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MEDIUM-TERM FOLLOW-UP OF DORSAL ONLAY GRAFT URETHROPLASTY USING PENILE SKIN OR BUCCAL MUCOSA IN ADULT BULBOURETHRAL STRICTURES
274
THE JOURNAL OF UROLOGY®
787 RESURFACING AND RECONSTRUCTION OF THE GLANS PENIS Enzo Palminteri*, Elisa Berdondini, Antonio Vitarelli, Francesco Montorsi. Arezzo, Italy, Bari, Italy, and Milan, Italy. INTRODUCTION AND OBJECTIVE: To describe the techniques and results of surgical reconstruction of the glans penis lesions. METHODS: Seventeen patients (mean age 53.2 years) were treated by resurfacing or reconstruction of the glans penis for benign, premalignant and malignant penile lesions. The aetiology of the lesions was: RQH=RRQ¶VEDODQLWLVIRXUOLFKHQVFOHURVXVRQHFDUFLQRPDin situ¿YH squamous cell carcinoma and six squamous cell carcinoma associated with lichen sclerosus. Five cases were treated using glans skinning and UHVXUIDFLQJ FDVHVXVLQJJODQVDPSXWDWLRQDQGUHFRQVWUXFWLRQRIWKH neo-glans and 7 cases using partial penile amputation and reconstruction of the neo-glans. Glans resurfacing and reconstruction were performed using a skin graft harvested from the thigh. RESULTS: The mean follow-up was 32 months. All patients were free of local pre-malignant/ malignant recurrence. Patients who underwent glans resurfacing reported glandular sensory restoration and complete sexual ability. Patients who underwent glansectomy or partial penectomy with neo-glans reconstruction maintained sexual function and activity, although sensitivity was reduced as a consequence of glans/ penile amputation. CONCLUSIONS: In selected cases of benign, pre-malignant or malignant penile lesions, glans resurfacing or reconstruction can DVVXUHDQRUPDODSSHDULQJDQGIXQFWLRQDOSHQLVZLWKRXWMHRSDUGL]LQJ cancer control. Source of Funding: None
788 MODIFIED TUBULARIZED INCISED PLATE URETHROPLASTY FOR HYPOSPADIAS REPAIR: A LONG-TERM RESULTS OF 764 PATIENTS Abdel Wahab El-Kassaby, Ahmed M Al-Kandari*, Tarek El-zayyat, Ahmed A Shokeir. Cairo, Egypt, Kuwait, Kuwait, and Mansoura, Egypt. INTRODUCTION AND OBJECTIVE: To present our experience ZLWKDPRGL¿FDWLRQRIWXEXODUL]HGLQFLVHGSODWH 7,3 XUHWKURSODVW\IRU treatment of subcoronal and distal penile hypospadias. METHODS: A total of 764 children with primary hypospadias (462 subcoronal and 302 distal penile) underwent hypospadias repair XVLQJ 7,3 XUHWKURSODVW\ ZLWK D PRGL¿FDWLRQ RI GRXEOH EUHDVWHG GH HSLWKHOLDOL]HG VNLQ ÀDS 7KH WHFKQLTXH LQYROYHV LQ DGGLWLRQ WR WKH standard TIP, the use of the dorsal prepuce which was divided in two ÀDSV7KHULJKWÀDSZDVGHHSLWKHOLDOL]HGRQERWKWKHRXWHUDQGLQQHU sides and transferred as interposing layer between the neourethra and WKHFRYHULQJV7KHOHIWÀDSZDVGHHSLWKHOLDOL]HGRQWKHLQQHUVLGHDQG transferred ventrally as skin coverage. The follow-up ranged between 3 and 52 months with a mean of 17 months. RESULTS: Excellent functional and cosmetic results were DFKLHYHGLQSDWLHQWV 8UHWKUDO¿VWXODHZHUHHQFRXQWHUHG in 16 cases (2 %) and were repaired successfully. Meatal stenosis was noted in 8 cases (1%) and successfully treated. Two patients developed complete disruption of the wound (0.2%) which was corrected. CONCLUSIONS: Excellent functional and cosmetic results can be achieved after repair of subcoronal and distal penile hypospadias XVLQJ7,3XUHWKURSODVW\ZLWKWKHPRGL¿FDWLRQRIXVLQJGRXEOHEUHDVWHG GHHSLWKHOLDOL]HGVNLQÀDS Source of Funding: None
789 STANDARD SNODGRASS TECHNIQUE IN CONJUNCTION WITH DOUBLE LAYERS COVERING OF NEOURETHRA BY DORSAL DARTOS FLAP REPRESENT THE FIRST CHOICE OF THERAPY FOR HYPOSPADIAS Mahmoud Mustafa*, Bassem S Wadie, Hassan Abol-Enein. Osmaniye, Turkey, and Mansoura, Egypt. INTRODUCTION AND OBJECTIVE: To evaluate the validity RIWXEXODUL]HGLQFLVHGSODWH 7,3 XUHWKURSODVW\WHFKQLTXHIRUGLIIHUHQW kinds of hypospadias
Vol. 179, No. 4, Supplement, Monday, May 19, 2008
METHODS: From June 2002 to December 2003 and from March 2006 to January 2007 total of 36 patients aged 1-22 years (average 7.5) were operated using the concept of TIP urethrolpasty. The hypospadiac meatus were subcoronal in 28 (77.7%), midshaft in 4 (11.11%) and penoscrotal in 4 (11.11%) patients. The standard TIP urethroplasty were performed in the primary cases (26 patients) while in the secondary cases (4 patients) and in the boys who were circumcised EHIRUHDGPLVVLRQ SDWLHQWV PRGL¿HG7,3XUHWKURSODVW\ZHUHXVHG 7KHVWDQGDUGWHFKQLTXHFRQVLVWRI 8VKDSHGLQFLVLRQPLGOLQHLQFLVLRQ DQG VXEFXWDQHRXV ÀDS FRYHULQJ 7KH GRUVDO VXEFXWDQHRXV ÀDS ZDV harvested from preputial skin and dissected from the midline then both OD\HUV RI ÀDS ZHUH WUDQVSRVHG WR WKH YHQWUDO VLGH RI WKH SHQLV ZLWK V\PPHWULFURWDWLRQ(DFKOD\HURIWKHVXEFXWDQHRXVÀDSZDVVXWXUHG to the wings of the glans and corpora cavernosa, thus the neourethra EHFDPH FRPSOHWHO\ FRYHUHG ZLWK GRXEOH OD\HUV RI ZHOOYDVFXODUL]HG tissue. In patients with chordee, hypospadias repair and chordee release ZHUHGRQHDWRQHVWDJH7KHPHDQSHULRGVRIKRVSLWDOL]DWLRQDQGIROORZ up were 0.92 days and 4.19 months respectively. 5(68/76 1R¿VWXODZDVREVHUYHGLQER\VZKRXQGHUZHQW primary reconstruction using standard TIP urethroplasty. Fistula ZDV REVHUYHG LQ WZR SDWLHQWV 2QH SDWLHQW ZLWK SHQRVFURWDO hypospadiass who underwent 2-stage repair, and another one was circumcised before admission. One patient had meatal stenosis at the early postoperative period which was corrected by dilatation of the external meatus at intervals up to two months postoperatively. Three ER\VKDGYHU\QDUURZ¿VWXODZKLFKMXVWDOORZOHDNVRIIHZGURSVRIXULQH through urination which was closed spontaneously within two months. CONCLUSIONS: Standard TIP urethroplasty with double layers covering of neourethra by dorsal subcutaneous tissues is the procedure of choice for the treatment of primary cases of distal / midshaft hypospadias and, the concept of this technique seems to be suitable for proximal, secondary and even complicated hypospadias reconstruction. Source of Funding: None
790 MEDIUM-TERM FOLLOW-UP OF DORSAL ONLAY GRAFT URETHROPLASTY USING PENILE SKIN OR BUCCAL MUCOSA IN ADULT BULBOURETHRAL STRICTURES Sao-Nam Tran*, Farshid Fateri, Giordano Venzi, Jose Saldarriaga, Gregory Wirth, Christopher Emmanuel Iselin. Geneva, Switzerland. INTRODUCTION AND OBJECTIVE: The concept of dorsal onlay graft (DOG) urethroplasty was based 10 years ago on providing a better graft bed, which might improve repair longevity in comparison to ventral grafts. Shortly after, buccal mucosa (BM) was reappraised as an eventually more suitable graft material than prepucial skin (PS). The goal of this study is to assess the overall outcome of DOG urethroplasty on a medium term basis, and to determine whether BM is better than PS grafts in such repairs of bulbar urethral strictures. METHODS: From 1998 to 2006, 48 patients with bulbar urethral strictures (>2cm) underwent DOG urethroplasty. PS or BM free grafts were used according to tissue availability and patient preference. According to the severity oft the stricture, a resection-anastomosis of the WLJKWHVWVHJPHQWZDVDVVRFLDWHG(QGSRLQWVZHUHXURÀRZPHWU\,366 number and so as complications. RESULTS: Forty two % of patients had had previous stricture treatment, eventually multiple (1 dilatation, 16 endoscopic incisions and 4 urethroplasties). Mean follow-up was 38 months (3-107). Overall success rate was 81 % A PS graft was used in 29 patients (60%) and a BM graft in 19 patients (40%). Mean stricture length was 4.3cm (2-8) for PS and 4.1 cm (2-9) for BM. In 52% of cases, a resection-anastomosis of the tightest segment was done. PS graft mean length was 5.9 x 2.7 cm and 5.2 x 2.4 cm for BM graft. Post-operative, there was no difference QHLWKHULQXURÀRZPHWU\QRULQ,366EHWZHHQWKHJURXSV UHVSHFWLYHO\ POVUDQJH,366 IRU36 POVUDQJH,366 = 8 for BM). 3 post-operative complications for PS ( hypertrophic scar, chronic prostatitis and compartimental syndrome) and 2 for MB ( abcess and gingival synechie). Nine patients, 6 (21%) patients with PS and 3 (16%) with MB graft patch, required further treatment due to stricture recurrence.
Vol. 179, No. 4, Supplement, Monday, May 19, 2008
CONCLUSIONS: Results of PS or MB are comparable at 3 years follow-up and provided a success rate of 79% respectively 83%. Source of Funding: None
791 MEDIUM-TERM OUTCOME OF BUCCAL GRAFT URETHROPLASTY FOR RECURRENT BULBAR STRICTURES Majid Shabbir*, Ben E Hughes, Matthew Perry, Nick Watkin. London, United Kingdom. INTRODUCTION AND OBJECTIVE: While optical urethrotomy has acceptable results in the short term, long term outcome is poor with high rates of recurrence. We assessed the medium term outcome of buccal graft urethroplasty for recurrent bulbar strictures. METHODS: Fifty patients who underwent a buccal graft µ%DUEDJOL¶XUHWKURSODVW\IRUUHFXUUHQWEXOEDUVWULFWXUHZHUHIROORZHGXS The stricture length ranged from 1.5-7 cm (mean 3.5cm) with the shorter strictures representing failed anastomotic repairs. Patients were followed XSDWDQGPRQWKVZLWKÀRZUDWHVDQGV\PSWRPDWLFUHYLHZ Further follow up was by annual postal questionnaires. Urethrograms ZHUHSHUIRUPHGLIDQ\DEQRUPDOLWLHVZHUHGHWHFWHGDWIROORZXSµ6XFFHVV¶ ZDVVWULFWO\FODVVL¿HGDVDQDEVHQFHRIV\PSWRPVDQRUPDOEHOOVKDSH ÀRZFXUYHDQGWKHDEVHQFHRIIXUWKHULQVWUXPHQWDWLRQLQFOXGLQJ&,6& RESULTS: Patients were followed up for 9-78 months (mean PRQWKV )RUW\¿YHSDWLHQWVKDGQRV\PSWRPVZLWKQRUPDOYRLGLQJ (90%). One patient (2%) developed a distal stenosis requiring graft revision (successful). Another patient (2%) had a distal stenosis requiring graft revision (unsuccessful) and declined further surgery. Two patients (4%) had proximal stenoses requiring optical urethrotomy (longest 24 months ago) and now void normally. A further patient (2%) had a PLOGSUR[LPDOVWHQRVLVDQGÀDWWRSSHGÀRZUDWH 4PD[POV EXWQR symptoms. Short-term complications included haematoma (6%) and wound infection (4%). Two patients (4%) had complications related to the donor site requiring further review by the Oral Surgeons, with one SDWLHQWUHTXLULQJUHYLVLRQRIDµEULGJH¶RYHUWKHEXFFDOKDUYHVWVLWH CONCLUSIONS: The Barbagli dorsal onlay buccal graft repair is an excellent option for recurrent bulbar urethral strictures with favourable and reproducible medium term outcome.
THE JOURNAL OF UROLOGY®
275
RESULTS: We highlighted proximal and distal communications between the pelvis plexus and the pudendal nerve. The hypogastric nerves and the pelvic splanchnic nerves classically considered to be respectively sympathetic and parasympathetic, were found to contain ERWKDGUHQHUJLFDQGFKROLQHUJLF¿EHUV7KHQHUYRXV¿EHUVLVVXLQJIURP the inferior hypogastric plexus contained cholinergic, adrenergic and VHQVLWLYH ¿EHUV LQQHUYLQJ WKH VHPLQDO YHVLFOHV SURVWDWH DQG XUHWKUDO sphincter. We precisely determined the location of cavernous nerves ZLWKLQWKHKDQGIDQODWHURSURVWDWLFQHUYRXV¿EHUV CONCLUSIONS: The three-dimensional reconstruction of pelvic nervous elements, precise their location and their nature and give the possibility to make a computer assisted dissection (CAD). 7KH SRVLWLRQ RI FDYHUQRXV QHUYHV ¿EHUV DQG WKH H[LVWHQFH RI PL[HG innervations at levels of prostate and vesicle seminal allows a better understanding of the sexual function anatomy and may improve its preservation during pelvic surgery. Further experiments using threedimensional cartography of neuro-transmitters may improve knowledge about continence-micturition cycle and sexual response.
Source of Funding: None
Source of Funding: None
793 Sexual Function/Dysfunction/Andrology: Basic Research (II) Moderated Poster Session 28 Monday, May 19, 2008
10:30 am - 12:30 pm
792 ADRENERGIC, CHOLINERGIC AND SENSITIVE NERVOUS FIBERS IN PELVIC PLEXUS: ANATOMICAL AND IMMUNOHISTOCHEMICAL STUDY WITH 3D RECONSTRUCTION IN HUMAN MALE FETUS Bayan Alsaid*, Thomas Bessede, Ibrahim Karam, Issam Abdlsamad, Jean-Francoit Uhl, Vincent Delmas, Gerard Benoit, Stephane Droupy. Le Kremlin Bicetre, France, and Paris, France. INTRODUCTION AND OBJECTIVE: Precise intra-pelvic QHUYHVGLVWULEXWLRQLVGLI¿FXOWWRREWDLQE\FODVVLFDODQDWRPLFDOVWXGLHV on cadaver dissection. The immunohistochemical computer assisted GLVVHFWLRQ JLYH WKH RSSRUWXQLW\ WR GHWHUPLQH WKH ¿EHU¶V QDWXUH 7KLV study was designed to identify precise location and nature (adrenergic, cholinergic and sensitive) of nerves in human male fetus pelvis by threedimensional representation. METHODS: Transverse serial sections were performed every 150-200µm along the pelvic portion of two human male fetuses (16 and 17 weeks of gestation). Sections were treated by histological and immunohistochimical methods (HES, LFB, and immunolabeling of: Protein S100, VACHT, TH, CGRP and Substance P). The twoGLPHQVLRQDO VHFWLRQV ZHUH WKHQ GLJLWL]HG E\ D VFDQQHU RI KLJK optical resolution and three-dimensional images were created by 3D reconstruction software (winsurf).
IMAGING OF PERIPROSTATIC NEURAL TISSUE WITH MULTIPHOTON MICROSCOPY 5DMLY
THE JOURNAL OF UROLOGY®
787 RESURFACING AND RECONSTRUCTION OF THE GLANS PENIS Enzo Palminteri*, Elisa Berdondini, Antonio Vitarelli, Francesco Montorsi. Arezzo, Italy, Bari, Italy, and Milan, Italy. INTRODUCTION AND OBJECTIVE: To describe the techniques and results of surgical reconstruction of the glans penis lesions. METHODS: Seventeen patients (mean age 53.2 years) were treated by resurfacing or reconstruction of the glans penis for benign, premalignant and malignant penile lesions. The aetiology of the lesions was: RQH=RRQ¶VEDODQLWLVIRXUOLFKHQVFOHURVXVRQHFDUFLQRPDin situ¿YH squamous cell carcinoma and six squamous cell carcinoma associated with lichen sclerosus. Five cases were treated using glans skinning and UHVXUIDFLQJ FDVHVXVLQJJODQVDPSXWDWLRQDQGUHFRQVWUXFWLRQRIWKH neo-glans and 7 cases using partial penile amputation and reconstruction of the neo-glans. Glans resurfacing and reconstruction were performed using a skin graft harvested from the thigh. RESULTS: The mean follow-up was 32 months. All patients were free of local pre-malignant/ malignant recurrence. Patients who underwent glans resurfacing reported glandular sensory restoration and complete sexual ability. Patients who underwent glansectomy or partial penectomy with neo-glans reconstruction maintained sexual function and activity, although sensitivity was reduced as a consequence of glans/ penile amputation. CONCLUSIONS: In selected cases of benign, pre-malignant or malignant penile lesions, glans resurfacing or reconstruction can DVVXUHDQRUPDODSSHDULQJDQGIXQFWLRQDOSHQLVZLWKRXWMHRSDUGL]LQJ cancer control. Source of Funding: None
788 MODIFIED TUBULARIZED INCISED PLATE URETHROPLASTY FOR HYPOSPADIAS REPAIR: A LONG-TERM RESULTS OF 764 PATIENTS Abdel Wahab El-Kassaby, Ahmed M Al-Kandari*, Tarek El-zayyat, Ahmed A Shokeir. Cairo, Egypt, Kuwait, Kuwait, and Mansoura, Egypt. INTRODUCTION AND OBJECTIVE: To present our experience ZLWKDPRGL¿FDWLRQRIWXEXODUL]HGLQFLVHGSODWH 7,3 XUHWKURSODVW\IRU treatment of subcoronal and distal penile hypospadias. METHODS: A total of 764 children with primary hypospadias (462 subcoronal and 302 distal penile) underwent hypospadias repair XVLQJ 7,3 XUHWKURSODVW\ ZLWK D PRGL¿FDWLRQ RI GRXEOH EUHDVWHG GH HSLWKHOLDOL]HG VNLQ ÀDS 7KH WHFKQLTXH LQYROYHV LQ DGGLWLRQ WR WKH standard TIP, the use of the dorsal prepuce which was divided in two ÀDSV7KHULJKWÀDSZDVGHHSLWKHOLDOL]HGRQERWKWKHRXWHUDQGLQQHU sides and transferred as interposing layer between the neourethra and WKHFRYHULQJV7KHOHIWÀDSZDVGHHSLWKHOLDOL]HGRQWKHLQQHUVLGHDQG transferred ventrally as skin coverage. The follow-up ranged between 3 and 52 months with a mean of 17 months. RESULTS: Excellent functional and cosmetic results were DFKLHYHGLQSDWLHQWV 8UHWKUDO¿VWXODHZHUHHQFRXQWHUHG in 16 cases (2 %) and were repaired successfully. Meatal stenosis was noted in 8 cases (1%) and successfully treated. Two patients developed complete disruption of the wound (0.2%) which was corrected. CONCLUSIONS: Excellent functional and cosmetic results can be achieved after repair of subcoronal and distal penile hypospadias XVLQJ7,3XUHWKURSODVW\ZLWKWKHPRGL¿FDWLRQRIXVLQJGRXEOHEUHDVWHG GHHSLWKHOLDOL]HGVNLQÀDS Source of Funding: None
789 STANDARD SNODGRASS TECHNIQUE IN CONJUNCTION WITH DOUBLE LAYERS COVERING OF NEOURETHRA BY DORSAL DARTOS FLAP REPRESENT THE FIRST CHOICE OF THERAPY FOR HYPOSPADIAS Mahmoud Mustafa*, Bassem S Wadie, Hassan Abol-Enein. Osmaniye, Turkey, and Mansoura, Egypt. INTRODUCTION AND OBJECTIVE: To evaluate the validity RIWXEXODUL]HGLQFLVHGSODWH 7,3 XUHWKURSODVW\WHFKQLTXHIRUGLIIHUHQW kinds of hypospadias
Vol. 179, No. 4, Supplement, Monday, May 19, 2008
METHODS: From June 2002 to December 2003 and from March 2006 to January 2007 total of 36 patients aged 1-22 years (average 7.5) were operated using the concept of TIP urethrolpasty. The hypospadiac meatus were subcoronal in 28 (77.7%), midshaft in 4 (11.11%) and penoscrotal in 4 (11.11%) patients. The standard TIP urethroplasty were performed in the primary cases (26 patients) while in the secondary cases (4 patients) and in the boys who were circumcised EHIRUHDGPLVVLRQ SDWLHQWV PRGL¿HG7,3XUHWKURSODVW\ZHUHXVHG 7KHVWDQGDUGWHFKQLTXHFRQVLVWRI 8VKDSHGLQFLVLRQPLGOLQHLQFLVLRQ DQG VXEFXWDQHRXV ÀDS FRYHULQJ 7KH GRUVDO VXEFXWDQHRXV ÀDS ZDV harvested from preputial skin and dissected from the midline then both OD\HUV RI ÀDS ZHUH WUDQVSRVHG WR WKH YHQWUDO VLGH RI WKH SHQLV ZLWK V\PPHWULFURWDWLRQ(DFKOD\HURIWKHVXEFXWDQHRXVÀDSZDVVXWXUHG to the wings of the glans and corpora cavernosa, thus the neourethra EHFDPH FRPSOHWHO\ FRYHUHG ZLWK GRXEOH OD\HUV RI ZHOOYDVFXODUL]HG tissue. In patients with chordee, hypospadias repair and chordee release ZHUHGRQHDWRQHVWDJH7KHPHDQSHULRGVRIKRVSLWDOL]DWLRQDQGIROORZ up were 0.92 days and 4.19 months respectively. 5(68/76 1R¿VWXODZDVREVHUYHGLQER\VZKRXQGHUZHQW primary reconstruction using standard TIP urethroplasty. Fistula ZDV REVHUYHG LQ WZR SDWLHQWV 2QH SDWLHQW ZLWK SHQRVFURWDO hypospadiass who underwent 2-stage repair, and another one was circumcised before admission. One patient had meatal stenosis at the early postoperative period which was corrected by dilatation of the external meatus at intervals up to two months postoperatively. Three ER\VKDGYHU\QDUURZ¿VWXODZKLFKMXVWDOORZOHDNVRIIHZGURSVRIXULQH through urination which was closed spontaneously within two months. CONCLUSIONS: Standard TIP urethroplasty with double layers covering of neourethra by dorsal subcutaneous tissues is the procedure of choice for the treatment of primary cases of distal / midshaft hypospadias and, the concept of this technique seems to be suitable for proximal, secondary and even complicated hypospadias reconstruction. Source of Funding: None
790 MEDIUM-TERM FOLLOW-UP OF DORSAL ONLAY GRAFT URETHROPLASTY USING PENILE SKIN OR BUCCAL MUCOSA IN ADULT BULBOURETHRAL STRICTURES Sao-Nam Tran*, Farshid Fateri, Giordano Venzi, Jose Saldarriaga, Gregory Wirth, Christopher Emmanuel Iselin. Geneva, Switzerland. INTRODUCTION AND OBJECTIVE: The concept of dorsal onlay graft (DOG) urethroplasty was based 10 years ago on providing a better graft bed, which might improve repair longevity in comparison to ventral grafts. Shortly after, buccal mucosa (BM) was reappraised as an eventually more suitable graft material than prepucial skin (PS). The goal of this study is to assess the overall outcome of DOG urethroplasty on a medium term basis, and to determine whether BM is better than PS grafts in such repairs of bulbar urethral strictures. METHODS: From 1998 to 2006, 48 patients with bulbar urethral strictures (>2cm) underwent DOG urethroplasty. PS or BM free grafts were used according to tissue availability and patient preference. According to the severity oft the stricture, a resection-anastomosis of the WLJKWHVWVHJPHQWZDVDVVRFLDWHG(QGSRLQWVZHUHXURÀRZPHWU\,366 number and so as complications. RESULTS: Forty two % of patients had had previous stricture treatment, eventually multiple (1 dilatation, 16 endoscopic incisions and 4 urethroplasties). Mean follow-up was 38 months (3-107). Overall success rate was 81 % A PS graft was used in 29 patients (60%) and a BM graft in 19 patients (40%). Mean stricture length was 4.3cm (2-8) for PS and 4.1 cm (2-9) for BM. In 52% of cases, a resection-anastomosis of the tightest segment was done. PS graft mean length was 5.9 x 2.7 cm and 5.2 x 2.4 cm for BM graft. Post-operative, there was no difference QHLWKHULQXURÀRZPHWU\QRULQ,366EHWZHHQWKHJURXSV UHVSHFWLYHO\ POVUDQJH,366 IRU36 POVUDQJH,366 = 8 for BM). 3 post-operative complications for PS ( hypertrophic scar, chronic prostatitis and compartimental syndrome) and 2 for MB ( abcess and gingival synechie). Nine patients, 6 (21%) patients with PS and 3 (16%) with MB graft patch, required further treatment due to stricture recurrence.
Vol. 179, No. 4, Supplement, Monday, May 19, 2008
CONCLUSIONS: Results of PS or MB are comparable at 3 years follow-up and provided a success rate of 79% respectively 83%. Source of Funding: None
791 MEDIUM-TERM OUTCOME OF BUCCAL GRAFT URETHROPLASTY FOR RECURRENT BULBAR STRICTURES Majid Shabbir*, Ben E Hughes, Matthew Perry, Nick Watkin. London, United Kingdom. INTRODUCTION AND OBJECTIVE: While optical urethrotomy has acceptable results in the short term, long term outcome is poor with high rates of recurrence. We assessed the medium term outcome of buccal graft urethroplasty for recurrent bulbar strictures. METHODS: Fifty patients who underwent a buccal graft µ%DUEDJOL¶XUHWKURSODVW\IRUUHFXUUHQWEXOEDUVWULFWXUHZHUHIROORZHGXS The stricture length ranged from 1.5-7 cm (mean 3.5cm) with the shorter strictures representing failed anastomotic repairs. Patients were followed XSDWDQGPRQWKVZLWKÀRZUDWHVDQGV\PSWRPDWLFUHYLHZ Further follow up was by annual postal questionnaires. Urethrograms ZHUHSHUIRUPHGLIDQ\DEQRUPDOLWLHVZHUHGHWHFWHGDWIROORZXSµ6XFFHVV¶ ZDVVWULFWO\FODVVL¿HGDVDQDEVHQFHRIV\PSWRPVDQRUPDOEHOOVKDSH ÀRZFXUYHDQGWKHDEVHQFHRIIXUWKHULQVWUXPHQWDWLRQLQFOXGLQJ&,6& RESULTS: Patients were followed up for 9-78 months (mean PRQWKV )RUW\¿YHSDWLHQWVKDGQRV\PSWRPVZLWKQRUPDOYRLGLQJ (90%). One patient (2%) developed a distal stenosis requiring graft revision (successful). Another patient (2%) had a distal stenosis requiring graft revision (unsuccessful) and declined further surgery. Two patients (4%) had proximal stenoses requiring optical urethrotomy (longest 24 months ago) and now void normally. A further patient (2%) had a PLOGSUR[LPDOVWHQRVLVDQGÀDWWRSSHGÀRZUDWH 4PD[POV EXWQR symptoms. Short-term complications included haematoma (6%) and wound infection (4%). Two patients (4%) had complications related to the donor site requiring further review by the Oral Surgeons, with one SDWLHQWUHTXLULQJUHYLVLRQRIDµEULGJH¶RYHUWKHEXFFDOKDUYHVWVLWH CONCLUSIONS: The Barbagli dorsal onlay buccal graft repair is an excellent option for recurrent bulbar urethral strictures with favourable and reproducible medium term outcome.
THE JOURNAL OF UROLOGY®
275
RESULTS: We highlighted proximal and distal communications between the pelvis plexus and the pudendal nerve. The hypogastric nerves and the pelvic splanchnic nerves classically considered to be respectively sympathetic and parasympathetic, were found to contain ERWKDGUHQHUJLFDQGFKROLQHUJLF¿EHUV7KHQHUYRXV¿EHUVLVVXLQJIURP the inferior hypogastric plexus contained cholinergic, adrenergic and VHQVLWLYH ¿EHUV LQQHUYLQJ WKH VHPLQDO YHVLFOHV SURVWDWH DQG XUHWKUDO sphincter. We precisely determined the location of cavernous nerves ZLWKLQWKHKDQGIDQODWHURSURVWDWLFQHUYRXV¿EHUV CONCLUSIONS: The three-dimensional reconstruction of pelvic nervous elements, precise their location and their nature and give the possibility to make a computer assisted dissection (CAD). 7KH SRVLWLRQ RI FDYHUQRXV QHUYHV ¿EHUV DQG WKH H[LVWHQFH RI PL[HG innervations at levels of prostate and vesicle seminal allows a better understanding of the sexual function anatomy and may improve its preservation during pelvic surgery. Further experiments using threedimensional cartography of neuro-transmitters may improve knowledge about continence-micturition cycle and sexual response.
Source of Funding: None
Source of Funding: None
793 Sexual Function/Dysfunction/Andrology: Basic Research (II) Moderated Poster Session 28 Monday, May 19, 2008
10:30 am - 12:30 pm
792 ADRENERGIC, CHOLINERGIC AND SENSITIVE NERVOUS FIBERS IN PELVIC PLEXUS: ANATOMICAL AND IMMUNOHISTOCHEMICAL STUDY WITH 3D RECONSTRUCTION IN HUMAN MALE FETUS Bayan Alsaid*, Thomas Bessede, Ibrahim Karam, Issam Abdlsamad, Jean-Francoit Uhl, Vincent Delmas, Gerard Benoit, Stephane Droupy. Le Kremlin Bicetre, France, and Paris, France. INTRODUCTION AND OBJECTIVE: Precise intra-pelvic QHUYHVGLVWULEXWLRQLVGLI¿FXOWWRREWDLQE\FODVVLFDODQDWRPLFDOVWXGLHV on cadaver dissection. The immunohistochemical computer assisted GLVVHFWLRQ JLYH WKH RSSRUWXQLW\ WR GHWHUPLQH WKH ¿EHU¶V QDWXUH 7KLV study was designed to identify precise location and nature (adrenergic, cholinergic and sensitive) of nerves in human male fetus pelvis by threedimensional representation. METHODS: Transverse serial sections were performed every 150-200µm along the pelvic portion of two human male fetuses (16 and 17 weeks of gestation). Sections were treated by histological and immunohistochimical methods (HES, LFB, and immunolabeling of: Protein S100, VACHT, TH, CGRP and Substance P). The twoGLPHQVLRQDO VHFWLRQV ZHUH WKHQ GLJLWL]HG E\ D VFDQQHU RI KLJK optical resolution and three-dimensional images were created by 3D reconstruction software (winsurf).
IMAGING OF PERIPROSTATIC NEURAL TISSUE WITH MULTIPHOTON MICROSCOPY 5DMLY