Urethral Defect Research Articles

To What Extent Buccal Mucosal Graft Can Shrink Immediately after Harvesting during Substitutional Urethroplasty for Stricture Urethra?

Introduction: Long segment stricture urethra is a difficult urological disease to treat. Substitutional urethroplasty utilising the Buccal Mucosal Graft (BMG) has shown promising results. Still up to one fourth of the patients can develop recurrence in the long term. Shrinkage of BMG immediately after harvesting, is a less studied phenomenon. It may compromise the tension free placement of BMG over the urethral defect, especially in long strictures. This may ultimately affect the final outcome. Aim: To study postharvest shrinkage of the BMG in patients undergoing substitutional urethroplasty. Materials and Methods: A prospective observational study was conducted during the study period from 2018 to 2020. All 18 patients of substitutional urethroplasty with BMG were enrolled. The baseline clinical profile was noted. Preharvest size of BMG was calculated and marked over the Buccal Mucosa (BM). Postharvest size was measured immediately after graft removal from the oral cavity. Changes in the donor area were also assessed. Alteration in BMG size and donor site area was analysed using paired t-test. Alterations in tobacco and non-tobacco users were compared using an unpaired t-test. Descriptive data were presented in the form of mean, range, percentage and standard deviation. Statistical analysis was completed using SPSS software, version 21.0 (IBM Corp, NY, USA). Statistical significance was kept below 0.05. Results: There were 18 cases which were finally available for analysis. Mean age was 32.9±14.2 years. Balanitis Xerotica Obliterans (BXO) was the most common aetiology. Pan-anterior stricture was found in 9/18 of cases. Mean pre and postharvest BMG size was 7.7×1.8 and 6.9×1.6 cm, respectively. An 8.8% decrease in length (p<0.001**) and 10.8% decrease in width of BMG (p<0.001**) occurred after harvesting, which were statistically significant. A significant Increase in the donor site area was also seen (18.5%, p<0.001**). Conclusion: A shrinkage of around 9% in the length and 11% of the width was seen in BMG after harvesting. The study suggests taking an extra 10% of measured size of BMG, in order to compensate for the expected shrinkage. The donor site area also increases and can be left open to heal by itself.

325 Does Urethral Repair Prevent Complications from AUS Cuff Erosions? A Decade of Experience

Artificial Urinary Sphincter (AUS) cuff erosion occurs in 8.5% of cases and requires removal of the device.1 Management options include urethral catheter placement alone or in situ urethroplasty (ISU) at the time of explant. It has previously been reported that stricture rates are higher in patients managed with catheter placement alone versus ISU (85% v 35% respectively)2. To determine the stricture rate in patients who undergo ISU after AUS cuff erosion in a large tertiary referral practice. We performed a retrospective cohort study of patients who underwent AUS removal by a single surgeon, secondary to erosion, from January 2006 to June 2019. We identified those who were managed with ISU at the time of explant. The electronic medical records were reviewed for patient demographics, operative details, and development of stricture at follow up. The degree of urethral erosion was defined by percent of urethral circumferential defect noted intra-operatively or on pre-operative cystoscopy. Urethral patency was studied at follow up with voiding cystourethrogram, retrograde urethrogram or cystoscopy.

Comparative study of one-stage and partial staged urethroplasty using transected urethral plate plus TIPF for severe hypospadias: a one-doctor experience

To explore the application value of staged urethroplasty by tubularization of reconstructed urethral plate using preputial island flap for severe hypospadias. We retrospectively analyzed 91 cases with severe hypospadias, using one-staged and two-staged urethroplasty by tubularization of reconstructed urethral plate using preputial island flap. In one-staged group, the age of surgery was 7 months to 12 years old; the length of urethral defect was 3–5cm; the diameter of glans was 1.0–1.4cm. In two-staged group, the initial operation time was 7 months–12 years old; the length of the urethral defect was 3–5cm and the diameter of the glans was 0.8–2.5cm. There was no significant difference in the age of surgery, glans diameter and length of urethral defect between the two groups. In the one-staged group, 18 cases had urinary fistula, 1 case glans dehiscence, 1 case urethral diverticulum, and 1 case had urethral diverticulum and glans dehiscence at the same time. All of them were addressed by urinary fistula repair/urethroplasty. There was no urinary fistula after secondary urethroplasty in the two-staged group. Four cases had new urethral dehiscence at the glans. 2 of them were successfully managed by reoperation, and the other’s parents did not agree to reoperation. The success rate of the one-staged operation group was 62.50%, and the two-staged group was 88.57%. There was a statistically significant difference in the success rate between the two groups. Two-staged urethroplasty by tubularization of reconstructed urethral plate using preputial island flap can significantly reduce the incidence of urethral fistula for severe hypospadias, but may increase the number of operations in children who do not need staged surgery.

Tissue expander capsule as an induced vascular bed to prefabricate an axial vascularized buccal mucosa-lined flap for tubularized posterior urethral reconstruction: preliminary results in an animal model

Surgical repair of complex posterior urethral disruptions remains one of the most challenging problems in urology. The efficacy of using a tissue expander capsule as an induced vascular bed to prefabricate axial vascularized buccal mucosa-lined flaps for tubularized posterior urethral reconstruction in a rabbit model was tested. The experiments were performed in three stages. First, silicone tissue expanders were inserted into the groin to induce vascularized capsule pouch formation. Next, buccal mucosa grafts were transplanted into the newly formed capsular tissue supplied by axial vessels for buccal mucosa-lined flap prefabrication. Then, circumferential posterior urethral defects were created and repaired with the buccal mucosa graft (Group 1), the capsule flap (Group 2), and the prefabricated capsule buccal mucosa composite flap (Group 3). After surgery, notable contracture of the tubularized buccal mucosa graft was observed in the neourethra, and none of the rabbits in Group 1 maintained a wide urethral caliber. In Group 2, the retrieved neourethra showed little evidence of epithelial lining during the study period, and the lumen caliber was narrowed at the 3-month evaluation. In Group 3, the buccal mucosa formed the lining in the neourethra and maintained a wide urethral caliber for 3 months. The capsule may serve as an induced vascular bed for buccal mucosa-lined flap prefabrication. The prefabricated buccal mucosa-lined flap may serve as a neourethra flap for posterior urethral replacement.

Fistula recurrence after urethrocutaneous fistulectomy in children with hypospadias: risk factors

To study the risk factors of recurrence after primary urethrocutaneous fistulectomy in children with hypospadias. In the period from 2009 to 2019 sixty-three patients underwent a urethrocutaneous fistulectomy after hypospadias repair in our hospital. Patients were divided into two groups: group 1, patients with successful urethrocutaneous fistulectomy 51 (81.0 %) and group 2, children who had a failed urethrocutaneous fistulectomy 12 (19.0%). The study was analyzed retrospectively, according to the demographic factors of the patients, findings of the previous urethroplasty and location, type, meatal stenosis, postoperative stricture, and size of the urethrocutaneous fistula. All data were statistically analyzed on SPSS. The overall success rate of primary fistula repair was 81.0% (51 of 63 fistulae). Most recurrences (8 of 12 fistulas, 66.6%) occurred in fistula at the penoscrotal area. Demographic factors show no difference between the two groups age (p=0.501), weight (p=0.063), low body weight (p=0.454), BMI (p=0.924) and prematurity (p=0.381). Types of hypospadias (p = 0.007) and urethral defect length (p = 0.021) were identified by Student’s t-test as independent risk factors for failed outcome. Other factors such as meatal stenosis (p=0.431), postoperative stricture (p=0.587), location of the fistula (p=0.173), multiplicity (p=0.588) and size (p=0.530), were performed by Chi-square test and they also not significant. Type of hypospadias and urethral defect length are significant risk factors of secondary fistula recurrence after primary urethrocutaneous fistulectomy.

The application of dried amniotic membrane scaffold with adipose derived-mesenchymal stem cell seeding as graft in urethral reconstruction (experiment on rabbit)

BackgroundUrethral reconstruction has been a problem for a long time and is a major challenge for surgeons. Surgical management of urethral defects is still controversial because there is no synthetic material that is considered ideal as a substitute for the urethra. With the development of adipose-derived mesenchymal stem cells, this research aims to observe the difference between the use of dried amniotic membrane as a scaffold with and without mesenchymal stem cells seeding as graft in urethral reconstruction. MethodsThis research was a pure experimental research with a post-test only control group design using 24 male New Zealand white rabbits. The samples were divided into 3 groups: one control group, one scaffold (dried amniotic membrane) without stem cell seeding group, and one stem cell-seeded scaffold group. The rabbits were evaluated at 28 days after treatment and the results were analyzed using Chi-Square test. ResultsThe number of urethras that were healed were higher in stem cell-seeded scaffold compared to scaffold without stem cell seeding group (p < 0.05). ConclusionConsidering the promising result, application of dried amniotic membrane as a scaffold with adipose-derived mesenchymal stem cell seeding could be an option for urethral reconstruction.

Designing a multifaceted bio-interface nanofiber tissue-engineered tubular scaffold graft to promote neo-vascularization for urethral regeneration.

Reconstitution of urethral defects through a tissue-engineered autologous urethra is an exciting area of clinical urology research. Despite rapid advances in this field, a tissue-engineered urethra is still inaccessible to clinical applications because of the poor vascularization of the current scaffold materials, especially for the reconstruction of complex urethral defects. In this study, we report the preparation of multifaceted bio-interfacing tissue-engineered autologous scaffolds based on alternating block polyurethane (abbreviated as PU-alt), a kind of tubular scaffold with a hierarchical nanofiber architecture, flexible mechanical properties and a hydrophilic PEGylation interface capable of promoting adhesion, oriented elongation, and proliferation of New Zealand rabbit autologous urethral epithelial cells (ECs) and smooth muscle cells (SMCs) simultaneously, and also upregulating the expression of keratin (AE1/AE3) in ECs and contractile protein (α-SMA) in SMCs as well as the subsequent synthesis of elastin. Three months in vivo scaffold substitution of rabbit urethras displayed that the engineered autologous PU-alt scaffold grafts, with a coating rich in seed cell-matrix, could induce local neo-vascularization, facilitating oriented SMC remodeling and lumen epithelialization as well as patency. Our findings indicate a central role of the synergistic interplay of seed cell-matrix bio-interface and nano-topographic cues in the vascularized urethral reconstruction.

Bracka's Method of Proximal Hypospadias Repair: Preputial Skin or Buccal Mucosa?

To analyze treatment results of staged surgical repair of proximal forms of hypospadias according to Bracka's technique using preputial vs buccal grafts. We retrospectively reviewed 220 patients with proximal forms of hypospadias treated with Bracka's urethroplasty technique. They were divided into 2 groups: Group I-108 patients treated with preputial skin grafts in 2001-2013; Group II-112 patients who underwent urethroplasty with buccal mucosa grafts in 2013-2016. Of the Group I patients with preputial skin grafts, complications were obtained in 33 (31%) cases; in Group II-23 (20%) cases. Complications include fistulas, defects of urethra, and scar contraction of grafts. The cosmetic results according to Hypospadias Objective Penile Evaluation scale were more satisfactory when buccal mucosa grafts were used. Further studies are needed to analyze the long-term changes posturethroplasty with both preputial skin and buccal mucosa grafts. This is one of the only studies to compare complications and histology of the 2 free grafts: preputial skin and buccal mucosa. This study affirms that a staged surgical method with the use of free grafts according to Bracka's technique is a successful method of treatment of proximal forms of hypospadias in children achieving good functional and cosmetic results with a relatively low rate of complications.

Stretchable collagen-coated polyurethane-urea hydrogel seeded with bladder smooth muscle cells for urethral defect repair in a rabbit model.

The major challenge to treat the clinical adverse effects of long-segment urethra is in achieving viable tissue substitution. The substituted construct's properties-such as its resilience, contraction, and ability to minimize scar-stenosis formation should be considered. In the present work, a unique polyurethane-urea (PUU) fibrous membrane is fabricated by electrospinning. Then PUU was coated by collagen and formed the elasticity hydrogel after immersed in collagen solution. Meanwhile, the cPUU hydrogel exhibited a fibrous microstructure. This cPUU hydrogel had outstanding stretching property with 404 ± 40% elongation at break compared with traditional hydrogels, which satisfied the requirement of urethra. The cPUU hydrogel also supported the adhesion and growth of bladder smooth-muscle cells (BSMCs) in natural state cell morphology. Urethral defects in New Zealand male rabbits were repaired with cPUU seeded with BSMCs in vivo. After three months, more smooth-surface area of reconstructed urethral tissues was observed in the cPUU hydrogel-BMSCs groups compared with that of the control group. The luminal patency and the incidence of complications-including calculus formation, urinary fistula, and urethral-stricture occurrence were significantly lower in the cPUU group compared with that of the control group. Hence, cPUU fibrous hydrogels are promising scaffolds for application in urological tissue engineering.

Urethral Defect in Setting of Recurrent Urethral Foreign Body Insertion

We present a case of recurrent episodes of foreign body insertion into the urethra, ultimately resulting in urethral defect at the penoscrotal junction. We have decided against treating the urethral defect as it facilitates nonoperative retrieval of the urethral foreign bodies. We present our experience and rationale for the clinical management of this complex patient.

The new etiology and surgical therapy of stress urinary incontinence in women

ObjectivesTo determine the subjective and objective cure rate of a urethral stabilization procedure (USP) for stress urinary incontinence (SUI) in women; to describe this new surgical intervention; to record its potential complications; to establish the SUI etiology. Study DesignThe author conducted a prospective case series study in ambulatory settings and under local anesthesia. Thirty-four consecutive women with uncomplicated SUI subjected to USP, which was performed by reconstructing site-specific defects within the urethral stabilizing mechanism (USM) and using no surgical slings, meshes or absorbable sutures. The paravaginal defect(s) was repaired by transvaginal approach. The endopelvic fascia was sharply separated from the ventral perineal membrane (VPM) just above the anterior urethral meatus. The vestibular bulbs sharply dissected from VPM and advance upwards. The VPM defect(s) reconstructed and vestibular bulbs placed back to the original location. The access to the peri- and the para-urethral region was created by making a lateral vertical incision, aside from the lateral urethral meatus and defects were repaired. The suburethral transverse incision was made beneath the urethral meatus and the stratum-by-stratum surgical dissection conducted until the lateral vaginourethral ligament is visualized bilaterally. The defect(s) within the vaginourethral ligaments was surgically reconstructed, and the vaginal wall repaired. The primary outcome measured subjective and objective cure rates, and the secondary outcome measured the occurrence of potential complications. The five-year postoperative follow-up was conducted. ResultsTwo out of thirty-four patients dropped-out from the study. The USP performed without difficulties, and no severe complication observed. One-subject developed superficial wound separation (3.1 %) and one-subject (3.1 %) developed urinary urge incontinence at the 5-postoperative-year. At 60-month follow-up subjective and objective cure rates were a 92 % and an 88 % respectively. ConclusionsThe urethral stabilization procedure yields a high degree of subjective and objective cure rates without severe complications and is a well-tolerated operation by women. The urethral stabilization procedure is a simple, easy to implement, and reproducible method for uncomplicated stress urinary incontinence in women. Site-specific defects within the urethral stabilizing mechanism constitute the etiology of the stress urinary incontinence in women.

Urethra-inspired biomimetic scaffold: A therapeutic strategy to promote angiogenesis for urethral regeneration in a rabbit model

Limited angiogenesis and epithelialization make urethral regeneration using conventional tissue-engineered grafts a great challenge. Consequently, inspired from the native urethra, bacterial cellulose (BC) and bladder acellular matrix (BAM) were combined to design a three dimensional (3D) biomimetic scaffold. The developed BC/BAM scaffold was engineered for accelerating urethral regeneration by enhancing angiogenesis and epithelialization. The BC/BAM scaffold reveals the closest mimic of native urethra in terms of the 3D porous nanofibrous structure and component including collagen, glycosaminoglycans, and intrinsic vascular endothelial growth factor (VEGF). In vitro studies showed that the bioinspired BC/BAM scaffold promoted in vitro angiogenesis by facilitating human umbilical vein endothelial cells (HUVECs) growth, expression of endothelial function related proteins and capillary-like tube formation. Effect of the BC/BAM scaffold on angiogenesis and epithelialization was studied by its implantation in a rabbit urethral defect model for 1 and 3 months. Results demonstrated that the improved blood vessels formation in the urethra-inspired BC/BAM scaffold significantly promoted epithelialization and accelerated urethral regeneration. The urethra-inspired BC/BAM scaffold provides us a new design approach to construct grafts for urethral regeneration. Statement of significanceFindings in urethral regeneration demonstrate that an ideal tissue-engineered urethra should have adequate angiogenesis to support epithelialization for urethral regeneration in vivo. In this study, inspired from the native urethra, a bioinspired bacterial cellulose/bladder acellular matrix (BC/BAM) scaffold was developed to promote angiogenesis and epithelialization. The designed scaffold showed the closest physical structure and component to natural urethra, which is beneficial to angiogenesis and regeneration of urethral epithelium. This is the first time to utilize BC and dissolved BAM to develop biomimetic scaffold in urethral tissue engineering. Our biomimetic strategy on urethra graft design provided enhanced angiogenesis and epithelialization to achieve an accelerated and successful rabbit urethral repair. We believe that our urethra-inspired biomimetic scaffold would provide new insights into the design of urethral tissue engineering grafts.

Application of branchedspongiosum repair in duckett surgery for hypospadias

Objective To explore the effect of reducing complication in branched spongiosum repair for hypospadias Duckett surgery. Methods Retrospective analysis was performed for the clinical data of 140 surgical infants with hypospadias Duckett surgery from January 2016 to April 2018. According to different covering materials on newly formed urethra, the experimental group (68 cases) cut dysplasia, branched spongiosum and lateral Buck′s fascia from tunica albuginea to coronary groove and then sutured over newly formed urethra, and the control group (72 cases) used Dartos fascia or subcutaneous fascia. The operative age, penile curvature, length of urethral defect, operation time, added value of coronary groove before and after operation, maximum urinary flow rate and complication rate of postoperative follow-up were compared between the two groups, and the therapeutic effect was analyzed. Results There was no statistically significant difference between two groups in operating time[(135±49)min vs.(135±45)min, P=0.580] and the value added of coronary sulcus[(0.1±0.2)cm vs.(0.1±0.1)cm, P=0.167]. In experimental group, there were 8 cases of urethra percutaneous fistula (11.8%) (coronary groove fistula in 3 cases, 4.4%)and 6 cases of urethral stenosis (8.8%) without urethral dehiscence. In control group, there were 18 cases of urethra percutaneous fistula (25.0%)(coronary groove fistula in 11 cases, 15.3%), 10 cases of urethral stenosis (13.9%), and 2 cases of urethral dehiscence (2.8%). The incidence of postoperative urinary fistula and total complications in experimental group was lower than that in the control group, and the difference was statistically significant (P 0.05). The maximum urine flow rate of experimental group at 6 months after surgery was significantly higher than control group[(9.5±3.8)ml/s vs.(6.8±2.8)ml/s], and the difference was statistically significant (P<0.001). Conclusions Urethral cavernosum reconstruction can significantly reduce the incidence of postoperative coronary groove fistula of hypospadias Duckett surgery and improve the postoperative urine flow rate. Key words: Hypospadias; Duckett; Urine flow rate; Follow up

Staged male genital reconstruction with a local flap and free oral graft: a case report and literature review

BackgroundMale genital skin loss is a common disease in urology. However, male genital skin loss accompanying a penile urethra defect is rarely reported. Herein, we describe a novel surgical technique using a composite local flap and oral mucosal graft to reconstruct the penis, which may provide a new solution for patients with similar conditions.Case presentationA 36-year-old male with a penile urethra defect and a large area of genital skin loss required urethral reconstruction. The meatus had descended to the penoscrotal junction. This procedure was divided into three stages. The first stage of the surgery involved burying the nude penile shaft beneath the skin of the left anteromedial thigh for coverage of the skin defect. The second stage consisted of releasing the penis and expanding the size of the urethral plate for further urethroplasty. The third stage consisted of reconstruction of the anterior urethra 6 months later. Postoperatively, the patient reported satisfactory voiding. The maximal flow rate (MFR) was 22.2 ml/s with no postvoiding residual urine at the 24-month follow-up visit. No edema, infection, hemorrhage, or cicatricial retraction were observed. The patient’s erectile function was satisfactory, and his international index of erectile function-5 score (IIEF-5 score) was 23 at the 24-month follow-up visit. Additionally, the presence of nocturnal penile tumescence demonstrated that he had normal erectile function.ConclusionsThis procedure is an effective surgical option for men with complete foreskin and penile urethra defects. It could also be extended as a treatment strategy when composite local or pedicle transposition flaps and free grafts are needed for specific patients.

Bioengineered Scaffolds as Substitutes for Grafts for Urethra Reconstruction.

Urethral defects originating from congenital malformations, trauma, inflammation or carcinoma still pose a great challenge to modern urology. Recent therapies have failed many times and have not provided the expected results. This negatively affects patients’ quality of life. By combining cells, bioactive molecules, and biomaterials, tissue engineering can provide promising treatment options. This review focused on scaffold systems for urethra reconstruction. We also discussed different technologies, such as electrospinning and 3D bioprinting which provide great possibility for the preparation of a hollow structure with well-defined architecture.

Drug-Delivering Nanoyarn Could Promote Effective Reconstruction of Functional Urethra in Dog by Inhibiting Wnt/Β-Catenin Signaling

Hypospadias and urethral stricture are common urological diseases which seriously affect voiding function and life quality of the patients. Current clinical treatments using autologous tissues or tissue engineered grafts often result in unsatisfactory clinical outcome with frequent complications at tissue-harvesting organ(s). In the present study, we performed RNA profiling (mRNA and miRNA sequencing) using urethral stricture animal model. Functional enrichment analysis of differential expressed genes showed that CTNNB1-centered Wnt signaling were significantly regulated during the scar formation and fibrosis, suggesting Wnt pathway as a promising therapeutic target for clinical treatment of urethral defects. In vitro experiments confirmed that ICG-001 (a well-established Wnt signaling inhibitor) could effectively prohibit fibroblast proliferation and the expression of fibrosis associated proteins. To testify whether inhibition of Wnt signaling could benefit tissue reconstruction from urethral defects in vivo, we applied a novel drug-delivering nanoyarn scaffold in urethroplasty in dog model, which could continuously deliver ICG-001 during the tissue reconstruction. The ICG-001 delivering nanoyarn could effectively promote urethral recovery and resume fully functional urethra within 12 weeks. Such attempts could be essential in the Next Generation Sequencing (NGS)-guided regenerative medicine to cure urethral defects and might be helpful for broader clinical applications in precision medicine.

Urethroplasty with a bilayered poly-D,L-lactide-co-ε-caprolactone scaffold seeded with allogenic mesenchymal stem cells.

Reconstructive surgery for urethral defects employing tissue-engineered scaffolds represents an alternative treatment for urethroplasty. The aim of this study was to compare the therapeutic efficacy of the bilayer poly-D,L-lactide/poly-ε-caprolactone (PL-PC) scaffold seeded with allogenic mesenchymal stem cells (MSCs) for urethra reconstruction in a rabbit model with conventional urethroplasty employing an autologous buccal mucosa graft (BG). The inner layer of the scaffold based on poly-D,L-lactic acid (PL) was seeded with MSCs, while the outer layer, prepared from poly-ε-caprolactone, protected the surrounding tissues from urine. To track the MSCs in vivo, the latter were labeled with superparamagnetic iron oxide nanoparticles. In rabbits, a dorsal penile defect was reconstructed employing a BG or a PL-PC graft seeded with nanoparticle-labeled MSCs. In the 12-week follow-up period, no complications were detected. Subsequent histological analysis demonstrated biointegration of the PL-PC graft with surrounding urethral tissues. Less fibrosis and inflammatory cell infiltration were observed in the experimental group as compared with the BG group. Nanoparticle-labeled MSCs were detected in the urothelium and muscular layer, co-localizing with the urothelium cytokeratin marker AE1/AE3, indicating the possibility of MSC differentiation into neo-urothelium. Our results suggest that a bilayer MSCs-seeded scaffold could be efficiently employed for urethroplasty.

Surgical treatment of pelvic fracture urethral distraction defects in boys: which approach is suitable?

Pelvic fracture urethral distraction defects (PFUDDs) are relatively infrequent in boys, and treatment for PFUDDs presents one of the most difficult problems in urological practice. Anastomotic urethroplasty is considered an ideal surgical procedure for PFUDDs in boys. However, various surgical approaches for anastomotic urethroplasty have been proposed, including a simple transperineal approach, a transperineal intercorporal septal separation approach, a transperineal inferior pubic approach, and a combined transpubic-perineal approach. This study aims to determine which surgical approach is best for PFUDDs in boys. We retrospectively identified 22 boys with PFUDDs aged 2–14 years who underwent anastomotic urethroplasty via different approaches between January 2008 and December 2017. Follow-up was performed in all the 22 patients for 6–123 (mean: 52.0) months. Finally, 20 of the 22 boys (90.9%) were successfully treated, including 1 of 2 patients treated with a simple transperineal approach, 3 of 3 with a transperineal approach with intercorporal septal separation, 14 of 15 with a transperineal inferior pubic approach, and 2 of 2 with a combined transpubic-perineal approach. Two patients had failed outcomes after the operation, and stenosis recurred. Based on the outcome of the 22 patients, we can draw a preliminary conclusion that most boys (20/22) can be treated with a transperineal inferior pubic approach or simpler procedures without the need of completely removing or incising the pubis. The combined transpubic-perineal approach can be used in cases of extremely long urethral distract defects.

PT021 - Gastro-urethroplasty for salvage of lengthy complex pelvic fracture urethral distraction defect: Long-term follow up

PT021 - Gastro-urethroplasty for salvage of lengthy complex pelvic fracture urethral distraction defect: Long-term follow up

PT023 - The sexual and continence outcome of patients with post anastomotic (end to end) urethroplasty for pelvic fracture posterior urethral distraction defects

PT023 - The sexual and continence outcome of patients with post anastomotic (end to end) urethroplasty for pelvic fracture posterior urethral distraction defects