Preputial Graft Research Articles

Oral Mucosal Graft Versus Inner Preputial Graft in Two Stage Surgical Repair of Proximal Hypospadias; A Comparative Study

Oral Mucosal Graft Versus Inner Preputial Graft in Two Stage Surgical Repair of Proximal Hypospadias; A Comparative Study

Evaluation of preputial graft urethroplasty in primary repair of narrow plate hypospadias

Background There is yet no perfect Procedure for repairing hypospadias. In certain cases, a graft is required to reinforce the poor urethral plate (UP). The study aims to assess the efficacy of dorsal inlay preputial graft urethroplasty (DIGU) as a primary repair for narrow urethral plate distal and mid-penile hypospadias. Patients and methods A 40- child who underwent dorsal inlay preputial graft urethroplasty Repair for primary distal or mid-penile hypospadias at least 6 months old, as well as a UP less than 8 mm in a noncircumcised penis, were included in the research. Results The success rate was 75% (30 patients) and the Complications rate was 25% (10 patients). Six (60%) of the ten complicated patients had UP widths of 2.5–4 mm (total of 8 patients), implying that 75% of these patients had complications. There were four patients with fistula, two patients with meatal stenosis, two patients with meatal retraction, and two patients with failure. Conclusion One of the main factors influencing the surgical result of the hypospadias correction is the width and configuration of the UP.

De-epithelialized overlap flap to secure urethroplasty in second stage hypospadias repair: revisiting the Smith technique

BackgroundThe application of a second layer between the neourethra and skin was a major contribution, which has improved the outcome of hypospadias repair. Here, we report our experience of revisiting the original Smith technique using a de-epithelialized overlap flap to support the urethroplasty in staged hypospadias repair.MethodsThe study included primary cases of proximal hypospadias with significant chordee who underwent two-stage repair during the period 2016 through 2021. The ventral curvature was corrected at first stage by excision of the urethral plate, followed by covering the ventral shaft by skin flaps or inner preputial graft. The second stage (Thiersch -Duplay urethroplasty) was performed six months later. The de-epithelialized overlap flap (double breasting) technique was used to cover the neo-urethra in all cases, which was combined with a dartos scrotal flap to cover the proximal neourethra when indicated.ResultsThe study included 17 boys with proximal hypospadias who underwent two-stage repair. Follow up period after the second stage ranged between 6 and 30 months (mean 19.7; median 18.5). Post-operative complications were detected in 7 cases (41%). Most complications were related to distal/glanular disruptions whether partial or complete (5 cases). One case developed a penoscrotal fistula that was closed surgically. Another case (belonging to the group which used preputial graft in the 1st stage) presented 21 months after the second stage with urethral stricture (penoscrotal).ConclusionApplying the de-epithelialized double-breasting skin closure can offer alternative second layer coverage for the neourethra along the penile shaft in staged repair of proximal hypospadias.

Outcome analysis of staged preputial graft technique for primary proximal hypospadias with and without post-operative vacuum physiotherapy

Management of proximal hypospadias remains challenging. We assessed the results of staged preputial graft repairs (SPG) for proximal hypospadias and hypothesize that post-operative vacuum physiotherapy (VP) improves graft suppleness and overall outcomes. Retrospective analysis of n=71 patients with proximal hypospadias and severe ventral penile curvature (PC) of ≥50° after degloving. PC was corrected using ventral transverse incisions of the tunica albuginea (VTITA) without applying a tourniquet, taking care to avoid injuring the underlying erectile tissue. The ventral raw area at the penile shaft, including VTITA, were covered with either divided and partially mobilized urethral plate, or with the inner preputial graft itself. During the second stage, a tunica vaginalis flap was often used to cover the tubularized neourethra. Outcomes and post-op complications were assessed after each stage, comparing patients who received vacuum physiotherapy (VP+, n=49) with those who did not (VP-, n=22). Mean PC was 66°, average follow-up duration was 13.01 months, and overall complication rate was 22.5%. Only 6 of 49 VP+patients experienced complications (12.24%; 4 fistulas; 2 urethral strictures) and no recurrence of PC after second stage was observed in this group. VP- patients displayed a significantly higher rate of complications, with 10 of 22 cases (45.45%) exhibiting fistula development (n=5) and glans dehiscence (n=5). Recurrence of mild PC after first-stage repair was comparable between patient groups (12% VP+, 18% VP-) and easily corrected by simple graft tubularization or dorsal plication during second-stage repair. Staged repair using VTITA is effective for correcting proximal hypospadias with severe chordee. VP appears to promote and expedite graft suppleness and significantly improves patient outcomes.

Novel single-stage preputial spiral graft for panurethral stricture: a step-by-step description of the technique.

To report the 12-month results of a novel urethroplasty technique relying on a spiral preputial graft for panurethral stricture disease. Twenty consecutive patients were treated between May and October 2021 at our center. A spiral preputial mucocutaneous graft is a foreskin-based graft, developed from a 5-cm-wide preputial skin, which is harvested using a helicoidal shape and can reach up to 20cm in length. Stricture characteristics were assessed through preoperative retrograde and voiding cystourethrogram and maximum uroflowmetry data (Qmax). Complications were collected up to 30days after surgery and graded using the Clavien-Dindo (C-D) classification. The patients were followed up to 12months. Preoperative median Qmax was 6.5ml/s [interquartile range (IQR): 4.0-8.7]. After a median follow-up of 12months (IQR 12-13), six patients experienced at least one complication. Of them, two patients had grade 2 C-D complications, while only one developed a grade 3a C-D complication. The median postoperative Qmax was 16ml/s (IQR: 13-18). Only one patient had early urethral stricture recurrence treated with dilatation after catheter removal. At one-year follow-up, no other patients had urethral stricture recurrence with an overall median Qmax of 15.1ml/s (IQR 13.5-16.4). Our novel single-stage spiral preputial graft urethroplasty for panurethral stricture treatment appears to be safe and could be used as a valid alternative to two-stage procedures or even to single-stage buccal mucosa graft augmentation.

Urethral Plate Grafting for Deficient Urethral Plate in Exstrophy: An Alternative Method to Augment Urethral Plate

IntroductionShort urethral plate remains a challenge in exstrophy management. We report our experience with urethral plate grafting in cases of exstrophy with deficient urethral plate. MethodsAmong the exstrophy patients treated at the authors’ institutions (2018–2022), those with a short urethral plate were prospectively included. A short urethral plate was defined as a distance between the verumontanum and the base of the glans of less than 10 mm. Urethral plate grafting was performed electively before the exstrophy closure. The urethral plate was divided just distal to verumontanum, and a thin inner preputial or para-exstrophy skin graft was harvested and deployed to cover the defect. Exstrophy closure was subsequently performed. The following parameters were recorded: age at grafting, type of graft and age at exstrophy closure. Reported outcomes include success of closure, complications, and follow up. ResultsSix male patients were included in the study: 3 classic bladder exstrophy (CBE) and 3 cloacal exstrophy (CE). Median age at grafting was 9 (3–18) months. Inner preputial grafts were utilized in the 3 CBE patients, and para-exstrophy skin grafts were used for the 3 CE patients. There was no graft loss, and longer and wide urethral plate was seen in all cases. Median time to bladder exstrophy closure was 3 (3–13) months after grafting. ConclusionPre-closure urethral plate grafting represents a safe and effective option for exstrophy patients with a short or inadequate urethral plate.

MP36-13 PEYRONIE'S DISEASE: PREPUTIAL GRAFT IN PENILE CURVATURE SURGERY CORRECTION, A SINGLE CENTER EXPERIENCE WITH 68 PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP36-13 PEYRONIE'S DISEASE: PREPUTIAL GRAFT IN PENILE CURVATURE SURGERY CORRECTION, A SINGLE CENTER EXPERIENCE WITH 68 PATIENTS Mattia Benedetti, Tommaso Arcelli, Nicola Nannola, Stefano Di Bari, Daniel Martens, Filippo Borgatti, Federcio Cantoni, Michele Potenzoni, Roberto Aarnaudi, Carmelo Destro Pastizzaro, Nicoletta Uliano, Chiara Grassani, Maria Chiara Sighinolfi, Stefani Ferretti, Stefano Puliatti, Bernardo Rocco, Andrea Prati, and Salvatore Micali Mattia BenedettiMattia Benedetti More articles by this author , Tommaso ArcelliTommaso Arcelli More articles by this author , Nicola NannolaNicola Nannola More articles by this author , Stefano Di BariStefano Di Bari More articles by this author , Daniel MartensDaniel Martens More articles by this author , Filippo BorgattiFilippo Borgatti More articles by this author , Federcio CantoniFedercio Cantoni More articles by this author , Michele PotenzoniMichele Potenzoni More articles by this author , Roberto AarnaudiRoberto Aarnaudi More articles by this author , Carmelo Destro PastizzaroCarmelo Destro Pastizzaro More articles by this author , Nicoletta UlianoNicoletta Uliano More articles by this author , Chiara GrassaniChiara Grassani More articles by this author , Maria Chiara SighinolfiMaria Chiara Sighinolfi More articles by this author , Stefani FerrettiStefani Ferretti More articles by this author , Stefano PuliattiStefano Puliatti More articles by this author , Bernardo RoccoBernardo Rocco More articles by this author , Andrea PratiAndrea Prati More articles by this author , and Salvatore MicaliSalvatore Micali More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003270.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical therapy for Peyronie's disease (PD) is reserved for patients with severe penile deformity that fails to improve with medical treatment and impedes sexual intercourse. Surgical treatment should be delayed until the acute inflammatory phase has resolved and should be considered in patients with deformity that impairs sexual function. Plaque incision or excision with grafting has been suggested as an option in patients with a penile curvature greater than 60°, a shortened penis, and/or an hourglass or complex deformity. Our purpose is to assess efficacy, complications and degree of patient satisfaction of preputial skin graft for treatment of penile curvatures by grafting corporoplasty. 68 patients (15-76 y) were treated between 2012 and 2021, with a degree of curvature between 30° and 80° at Fidenza Hospital. The patients analyzed had more than 17 valutaden with IEFF-5 score before the surgical procedure. METHODS: The surgery was performed by subcoronal incision, next degloving and preputial patch preparation. Next detachment of the nervous vascular bundle and incision of the double inverted T plate and application of the preputial patch. Compressive medication and catheterization. All patients were hospitalized for 4 days with removal of compressive medication on the third day and removal of the bladder catheter. Post-operative medication about 7 days after discharge with no evidence of major complications (about 10 patients had penile hematoma resolved with conservative therapy). About 6 months after surgery, patients were asked about the degree of satisfaction valueted IEFF-5 and the possible appearance of postoperative penile curvatures. RESULTS: Of the 68 patients operated 44 (64.7% of patients) had an IEFF-5 greater than 17 without a recurrence of curvature, 19 patients had an IEFF-5 less than 17 (27.9%) without a recurrence of curvature, 5 patients (7.4%) had an IEFF-5 greater than 17 but had a penile curvature recurrence of less than 30%. Only 10 patients post-operative complication. CONCLUSIONS: The aim of the surgical treatment in Peyronie's disease is to correct the deformity while preserving or improving erectile capacity of the penis. Appropriate treatment options should be individualized according to the patients' expectations and erectile capacity. Preputial graft has similar outcome compared to other Autologous grafts like Vein, Tunica vaginalis, Tunica albuginea, Buccal mucosa, Lingual mucosa, Fascia lata. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e484 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mattia Benedetti More articles by this author Tommaso Arcelli More articles by this author Nicola Nannola More articles by this author Stefano Di Bari More articles by this author Daniel Martens More articles by this author Filippo Borgatti More articles by this author Federcio Cantoni More articles by this author Michele Potenzoni More articles by this author Roberto Aarnaudi More articles by this author Carmelo Destro Pastizzaro More articles by this author Nicoletta Uliano More articles by this author Chiara Grassani More articles by this author Maria Chiara Sighinolfi More articles by this author Stefani Ferretti More articles by this author Stefano Puliatti More articles by this author Bernardo Rocco More articles by this author Andrea Prati More articles by this author Salvatore Micali More articles by this author Expand All Advertisement PDF downloadLoading ...

Urethral Plate Substitution in Two-Stage Hypospadias Repair: Grafts Versus Flaps

BackgroundChoosing between flaps or grafts to substitute the urethral plate in 2-stage hypospadias repair has been a matter of debate with no consensus in the literature. Flaps have reliable blood supply that maybe theoretically less liable for strictures or contractures. Grafts are more versatile, which can be used in primary and recurrent cases when healthy local skin is deficient.In this report, our aim was to compare outcomes of grafts and flaps when used to substitute the urethral plate in two-stage repair of primary proximal hypospadias with ventral curvature. MethodsThis retrospective study included primary cases of hypospadias with significant curvature who underwent two-stage repair using either grafts or flaps to substitute the urethral plate in the first stage. Cases included in the study were divided into two groups according to the technique of substituting the urethral plate at the first stage of repair. During first part of the study period (2015 through 2018), we mostly used grafts to substitute the urethral plate (group A); later, we shifted to skin flaps (Group B) during the period 2019 through 2021. ResultsThe study included 37 boys with primary proximal hypospadias who underwent two-stage hypospadias repair. The meatus position was penoscrotal in 18, scrotal in 16, and perineal in three. Inner preputial graft was used to substitute the urethral plate in 18 cases (group A), while dorsal skin flaps were used in 19 (group B). Out of the 37 cases, 27 were available at follow-up after second stage (group A = 14; group B = 13). Follow up period ranged between 6 and 42 months (mean 19.7; median 18.5). Overall, 14 cases required reoperations for different indications: partial disruptions of distal part of the repair in six, closure of urethro-cutaneous fistula in six, and urethral strictures in two. The rate of complications was higher in group A (10 cases: 71%) compared to group B (4 cases: 31%) (Fisher exact test, p-value = 0.057). ConclusionGrafts were associated with higher complication rate than flaps when used to substitute the urethral plate in two-stage repair of proximal hypospadias with chordee. Type of Study and Level of EvidenceThis is non-randomized comparative study (level III evidence).

Dorsal inlay inner preputial graft repair versus ventral-only preputial graft repair in primary distal penile hypospadias with narrow urethral plate.

Tubularized incised plate (TIP) is the most common technique used for distal hypospadias repair with good outcome but with a high rate of urethral stricture. Inner preputial-free graft can be used as an inlay graft in the incised area of the narrow urethral plate, also can be used as an onlay graft for urethroplasty in hypospadias repair to avoid this complication. A comparative prospective randomized study was conducted on two groups of hypospadias patients with narrow urethral plate. Group A: dorsal inlay inner preputial graft repair was performed (grafted TIP [G-TIP]) and Group B: ventral onlay preputial graft repair was performed. The assessment of outcome and hypospadias objective scoring evaluation (HOSE) score was done at 2 weeks and 6 months. Group A included 55 patients for whom dorsal inlay inner preputial graft repair was performed (G-TIP), and Group B which was planned to be conducted on 55 patients using onlay preputial graft (onlay graft) but was terminated after 15 cases due to high failure rate (33%). Group A showed better success rate 96% and better HOSE score (score 16) at 2 months and 6 months 83.6% and 88.2% versus 26.7% and 33.3% in Group B. Postoperative complications showed a statistically significant difference; glans dehiscence (3.6% vs. 40%), wound infection (1.8% vs. 33.3%), and skin sloughing (3.6% vs. 26.7%) in Groups A and B, respectively. G-TIP is a good technique for the management of distal hypospadias with narrow urethral plate with good success rate, cosmetic outcome, and with less complications compared to onlay graft.

SC21 - Peyronie’s disease: preputial graft in penile curvature surgery correction, a single center experience with 68 patients

SC21 - Peyronie’s disease: preputial graft in penile curvature surgery correction, a single center experience with 68 patients

V04-04 NEW SURGICAL TECHNIQUE: A SINGLE LONG SPIRAL PREPUTIAL GRAFT FOR PANURETHRAL STRICTURE

You have accessJournal of UrologyCME1 May 2022V04-04 NEW SURGICAL TECHNIQUE: A SINGLE LONG SPIRAL PREPUTIAL GRAFT FOR PANURETHRAL STRICTURE Pankaj Joshi, Marco Bandini, Shreyas Bhadranawar, Vipin Sharma, Sandeep Bafna, and Sanjay Kulkarni Pankaj JoshiPankaj Joshi More articles by this author , Marco BandiniMarco Bandini More articles by this author , Shreyas BhadranawarShreyas Bhadranawar More articles by this author , Vipin SharmaVipin Sharma More articles by this author , Sandeep BafnaSandeep Bafna More articles by this author , and Sanjay KulkarniSanjay Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002560.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of panurethral stricture is challenging. Etiology is usually either Lichen Sclerosus or Iatrogenic. Single stage dorsal onlay with Kulkarni Technique is a preferred approach. In lichen sclerosus, local genital skin cannot be used. We describe a new spiral preputial graft dorsal onlay single stage Urethroplasty for non LS Panurethral strictures. METHODS: Ours is a tertiary care referral center for urethroplasty with experience of more than 6000 Urethroplasties in last 2 decades. This is a prospective study from Jan 2020-July 2021.9 patients of Panurethral stricture were included. None of them had LS. Stricture length was 14 cm. Urethrogram was performed prior to Urethroplasty. Perineal incision, penile invagination, dorsal onlay approach was performed. A outer circumcision incision was made just deep to the skin. The prepuce was harvested with dissection above the dartos. This was continued to the inner prepuce. Inner circumcision incision was made. The prepuce was harvested like a cylinder. The prepuce was then slided over a 20 cc disposable syringe. A spiral incision was made and a long continuous 1.5 cm wide and 20 cm long graft was made. This was described by Anderson et el. This graft was applied as dorsal onlay like Kulkarni technique from meatus till proximal bulbar urethra. Catheter was removed after 4 weeks. RESULTS: At follow up, all the patient passed urine within normal uroflow. At 6 months follow up, uroflow remained excellent with a Qmax of 22.3ml/sec. 1 patient had proximal narrowingThere was no chordee, urinary tract infections or sexual dysfunction. There were no local complications. CONCLUSIONS: BMG Urethroplasty is the preferred augmentation material for strictures. The results of Penile skin and BMG are almost comparable. In Asian subcontinent, many men have an intact prepuce. By harvesting a spiral long graft, we avoid junctional strictures (which can take place at the site of 2 BMG). The graft is long and there is no need to harvest another graft. There is no oral morbidity. We also preserve the preputial dartos, which preserves the neurovascular supply. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e367 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pankaj Joshi More articles by this author Marco Bandini More articles by this author Shreyas Bhadranawar More articles by this author Vipin Sharma More articles by this author Sandeep Bafna More articles by this author Sanjay Kulkarni More articles by this author Expand All Advertisement PDF downloadLoading ...

Tubularized Preputial Free Graft One-Stage Repair for Proximal Hypospadias

Background: One of the most frequent urogenital malformations in newborn boys is hypospadias. After undescended testis, in boys, it is the second most popular congenital abnormality. There are different one-stage surgical procedures used to repair proximal hypospadias, each has its own advantages and outcome. One of them is tubularized preputial free graft, which is first tried by the urologist team of Horton and Devine who used full thickness preputial grafts tubularized in a single-stage operation. Aim: The aim of this article is to assess the outcome of a one-stage tubularized preputial free graft. Materials and Methods: The present case series study provides a prospective analysis of 88 proximal hypospadiac boys operated on primarily over more than 5.5 years (from March 2014 to September 2019) using preputial skin as a tubularized free graft in one stage. Ethical approval for this review was obtained. Results: The present study includes 88 boys with hypospadias with mean age 20.6 months (ranging from 5 months to 7.5 years). The proximal hypospadias represents 33 (37.5%), penoscrotal 51 (58.0%), and scrotal 4 (4.5%) boys. Thirty-three boys out of 88 are under 12 years, 29 are between 12 and 24 years, and 26 above 24 years. The postoperative complications reported are fistula which occurs in 9 (10.3%), glans dehiscence in 3 (3.4%), meatal stenosis in 3 (3.4%), and diverticulum in 2 (2.3%), and numbers of complications with respect to age groups were six complications under 12 years, two complications between 12 and 24 years, and nine complications above 24 years. Conclusion: One-stage correction using a tubularized preputial free graft is an appropriate choice for repairing proximal hypospadias with chordee when compared with other widely used procedures for proximal cases.

V17 - Technique of Inner preputial graft urethroplasty: Feasibility, advantages and long-term outcomes

V17 - Technique of Inner preputial graft urethroplasty: Feasibility, advantages and long-term outcomes

V16 - New surgical technique: A single long spiral preputial graft for panurethral stricture

V16 - New surgical technique: A single long spiral preputial graft for panurethral stricture

Comparative analysis of one- and two-stage urethroplasty in the treatment of proximal hypospadias in children: flap or transplant?

BACKGROUND: Surgical treatment of proximal forms of hypospadias in children is still a complex and largely unsolved problem. The large number of postoperative complications following reconstructive surgery for proximal forms of hypospadias supports scientific interest in this issue.
 AIM: This study aimed to conduct a retrospective comparative analysis of the effectiveness of two types of urethroplasty. We compared fundamentally different approaches to the formation of the artificial urethra, surgical techniques that use a different type of movement, and blood supply of the plastic materials a flap and a graft.
 MATERIALS AND METHODS: The study included 113 primary patients with proximal hypospadias aged 8 months to 15 years who underwent surgery between 2013 and 2019 and were divided into two comparison groups. Group 1 included 53 (46.9%) boys; a single-stage urethroplasty was performed by the onlay-tube method, where a longitudinal skin flap of the dorsal surface of the penis was used as a plastic material. Group 2 included 60 (53.1%) patients; two-stage urethroplasty was performed by the Bracka method, where the plastic material for the formation of the artificial urethra was a preputial graft in 44 (73.3%) patients and a graft of the oral mucosa in 16 (26.7%) patients.
 RESULTS: When comparing the surgical results in the form of the number of complications requiring repeated surgical interventions under anesthesia to eliminate them, corresponding to ClavienDindo 3B complications, a significant difference was obtained in the study groups. The surgical results were significantly better when performing the two-stage Bracka method.
 CONCLUSIONS: In the surgical treatment of proximal forms of hypospadias in children, the two-stage Bracka method, where the plastic material for the formation of the artificial urethra is a preputial or mucosal graft, significantly reduced the number of postoperative complications.

P0403 - Feasibility and outcomes of dorsolateral inner preputial graft urethroplasty for anterior urethral strictures: Follow-up of 60 months from a tertiary care center

P0403 - Feasibility and outcomes of dorsolateral inner preputial graft urethroplasty for anterior urethral strictures: Follow-up of 60 months from a tertiary care center

Augmentation of the urethral plate in the glans penis area and the distal urethra – effective method of fistula correction in children with hypospadias

Background. Important causes of complications of hypospadias repair are the deficit of tissues for plastic surgery, grooveless and small size of glans, obliteration of the urethral platewith varying degrees of scarring. The coronal urethral fistula is the most common complication of urethroplasty. Surgeons continue to search for reliable methods of correction of complications.Materials and methods. Between 2011 and 2019, 85 children aged 2 and 17 years presented with coronal fistula of urethra after hypospadias repair. (TIP) Snodgrass – 78 (91.7 %) and Mathiue – 7 (8.2 %) procedures have been performed them earlier. In our clinic previously operated 28 (32 %) boys, primary surgery of the remaining 57 (67 %) was performed in other medical institutions.Results. All patients (85), conditionally, were divided into two groups. The first group included 39 children (45.8 %), with stitching a fistula, the second group consisted of 46 patients (54.1 %), with augmentation of the urethral plate of the glans and distal urethra with the implantation of a rectangular preputial or oral mucosa free graft. Recurrent urethral fistula after stitching was observed in 10 boys (25.6 %) of the first group, and only in 2 cases (4.3 %) in children with the augmentation of the urethral plate (p <0.05). The decrease of urine flow according to the data of uroflowmetry was observed in 15 patients (52 %) the first group, the children of the second group did not have a decrease in the flow of urine.Discussion. The shape, size of the glans and the condition of the urethral plate affect to the result of urethroplasty. The connection of the wings of the glans in accordance with normal anatomy, avoid obstruction in the distal part of urethra. A wide urethra in the glans and meatal area improves urine flow. Conclusion. The augmentation of the urethral plate of the penile glans and the distal urethra with the implantation of a wide rectangular free flap in to the meatus, in our opinion, an advantage over the implantation of diamond-shaped grafts using the GTIP or TIP graft technique.

Commentary to ‘The learning curve in proximal hypospadias repair’

Hisamatsu et al. present an interesting analysis of their single stage technique (urethroplasty with free preputial graft) for repair of proximal hypospadias. Complication rate stabilised after approximately 50 cases and they suggest that the supervision of an experienced surgeon is required during the early phase of the learning curve.

Dorsolateral inner preputial graft urethroplasty for anterior urethral strictures: long-term outcomes from a single tertiary care centre.

PurposeBuccal mucosa graft (BMG) is long used as favoured substitute by most reconstructive surgeons for substitution urethroplasty (SU). Though inner preputial skin graft (IPG) was described even earlier than BMG, its usage lately has fallen out of favour. The aim of the study was to evaluate the outcome of a SU with IPG from a tertiary care centre.MethodsA retrospective analysis of prospectively maintained clinical data was conducted at our tertiary care centre enrolling 80 patients with anterior urethral stricture from January 2015 to January 2018. Patients were evaluated for the aetiology, length and site of the urethral stricture. All patients underwent dorsolateral SU with IPG. Post-operative assessment including uroflowmetry and sexual outcomes using IIEF and MSHQ-EJD questionnaires was done at 3 weeks, 3 months, 12 months and half-yearly thereafter. Success was defined by the stable maximum urinary flow value > 14 ml/s or urethral calibration with 16 French Foley catheter.ResultsMean age of patients was 40 years (18–69). The most common aetiology was post-instrumentation (65%) and 60% had stricture at penobulbar site. Mean stricture length was 65 mm. At a mean follow-up of 48 months (range 30–66 months), successful outcomes were seen in 69/80 (87%). Patients with failure were managed with optical internal urethrotomy (OIU). Uroflowmetry and obstructive symptoms significantly improved and sexual function remained unaffected using IPG for SU.ConclusionsPreputial graft is a tissue familiar to the urologist, located very close to the surgical field, easily harvested and operated under regional anaesthesia. Overall success outcomes are acceptable to BMG urethroplasty.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00345-021-03613-9.

Novel use of Asopa technique for penile urethrocutaneous fistula repair.

To evaluate the feasibility of ventral urethrotomy, dorsal inlay (Asopa) technique in management of urethrocutaneous fistula. The Asopa technique has been employed for management of urethral stricture repair but has not been described in adult penile urethrocutaneous fistula. This is a retrospective review of IRB-approved databases of patients undergoing urethral reconstruction from two urologic reconstruction units. In this technique, the fistulous tract is circumscribed and excised, leaving a larger ventral urethral defect with healthy edges. The ventral-sagittal urethrotomy is extended, a dorsal urethrotomy made, and a graft inlaid dorsally to augment the urethral caliber prior to tension-free closure of the ventral urethrotomy. From 2010 to 2019, ten patients underwent repair of urethrocutaneous fistula using the Asopa technique. Median patient age was 33.5years (IQR 35.5). All fistulae involved penile urethra, eight had concomitant adjacent urethral stricture. Five patients failed prior hypospadias repair, three developed fistulae after surgery for penile urethral stricture, and two developed fistulae after extensive debridement (hidradenitis and Fournier's gangrene). Of these ten patients, oral mucosa graft was used in nine and preputial graft in one to augment the urethra. At median follow-up of 50.5months (IQR 26.5), 80% (8/10) of patients demonstrated durably patent urethra, with no recurrence of fistula. The Asopa technique is an established option for augmenting urethral caliber for urethral stricture disease. We demonstrate in our series that this technique can be applied to patients with urethrocutaneous fistulae.