The bioflowTM biodegradable stent for the treatment of bulbar urethral strictures: Initial clinical experience

590

589 THE BIOFLOWTM BIODEGRADABLE OF

BULBAR

URETHRAL

STENT FOR THE TREATMENT

STRICTURES:

INITIAL

CLINICAL

EXPERIENCE

Radoooulos

Gilling P., Kennett K., Westenberg A., Fraundorfer

Aristotle Greece

M.

Tauranga Hospital, Urology, Tauranga, New Zealand INTRODUCTION introduced

&

OBJECTIVES:

in the 1960’s as surgical

used for the treatment of strictures

Bioabsorbable

suture material.

polymers

& METHODS:

for over 15 years. A new poly-L-lactic

employed.

was performed

All patients were treated as day-case

procedures.

reassessed at 1,4, 8 and 12 weeks postoperatively assessment. RESULTS: treatment,

Cystoscopy

cystoscopically.

prior to stent placement.

A visual

No catheter was All patients were

with a flow rate and symptom

was repeated at 12 weeks.

The mean age was 71.4 years. 2 had undergone

Two patients

had had no prior

previous dilation and 1 a VIU. The mean stricture

length was 1.9cm and the median stent was 2.0cm. The mean peak flow rates were 25.3, 23.5, 17.0 and 20.0 ml/s at I, 4, 8 and 12 weeks respectively. fragments perineal

were still visible in all patients at 3 months. Mild symptoms discomfort

(n=l)

transient

hematuria

REPAIR OF HYPOSPADIAS GRAFT OR FLAP

WITH

D., Soteriades D., Kalyvas K., Papadopoulos

University

of Thessaloniki,

Department

CHORDEE

USING

A., Zoumpos J

of Urology,

Thessaloniki.

INTRODUCTION & OBJECTIVES: Proximal or middle penile hypospadias can be treated with a one-stage operative procedure and the aim of the repair is the recreation of a normal looking penis. Urethral defect after complete straightening of the penis is followed by urethroplasty performed with preputial skin, used as a tubed graft or flap.

acid

of short bulbar

The initial 5 patients are reviewed. All patients

had an isolated short (i2cm) bulbar stricture diagnosed internal urethrotomy

were

Urethral stents have been

braided expandable mesh stent (BioflowTM) for the management urethral strictures is presented. MATERIAL

ONE-STAGE PREPUTIAL

Stent include

(n=2) and post void dribbling

MATERIAL & METHODS: From March 19X4-Septemper 2002, a cohort of 98 patients (78 boys, aged 3- 11 years and 20 young adults, aged 17-38 years) suffering penile hypospadias with chordee (54 primary and 44 secondary). underwent one-stage repair. An artificial erection was used for the penis to be checked straight after chordee release, which was followed by preputial skin urethroplasty. The inner surface of the prepuce was used as a tubed graft (Horton-Devine procedure) in 63 cases (32 primary and 31 secondary) but Duckett’s procedure (preputial island tubed flap) was applied to the rest 35 and more recently treated patients (22 primary and 13 secondary). Among the latter there were 3 perineal primary hypospadias cases and a secondary case with long urethral defect, where the preputial skin tubed flap was combined with Dupley tube extension and with a tubed bladder mucosa graft, respectively. The above patients underwent a suprapubic diversion but a perineal urethrostomy was offered to the rest and a coffee cup dressing of the penis was used as well. RESULTS: Urethrocutaneous fistula formation, repaired by a second operation, was the most common complication, whose rate has changed since we have started covering the urethroplasty with a blanket from tunica vaginalis flap (May 1997). There were 28 fistulas among the 77 patients of the first group (rate 36.36%), but their rate formation was reduced to 19%. among the patients of the second group (4 fistulas in 21 cases).

(n=2). CONCLUSIONS: for an indwelling

The Bioflow ‘IMdegradable urethral catheter following

urethral stent obviates the need VIU. Longer-term

assessment

will

be required to assess stricture recurrence.

CONCLUSIONS: The one-stage repair of the middle or posterior hypospadias is surgically feasible and preputial skin can easily be applied as a graft or flap for the neo-urethra construction. We did not find any difference between the flaps or the grafts, which can be safely used, but we have found it easier to create the nco-urethra, applying the prepuce as an island tube flap.

591 SATISFACTION WITH FUNCTIONAL AND AFTER HYPOSPADIAS SURGERY: PATIENTS Bubani T.B.‘, Perovic S.V.‘, Milicevic

COSMETIC VIEW

R.‘, JOVCK S.‘, Djqic

D.:‘, Bojanovic

RESULTS

592 MANAGEMENT REPAIR

OF THE LATE COMPLlCATlONS

M.’

Kelemen Z., Pgnovics ‘University Childrens Hospital, Paediatnc Urology, Belgrade, Center. Chlldrens Hospital, Paediatric Urology, Nis, Yugoslavia

Yugoslavia,

MATERIAL & METHODS: Of 130 hypospadias patients operated on between 19x5 and 1990, 37 (mean age 27.8 years; 62.16% with distal, 16.22% with middle and 21.62% with proximal hypospadias) were included in our study. From 1999 to 2001 a standardized questionnaire consisting of 5 items was completed by participants. Satisfaction with genital aspect and surgical intervention was rated on a 5 marks scale with 5 being the best. Patients were asked to point out the most frequent motive of dissatisfaction and willingness for further improvement. RESULTS: Of the 37 hypospadias patients 52.17% with distal, 33.3% with middle and 75% with proximal hypospadias localised the urethral meatus on the top of the glans. In total, 54.05% of operated patients localised the urethral meatus on the top of the glans. 35.14% under the glans and 10.81% in the middle of the penile shaft. Ventral curvature during erection was noted by 40% of operated patients. When asked about satisfaction with achieved surgical results, 40.54% said that they were not satisfied. Surgical intervention was appraised by patients on a scale from I to 5 as follows: the best mark 5 was given by 18.92%; 4 by 54.05%; 3 by 24.3 ‘ 0 and 2 70”/of patients gave the mark I-complete dissatisfaction; mean score was K 86 The most frequent motives of dissatisfaction were scars (64.86%), the size of the penis (54.05%), voiding disturbances (40.54%), penile appearance (37.84%) and ejaculation problems (5.41%). Only 37.50% of patients with proximal hypospadias were satisfied with penile aesthetic appearance. Patients average score of penile appearance was 3 in a group with proximal, 3.25 in a group with middle and 3.59 in a group with distal hypospadias. Finally, 54.05% of patients wanted further surgical revision for improvement of whom almost 90% of patients with proximal hypospadias. CONCLUSIONS: Continuous evaluation of operated patients through adolescence and adulthood is of outmost importance for adequate judgement of accomplished surgical results. Patients should be asked if they are satisfied with the results of surgery and if not, what is the motive of their dissatisfaction. They should be thoroughly informed whether it could be feasible to improve accomplished results. Since the penile size was the second

most frequent motive of dissatisfaction in our study, the demand for normal function and aesthetic appearance should no longer be separated from the demand for the penile lengthening. Urology

Supplements

2 (2003) No. 1,

pp. 150

J., Nvirddv

P., Romics

1.

‘Clinical

INTRODUCTION & OBJECTIVES: Reports on long-term outcome of hypospadias surgery through a patients view are scarce and contradictory Our aimwas to evaluate patients’ judgement and satisfaction with achieved surgical results, the most frequent motive of dissatisfaction and willingness for further improvement. Their opinion is without any doubt essential to guide our future modifications in hypospadias surgery.

European

OF HYPOSPADIAS

Semmelwcis

University,

Urology. Budapest,

Hungary

INTRODUCTION & OBJECTIVES: Late complications are occurring eben after cosmetically satisfactory correction of hypospadias. Cripple hypospadiasis is a challenging problem for adult urologists. The aim of this study is to evaluate the clinical forms of complications and to present adequate surgical therapy in our practice. MATERIAL & METHODS: 50 patients were operated on between 1976 and 2002 for failed or unsatisfactory hypospadias repair. Primary surgery was done in different paediatric surgical units. Mainly. the causes of complications were either due to insufficient correction or to any postoperative complication. We could divide main problems leading to abnormality: curvature of the penis, urethral stenosis, defect of the neourethra and cosmetically not satisfied appearance. In majority of the cases more than one of these were present individually. We performed one stage procedure in IO patients. The majority of the patients were underwent two-stage procedure: 1. straightening and marsupialization of the urethra (Michalowskl methodl, II. Urethral reconstruction. RESULTS: Penile curvature disappeared or became insignificant in all cases. Urethral stricture recurrence occurred in 4 (10%) patients who underwent twostage procedure. However patients operated on one stage method 3 (33%) developed stricture. Although the external meatus was brought only to the inferior part of the glans, most of the patients could live normal sexual life. Furthermore they were also satisfied with cosmetic result. CONCLUSIONS: Patients who underwent unsuccessful hypospadias corrections in childhood can be successfully treated by two-stage redo reconstruction in adulthood. It is also strongly recommended for patients operated with hypospadias in childhood to visit adult urologist for later followup whether

their condition

is satisfactory

or not.