Preputial Graft Research Articles

Strictures and fistulas of the anterior urethra

– The first documents of urethral surgery for urethral strictures date back to the 4th century BC. In the past, endoscopic surgery was the best solution for most urologists. Nowadays, literature shows that the approach to urethral strictures depends on the degree of involvement of the spongy body. The choice of surgical reconstruction technique depends on the anatomical differences in the anterior portion of the urethra, which is divided anatomically into navicular, penile and bulbar. The gold standard for urethroplasty of the navicular urethra is the free graft which can take root due to the presence of glandular tissue. Techniques using a preputial pedunculated graft are good for penile urethra, while a free graft of preputial origin, that has first been perforated and then tubularised, is suggested for very long strictures (> 5 cm). Epidermal or mucosal free grafts can be used for bulbous urethral strictures, due to the presence of thick spongy tissue. The urethra should be completely substituted with a neo-urethra formed by preputial pedunculated and tubularised graft only for wide strictures with associated fibrosis of the spongy portion. Recurrent strictures can be treated twice with surgery.

Single-Stage Correction of Posterior Hypospadias (178 Cases). Comparison of Three Techniques: Free Skin Graft, Free Bladder Mucosal Graft, Transverse Pedicle Preputial Graft

Three techniques have been developed for single-stage repair of posterior hypospadias: free skin grafts, free bladder mucosal grafts, and pedicle preputial grafts. This multicenter retrospective study of 178 children who underwent surgery for posterior hypospadias was designed to compare the results achieved with these procedures. Free skin grafts (15 cases) resulted in the most frequent complications, and in particular the most severe strictures; in our opinion this technique should be abandoned. Pedicle preputial grafts (133 cases) gave the greatest number of successes from the outset, and should be preferred whenever the dimensions of the prepuce are sufficient for urethroplasty. Results with bladder mucosal grafts (30 cases) were not as good as with preputial grafts, but this technique remains the only solution when the meatus is in a very posterior position, and for children who have already undergone multiple operations.

Isolated penile burns: A plea for early excision

Abstract We report our experience of eight cases of isolated full thickness burns of the penis. Early excision of burns of the penile shaft and repair with a preputial flap or mesh split skin graft produces excellent results, with a reduction in complications and an early re-establishment of sexual function. Conservative treatment of burns of the glans, on the other hand, is appropriate and results in minimal scarring.

Free tunica vaginalis patch in urethroplasty. An experimental study.

The management of urethral strictures is a challenge for surgery. In the present study the value of tunica vaginalis tissue for urethroplasty was investigated. 30 male rabbits were divided into two groups. In group I (11 animals) a urethral defect was covered with a tunica vaginalis patch (n = 6) or was left uncovered (n = 5). In group II (19 animals) a preoperative urethral stricture was induced by electrocoagulation through a urethroscope. The strictured urethra was plastied with tunica vaginalis (n = 9) or preputial (n = 10) patches. The results were analyzed after a period of 2 weeks to 5 months with radiographic, macroscopic and microscopic methods. The tunica vaginalis graft showed its superiority over the preputial graft: only 1 postoperative short stricture from 15 plasties (6 normal and 9 strictured urethrae) was found in the plastied group, whereas 2 strictures from 10 plasties were seen in the preputial patch group. In the urethral defect group, strictures were seen in 2 of 5 animals. The mesenchymal tunica vaginalis epithelium was covered with thin transitiocellular-like epithelium resembling transitiocellular layers. The present study supports the earlier findings on the use of tunica vaginalis tissue in urethroplasty.