Penile urethroplasty using Orandi's dorsal skin flap: a new technique
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01.11.2019 |
Barbagli G.
Joshi P.
Kulkarni S.
Butnaru D.
Sansalone S.
Lazzeri M.
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BJU International |
10.1111/bju.14881 |
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© 2019 The Authors BJU International © 2019 BJU International Published by John Wiley & Sons Ltd Objectives: To describe, step by step, a new one-stage dorsal skin flap urethroplasty for penile stricture repair. Materials and Methods: The surgery was accomplished through a midline incision on the ventral penile surface, the urethra was fully dissected from the corpora cavernosa and longitudinally opened along its dorsal surface. A penile skin island, based on the dartos fascia flap, was dissected and moved over the corpora cavernosa, and the urethra was moved and sutured over the penile skin flap. Results: Out of the 12 cases, 10 were classified successful and there were two failures. The operating time was 60 min. There was no postoperative fistula or urethral diverticulum. Conclusion: Our modified Orandi's technique was easy and feasible, and avoided fistula and diverticulum formation after repair.
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Complex radiology diagnostic at the pre and postoperative stages in patients with the reconstruction of the urogenital area using the method of microsurgical autotransplantation of tissue complexes
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01.01.2018 |
Schekoturov I.
Istranov A.
Serova N.
Ternovoy S.
Bakhtiosin R.
Adamyan R.
Matevosyan A.
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Russian Electronic Journal of Radiology |
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© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: To develop a technique for conducting of complex radiology diagnostics in combination with dynamic MSCT-cystureterography in patients with reconstruction of the urogenital area and to study the possibilities of its application in clinical practice. Materials and methods: At the pre and postoperative stages 8 patients were examined by MSCT, from whom all men were presented with such acquired and congenital diseases of the urogenital area as followings: stricture or obliteration of the urethra, as well as hypoplasia of the penis. The age of the patients varied from 33 to 58 years with the average of 43.8 years. The studies were performed by a multispiral computer tomograph Toshiba Aquilion One. This 640-slice computer tomograph has 320 rows of detectors with 0.5 mm wide, which allows the detector to cover the scan zone at 16 cm by one rotation of the X-ray tube. Results: By studying the data obtained in five cases, hypoplasia of the penis was revealed. In three cases urethral obstruction was diagnosed, its cause and localization were determined. At the pre and postoperative stages the anatomy of the donor and recipient vessels was assessed, surgical intervention was planned, and the dynamic MSCT-cystureterography method allowed avoiding invasive examination of the urethra. The MSCT method with intravenous contrasting in combination with dynamic MSCT-cystureterography surpasses the standard X-ray examination, ultrasound method and endoscopic urethroscopy at terms of accuracy and informativeness. In addition, these methods are separated in time and in the implementation techniques and most of them are not physiological. Conclusions: Analyzing the obtained data, we can confidently state that MSCT with intravenous contrast showed its high informative value in the study of donor and recipient vessels, and the combination with dynamic MSCT-cystureterography in order to assess the patient's urethra further increases the informativeness and value of this study. The proven effectiveness of the developed method suggests that it can become routine in examining patients with diseases of the urogenital area.
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Focus on Internal Urethrotomy as Primary Treatment for Untreated Bulbar Urethral Strictures: Results from a Multivariable Analysis
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01.01.2018 |
Barbagli G.
Fossati N.
Montorsi F.
Balò S.
Rimondi C.
Larcher A.
Sansalone S.
Butnaru D.
Lazzeri M.
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European Urology Focus |
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© 2018 European Association of Urology Background: The use of internal urethrotomy for treatment of urethral stricture remains a controversial topic in urology. Objective: To investigate outcomes and predictors of failure for internal urethrotomy as primary treatment for untreated bulbar urethral strictures. Design, setting, and participants: We performed a retrospective analysis of patients who underwent internal urethrotomy. Patients with bulbar urethral stricture who did not receive any previous treatment were included. Patients with traumatic, penile or posterior urethral strictures, lichen sclerosus, failed hypospadias repair, or stricture length >4 cm were excluded. Outcome measurements and statistical analysis: The primary outcome was treatment failure. Kaplan-Meyer plots were used to depict treatment failure–free survival. Univariate and multivariable Cox regression analyses were used to test the association between predictors (age, body mass index, diabetes, history of smoking, etiology, stenosis type and length, preoperative maximum flow [pQmax]) and treatment failure. Results and limitations: Overall, 136 patients were included. The median stricture length was 2 cm. Median follow-up was 55 mo. At 5-yr follow-up the failure-free survival rate was 57%. On univariate analysis, diabetes, nonidiopathic etiology, stricture length of 3–4 cm, and pQmax were significantly associated with treatment failure. These predictors were included in a multivariable analysis, in which pQmax was the only significant predictor of treatment failure. Conclusions: Failure of internal urethrotomy for untreated bulbar urethral strictures greatly depends on pQmax flow at uroflowmetry. Patients with pQmax > 8 ml/s have a high probability of success, while patients with pQmax <5 ml/s have a low probability of success. Patient summary: The use of internal urethrotomy in patients with an untreated bulbar urethral stricture should only be considered in selected cases. The use of internal urethrotomy in patients with untreated bulbar urethral stricture should be suggested only in selected cases.
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