, and human endothelial cells. The clinical study evaluated wound healing in 52 patients with acute burns who underwent skin grafting on donor sites from January 2019 to December 2020. The study was conducted with two groups; while only Kerecis® was tested in one group, Kerecis® and ProHeal® were compared in the other. In both groups, the application time of the dressing material was one to two days after split-thickness skin grafting to the donor sites. The Kerecis®-treatment group experienced faster healing than the other treatment group. In particular, the average wound healing time using the Kerecis® treatment and the ProHeal® treatment was 10.7±1.5days and 13.1±1.4days, respectively. We believe that the faster healing of the Kerecis® treatment, compared to that of the ProHeal® treatment, maybe due to the synergistic effect of the unique biophysical structure and the bioactive components of acellular fish skin.

In Vitro Toxicity of Bone Graft Materials to Human Mineralizing Cells.

Bone graft materials from synthetic, bovine, and human sources were analyzed and tested for in vitro cytotoxicity on dental pulp stem cells (DPSCs) and osteosarcoma cells (Saos-2). Raman spectroscopy indicated significant amounts of collagen only in human bone-derived materials, where the mineral to protein ratio was 3.55 ± 0.45, consistent with bone. X-ray fluorescence revealed tungsten (W) concentrations of 463 ± 73, 400 ± 77, and 92 ± 42 ppm in synthetic, bovine, and human bone chips, respectively. When these chips were added to DPSCs on tissue culture plastic, the doubling times after two days were the same as the controls, 16.5 ± 0.5 h. Those cultured with synthetic or bovine chips were 96.5 ± 8.1 and 25.2 ± 1.4 h, respectively. Saos-2 was more sensitive. During the first two days with allogeneic or bovine graft materials, cell numbers declined. When DPSC were cultured on collagen, allogeneic and bovine bone chips did not increase doubling times. We propose cytotoxicity was associated with tungsten, where only the concentration in human bone chips was below 184 ppm, the value reported as cytotoxic in vitro. Cells on collagen were resistant to bone chips, possibly due to tungsten adsorption by collagen.

Early post-operative performance of an anatomically designed hybrid thread interference screw for ACL reconstruction: A comparative study

Although the anterior cruciate ligament (ACL) reconstruction using interference screw is a well-accepted surgical procedure, patients still suffer graft failure in the initial rehabilitation phase. Graft fixation stability of a newly designed anatomical hybrid thread tapered interference screw (AHTTIS) was compared with a conventional standard one (CSIS) by conducting in-vitro mechanical tests. According to the CSIS manufacturer’s instruction, eight tapered bone tunnels, matching AHTTIS geometry, and eight straight cylindrical tunnels were drilled in artificial bone blocks. Bovine tendon grafts were fixed using AHTTIS and CSIS in their corresponding bone tunnels. Each graft was subjected to a pre-load, a dynamic cyclic sinusoidal tensile load, and a tensile pullout load. Aggregate graft displacement relative to the bone tunnel under dynamic cyclic load, load corresponding to a 3 mm displacement; load and displacement at yield and ultimate failure of the graft; and graft-bone-screw stiffness resulted from pullout tests were recorded. There were no significant differences between recorded parameters of the two groups, except the graft displacements relative to the bone tunnel at ultimate failure load (8.35 ± 3.03 mm versus 5.28 ± 1.37 mm) and at the yield point (7.73 ± 3.02 mm versus 4.59 ± 1.25 mm) (P < 0.05), which were both significantly greater for the AHTTIS group. Considering all tests were made in the worst-case scenario of fixation of an interference screw, i.e., the employed synthetic bone just mimicked cancellous bone, graft fixation with the AHTTIS is practical. However, in the case of employing high strain rate loads on AHTTIS, further considerations are needed to reduce the side effect of slippage of the graft.

Endocarditis in Bovine Vein Grafts in the Pulmonary Position Placed Surgically & Percutaneously.

Background: Infective endocarditis (IE) is one of the major complications following pulmonary valve replacement (PVR). This analysis hopes to evaluate the incidence, outcomes and possible risk factors of IE associated with trans-catheter and surgical placement of a bovine jugular vein (BJV) graft in the pulmonary position. Methods: In this single-center retrospective study, all records of trans-catheter and surgical PVR from 3/2010 to 12/2019 were reviewed. IE was defined as positive blood cultures, with vegetations seen on echocardiography or sudden increase in peak gradient across the valve or vegetations confirmed at time of valve replacement. Poor dental hygiene:1.dental procedures without S.B.E prophylaxis AND/OR 2.one or more dental cavities, caries, dental abscess. Results: 165 patients had PVR with BJV:107 trans-catheter and 63 surgical. 7%(12/170) of PVRs developed IE(catheter:n = 10, surgery:n = 2) at a median time from valve placement of 38 months. The incidence of IE in the catheter group:3-per-100patient-years and in surgical group:1-per-100patient-years. Multivariate cox regression showed that poor dental hygiene was significantly associated with IE [HR(95% CI):16.9(4.35-66.2)](p value <.001). Kaplan-Meier curves showed a significant difference in freedom from IE between patients with poor and appropriate dental hygiene (p value<.001). Conclusions: There is a 7% incidence of IE with the use of BJV grafts in the pulmonary position at mid-term follow-up. Though the rate in catheter placed BJV seems 3x higher than surgically placed ones, their cohorts are quite different making this comparison flawed. Poor dental hygiene is a strong predictor for post-operative IE and offers a significant opportunity for lowering the rate of infective endocarditis.

Eosinophilic meningitis following suboccipital craniotomy without bovine dural graft: illustrative case.

BACKGROUNDEosinophilic meningitis is a rare known complication after brain surgery associated with duraplasty using artificial bovine graft. However, eosinophilic meningitis after craniotomy without bovine dural graft has not been reported.OBSERVATIONSA 48-year-old female presented with lateral medullary infarction caused by a vertebral artery dissecting aneurysm incorporating the posterior inferior cerebellar artery (PICA). The authors performed occipital artery–PICA anastomosis and repaired the dura by primary suture without bovine graft. Thereafter, endovascular internal trapping using coils was conducted. Severe headache developed at postoperative day 17, and the patient was diagnosed with eosinophilic meningitis. After administration of a high-dose corticosteroid for 2 weeks, her symptoms and laboratory findings were improved.LESSONSPostoperative eosinophilic meningitis is rarely related to craniotomy without using bovine graft. Neurosurgeons should consider the possibility of eosinophilic meningitis after craniotomy without a xenogeneic dural material.

Primary Lower-Limb Arterial Stent Infection Managed with Resection and in Situ Bovine Pericardial Revascularization

Peripheral arterial stent infection is a rare but morbid condition. We present the case of a patient with primary stent infection of his superficial femoral artery (SFA) and popliteal artery, managed with surgical explant and in situ reconstruction using rifampicin-soaked bovine pericardial tube graft. A 69-year-old man presented with a 3-day history of left groin pain. He had had stents placed into his SFA and popliteal artery in 6 months prior. Duplex ultrasound demonstrated a pseudoaneurysm of the common femoral artery (CFA), with ying-yang flow. A computed tomography angiogram confirmed this pseudoaneurysm, which had a thick rind of nonenhancing soft tissue. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. The patient was taken to the operating theater, and the CFA, profunda femoris artery, and SFA were exposed. After heparinization and clamp control, the pseudoaneurysm was incised, which revealed that the proximal SFA had been completely eroded. All infected tissues were resected. In situ arterial reconstruction was undertaken using a rifampicin-soaked bovine pericardium tube graft. A subsequent positron emission tomography scan revealed high fluorodeoxyglucose uptake around the patients remaining distal SFA and popliteal artery stents. These were explanted in the same manner described above. There is limited evidence regarding the prevention of infection when placing peripheral arterial stents. The Society of Interventional Radiology does not recommend routine prophylactic antibiotics when placing peripheral stents. In situ reconstruction using bovine pericardium is a well-described technique in the management of aortic graft infections, but there is limited experience in its use in a peripheral setting.

In Vitro Analysis of the Cytocompatibility of a Novel Porcine Aortic Patch for Vascular Reconstruction.

Cardiovascular diseases are one of the most common causes of morbidity and mortality in the world. In the case of severe arteriosclerotic damage, surgical treatment is necessary. Although the use of autologous vessels is still considered to be the gold standard, sufficient autologous vessels for transplantation are lacking. In the present study, histological examination and in vitro cytotoxicity analysis according to DIN EN ISO 10993-5 were performed on a newly developed porcine vascular graft from a decellularized aorta. A conventional bovine graft was used as control. The ex vivo-histological analysis revealed the effectiveness of a new purification process on the microstructure and the removal of xenogeneic antigen-bearing structures in the new vessels. Furthermore, cell viability and cytotoxicity assays revealed full cytocompatibility. The novel graft shows no structural damage and gets completely decellularized by the purification process. Superior cytocompatibility, compared with the bovine-derived vascular graft, was demonstrated.

Sinus Mucosa Thinning and Perforations after Sinus Lifting Performed with Different Xenografts: A Histological Analysis in Rabbits

Background: Experimental studies have shown a progressive thinning and perforations of the sinus mucosa associated with sharpened edges and the cutting projections of graft particles used simultaneously for maxillary sinus augmentation. Hence, the aim of the present study was to evaluate the damaging effects of two different bovine grafts on the sinus mucosa after sinus augmentation. Methods: Twenty New Zealand rabbits received a bilateral sinus lifting using, as fillers, two different types of deproteinized bovine bone in granules, one processed at low temperature (low-T group), and the other at high temperature (high-T group). Thinned mucosa sites (<40 µm) and perforations were evaluated in the sinus mucosa that were in contact with graft granules after 2 and 10 weeks, in ten animals per period. Results: After 2 weeks of healing, the number of thinned mucosa sites was 118 in the low-T group, and 149 in the high-T group (p = 0.191). At the 10-week assessment, the thinned sites increased to 237 and 195 sites, respectively. The numbers of sinus mucosa perforations after 2 weeks were eight and three in the low-T and high-T group, respectively. At the 10-week evaluation, the perforations increased to 19 in the low-T group, and to 14 in the high-T group. Conclusions: The contact with bovine xenografts yielded thinning and perforations of the sinus mucosa. Despite the differences in characteristics and dimensions, no differences were found between the two xenografts in the numbers of thinning mucosa sites and perforations. However, a trend of more events was found in the low-T compared to the high-T group.

An alternative valve for mitral valve replacement in young children: using an NO-REACT® INJECTABLE BIOPULMONIC™ prosthesis as a mitral valve replacement in a 14-month-old child.

Mitral valve replacement in infants is challenging and there are limited alternative valves available. Since the Boston group published their first report on alternative valves for mitral valve replacement in infants, there has been a growth in the literature on the topic, mostly based on the use of a stented bovine jugular vein graft (Melody® valve). The challenges of the Melody valve are firstly in its length of 28 mm unexpanded, which has the potential to cause left ventricular outflow tract obstruction, and secondly, the valve needs mechanical dilatation, which is laborious. A modified No-React® Injectable Biopulmonic™ Prosthesis (Bio Integral Surgical, Inc., Mississauga, ON, Canada) which is shorter (19 mm) and simpler in that it is self-expanding was implanted in a 14-month-old child to replace her mitral valve. The operation was successful and the short-term function of the prosthesis is good.

Independent Suture Augmentation With All-Inside Anterior Cruciate Ligament Reconstruction Reduces Peak Loads on Soft-Tissue Graft. A Biomechanical Full-Construct Study

To evaluate the effect of suture augmentation (SA) of 7-mm and 9-mm diameter graft on load sharing, elongation, stiffness, and load to failure for all-inside anterior cruciate ligament reconstruction (ACLR) in a biomechanical Study was funded by Arthrex ID: EMEA-16020. full-construct porcine model. Bovine tendon grafts, 7-mm and 9-mm diameter, with and without SA were tested using suspensory fixation (n= 8). The independent SA was looped over a femoral button and knotted on a tibial button. Preconditioned constructs were incrementally increased loaded (100N/1,000 cycles) from 100N to 400N for 4,000 cycles (0.75 Hz) with final pull to failure (50 mm/min). Isolated mechanical and optical measurements during construct loading of the SA allowed to quantify the load and elongation range during load sharing. Construct elongation, stiffness and ultimate strength were further assessed. Load sharing in 7-mm grafts started earlier (200N) with a significant greater content than 9-mm grafts (300N) to transfer 31% (125N) and 20% (80N) of the final load (400N) over the SA. Peak load sharing with SA reduced total elongation for 7-mm (1.90 ± 0.27 mm vs 4.77 ± 1.08 mm, P < .001) and9-mm grafts (1.50 ± 0.33 mm vs 3.57 ± 0.54 mm, P < .001) and adequately increased stiffness of 7-mm (113.4 ± 9.3 N/mm vs 195.9 ± 9.8 N/mm, P < .001) to the level of augmented 9-mm grafts (208.9 ± 13.7N/mm). Augmentation of 7-mm (835 ± 92N vs 1,435 ± 228N, P < .001) and 9-mm grafts (1,044 ± 49N vs 1,806 ± 157N, P < .001) significantly increased failure loads. Load sharing with SA occurred earlier (200N vs 300N) in lower stiffness 7-mm grafts to carry 31% (7-mm) and 20% (9-mm) of the final load (400N). Loads until peak load sharing were transferred over the graft. Augmented constructs showed significantly lower construct elongation and increased stiffness without significance between variable grafts. Failure load of augmented grafts were significantly increased. Suture tape ligament augmentation may potentially protect biological grafts from excessive peak loading and elongation, thus reducing the risk of graft tears.

705 Aortic Graft Infection Managed with Bovine Patch, A Case Report and Literature Review

Abstract Aim to describe good outcomes in a case with Aortic graft infection (AGI) managed with Bovine patch and outline management of AGI. Method Literature review utilising keywords ‘’Aortic graft infection’’AND’’Bovine Patch’’ revealed initially 1350 articles, all studies in English were included, all duplicates were removed, screening was performed using the PRISMA flow. To correlate with the findings, we followed up a 72-year-old patient who presented with aortic graft infection followed by graft explantation and a fashioned Bovine graft insertion and followed up for 1 year for any re-infection in the clinics. Results Literature search resulted 73 articles discussing the role of Bovine Patch as a choice in prevention of Aortic graft re-infection. In our case, there was no clinical nor radiological evidence of Bovine patch re-infection for over a year. Literature review showed that AGI is a rare but serious complication with mortality up to 60%.The main management is IV antibiotics, followed by graft explantation and consideration of re-implantation of various types of grafts. The European society of vascular surgery (ESVS) guidelines recommend re-implantation with an aortic antibiotic soaked graft, yet re-infection rate is quoted at 20%. however, in our case Bovine graft was free from re-infection at 1 year follow up. Conclusions IV anitbioics and explantation remain the mainstay for treatment of aortic grafts infection, however, there is increasing evidence that Bovine grafts show excellent freedom from re-infection at follow up. Hence, this might be the conduit of choice when performing such surgeries; however, more evidence is needed.

V11-04 ROBOTIC-ASSISTED LAPAROSCOPIC RIGHT RADICAL NEPHRECTOMY WITH RIGHT IVC THROMBECTOMY AND REPAIR WITH BOVINE GRAFT

You have accessJournal of UrologyRenal Oncology II (V11)1 Sep 2021V11-04 ROBOTIC-ASSISTED LAPAROSCOPIC RIGHT RADICAL NEPHRECTOMY WITH RIGHT IVC THROMBECTOMY AND REPAIR WITH BOVINE GRAFT Rohan Sawhney, Mubashir Billah, Mutahar Ahmed, and Michael Stifelman Rohan SawhneyRohan Sawhney More articles by this author , Mubashir BillahMubashir Billah More articles by this author , Mutahar AhmedMutahar Ahmed More articles by this author , and Michael StifelmanMichael Stifelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002073.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Extension of renal cell carcinoma (RCC) into the inferior vena cava (IVC) has been reported in 3-7% of patients. Definitive treatment is surgical resection with a 5-year cancer-specific survival of 32%. Various treatment choices exist including open radical nephrectomy with IVC thrombectomy, hybrid robot-assisted laparoscopic (RAL) radical nephrectomy with limited subcostal for IVC thrombectomy and complete RAL radical nephrectomy with IVC thrombectomy. In all cases one must be prepared to reconstruct the vena cava to prevent narrowing. We present a unique case of RCC with subhepatic IVC thrombosis that was treated entirely robotically and utilized a bovine patch to reconstruct the vena cava. METHODS: A 77-year-old male presented with gross hematuria, an eGFR of 42 and MRI revealing a heterogenous ill-defined mass in the upper pole of the right kidney, level 2 IVC thrombosis, and numerous pulmonary parenchymal metastases. CT guided renal biopsy confirmed clear cell RCC and the patient was treated pre-operatively with immunotherapy. This video will review pertinent steps to performing a robotic IVC thrombectomy with bovine patch. In addition, we will review our single institution experience with complete RAL radical nephrectomy with IVC thrombectomy. RESULTS: The video outlines our technique for robotic radical nephrectomy, IVC thrombectomy and placement of bovine graft. Reviewing our retrospective and prospective data renal cancer databases, we completed 18 IVC thrombectomies, of which 3 were done completely robotically. Of the 9 requiring a bovine patch, 4 were done open, 4 were done as a hybrid technique and 1 was done robotically. Our data for complete robotic IVC thrombectomy is summarized in Table 1. CONCLUSIONS: Management of Level 1 and 2 IVC thrombus can be safely performed through a hybrid technique or completely robotically technique. No matter the technique, one must be prepared for IVC reconstruction. Our experience suggests that complete robotic IVC thrombectomy and reconstruction with bovine graft is feasible in select patients. We recommend having a vascular surgeon close by and anesthesia ready with blood products if necessary. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e858-e859 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rohan Sawhney More articles by this author Mubashir Billah More articles by this author Mutahar Ahmed More articles by this author Michael Stifelman More articles by this author Expand All Advertisement Loading ...

V07-09 PENILE PROSTHESIS IMPLANTATION AND PEYRONIE'S DISEASE: HOW TO APPROACH THE RESIDUAL CURVATURE; A DETAILED DEMONSTRATION OF MOULDING TECHNIQUE AND GRAFTING PROCEDURE

You have accessJournal of UrologySexual Dysfunction & Transgender (V07)1 Sep 2021V07-09 PENILE PROSTHESIS IMPLANTATION AND PEYRONIE'S DISEASE: HOW TO APPROACH THE RESIDUAL CURVATURE; A DETAILED DEMONSTRATION OF MOULDING TECHNIQUE AND GRAFTING PROCEDURE Giovanni Chiriaco, Enya Maher, Wai Gin Lee, and David Ralph Giovanni ChiriacoGiovanni Chiriaco More articles by this author , Enya MaherEnya Maher More articles by this author , Wai Gin LeeWai Gin Lee More articles by this author , and David RalphDavid Ralph More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002034.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: 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. 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°) following moulding. TachoSil sealant matrix 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 TachoSil or bovine pericardium. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e553-e553 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giovanni Chiriaco More articles by this author Enya Maher More articles by this author Wai Gin Lee More articles by this author David Ralph More articles by this author Expand All Advertisement Loading ...

Comparison of immunohistochemical analysis on sinus augmentation using demineralized tooth graft and bovine bone.

ObjectivesThe purpose of this animal research was to compare bone regeneration in augmented rabbit maxillary sinuses treated with demineralized particulate human-tooth graft and anorganic bovine bone by immunohistochemical analysis.Materials and MethodsPiezoelectric bilateral sinus augmentation was performed in eight adult rabbits. In the control group, anorganic bovine was grafted in the maxillary sinus following elevation of the sinus membrane. In the experimental group, demineralized human particulate tooth bone was grafted in the sinus. Bone regeneration in augmented sinuses was evaluated by immunohistochemical analysis using various markers of osteoprogenitor cells.ResultsThe number of bromodeoxyuridine-labeled cells was significantly higher in the experimental group than in the control group at eight weeks. The immunoreactivity of proliferating-cell nuclear antigen was increased slightly in the experimental group relative to the control group at eight weeks. Other bone markers were expressed equally in the two groups.ConclusionIn the rabbit maxillary sinus, higher osteoinduction was correlated with demineralized human particulate tooth bone grafting than with anorganic bovine grafting.

P–451 Improving neovascularization and follicle viability in cryopreserved bovine ovarian tissue transplants

Abstract Study question Does cryopreservation and transplantation of bovine ovarian medulla-containing cortex tissue improve the viability and vascularization of the graft? Summary answer: Transplantation of bovine ovarian cortex containing medulla has a positive effect on follicular viability and neovascularization of the graft compared to cortex transplantation alone. What is known already For female fertility protection, cryopreservation and retransplantation of ovarian tissue is a widely used method. During cryopreservation, ovarian tissue is exposed to mechanical and hypoxic stress resulting in follicular loss. Moreover, after retransplantation tissue vitality and follicle survival is limited due to ischemia. As follicular viability is of major importance for fertility and hormonal activity, the main focus is on improving vitality and viability of the grafts. In current protocols, ovarian medulla is discarded and merely cortex tissue is preserved. However, medulla tissue predominantly contains blood vessels, thereby obtaining high potential for revascularization processes and thereby supporting tissue vitality. Study design, size, duration This experimental laboratory work was performed during a period of ten months. The rapidly vascularized chorioallantoic-membrane (CAM) of fertilized chicken eggs was used as model system to investigate neovascularization, follicle survival and tissue vitality of different bovine ovarian grafts. In four independent experimental rows four different tissue types (isolated cortex, thick medulla-containing cortex (8 x 10 x 3 mm), thin medulla-containing cortex (5 x 10 x 3 mm) and sole medulla tissue were compared. Participants/materials, setting, methods Out of four bovine ovaries preserved from the slaughterhouse, in total 117 samples of the four different tissue types were primed and cryopreserved by the common slow-freezing protocol. After thawing, grafts were transplanted on separate CAMs at day four of fertilized eggs. After four days of incubation, blood vessels growing towards the grafts were counted. Subsequently, grafts were harvested, digested with collagenase and stained with Neutral Red® to determine the total amount of vital follicles. Main results and the role of chance To investigate the neovascularization, all graft-supplying blood vessels were determined and distinguished between small and thick vessels. Compared to sole cortex, there were more small vessels in the medulla-containing grafts (9,72 vs. 8,65). Especially thin medulla- containing cortex pieces exhibited the highest number of small vessels (9,90). Also in isolated medulla tissue an increased amount of small vessels was observed (9,79). However, the average number of big vessels was not significantly different in all four test groups (Cortex: 2,12; thin medulla-containing cortex: 1,69; thick medulla-containing cortex: 1,5; medulla: 2). The total number of all vessels differed from 10,76 (sole cortex) to 11,75 (medulla-containing grafts), indicating a support of neoangiogenesis by medulla tissue. To further examine whether medulla tissue also alters the amount of vital follicles, Neutral Red® stained vital follicles were determined in all different sample groups. Indeed, in medulla-containing cortex samples was an augmented average number of vital follicles (342,4) compared to sole cortex tissue (256,11). Most vital follicles were detectable in the thick medulla-containing cortex tissue (346,61), closely followed by the thin medulla-containing cortex grafts (338,19). As expected, there was just a rare amount of vital follicles in sole medulla grafts (8,13). Limitations, reasons for caution As the ovarian reserve in cattle is very individual, the prepared ovaries are different in their follicle amount. These individual differences may influence the number of counted follicles. Furthermore, the CAM model is only a short term experimental approach to investigate neovascularization and follicle survival. Wider implications of the findings: According to our results, transplantation of human medulla-containing cortex appears promising. Keeping medulla tissue on the graft seems to improve both follicle viability and revascularization. Our findings need to be proven with human tissue, but might change the preparation of human ovarian tissue for fertility preservation in future. Trial registration number Not applicable

In vivo recellularization of xenogeneic vascular grafts decellularized with high hydrostatic pressure method in a porcine carotid arterial interpose model.

Autologous vascular grafts are widely used in revascularization surgeries for small caliber targets. However, the availability of autologous conduits might be limited due to prior surgeries or the quality of vessels. Xenogeneic decellularized vascular grafts from animals can potentially be a substitute of autologous vascular grafts. Decellularization with high hydrostatic pressure (HHP) is reported to highly preserve extracellular matrix (ECM), creating feasible conditions for recellularization and vascular remodeling after implantation. In the present study, we conducted xenogeneic implantation of HHP-decellularized bovine vascular grafts from dorsalis pedis arteries to porcine carotid arteries and posteriorly evaluated graft patency, ECM preservation and recellularization. Avoiding damage of the luminal surface of the grafts from drying significantly during the surgical procedure increased the graft patency at 4 weeks after implantation (P = 0.0079). After the technical improvement, all grafts (N = 5) were patent with mild stenosis due to intimal hyperplasia at 4 weeks after implantation. Neither aneurysmal change nor massive thrombosis was observed, even without administration of anticoagulants nor anti-platelet agents. Elastica van Gieson and Sirius-red stainings revealed fair preservation of ECM proteins including elastin and collagen after implantation. The luminal surface of the grafts were thoroughly covered with von Willebrand factor-positive endothelium. Scanning electron microscopy of the luminal surface of implanted grafts exhibited a cobblestone-like endothelial cell layer which is similar to native vascular endothelium. Recellularization of the tunica media with alpha-smooth muscle actin-positive smooth muscle cells was partly observed. Thus, we confirmed that HHP-decellularized grafts are feasible for xenogeneic implantation accompanied by recellularization by recipient cells.

External administration of moon jellyfish collagen solution accelerates physiological wound healing and improves delayed wound closure in diabetic model mice

IntroductionArtificial dermis is an effective therapeutic method for full-thickness dermal defects. However, the currently available artificial dermis made of porcine or bovine type I collagen has several limitations such as incomplete epithelialization and delayed migration of fibrogenic and angiogenic cells into the graft. We previously developed a composite dermal graft containing a mixture of moon jellyfish collagen and porcine type I collagen, and reported its stimulatory effect on both the re-epithelialization of the epidermis and the migration of fibrogenic and angiogenic cells into the graft. In the present study, we examined whether the same effect was observed by administering jellyfish collagen solution externally onto an artificial dermal graft made of bovine type I collagen.MethodsWe used a 6 mm full-thickness wound defect model. Moon jellyfish collagen was prepared as a concentrated 0.5% solution and dripped externally onto a transplanted artificial dermal graft made of bovine type I collagen. Wound repair and long-term dermal tissue remodeling were compared between mice administered jellyfish collagen solution on the bovine collagen graft and those transplanted with a composite dermal graft containing the same amounts of jellyfish and bovine collagens. The stimulatory effect of jellyfish collagen solution was also evaluated using diabetic dB/dB mice.ResultsExternal administration of jellyfish collagen solution onto the bovine collagen graft significantly accelerated wound closure compared to control saline. It also decreased the number of inflammatory cells infiltrating the wound and suppressed absorption of the transplanted graft, as well as reduced subsequent scar formation. Furthermore, external administration of jellyfish collagen solution onto the bovine collagen graft improved the delayed wound healing in diabetic model mice, and this effect was superior to that of the currently used basic fibroblast growth factor.ConclusionsExternal administration of moon jellyfish collagen solution onto a bovine collagen graft significantly accelerated physiological wound healing and prevented excessive scar formation. It also improved wound closure in diabetic model mice, confirming its therapeutic application for intractable skin ulcers caused by impaired wound healing.

Self-made bovine pericardial tube grafts: maybe the best thing since sliced bread.

Self-made bovine pericardial tube grafts: maybe the best thing since sliced bread.