Urethral Repair Research Articles

The effect of platelet-rich fibrin on the biological properties of urothelial cells

Urethral reconstruction presents a challenging issue in urology, primarily due to the limited availability of alternative materials for repair. The advancement of bioengineering technology has brought new hope to researchers, with a focus on the selection of appropriate biological scaffolds and seed cells. In order to find an ideal alternative material, we used platelet-rich fibrin as the bioscaffold and urothelial cells as the seed cells, meanwhile, we intended to investigate the effect of platelet-rich fibrin on the biological properties of urothelial cells. We transformed and characterised induced pluripotent stem cells into urothelial cells and prepared platelet-rich fibrin. Platelet-rich fibrin was cultured in a complex with urothelial cells to observe the effect of platelet-rich fibrin on the proliferation and migration ability of urothelial cells. The results showed that the induced pluripotent stem cells were successfully transformed into urothelial cells, platelet-rich fibrin was regularly arranged in cords, with platelets and other structures distributed between them, and the proliferation and migration of urothelial cells were significantly increased. These results suggested that platelet-rich fibrin is biocompatible with urothelial cells and it promotes the proliferation and migration of urothelial cells, which lays a good foundation for its use as an alternative material for urethral repair.

Constructing Mg-phytic acid enhanced hydrogel patch with janus structure for antibacterial and angiogenic urethral repair

Due to bacteria in urine and inadequate blood supply, urethral defect repair faces great clinical difficulties. Inspired by the natural structure of the urethra, in this study, we designed a multifunctional hydrogel urethral patch with a Janus structure. The inner layer was a double-network hydrogel of polyvinyl alcohol/carboxymethyl chitosan (PVA/CMCS) enhanced by natural phytic acid (PA) and Mg2+ (Mg2+-PA/PVA/CMCS). The outer layer was composed of poly (L-lactic acid) (PLLA) nanofibers to form a hydrophobic barrier, coupling via a micelle layer to ensure interfacial bonding. The patch exhibited mechanical properties matching soft tissues, with maximum tensile strength and toughness of 1.69±0.13 MPa and 24.7±0.9 MJ/m3, respectively, under the strengthening effect of Mg2+-PA chelation. Therein, the 4 % Mg2+-PA/PVA/CMCS composite patch could maintain unilateral hydrophobicity for at least 14 days and demonstrated an antibacterial rate of 99.0 %±0.1 % against E. coli. In PBS, the patch could deliver Mg2+ for at least 7 days and stabilize the surrounding pH environment for up to 28 days. In vitro cell experiments indicated that the 4 % Mg2+-PA/PVA/CMCS composite patch could promote the human umbilical vein endothelial cell (HUVEC) proliferation and migration, with the angiogenic protein expression enhanced more than 1.2 times compared with the Control group. In conclusion, the patch constructed in this study may provide a new approach to clinical urethral injury repair.

Efficacy and safety of laparoscopic urethral anastomosis in the repair of congenital urethral stricture in children: a systematic review

Introduction: Congenital urethral strictures are rare but significant defects in pediatric urology, causing urinary system abnormalities. These defects are difficult to manage in children due to differences in anatomy and physiology. Laparoscopic urethral anastomosis, a minimally invasive surgery, has become a popular option in pediatric urology.Objective: The research paper was aimed to assess the outcomes of laparoscopic urethral anastomosis in the pediatric patients with congenital urethral strictureMethods: This review article focuses on the effectiveness and safety of laparoscopic urethral anastomosis in pediatric patients. It includes studies focusing on pediatric patients, surgical outcomes, and published in peer-reviewed journals. Exclusions include adult populations, non-academic studies, non-academic methods, lack of adequate outcome data, and non-academic studies. Data integration and statistical evaluation are performed using a systematic review approach.Result: The studies were selected for the analysis, and the results showed that laparoscopic urethral repair is a secure method with positive postoperative results. The subcuticular uninterrupted suturing method exhibited a reduced complication rate compared to full-thickness interrupted stitches in distal hypospadias treatment. Various suturing methods such as close and open reported various complications. Interrupted suturing in the urological surgical procedure showed a tendency for reduced incidence of urethrocutaneous fistula development. The review indicated that urethral surgical intervention showed significant positive consequences.Conclusion: It was concluded that both interrupted and continuous suturing techniques were effective in treating pediatric patients with congenital urethral strictures. However interrupted suturing showed a potential benefit. The study highlighted the need for more large-scale, randomized controlled trials to validate these findings and improve surgical methodologies and postoperative outcomes

Analysis of the Pathogen Distribution and Antimicrobial Resistance after Plastic Surgery of the Urogenital System.

We aimed to summarize the distribution of pathogenic bacteria for postoperative infection of different genitourinary plastic surgery and the antimicrobial resistance of the major pathogens. Between January 2011 and December 2021, following plastic surgery of the urogenital system, microbial strains from infected patients were collected, identified, and counted. The antibiotic sensitivity and distribution characteristics of common pathogens in relation with the surgical procedures were studied by WHONET 5.6, along with the main bacteria accounting for early infection. A total of 76 cases were included in the study. Among these, 53 Gram-negative bacteria were detected, with Escherichia coli (18 of 53) and Pseudomonas aeruginosa (nine of 53) accounting for the majority. There were also 23 Gram-positive bacteria, among which Staphylococcus aureus (six of 23) and Coagulase-negative Staphylococcus (five of 23) were the most common. In terms of antimicrobial resistance, E. coli was highly sensitive to amikacin, piperacillin/tazobactam, cefoxitin, and imipenem, whereas P. aeruginosa was highly sensitive to gentamicin, amikacin, cefepime, piperacillin/tazobactam, imipenem, ceftazidime, and ciprofloxacin. Procedures for urethral repair, urethral reconstruction, and lump resection were most commonly associated with infection. Among these, urethral repair was responsible for the majority of infections. The pathogenic bacteria involved in postoperative infections varied overall, but the most prevalent was E. coli. Gram-negative bacteria are the major cause of infection following genitourinary plastic surgery. The specific bacterial strains, degrees of antimicrobial resistance, and length of infection varied among the various procedures. The results of this study may provide references for clinical medication and the prevention and control of such infections.

History and Determinant of Adult Neourethral Stricture After Hypospadias Repair in Childhood A Single Center Study Derived From a Single Procedure by a Single Surgeon

ObjectiveTo elucidate the incidence, presentation timing, and determinants of adulthood neourethral strictures after childhood hypospadias repair, using data from a database derived from a single procedure performed by a single surgeon. MethodsPediatric patients with hypospadias who underwent staged surgery using a foreskin-derived neourethra served as the Denominator population. Clinical data from adult neourethral stricture patients who re-visited us were analyzed. ResultsFourteen of 723 Denominator population (1.9%) revisited for adult neourethral stricture. The median age at completion of the initial hypospadias repair was 6 years (IQR 4–7). Seven patients (50.0%) underwent surgical interventions in childhood, and six (42.9%) had a history of childhood stricture surgery at the age of 4–17 years (median, 5.5). Strictures sites were meatal in 3 (21.4%), entire neourethra in 2 (14.3%), and junctional in 9 (64.3%), with a median length of 17.5 mm (IQR 15–25). Urethral self-dilation was initiated in nine patients. Eleven patients, including six initially treated with self-dilation, required open urethral repair. Time from childhood repair to stricture symptoms ranged from 18 to 34 years (median, 26.5). Median ages at urethral stricture symptoms, re-visit, and open urethral repair were 34 (IQR 25–38), 38.5 (IQR 32–45) and 45 years (IQR 37–53), respectively. Multivariate Cox hazard analysis identified childhood surgical intervention post-initial repair as the only significant risk factor for neourethral stricture (p<0.05). ConclusionsThese results highlight the importance of educating patients about the risk of late strictures following childhood hypospadias repair.

Evaluation of bi-layer silk fibroin grafts for onlay urethroplasty in a rabbit model of urethral stricture disease.

Background: Autologous tissues such as buccal mucosa (BM) are widely used for reconstruction of urethral strictures; however, limitations such as donor site morbidity and scarce tissue supply require the development of alternative biomaterials for urethral repair. The goals of this study were to determine the safety and efficacy of bi-layer silk fibroin (BLSF) matrices for urethral stricture repair and compare histological and functional outcomes to the standard approach, BM urethroplasty under good laboratory practices.Material and methods: A total of 13 rabbits exhibiting urethral stricture formation following electrocoagulation injury were treated with onlay urethroplasty with either acellular BLSF (N=7) or autologous BM (N=6) grafts for 3months. Uninjured control rabbits were maintained in parallel (N=4).Results and conclusion: Animals receiving BLSF implants were demonstrated to be functionally equivalent to BM grafts in their ability to restored strictured calibers, support micturition and promote tissue regeneration with minimal inflammation.

Multilayered hydrogel scaffold construct with native tissue matched elastic modulus: A regenerative microenvironment for urethral scar-free healing

The unsuitable deformation stimulus, harsh urine environment, and lack of a regenerative microenvironment (RME) prevent scaffold-based urethral repair and ultimately lead to irreversible urethral scarring. The researchers clarify the optimal elastic modulus of the urethral scaffolds for urethral repair and design a multilayered PVA hydrogel scaffold for urethral scar-free healing. The inner layer of the scaffold has self-healing properties, which ensures that the wound effectively resists harsh urine erosion, even when subjected to sutures. In addition, the scaffold's outer layer has an extracellular matrix-like structure that synergizes with adipose-derived stem cells to create a favorable RME. In vivo experiments confirm successful urethral scar-free healing using the PVA multilayered hydrogel scaffold. Further mechanistic study shows that the PVA multilayer hydrogel effectively resists the urine-induced inflammatory response and accelerates the transition of urethral wound healing to the proliferative phase by regulating macrophage polarization, thus providing favorable conditions for urethral scar-free healing. This study provides mechanical criteria for the fabrication of urethral tissue-engineered scaffolds, as well as important insights into their design.

The benefit of tissue sealant on urethroplasty in hypospadias patients - A systematic review and meta-analysis.

Hypospadias was ranked second after undescended testis as the most prevalent congenital abnormality in newborn males. Hypospadias can be successfully repaired through multiple surgeries in the majority of children. Postoperative complications were not rarely seen after surgeries, such as urethrocutaneous fistula (UCF), meatal stenosis, and glans breakdown. Tissue sealant application in hypospadias repair serves as additional suture line coverage and reduces the post surgery complications. However, the effects of sealants usage during urethroplasty are still uncertain. This review aimed to know the effects of tissue sealant usage on patients with hypospadias who undergo urethroplasty. The study was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Literature was searched on PubMed, Embase, and Scopus following PRISMA guidelines. The search was conducted on October 12th, 2021, using the search term ("glue" OR "sealants" OR "tissue glue" OR "tissue sealant" OR "tissue adhesive") AND ("hypospadias" OR "urethrocutaneous fistula" OR "urethral repair" OR "urethroplasty" OR "hypospadiology"). Systematic searching from all databases resulted in 160 potential articles. After a full-text review, eight articles were included in this study. Urethrocytaneous fistula complication was reported in all studies. The occurrence of complication reported by all studies was urethrocutaneous fistula. Several studies also reported tissue edema and flap-related complications. Tissue sealant had no significant effect in reducing meatal stenosis. This systematic review revealed additional benefits from several types of tissue sealant in hypospadias repair surgery. Fibrin sealant application over the urethroplasty suture line in hypospadias repair offers a water-proof coverage and may enhance the outcome from the surgery.

Four-dimensional hydrogel dressing adaptable to the urethral microenvironment for scarless urethral reconstruction

The harsh urethral microenvironment (UME) after trauma severely hinders the current hydrogel-based urethral repair. In fact, four-dimensional (4D) consideration to mimic time-dependent physiological processes is essential for scarless urethral reconstruction, which requires balancing extracellular matrix (ECM) deposition and remodeling at different healing stages. In this study, we develop a UME-adaptable 4D hydrogel dressing to sequentially provide an early-vascularized microenvironment and later-antifibrogenic microenvironment for scarless urethral reconstruction. With the combination of dynamic boronic ester crosslinking and covalent photopolymerization, the resultant gelatin methacryloyl phenylboronic acid/cis-diol-crosslinked (GMPD) hydrogels exhibit mussel-mimetic viscoelasticity, satisfactory adhesion, and acid-reinforced stability, which can adapt to harsh UME. In addition, a temporally on-demand regulatory (TOR) technical platform is introduced into GMPD hydrogels to create a time-dependent 4D microenvironment. As a result, physiological urethral recovery is successfully mimicked by means of an early-vascularized microenvironment to promote wound healing by activating the vascular endothelial growth factor (VEGF) signaling pathway, as well as a later-antifibrogenic microenvironment to prevent hypertrophic scar formation by timing transforming growth factor-β (TGFβ) signaling pathway inhibition. Both in vitro molecular mechanisms of the physiological healing process and in vivo scarless urethral reconstruction in a rabbit model are effectively verified, providing a promising alternative for urethral injury treatment.

Injectable Decellularized Extracellular Matrix-Based Bio-Ink with Excellent Biocompatibility for Scarless Urethra Repair.

In recent years, decellularized extracellular matrices (dECM) derived from organs have attracted much attention from researchers due to their excellent biocompatibility, capacity to promote cell proliferation and migration, as well as pro-vascularization. However, their inferior mechanical properties, slow cross-linking, weak strengths, and poor supporting properties remain their inevitable challenges. In our study, we fabricated a novel dECM hydrogel with better crosslinking strength and speed, stronger support properties, and better mechanical properties. The hydrogel, which we named gelatin-based dECM powder hydrogel (gelatin-dECM hydrogel), was prepared by mixing dECM microparticles in gelatin solution and adding certain amount of 1-Ethyl-3-(3-dimethyl-aminopropyl-1-carbodiimide) (EDC) and N-hydroxysuccinimide (NHS). We evaluated the utility of this hydrogel by assessing the degradation rate, mechanical properties, and biocompatibility. The results showed that the gelatin-dECM hydrogel has high mechanical properties and biocompatibility and also has the ability to promote cell proliferation and migration. After injection of this hydrogel around the surgical sites of urethras in rabbits, the incorporation of dECM powder was demonstrated to promote angiogenesis as well as scarless repair by histological sections after surgery. The application of this novel hydrogel provides a new perspective for the treatment of post-traumatic urethral stricture.

Urethral Microenvironment Adapted Sodium Alginate/Gelatin/Reduced Graphene Oxide Biomimetic Patch Improves Scarless Urethral Regeneration.

The nasty urine microenvironment (UME) is an inherent obstacle that hinders urethral repair due to fibrosis and swelling of the oftentimes adopted hydrogel-based biomaterials. Here, using reduced graphene oxide (rGO) along with double-freeze-drying to strengthen a 3D-printed patch is reported to realize scarless urethral repair. The sodium alginate/gelatin/reduced graphene oxide (SA/Gel/rGO) biomaterial features tunable stiffness, degradation profile, and anti-fibrosis performance. Interestingly, the 3D-printed alginate-containing composite scaffold is able to respond to Ca2+ present in the urine, leading to enhanced structural stability and strength as well as inhibiting swelling. The investigations present that the swelling behaviors, mechanical properties, and anti-fibrosis efficacy of the SA/Gel/rGO patch can be modulated by varying the concentration of rGO. In particular, rGO in optimal concentration shows excellent cell viability, migration, and proliferation. In-depth mechanistic studies reveal that the activation of cell proliferation and angiogenesis-related proteins, along with inhibition of fibrosis-related gene expressions, play an important role in scarless repair by the 3D-printed SA/Gel/rGO patch via promoting urothelium growth, accelerating angiogenesis, and minimizing fibrosis in vivo. The proposed strategy has the potential of resolving the dilemma of necessary biomaterial stiffness and unwanted fibrosis in urethral repair.

Immediately repaired penile fractures: age is the only predictor of postoperative long-term functional outcomes.

Penile fractures can lead to many functional complications, especially erectile dysfunction (ED). Few studies have evaluated the factors that predict late complications of an immediately repaired penile fracture. To identify the potential predictors of long-term poor functional outcomes following immediate surgical intervention for penile fractures. Sixty-eight consecutive patients with suspected penile fracture between 2003 and 2022 were retrospectively reviewed. Functional outcomes, postoperative complications, and follow-up duration were obtained from the records of follow-up visits. Age at presentation, location and length of the tunical tear, the presence of urethral rupture, and time to surgery were all analyzed as potential risk factors for postoperative functional outcomes. Postoperative erectile function and intercourse satisfaction were measured by the IIEF-5 (the 5-item version of the International Index of Erectile Function). Penile curvature, a palpable nodule, and paresthesia/numbness were detected by physical examination. Uroflowmetry was used to assess urinary flow in patients who underwent urethral repair. Fifty-eight patients were analyzed. The mean ± SD age was 38.1 ± 10.4years; the median follow-up was 79.0 months (range, 13-180); the median time to surgery was 9.8 hours (4-30); and the median tunical tear length was 15.5 mm (4-40). Urethral rupture was observed in 8 patients (13.8%). In univariable analyses, urethral rupture was associated with postoperative complications (P = .034). In addition, age at presentation and tunical tear size were significantly associated with postoperative complications and ED (P < .05). However, in multivariable analyses, only age at presentation significantly predicted postoperative complications and ED (P = .004 and P = .037). Age at presentation is the most important factor determining the prognosis of immediate surgical repair of the penile fracture, which aids in predicting potential complications and discussing them with patients prior to surgical intervention and during the follow-up period. The study's retrospective design is an important limitation. Furthermore, there were no data on an IIEF-5 outcome measuring preoperative erectile function. These results revealed an association between (1) urethral rupture, longer tunical tears, and older age and (2) the development of late complications. The remarkable finding of this study was that age at presentation was the only significant predictor of functional complications based on multivariable analyses. This relationship also remained robust in tests evaluating the covariance of the effects of aging on ED.

MP78-15 MANAGEMENT AND OUTCOMES OF ILEAL POUCH-URETHRAL FISTULAS

You have accessJournal of UrologyCME1 Apr 2023MP78-15 MANAGEMENT AND OUTCOMES OF ILEAL POUCH-URETHRAL FISTULAS João Pedro Emrich Accioly, Marianna Maspero, Hanson Zhao, Roger K. Khouri, Olga Lavryk, Kenneth W. Angermeier, Tracy Hull, and Hadley M. Wood João Pedro Emrich AcciolyJoão Pedro Emrich Accioly More articles by this author , Marianna MasperoMarianna Maspero More articles by this author , Hanson ZhaoHanson Zhao More articles by this author , Roger K. KhouriRoger K. Khouri More articles by this author , Olga LavrykOlga Lavryk More articles by this author , Kenneth W. AngermeierKenneth W. Angermeier More articles by this author , Tracy HullTracy Hull More articles by this author , and Hadley M. WoodHadley M. Wood More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fistulas may develop following ileal pouch anal anastomosis (IPAA), but urinary tract involvement in this setting is rare. We thus aim to describe our experience with the management of ileal pouch-urethral fistulas (IPUF) following restorative proctocolectomy with IPAA. METHODS: We retrospectively identified patients with documented IPUF managed at our institution from a urethral fistula cohort through keywords and procedure codes. In a retrospective medical record review, we obtained demographic, clinical and operative data, including diagnostic methods, individual management strategies and outcomes and described our findings. RESULTS: We identified thirteen patients with a diagnosis of IPUF managed from 2005–2022. Median age at IPAA was 29 years (range 11–53). Indications for IPAA included familial adenomatous polyposis (n=3) and ulcerative colitis (n=10). Interval events included IPAA dilations (n=5) and dual radiation therapy for prostate cancer (n=2). Median time from IPAA to fistula diagnosis was 15 years (range 0.5–38.5). Initial management consisted of urinary diversion with either suprapubic tube (n=6) or Foley catheter (n=1) and fecal diversion with either loop (n=8) or end ileostomy (n=3); five had dual urinary/fecal diversion. Four patients experienced resolution with either urinary (n=2) or fecal (n=2) diversion alone. Eight patients eventually required pouch excision and end ileostomy, of which seven underwent concomitant urethral repair. Gracilis muscle interposition was employed in addition to primary closure in five patients. Only one patient successfully underwent re-do IPAA. With a median follow-up of 4 years (range 0.3–13 years), all patients had resolution of their fistulas without recurrence. CONCLUSIONS: IPUFs are an uncommon complication of IPAA. In this cohort, all patients had urinary tract preservation, but in most instances, permanent fecal diversion was necessary. These results can help guide management of this complex issue. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1137 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information João Pedro Emrich Accioly More articles by this author Marianna Maspero More articles by this author Hanson Zhao More articles by this author Roger K. Khouri More articles by this author Olga Lavryk More articles by this author Kenneth W. Angermeier More articles by this author Tracy Hull More articles by this author Hadley M. Wood More articles by this author Expand All Advertisement PDF downloadLoading ...

V09-04 REPAIR OF URINARY INCONTINENCE AND VENTRAL DEHISCENCE AFTER MASCULINIZING GENITAL GENDER AFFIRMATION SURGERY

You have accessJournal of UrologyCME1 Apr 2023V09-04 REPAIR OF URINARY INCONTINENCE AND VENTRAL DEHISCENCE AFTER MASCULINIZING GENITAL GENDER AFFIRMATION SURGERY Joshua Sterling and Dmitriy Nikolavsky Joshua SterlingJoshua Sterling More articles by this author and Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003317.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stress urinary incontinence (SUI) is an infrequently reported complication following transmasculine genital gender affirming surgery (gGAS), thus far there are no reports to help with management of severe SUI post gGAS. In this video, we demonstrate a case of de novo SUI following vaginectomy and metoidioplasty. These were treated with autologous fascial sling and staged urethral repair. METHODS: Patient is a 22 year old transgender male who underwent vaginectomy and metoidioplasty and developed severe SUI. Three months of pelvic therapy improved incontinence to 168g daily. He was referred for treatment of SUI and correction of ventral shaft dehiscence. Stage-1 included placement of an autologous fascial retropubic sling, and stage 1 urethroplasty with buccal mucosa graft (BMG). In the time interval before the Stage 2, the patient was monitored for evidence of recurrent SUI or urinary retention. Stage 2 involved tubularization of the neourethra. The procedure was done in dorsal lithotomy position. Perineum (site of prior vaginectomy) and previously created pars fixa were opened ventrally. Using the balloon of the Foley at the bladder neck as a palpable landmark, the native urethra and the bladder neck were dissected to the inferior aspect of the pubic symphysis. A 1.5x8cm segment of rectus fascia was harvested for the autologous sling. Full length 2-0 polypropylene suture was secured to either end of the fascial sling and delivered retropubicly to the abdominal incision from the perineal incision using a fine tonsil clamp. The sling was appropriately tensioned and secured. Ventral penile chordee was released sharply and a stage 1 urethroplasty was performed with dorsal BMG inlay. After a 6-month delay the patient did not show any signs of recurrence of SUI or retention and the Stage 2 urethroplasty was performed. The patient's urethral plate was augmented with an additional BMG to achieve 3cm width. The neourethra was tubularized and the neophallus was closed in multiple layers with non-overlapping suture lines. RESULTS: The procedure resulted in the successful repair of the patient’s SUI and metoidioplasty shaft dehiscence. The patient achieved durable social continence (completely dry) with normal voiding patterns and low residuals after placement of autologous retropubic sling. CONCLUSIONS: SUI is a real and devastating complication following masculinizing gGAS. Here we show it can be safely and effectively treated using an established pelvic floor reconstructive technique for a new indication. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e837 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Sterling More articles by this author Dmitriy Nikolavsky More articles by this author Expand All Advertisement PDF downloadLoading ...

Ascorbic Acid 2-Phosphate-Releasing Supercritical Carbon Dioxide-Foamed Poly(L-Lactide-Co-epsilon-Caprolactone) Scaffolds Support Urothelial Cell Growth and Enhance Human Adipose-Derived Stromal Cell Proliferation and Collagen Production

Tissue engineering can provide a novel approach for the reconstruction of large urethral defects, which currently lacks optimal repair methods. Cell-seeded scaffolds aim to prevent urethral stricture and scarring, as effective urothelium and stromal tissue regeneration is important in urethral repair. In this study, the aim was to evaluate the effect of the novel porous ascorbic acid 2-phosphate (A2P)-releasing supercritical carbon dioxide-foamed poly(L-lactide-co-ε-caprolactone) (PLCL) scaffolds (scPLCLA2P) on the viability, proliferation, phenotype maintenance, and collagen production of human urothelial cell (hUC) and human adipose-derived stromal cell (hASC) mono- and cocultures. The scPLCLA2P scaffold supported hUC growth and phenotype both in monoculture and in coculture. In monocultures, the proliferation and collagen production of hASCs were significantly increased on the scPLCLA2P compared to scPLCL scaffolds without A2P, on which the hASCs formed nonproliferating cell clusters. Our findings suggest the A2P-releasing scPLCLA2P to be a promising material for urethral tissue engineering.

Periurethral and Anterior Vaginal Wall Masses: Etiology, Presentation, and Treatment Outcomes

ABSTRACT Periurethral and anterior vaginal masses are relatively common with an estimated prevalence of 3% to 4% and 1%, respectively. These masses often cause diagnostic challenges due to nonspecific and overlapping symptoms. Urinary symptoms include frequency, urgency, and dysuria; vaginal discharge, urinary tract infection (UTI), dyspareunia, bleeding, postvoid dribbling, pelvic and urethral pain, and palpable mass can also present. Familiarity with differentiation of masses is important to make timely diagnoses and to expedite treatment without delays. This study aimed to describe the etiology of periurethral and anterior vaginal wall masses in a large series, as well as report the clinical presentations to determine whether the differential diagnosis can be narrowed based on presenting symptoms. The study consisted of a retrospective chart review, based on charts of patients from November 2001 to July 2021 at a tertiary referral center. Analyzed data included age, body mass index, operative findings, operative time, concomitant procedures, pathologic diagnosis, catheterization time, complications, length of stay, symptoms on follow-up, and follow-up duration. Describing the etiology of periurethral and anterior vaginal wall masses was the primary objective of the study (including underlying etiology distribution), followed by the secondary objective of describing rates of other clinical characteristics. A systematic search of literature was performed using various databases: MEDLINE (Ovid), Cochran Central Register of Controlled Trials (Wiley Online Library), EMBASE (Elsevier), and Scopus. The study included a total of 126 patients, all with at least 1 symptom exhibited. The most common presenting symptoms were palpable mass, dyspareunia, and urinary tract symptoms (dysuria, stress urinary incontinence [SUI], and UTI). There was an infection rate of 21.4% and a malignancy rate of 1.6%. Each patient underwent surgical treatment, including urethral repair, periurethral cyst excision, urethral diverticulectomy, and lesion excision. A total of 29.4% of patients reported SUI preoperatively. Postoperatively, 105 patients reported no incontinence (83.3%), 15 reported SUI (11.9%), 5 reported mixed urinary incontinence (4%), and 1 presented with overflow incontinence (0.8%). Limitations of the study include the prospective collection of data but its retrospective analysis, thereby limiting findings according to the accuracy and completeness of the medical records. In addition, there was an absence of patient-reported outcome measures when SUI or other symptoms were assessed, and the authors recognize a need for future prospective studies to include such outcome measures. This large series evaluation of periurethral and anterior vaginal wall masses is the largest of its kind, as the previous study included only 79 patients with periurethral masses, 96% of whom had definitive pathological diagnoses and surgical treatment. This study provides a broad view into the etiological spectrum underlying periurethral and anterior vaginal masses. Malignancy is rare. Infectious pathology is common and found in 21.4% of patients, whereas urethral diverticulum was the most common pathology (40% of cases). Finally, this study indicated high success rates for surgical excisions, as there were no recurrences among diverticula patients in the study. For Skene’s gland cyst excisions, a recurrence rate of less than 1% was noted.

Management of complex urethral stricture in public health facilities in developing nations in the 21st century

Management of complex urethral stricture in public health facilities in developing nations in the 21^st century

Komplet üretra rüptürüyle birlikte olan penil fraktür

Penile fracture with complete urethral rupture OBJECTIVES: Penile fracture is a trauma that develops as a result of the rupture of the corpus cavernosum by forcing the erect penis to bend and twist and requires emergency surgery. Urethral trauma accompanies penile fracture in 1–40% of cases. In this study, we aimed to present a case of penile fracture with complete urethral rupture. CASE REPORT: A 51-year-old male patient presented to the emergency service with the complaints of sudden loss of erection, bruising and pain in the penile shaft after a cracking sound during coitus. Physical examination revealed limited ecchymosis and swelling in the penile shaft and hemorrhage in the external urethral meatus. Urethrography was performed on the patient due to urethrography. On urethrography, it was observed that there was contrast extravasation from the middle urethra. The patient was operated in the early period. In the midpenile region, it was observed that there were ruptures of approximately 1 cm in both corpus cavernosum and complete rupture in the urethra. Cavernosal ruptures and urethral rupture were repaired. At the postoperative 6th month follow-up, the patient had no erectile dysfunction and voiding symptoms. CONCLUSIONS: The “crackling sound” heard during coitus, severe pain and penile detumescence are typical clinical findings of penile fracture. If there are symptoms of bleeding in the meatus, hematuria and difficulty in voiding, urethral trauma should be considered. In these patients, urethral repair is also required during the operation. Keywords: penile fracture, urethral rupture, urethrorrhagia

Penetrating trauma to scrotum and penis caused by a gunshot in 17-year old man: A case report

Penetrating trauma to male external genitalia is a rare trauma case. It accounts for 20% of all genitourinary trauma cases, and penile involvements are presented between 10- 16% of all cases. Male genital trauma is considered a urological emergency due to the high risk of infection, sexual dysfunction, and infertility. In this work, a 17-year-old male patient presented with scrotal and penile injuries due to a low-velocity gunshot wound. Genital examination revealed tissue loss in the foreskin, glans, anterior urethra (distal third), cavernous corpora, and total loss of right testis with a scrotal laceration. The patient was treated with partial penectomy, penile reconstruction, and urethral repair with an excellent uneventful postoperative cosmetic and functional outcome. In conclusion, penetrating male external genital injuries are rare with extremely serious consequences due to the functional, psychological, and aesthetic consequences. The best treatment with penile reconstruction and urethral and cavernous corpora repair may be achieved.

Transperineal bulbovesical anastomosis for extensive posterior urethral stenoses after treatment of prostatic disease.

We report our surgical experience of transperineal bulbovesical anastomosis (BVA) for extensive posterior urethral stenosis (PUS). Six male patients who had extensive PUS extending from the bulbomembranous urethra to the bladder neck due to prostatic disease treatment and underwent transperineal BVA between 2014 and 2020 were retrospectively reviewed. BVA was performed according to the elaborate perineal approach for pelvic fracture urethral repair with minor modifications. After confirming the absence of recurrent stenosis 6 months postoperatively, the patients were offered artificial urinary sphincter (AUS) placement for subsequent urinary incontinence (UI). Median patient age was 68, and the etiology of PUS was radical prostatectomy for prostate cancer in four patients, brachytherapy for prostate cancer in one, and transurethral resection of the prostate for benign prostatic hyperplasia in one. All patients had been previously treated with multiple transurethral procedures such as urethrotomy and dilation. Median operative time and blood loss were 211 min and 154 ml, respectively. Five cases (83.3%) had no recurrent stenosis with a median follow-up of 45 months, but a single direct vision internal urethrotomy was performed in one (16.7%) due to restenosis. Four (66.7%) patients underwent AUS placement via transcorporal approach for subsequent UI, but two had it removed due to urethral erosion. Transperineal BVA could effectively manage extensive PUS after prostatic disease treatment. Staged AUS placement could be a viable option for subsequent UI, but the risk of urethral erosion seemed high.