Multistage Repair Research Articles

Ultrasound-triggered functional hydrogel promotes multistage bone regeneration

The dysfunction of bone mesenchymal stem cells (BMSCs), caused by the physical and chemical properties of the inflammatory and repair phases of bone regeneration, contributes to the failure of bone regeneration. To meet the spatiotemporal needs of BMSCs in different phases, designing biocompatible materials that respond to external stimuli, improve migration in the inflammatory phase, reduce apoptosis in the proliferative phase, and clear the hurdle in the differentiation phase of BMSCs is an effective strategy for multistage repair of bone defects. In this study, we designed a cascade-response functional composite hydrogel (Gel@Eb/HA) to regulate BMSCs dysfunction in vitro and in vivo. Gel@Eb/HA improved the migration of BMSCs by upregulating the expression of chemokine (C–C motif) ligand 5 (CCL5) during the inflammatory phase. Ultrasound (US) triggered the rapid release of Ebselen (Eb), eliminating the accumulation of reactive oxygen species (ROS) in BMSCs, and reversing apoptosis under oxidative stress. Continued US treatment accelerated the degradation of the materials, thereby providing Ca2+ for the osteogenic differentiation of BMSCs. Altogether, our study highlights the prospects of US-controlled intelligent system, that provides a novel strategy for addressing the complexities of multistage bone repair.

An Image Enhancement Method for Side-Scan Sonar Images Based on Multi-Stage Repairing Image Fusion

The noise interference of side-scan sonar images is stronger than that of optical images, and the gray level is uneven. To solve this problem, we propose a side-scan sonar image enhancement method based on multi-stage repairing image fusion. Firstly, to remove the environmental noise in the sonar image, we perform adaptive Gaussian smoothing on the original image and the weighted average grayscale image. Then, the smoothed images are all processed through multi-stage image repair. The multi-stage repair network consists of three stages. The first two stages consist of a novel encoder–decoder architecture to extract multi-scale contextual features, and the third stage uses a network based on the resolution of the original inputs to generate spatially accurate outputs. Each phase is not a simple stack. Between each phase, the supervised attention module (SAM) improves the repair results of the previous phase and passes them to the next phase. At the same time, the multi-scale cross-stage feature fusion mechanism (MCFF) is used to complete the information lost in the repair process. Finally, to correct the gray level, we propose a pixel-weighted fusion method based on the unsupervised color correction method (UCM), which performs weighted pixel fusion between the RGB image processed by the UCM algorithm and the gray-level image. Compared with the algorithm with the SOTA methods on datasets, our method shows that the peak signal-to-noise ratio (PSNR) is increased by 26.58%, the structural similarity (SSIM) is increased by 0.68%, and the mean square error (MSE) is decreased by 65.02% on average. In addition, the processed image is balanced in terms of image chromaticity, image contrast, and saturation, and the grayscale is balanced to match human visual perception.

PD06-07 HOW DURABLE IS THE CHILDHOOD HYPOSPADIAS REPAIR? A DATA-LINKAGE STUDY OF PENILE REOPERATIONS OVER 30 YEARS

You have accessJournal of UrologyCME1 Apr 2023PD06-07 HOW DURABLE IS THE CHILDHOOD HYPOSPADIAS REPAIR? A DATA-LINKAGE STUDY OF PENILE REOPERATIONS OVER 30 YEARS Sergey Vavilov, Erin Nolan, Grahame H. Smith, Peter Pockney, Malcolm Starkey, and Aniruddh V. Deshpande Sergey VavilovSergey Vavilov More articles by this author , Erin NolanErin Nolan More articles by this author , Grahame H. SmithGrahame H. Smith More articles by this author , Peter PockneyPeter Pockney More articles by this author , Malcolm StarkeyMalcolm Starkey More articles by this author , and Aniruddh V. DeshpandeAniruddh V. Deshpande More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003230.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this study is to estimate the overall risk of penile reoperations after a childhood hypospadias repair, especially in the second and third decades of life, and explore the risk factors of reoperations. METHODS: All children operated on for hypospadias in three children’s hospitals in NSW Australia between April 1991 and December 2006 were identified and their health records linked (July 2001 to December 2020) using the Centre of Health Record Linkage NSW. The details regarding penile reoperations (procedure codes and dates) were captured. Patients were then grouped in three age categories for the analysis: 1 - 0-10, 2 - 10-20, and 3 - 20-30 years old. Primary reconstructive operations performed over 15 years (between 1991 and 2006) were classified into six categories: Distal – Hemicircumcision, Distal – MAGPI, Distal – TIP, Distal – Other, Proximal, Multi-Stage Repair. The reoperations were collapsed into four patient relevant categories: 1) Urethroplasty related, 2) Chordee related 3) Cystoscopies, and 4) Others. The cumulative incidence rate was measured by calculating the sum of reoperations divided by 100 person years at risk. The differences in the incidence of reoperations by hypospadias severity, urethral plate division and persistent chordee after degloving were calculated using chi-square tests with the Yates continuity correction to account for smaller cell sizes. RESULTS: 1105 patients (group 1=617, group 2=1099, group 3=473) were identified with a median follow-up of 18.4 years. The cumulative incidence rate of a penile reoperation in group 1 was 7.3, in group 2 was 1.7, and in group 3 was 0.6 per 100-patient years at risk. The cumulative incidence (risk) of a penile reoperation over 20 years was 37%. Over the entire follow-up period, the highest incidence rate of penile reoperations was after multi-stage (9.9) and single-stage proximal hypospadias repair (5.7) and TIP repair (3.6). There was a higher penile reoperation risk after proximal hypospadias repair, if at primary repair the native urethral plate was divided (p<0.0001), and if there was a persistent chordee after degloving (p=0.04). No reoperations for chordee were identified. CONCLUSIONS: This study is the first of its kind that identifies the quantum and the risk factors for reoperations over 30 years of follow-up and will inform not only better counselling but also further research into technical and non-technical aspects of hypospadias care. Source of Funding: 1. School of Medicine and Public Health, University of Newcastle, Small Project Grant. 2. Hunter New England Research and Translation Centre Research Grant 3. Priority Research Centre GrowUpWell Seed Funding 2020 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e158 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sergey Vavilov More articles by this author Erin Nolan More articles by this author Grahame H. Smith More articles by this author Peter Pockney More articles by this author Malcolm Starkey More articles by this author Aniruddh V. Deshpande More articles by this author Expand All Advertisement PDF downloadLoading ...

The landscape of targets and lead molecules for remyelination.

Remyelination, or the restoration of myelin sheaths around axons in the central nervous system, is a multi-stage repair process that remains a major need for millions of patients with multiple sclerosis and other diseases of myelin. Even into adulthood, rodents and humans can generate new myelin-producing oligodendrocytes, leading to the therapeutic hypothesis that enhancing remyelination could lessen disease burden in multiple sclerosis. Multiple labs have used phenotypic screening to identify dozens of drugs that enhance oligodendrocyte formation, and several hit molecules have now advanced to clinical evaluation. Target identification studies have revealed that a large majority of these hits share the ability to inhibit a narrow range of cholesterol pathway enzymes and thereby induce cellular accumulation of specific sterol precursors to cholesterol. This Perspective surveys the recent fruitful intersection of chemical biology and remyelination and suggests multiple approaches toward new targets and lead molecules to promote remyelination.

Anaesthetic management of bladder exostrophy in a three month old baby

Exostrophy of bladder and cloaca are the defects in the ventral abdominal wall caused due to failure of mesodermal invasion of cloacal membrane at 4-5 weeks of gestation. These congenital defects require multistaged repair and surgeries can last longer therefore causing repeated exposure of the baby to anaesthesia and can cause electrolyte imbalance, infection, hypothermia, coagulopathies and even mortality. We report a case of exostrophy of bladder with epispadius in a three month old child which was done under general anaesthesia and continous caudal catheter infusion of bupivaciane in intraoperative and postoperative period which helped in providing opioid free analgesia thus avoiding their respiratory depressant effects and aided in the early recovery of the baby.

Exogenous PTH 1-34 Attenuates Impaired Fracture Healing in Endogenous PTH Deficiency Mice via Activating Indian Hedgehog Signaling Pathway and Accelerating Endochondral Ossification

Fracture healing is a complicated, long-term, and multistage repair process. Intermittent administration of parathyroid hormone (PTH) has been proven effective on intramembranous and endochondral bone formation during the fracture healing process, however, the mechanism is unclear. In this study, we investigated the role of exogenous PTH and endogenous PTH deficiency in bone fracture healing and explored the mechanism by using PTH knockout (PTH-/-) mice and ATDC5 cells. In a mouse femur fracture model, endogenous PTH deficiency could delay endochondral ossification whereas exogenous PTH promotes accumulation of endochondral bone, accelerates cartilaginous callus conversion to bony callus, enhances maturity of bony callus, and attenuates impaired fracture healing resulting from endogenous PTH deficiency. In fracture callus tissue, endogenous PTH deficiency could inhibit chondrocyte proliferation and differentiation whereas exogenous PTH could activate the IHH signaling pathway to accelerate endochondral ossification and rescue impaired fracture healing resulting from endogenous PTH deficiency. In vitro, exogenous PTH promotes cell proliferation by activating IHH signaling pathway on ATDC5 cells. In mechanistic studies, by using ChIP and luciferase reporter assays, we showed that PTH could phosphorylate CREB, and subsequently bind to the promoter of IHH, causing the activation of IHH gene expression. Therefore, results from this study support the concept that exogenous PTH 1-34 attenuates impaired fracture healing in endogenous PTH deficiency mice via activating the IHH pathway and accelerating endochondral ossification. Hence, the investigation of the mechanism underlying the effects of PTH treatment on fracture repair might guide the exploration of effective therapeutic targets for fracture.

Recurrent Anterior Urethral Stricture: Challenges and Solutions.

Recurrent male anterior urethral stricture disease is a complex surgical challenge that should be managed by reconstructive urologists with experience in stricture management. Diagnosis of recurrence requires both anatomic narrowing and patient symptoms identified on validated questionnaires, with limited role for intervention in asymptomatic treatment “failures”. Endoscopic management has a very specific role in recurrence, and the choice of technique for urethroplasty depends on pre-operative urethrography and cystoscopy. Surgical success depends on addressing patient concerns, complete stricture excision, tissue quality optimization, and the use of multi-stage repair when indicated. Augmentation with genital skin flaps and/or grafts is often required, with buccal mucosa as the ideal graft source if local tissue is compromised. Salvage options including urinary diversion and perineal urethrostomy must also be considered in debilitated patients with severe disease or repeated treatment failures. Unique patient populations including patients with hypospadias and lichen sclerosis are among the highest risk for repeated recurrence and require special care in surgical technique, graft selection, and post-operative management.

Risk Factors For Wound Dehiscence After Posterior Sagittal Anorectoplasty In Children With Anorectal Anomalies

ABSTRACT:Background/purpose: Wound dehiscence after PSARP is a considerable complication which may affect the functional outcome. The aim of our study is to assess the frequency of wound dehiscence after posterior sagittal anorectoplasty done for children with ARM and to identify the possible risk factors predisposing for it.Methods: A retrospective chart study where files of children with ARM who underwent PSARP in Pediatric Surgery Department in Zagazig University between 2015 and 2020 were reviewed and analysed regarding the incidence of post-operative wound dehiscence and the possible predisposing factors including type of surgery, was it single- or multi-staged, gender, age, prematurity, birth weight, type of ARM, associated anomalies and use of antibiotics.Results: Eighty-six patients with ARM operated by PSARP were included. Multi-staged repair was done in 49 patients and single-staged in 37 patients. Wound dehiscence was significantly more common in single-staged repair (43.2%), while only 20.5% of patients of multi-staged group experienced dehiscence. ARM associated with cardiac anomalies is another significant risk factor. None of the other studied factors was identified to be considered as a risk factor for dehiscence.Conclusion: Wound dehiscence was more common in single-staged PSARP. Association of cardiac anomalies is another significant risk factor for wound dehiscence. We recommend to avoid single-staged PSARP in patients of ARM associated with cardiac anomalies, to avoid adding of another risk factor. No other significant risk factor for wound dehiscence was detected in our study. Further studies are recommended to search for other possible contributing factors.

Scrotal Hypospadias with Severe Chordee, Micropenis, and Bifid Scrotum in A Child Treated with Multi Stage Repair and Hormonal Therapy

Proximal hypospadias, include proximal penile, penoscrotal, scrotal and perineal types, are a less common occurrence and correspond to 20% of total hypospadias. Surgical reconstruction is the only possible therapeutic option for hypospadias. The primary objectives of the reconstruction are to create a vertically slit orthotopic meatus, straighten the penis and establish good cosmetic results that include a conically shaped glans. Other important aspects for the reconstruction are to avoid shortening the penis and optimal skin coverage. A 9 years old male presented with abnormal spraying during urination. The parents said that the opening of his urethra is located under the penis. Everytime he urinates, the urine flowing along the thighs. In physical examination, the opening of urethra is in the scrotum. The penis was uncircumcised while the scrotum was bifid in the normal position, and bilateral testes were fully descended in the well-developed scrotum. Repair of proximal hypospadias involves correction of several components of the hypospadias complex with the intent of optimizing long-term functional and cosmetic outcomes. These components include ventral penile curvature, proximal location of the urethral meatus, ventral skin deficiency, glans morphology abnormality, abnormal division of the corpus spongiosum, penile torsion and penoscrotal transposition. Surgical correction of several components divide into five sequential steps. Severe forms of hypospadia are typically accompanied by an abnormal ventral curvature of the penis (chordee). Surgical correction of both chordee and hypospadias is recommended. When properly corrected, it does not cause long-term problems, and a natural appearance of the penis is usually restored.

DOZ047.93: Thoracoscopic multistage repair of long-gap esophageal atresia using internal traction suture technique—evolution of the method

Abstract Treatment of long-gap esophageal atresia poses a great challenge for a surgeon. A new multistage thoracoscopic repair of long-gap esophageal atresia using internal traction technique was developed that evolved with time and growing experience. The goal of this study is to present the changes in the strategy and important technical aspects of the operative method based on a retrospective analysis of performed surgeries. Methods and Materials Thirty-five cases of newborns with long-gap esophageal atresia (type A-26 cases and B-9 cases exclusively) were operated thoracoscopically between 2008 and 2019 using internal traction technique in different pediatric surgery centers (Poland–28, Czech–1, Ukraine–1, Switzerland–2, Egypt–2, Russia–1). The idea of the internal traction technique was to place the suture between thoracoscopically mobilized esophageal pouches and keep a static tension between them for a period of time. Patients were operated on as early as it was possible after birth. Results Of the 35 newborns operated on using internal traction 2 patients died before the final stage from not surgically-related causes. Two patients had complications that required neck fistula and had later Collis–Nissen and colon interposition, respectively. One case is awaiting the final procedure. For 31 cases the final esophageal anastomosis was completed in two stages–16 cases, three stages–9, four stages–2, five stages–2, and six stages–1. At the beginning the time between stages was planned for 4 weeks (for some cases it was even longer) and it was shortened for the last three cases to 5 days. It allowed avoiding gastrostomy in two cases. The internal traction was modified from using two traction loops to one traction loop with two slipping knots on each branch of the loop. The clips were applied transversely through the tip of each pouch and part of the traction loop to prevent disruption and pouch perforation. It also allowed increasing of the created static traction force. Conclusion Results of the study may indicate that in a majority of long-gap esophageal atresia it is possible to preserve the native esophagus by a thoracoscopic approach using an internal traction suture technique. Shortened time between stages allowed completion of the final esophageal anastomosis with gastrostomy avoidance.

Single-Stage Complete Repair versus Multistage Repair of Tetralogy of Fallot with Borderline Pulmonary Arteries.

Tetralogy of Fallot is the most common cyanotic congenital heart defect. Borderline pulmonary anatomy has been associated with a higher risk of mortality and morbidity. Strategies to manage this condition-namely, single- or multistage repair-have long been debated. The overall outcomes of patients with tetralogy of Fallot with borderline pulmonary arteries (McGoon ratio 1.3 to 1.7) with regard to the need for a single-stage or multistage repair and the outcome of each surgical management were evaluated. A retrospective, nonrandomized comparative study designed to evaluate patient outcomes comprised 60 patients with tetralogy of Fallot with borderline pulmonary arteries who underwent surgery at the Cardiothoracic Surgery Academy, Ain Shams University, Cairo, Egypt, between January 2016 and December 2017. After gaining approval from the affiliated ethical and research committee, and informed consent of the guardians, the patients were assigned into one of two groups. Shunt group included 30 patients managed surgically by a modified Blalock-Taussig (MBT) shunt as a part of a multistage repair, and repair group included 30 patients managed surgically by single-stage complete repair. The medical records of the patients were reviewed, and data relating to age, sex, weight, and preoperative oxygen saturation were collected. All patients underwent preoperative echocardiography and multislice computed tomography (CT) with angiography. The follow-up was performed by echocardiography at discharge and at one month and six months after surgery. Multislice CT with angiography was performed in patients who received a shunt once the echocardiography showed acceptable pulmonary arteries. The patients' age ranged from 5 to 50 months with a mean age of 18.63 ± 9.15 (19.84 ± 12.34 for the shunt group and 17.43 ± 8.54 for the repair group). The weight ranged from 5 kg to 18 kg with a mean of 9.6 ± 2.53 (8.82 ± 2.79 for the shunt group and 10.41 ± 2.63 for the repair group). The mean preoperative O2 saturation was 68.95% ± 7.8% for the shunt group and 87.93% ± 6.18% for the repair group. The median McGoon ratio was 1.4 for the shunt group and 1.6 for the repair group, the difference of which was highly significant (P < .0001). The mortality rate in our study was 10% (10% for the shunt group and 10% for the repair group). The morbidity incidence rate was 26.6% for the shunt and repair groups. The ICU stay ranged from 2 to 31 days, with a median of three days for the shunt group (mean 3.61 ± 1.91) and four days for the repair group (mean 6.07 ± 6.63 days). The calculated P value showed a significant difference between the two groups concerning ICU stay. The postoperative SO2 significantly increased to a mean of 85.58 ± 7.05 in the shunt group and 98.14 ± 3.36 in the repair group (P < .0001). There was no statistically significant difference between multistage repair and single-stage complete repair regarding morbidity and mortality. Regarding ICU stay, patients in the single-stage had a better outcome. A McGoon ratio of 1.5 can be used as a guideline in the decision-making process.

One-stage repair of anorectal malformations in females with vestibular fistula: a systematic review and meta-analysis.

Females with recto-vestibular fistula (RVF) can be managed either by one-stage sagittal anorectoplasty (SARP) or by conventional multi-stage approach with colostomy followed by SARP. Our aim was to define which approach, one-stage or multi-stage, is safer and more beneficial. Using a defined search strategy, two investigators identified all comparative studies on the mentioned procedures. The study was conducted under PRISMA guidelines. The meta-analysis was performed using RevMan 5.3. Data are mean ± SD. Of 649 titles/abstracts screened, 13 full-text articles were analyzed. Three studies were included (156 females). One-stage SARP was associated with increased risk of wound infection (24.3 ± 8.7%) compared to multi-stage approach (10.9 ± 2.5%; p < 0.01) and increased risk of wound dehiscence (16.2 ± 4.8% vs. 2.4 ± 1.1%, respectively; p < 0.01). The incidence of anorectal stenosis was higher following one-stage repair (33.3%) vs. multi-stage approach (10.7%; p < 0.05). No differences were found with regards to redo SARP in both groups (12.9 ± 7.3% vs. 4.8 ± 0.8%; p = ns). At follow-up, the prevalence of soiling and constipation were similar after one-stage (19.7 ± 10.3% and 29.5 ± 5.4%) and multi-stage repair (13.7 ± 8.9% and 28.7 ± 4.4%; p = ns). In females with RVF, the SARP performed without protective colostomy increases the risk of postoperative complications. However, this one-stage approach seems not to be associated with reduced fecal continence.

Pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals: collateral vessel disease burden and unifocalisation strategies.

Median follow-up was 4.8 compared with 5.7 years for Groups 1 and 2, respectively, p = 0.65. Median number of major aortopulmonary collaterals/patient was 3, ranging from 1 to 8, in Group 1 compared with 4, ranging from 1 to 8, in Group 2, p = 0.09. Group 2 had a higher number of lobar/segmental stenoses within collateral vessels (p = 0.02). Group 1 had fewer catheter-based branch pulmonary artery reinterventions, with 5 (inter-quartile range from 1 to 7) per patient, compared with 9 (inter-quartile range from 4 to 14) in Group 2, p = 0.009. Among patients who achieved ventricular septal defect closure, median right ventricle/left ventricle pressure was 0.48 in Group 1 compared with 0.78 in Group 2, p = 0.03. Overall mortality was 6 (17%) in Group 1 compared with 9 (21%) in Group 2.DiscussionSingle-stage unifocalisation is a promising repair strategy in select patients, achieving low rates of reintervention for branch pulmonary artery restenosis and excellent mid-term haemodynamic outcomes. However, specific anatomic substrates of pulmonary artery/ventricular septal defect/major aortopulmonary collaterals may be better suited to multi-stage repair. Preoperative evaluation of collateral vessel calibre and function may help inform more patient-specific surgical management.

Surgical Surprise in a Case of Pure esophageal atresia: How High Can the Lower Pouch Be?

The gap between the upper and lower pouches in case of pure esophageal atresia (EA) is usually long and requires multistaged repair. However, in rare cases, the gap may be short and can be repaired primarily commonly through thoracotomy approach. We report an unusual case of a 2-day-old baby girl who presented with short gap EA where the lower esophageal pouch was found adjacent to the blind upper pouch in the neck and primary repair could be performed through the cervical route itself.

Growth and Psychological Development in Postoperative Patients With Anterior Encephaloceles

PurposeAnterior encephaloceles are rare malformations that are frequently associated with other brain anomalies. This study evaluates the growth and psychological development of children following encephalocele repair. Materials & MethodsGrowth and psychological assessment was done in 24 children with only encephalocele (group I); nine children with encephalocele and hydrocephalus (group II); seven children with encephalocele, hydrocephalus, and secondary malformations (group III); and 40 apparently healthy control subjects. Psychological assessment was done by evaluating intelligence and temperament. ResultsSingle-stage repair was performed in 38 children, and two underwent multistage repair. Major postoperative complications were noted in three individuals. The follow-up period ranged from 12 to 168 months, and during this time the growth velocity declined significantly among group II and group III patients when compared with control subjects. After adjusting the body mass index for age, our data revealed that group III participants had a significantly (P = 0.02) lower body mass index than the control group. Group III also had poor indices for intelligence quotient (P ≤ 0.01) and temperament (P ≤ 0.01). Female patients had lower temperament indices when compared with unaffected females with regard to approach withdrawal (P ≤ 0.01), mood (P = 0.026), and intensity (P = 0.03). Overall, increased disease severity adversely affected the psychological indices. ConclusionIndividuals with anterior encephalocele without associated intracranial defects had excellent postoperative outcomes in terms of growth and psychological developments. Hydrocephalus and agenesis of corpus callosum had the least impact on psychological development. However, the presence of secondary brain defects led to developmental delays. Gender differences in temperament may suggest a need for distinct treatment regimens to assess psychosocial well-being for males and females.

Facial Soft Tissue Trauma from Honey Badger Bite: A Case Report

Facial injuries have the potential to cause disfigurement and loss of function. Although it is seldom life-threatening, facial trauma can also be deadly, because it can cause severe bleeding, interference with the airway or wound infections. We present a rare case of 3 years old boy that underwent a multistage repair of facial soft tissue injuries he got from a Honey Badger bite. A good wound management that consists of thorough irrigation and careful debridement are important to diminish the risks of infection after primary closure, which should be considered for animal bite injuries to the face, and for this case honey badger. Reconstruction can be very challenging but if carefully done may help make patients cosmetically acceptable and have satisfactory physiological outcomes.

One-stage dorsal lingual mucosal graft urethroplasty for the treatment of failed hypospadias repair.

The aim of this study was to retrospectively investigate the outcomes of patients who underwent one-stage onlay or inlay urethroplasty using a lingual mucosal graft (LMG) after failed hypospadias repairs. Inclusion criteria included a history of failed hypospadias repair, insufficiency of the local skin that made a reoperation with skin flaps difficult, and necessity of an oral mucosal graft urethroplasty. Patients were excluded if they had undergone a failed hypospadias repair using the foreskin or a multistage repair urethroplasty. Between January 2008 and December 2012, 110 patients with failed hypospadias repairs were treated in our center. Of these patients, 56 underwent a one-stage onlay or inlay urethroplasty using LMG. The median age was 21.8 years (range: 4–45 years). Of the 56 patients, one-stage onlay LMG urethroplasty was performed in 42 patients (group 1), and a modified Snodgrass technique using one-stage inlay LMG urethroplasty was performed in 14 (group 2). The median LMG urethroplasty length was 5.6 ± 1.6 cm (range: 4–13 cm). The mean follow-up was 34.7 months (range: 10–58 months), and complications developed in 12 of 56 patients (21.4%), including urethrocutaneous fistulas in 7 (6 in group 1, 1 in group 2) and neourethral strictures in 5 (4 in group 1, 1 in group 2). The total success rate was 78.6%. Our survey suggests that one-stage onlay or inlay urethroplasty with LMG may be an effective option to treat the patients with less available skin after failed hypospadias repairs; LMG harvesting is easy and safe, irrespective of the patient's age.

PD22-10 HYPOSPADIAS REPAIR OF 223 ADOLSCENTS AND ADULTS: LESSONS LEARNED

You have accessJournal of UrologyTrauma/Reconstruction: Urethral Reconstruction (including Stricture) III1 Apr 2015PD22-10 HYPOSPADIAS REPAIR OF 223 ADOLSCENTS AND ADULTS: LESSONS LEARNED Moneer Hanna and Gina Cambareri Moneer HannaMoneer Hanna More articles by this author and Gina CambareriGina Cambareri More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1452AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hypospadias repair in adults is divided into 3 groups, the first group include primary hypospadias cases, the second are patients who have had prior hypospadias repair during childhood and present with late complication, and the third group are patients who had undergone multiple failed surgeries (hypospadias cripples). Herein we report on the management and outcome of treatments of the first and second groups METHODS We reviewed the records and photographs of 223 patients (18-39 years old) treated between 1981 and 2013. 10 patients with primary hypospadias underwent Thiersch-Duplay repair. In the second group 41 patients complained of penile curvature of whom 11 had a urethral fistula. Their repairs were Nesbitt procedure (16 pts), Baskin modification (10 pts) and two stage corporal-dermal grafting (15 pts). 172 patients presented with micturitional abnormalities (straining, spraying or leakage) and or cosmetic concerns of whom 36 pts had urethral stricture, 11 pts had BXO, 5 developed hairy urethra of whom 2 had urethral stone, and 3 pts had urethral diverticulum. 117 patients complained of spraying of urine and/or had esthetic concerns RESULTS 186 patients underwent one stage surgical repair, and staged repair was performed in 37 pts. The follow up of 31 pts was 2 weeks and in 192 pts the follow up varied between three months to five years with a median of 18 months. Early in the series we encountered wound infections in 12 patients resulting in dehiscence of the repair. The early and late complication rates were: 21/186 (11%) of the one stage repair group,and 10/37 (27%) in the multi-staged repair group CONCLUSIONS Complications of childhood hypospadias repair may present later in life and it would appear that some urethroplasties deteriorate with time. Urethral strictures may appear many years later and penile curvature can recur in some cases of proximal hypospadias. Furthermore esthetics acquire greater importance during adolescence and spraying from a sub-terminal or irregular meatus accounted for more than 50% of the complaints in this series. We have recommended to the parents of repaired hypospadias children especially for those with proximal hypospadias to come for follow up as their child transitions to adolescence. The patients are advised to use antiseptic soap the evening prior to and the morning of surgery. Currently we avoid prolonged catheterization which in conjunction with nocturnal erections can cause shearing movements between the sutured margins and the catheter. We therefore prefer using urine drainage via suprapubic cystotomy and brief urethral stenting for the more extensive repairs © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e479-e480 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Moneer Hanna More articles by this author Gina Cambareri More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD22-11 DONOR SITE COMPLICATIONS FOLLOWING URETHROPLASTY WITH ORAL MUCOSAL GRAFT: ANALYSIS OF 442 PATIENTS WITH URETHRAL STRICTURE

Baskin modification (10 pts) and two stage corporal-dermal grafting (15 pts). 172 patients presented with micturitional abnormalities (straining, spraying or leakage) and or cosmetic concerns of whom 36 pts had urethral stricture, 11 pts had BXO, 5 developed hairy urethra of whom 2 had urethral stone, and 3 pts had urethral diverticulum. 117 patients complained of spraying of urine and/or had esthetic concerns RESULTS: 186 patients underwent one stage surgical repair, and staged repair was performed in 37 pts. The follow up of 31 pts was 2 weeks and in 192 pts the follow up varied between three months to five years with a median of 18 months. Early in the series we encountered wound infections in 12 patients resulting in dehiscence of the repair. The early and late complication rates were: 21/186 (11%) of the one stage repair group,and 10/37 (27%) in the multi-staged repair group CONCLUSIONS: Complications of childhood hypospadias repair may present later in life and it would appear that some urethroplasties deteriorate with time. Urethral strictures may appear many years later and penile curvature can recur in some cases of proximal hypospadias. Furthermore esthetics acquire greater importance during adolescence and spraying from a sub-terminal or irregular meatus accounted for more than 50% of the complaints in this series. We have recommended to the parents of repaired hypospadias children especially for those with proximal hypospadias to come for follow up as their child transitions to adolescence. The patients are advised to use antiseptic soap the evening prior to and the morning of surgery. Currently we avoid prolonged catheterization which in conjunction with nocturnal erections can cause shearing movements between the sutured margins and the catheter. We therefore prefer using urine drainage via suprapubic cystotomy and brief urethral stenting for the more extensive repairs

Efficacy of one–stage dorsal lingual mucosal graft urethroplasty for the treatment of failed hypospadias repair

Objective To evaluate the outcomes of patients who underwent one–stage onlay or inlay urethroplasty using lingual mucosal grafts (LMG) to treat male patients with less available skin after a failed attempt at hypospadias repair. Methods We retrospective analyze the clinical material of 68 patients with failed hypospadias repairs were treated in our hospital between Jan. 2008 and Dec. 2013, The median age was 22 (4–45) years. The median prior unsuccessful repairs was 1.9 (1–6) times. Inclusion criteria were a history of failed hypospadias repair, insufficiency of the local skin that made a reoperation with skin flaps difficult, and necessity of another graft urethroplasty. Patients were excluded if they had undergone a failed hypospadias repair with a reoperative urethroplasty using the foreskin or a multistage repair urethroplasty. Two techniques of urethroplasty were performed according to the patients with or not penile curvature during the erection. One–stage onlay LMG urethroplasty was performed in 52 patients and a modified Snodgrass technique using one–stage inlay LMG urethroplasty was performed in 16. The median LMG urethroplasty length was 5.6 (4–13) cm. Results The median follow–up was 39 (5–70) mon, 54 patients voided well with urinary peak flow rates were median 24.5 (14.0 to 46.0) ml/s and complications developed in 14 patients (21.6%), including urethrocutaneous fistulas in 8 patients and neourethral strictures in 6 patients (meatal stenosis in 3 cases, proximal anastomotic site stricture in 3 cases). 8 patients with urethrocutaneous fistulas were repaired with salvage procedure, succeed in 4 and another 4 patients await further reoperation. Three patients with meatal stenosis were corrected by meatoplasty and 3 patients with proximal anastomotic site stenosis were only treated by dilatation for 4 and 6 months respectively, after that the patients voided well. Conclusions One stage onlay or inlay urethroplasty with LMG may be an effective option to treat the patients with less available skin after failed hypospadias repairs. Key words: Hypospadias; Failed; Urethroplasty; Lingual mucosa