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101 TOTAL PHALLOPLASTY USING MUSCULOCUTANEOUS LATISSIMUS DORSI FLAP - EXPERIENCE IN 92 PATIENTS
Vol. 185, No. 4, Supplement, Saturday, May 14, 2011
THE JOURNAL OF UROLOGY姞
100
101
RESULTS AND RENAL FUNCTION SIX MONTHS AFTER CONSERVATIVE TREATMENT OF SEVERE GRADE IV AND V BLUNT RENAL TRAUMA: A PROSPECTIVE EVALUATION
TOTAL PHALLOPLASTY USING MUSCULOCUTANEOUS LATISSIMUS DORSI FLAP - EXPERIENCE IN 92 PATIENTS
Gaelle FIARD*, Jean-Alexandre LONG, Nicolas TERRIER, Caroline THUILLIER, Marine CHODEZ, Alexis ARVIN-BEROD, Valentin ARNOUX, Jean-Luc DESCOTES, Jean-Jacques RAMBEAUD, Grenoble, France INTRODUCTION AND OBJECTIVES: A prospective multi-center study was set up to evaluate the results and relative renal function 6 months after conservative treatment for severe blunt renal trauma (grades IV or V). METHODS: From January 2004 to april 2010, 88 patients were admitted to a center of the French Alps with a grade IV or V blunt renal trauma (confirmed on CT scan). Conservative treatment was allowed in 79 cases (90%). Mean age was 27 (10 –70). The lesions were classified according to the AAST classification, grade IV in 69 cases (including 51 with urinary extravasation), and grade V in 10 cases. Their management required endoscopic drainage in 21 cases, selective arterial embolization in 10 cases, 3 attempted endovascular revascularisation (angioplasty⫹/⫺stenting), and a mean transfusion rate of 1 red blood cell unit (0 –10). RESULTS: An evaluation of the relative renal function with renal scintigraphy was available in 22 patients (28%), 4 grades V and 18 grades IV. The mean relative function of the traumatized kidney was 34%, and 39% in grades IV (15–50%). Considering grade V traumas, 2 kidneys showed no remaining function, the other 2 had a relative function of 20% and 25%. No arterial hypertension was noted during follow-up. Mean hospital stay was 16 days. The mean hospital stay of grade V traumas treated conservatively (14 days) was significantly shorter when compared to the nephrectomy group (24 days, p⫽0,032). CONCLUSIONS: Our attitude of first-line conservative treatment for grade IV blunt renal trauma provides excellent results at 6 months. On the other hand, conservative treatment of grade V trauma provides mixed results regarding renal function, but a major benefit in terms of hospital stay, without clinical consequences at 6 months.
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Rados Djinovic*, Sasa Tomovic, Belgrade, Yugoslavia; Salvatore Sansalone, Rome, Italy; Marko Milosavljevic, Vladislav Pesic, Nikola Stanojevic, Miodrag Lazic, Belgrade, Yugoslavia INTRODUCTION AND OBJECTIVES: We present total phalloplasty in children and adults using latissimus dorsi free flap for creation of large neophallus that allow easy performance of urethroplasty and prosthesis implantation. METHODS: In the period from April 1999 to January 2010 total phalloplasty is performed in 92 patients aged between 10 and 46 yr (mean 34 yr). Indications were: congenital anomalies (9), iatrogenic injury (7) or accidental (6) trauma and transsexualism (71 patients). The flap is harvested on subscapular artery, vein and thoracodorsal nerve. Neophallus is created on site, transferred to the pubic region and anastomozed with femoral artery, saphenous vein and ilioinguinal nerve. Two-stage urethroplasty is performed in 77 patients using only buccal mucosa alone (12) or combined with split thickness skin graft (65). Donor site was closed directly in 23 patients, while in the remaining 4 split thickness skin graft was used. Inflatable prsthesis was implanted in 31 and semi-rigid in 43 pts. RESULTS: Follow-up was 9 months to 11 years. Penile size varied from 13 to 19 cm in length and from 12 to 15 cm in circumference. Total flap necrosis occurred in 2 and partial in 3 patients. The donor site healed good in 34 pts, acceptably in 53, while in the remaining 12 mild to moderate moderate scarring occured. Two urethral dehiscences, 11 uretrocutaneous fistulas and 13 urethral stenosis developed that were successfully treated surgically. Function of implanted penile prostheses is satisfactory. CONCLUSIONS: Musculocutaneous latissimus dorsi flap provides excellent neophallus size, good aesthetic appearance, easy implantation of penile prosthesis and urethroplasty. It can be also used successfully in pediatric population. Source of Funding: None
102 TOTAL PENILE SIZE AND SHAPE RESTORATION IN DIFFERENT DEFORMITIES CAUSED BY IPP IN 98 PATIENTS Rados Djinovic*, Sasa Tomovic, Belgrade, Yugoslavia; Salvatore Sansalone, Rome, Italy; Marko Milosavljevic, Vladislav Pesic, Nikola Stanojevic, Miodrag Lazic, Belgrade, Yugoslavia
Source of Funding: none
INTRODUCTION AND OBJECTIVES: To report the results of penile re-sculpturing of different deformities caused by M. Peyronie: restoration of penile length, girth and shape with or without penile prosthesis implantation. METHODS: In the period between February 2007 and March 2009, we performed grafting surgery for M. Peyronie in 98 patients aged between 24 and 72 years (mean 52 years). Penile deformities were diferent: dorsal curvature in 54 (54%), lateral in 7 (7%), ventral in 11 (11%), and combined curvature in 21 (22%); corporal narrowing in 24 (27%). All patients presented penile shortening combined with other deformities, but 4 (4%) patients had only penile shortening. Isolated diffuse corporal narrowing was in two (2%) patients, without any other deformities. Severity of curvature ranges from 60 to 90 degrees, mean 72. Thirty one (31%) patients had associated ED. Surgical options for severe Peyronie’s disease were: single grafting 23pts (25%), complex grafting including circular tunical incision, 31 pts (34%), and in patients with ED the same procedures combined with penile prosthesis implantation (37pts, 41%). Surgical correction was based on measurement of the tunical defect and precise graft size and shape calculation. Penile straightening and lengthening was achieved by equalizing of shortened penile side/s with the longest one (convex) and grafting. Penile width is reestablished with additional longitudinal incision/s and grafting; graft width is determined by measurement of difference in circumference between normal and narrowed part of the corpora. As grafting material, we used solely Intexen LP (AMS).
THE JOURNAL OF UROLOGY姞
100
101
RESULTS AND RENAL FUNCTION SIX MONTHS AFTER CONSERVATIVE TREATMENT OF SEVERE GRADE IV AND V BLUNT RENAL TRAUMA: A PROSPECTIVE EVALUATION
TOTAL PHALLOPLASTY USING MUSCULOCUTANEOUS LATISSIMUS DORSI FLAP - EXPERIENCE IN 92 PATIENTS
Gaelle FIARD*, Jean-Alexandre LONG, Nicolas TERRIER, Caroline THUILLIER, Marine CHODEZ, Alexis ARVIN-BEROD, Valentin ARNOUX, Jean-Luc DESCOTES, Jean-Jacques RAMBEAUD, Grenoble, France INTRODUCTION AND OBJECTIVES: A prospective multi-center study was set up to evaluate the results and relative renal function 6 months after conservative treatment for severe blunt renal trauma (grades IV or V). METHODS: From January 2004 to april 2010, 88 patients were admitted to a center of the French Alps with a grade IV or V blunt renal trauma (confirmed on CT scan). Conservative treatment was allowed in 79 cases (90%). Mean age was 27 (10 –70). The lesions were classified according to the AAST classification, grade IV in 69 cases (including 51 with urinary extravasation), and grade V in 10 cases. Their management required endoscopic drainage in 21 cases, selective arterial embolization in 10 cases, 3 attempted endovascular revascularisation (angioplasty⫹/⫺stenting), and a mean transfusion rate of 1 red blood cell unit (0 –10). RESULTS: An evaluation of the relative renal function with renal scintigraphy was available in 22 patients (28%), 4 grades V and 18 grades IV. The mean relative function of the traumatized kidney was 34%, and 39% in grades IV (15–50%). Considering grade V traumas, 2 kidneys showed no remaining function, the other 2 had a relative function of 20% and 25%. No arterial hypertension was noted during follow-up. Mean hospital stay was 16 days. The mean hospital stay of grade V traumas treated conservatively (14 days) was significantly shorter when compared to the nephrectomy group (24 days, p⫽0,032). CONCLUSIONS: Our attitude of first-line conservative treatment for grade IV blunt renal trauma provides excellent results at 6 months. On the other hand, conservative treatment of grade V trauma provides mixed results regarding renal function, but a major benefit in terms of hospital stay, without clinical consequences at 6 months.
e43
Rados Djinovic*, Sasa Tomovic, Belgrade, Yugoslavia; Salvatore Sansalone, Rome, Italy; Marko Milosavljevic, Vladislav Pesic, Nikola Stanojevic, Miodrag Lazic, Belgrade, Yugoslavia INTRODUCTION AND OBJECTIVES: We present total phalloplasty in children and adults using latissimus dorsi free flap for creation of large neophallus that allow easy performance of urethroplasty and prosthesis implantation. METHODS: In the period from April 1999 to January 2010 total phalloplasty is performed in 92 patients aged between 10 and 46 yr (mean 34 yr). Indications were: congenital anomalies (9), iatrogenic injury (7) or accidental (6) trauma and transsexualism (71 patients). The flap is harvested on subscapular artery, vein and thoracodorsal nerve. Neophallus is created on site, transferred to the pubic region and anastomozed with femoral artery, saphenous vein and ilioinguinal nerve. Two-stage urethroplasty is performed in 77 patients using only buccal mucosa alone (12) or combined with split thickness skin graft (65). Donor site was closed directly in 23 patients, while in the remaining 4 split thickness skin graft was used. Inflatable prsthesis was implanted in 31 and semi-rigid in 43 pts. RESULTS: Follow-up was 9 months to 11 years. Penile size varied from 13 to 19 cm in length and from 12 to 15 cm in circumference. Total flap necrosis occurred in 2 and partial in 3 patients. The donor site healed good in 34 pts, acceptably in 53, while in the remaining 12 mild to moderate moderate scarring occured. Two urethral dehiscences, 11 uretrocutaneous fistulas and 13 urethral stenosis developed that were successfully treated surgically. Function of implanted penile prostheses is satisfactory. CONCLUSIONS: Musculocutaneous latissimus dorsi flap provides excellent neophallus size, good aesthetic appearance, easy implantation of penile prosthesis and urethroplasty. It can be also used successfully in pediatric population. Source of Funding: None
102 TOTAL PENILE SIZE AND SHAPE RESTORATION IN DIFFERENT DEFORMITIES CAUSED BY IPP IN 98 PATIENTS Rados Djinovic*, Sasa Tomovic, Belgrade, Yugoslavia; Salvatore Sansalone, Rome, Italy; Marko Milosavljevic, Vladislav Pesic, Nikola Stanojevic, Miodrag Lazic, Belgrade, Yugoslavia
Source of Funding: none
INTRODUCTION AND OBJECTIVES: To report the results of penile re-sculpturing of different deformities caused by M. Peyronie: restoration of penile length, girth and shape with or without penile prosthesis implantation. METHODS: In the period between February 2007 and March 2009, we performed grafting surgery for M. Peyronie in 98 patients aged between 24 and 72 years (mean 52 years). Penile deformities were diferent: dorsal curvature in 54 (54%), lateral in 7 (7%), ventral in 11 (11%), and combined curvature in 21 (22%); corporal narrowing in 24 (27%). All patients presented penile shortening combined with other deformities, but 4 (4%) patients had only penile shortening. Isolated diffuse corporal narrowing was in two (2%) patients, without any other deformities. Severity of curvature ranges from 60 to 90 degrees, mean 72. Thirty one (31%) patients had associated ED. Surgical options for severe Peyronie’s disease were: single grafting 23pts (25%), complex grafting including circular tunical incision, 31 pts (34%), and in patients with ED the same procedures combined with penile prosthesis implantation (37pts, 41%). Surgical correction was based on measurement of the tunical defect and precise graft size and shape calculation. Penile straightening and lengthening was achieved by equalizing of shortened penile side/s with the longest one (convex) and grafting. Penile width is reestablished with additional longitudinal incision/s and grafting; graft width is determined by measurement of difference in circumference between normal and narrowed part of the corpora. As grafting material, we used solely Intexen LP (AMS).