- Email: [email protected]
POS-02.136: Dorsal onlay small intestinal submucosa urethroplasty : our experience
UNMODERATED POSTER SESSIONS
Conclusions: This study demonstrates that ureteral reimplantation with psoas hitch can be performed safely and effectively to treat distal ureteral disease using the da Vinci Surgical System. POS-02.134 Ureteral substitution by an isolated ileal segment via novel antireflux technique Hinev A, Paunov S, Raikov R, Chankov P, Anakievski D, Dyakov S, Balev B “St. Marina” University Hospital, Varna Medical University, Varna, Bulgaria Introduction: With an aim to provide an optimal solution for the management of large defects of the distal ureter we developed a novel antireflux technique of ileal ureteral substitution. Methods: The new method was applied in 5 female patients (mean age 49.4 years, range 29 - 53 years) with iatrogenic injury to the distal ureter that occurred as a complication after total hysterectomy and pelvic irradiation for gynaecological malignancies. Reconstructive surgery was done, and the damaged ureter was replaced by an isolated ileal segment. The ureteroileal anastomosis was created in an antireflux manner by the implementation of the serous-lined extramural tunnel technique, originally described in orthotopic bladder substitutes. To avoid mucus retention, the distal end of the isolated ileal segment was widely anastomosed with the bladder. Results: Surgery was performed without any major perioperative complications. The follow up ultrasound and radiological studies confirmed that the procedure efficiently provided a nonobstructed unidirectional flow of urine. Optimization of the renal function and restoration of the previous patient quality of life were recorded in all cases treated by the new technique. Conclusion: Ureteral substitution by an isolated ileal segment via antireflux ureteroileal and reflux ileovesical anastomosis could be a viable option when large defects of the distal ureter are encountered. POS-02.135 Penile fractures: immediate surgical approach with a midline dorsal incision Livadas K, Mazaris E, Chalikopoulos D, Skolarikos A, Bisas A, Kastriotis I 2nd Department Of Urology, University of Athens, Sismanoglio Hospital, Athens, Greece Objectives: The choice of immediate surgical either conservative treatment in penile fractures is even today controversial.
270
We present our experience with the immediate surgical treatment of penile fractures with a midline dorsal incision. Materials & Methods: In a period of 4 years (2002-2005) 6 patients were treated in our department with penile fracture. All patients developed acute penile pain and associated crackle during sexual intercourse. They all arrived at our hospital within 2 to 48 hours from the incident. Diagnosis was established by history and clinical examination in all patients, while in 5 of them it was confirmed by ultrasonography located in the right corpora cavernosa distally from the penoscrotal junction. All patients were immediately surgically treated and followed-up postoperatively for a mean period of one year. Results: All penile fractures were associated with penile hematoma, in 4 of them scrotal and in the other 2 perineal. In 1 patient there was concomitant anterior urethral rupture (penile). All patients had a midline dorsal incision performed at the raphea of the penis, distally from the penoscrotal junction, with a maximum length of 5cm. Clinical diagnosis was confirmed intra-operatively in all patients with rupture of one of the corpora cavernosa occurring in 5 patients and bilateral rupture in one of them concomitantly with urethral rupture. Suturing of the defect in the fascia followed in all patients and an end-to-end anastomosis was performed in the case of urethral rupture. The postoperative period was without complications. Nobody experienced a late complication while tumescence was not affected during follow-up. Conclusion: Immediate intervention for penile fractures with a midline dorsal incision achieves good early and late postoperative results. Our technique has the advantage of direct access to both corpora cavernosa and anterior urethra with a minimal skin incision.
Methods: Between September 1999 to December 2001, 13 patients underwent substitution urethroplasty with SIS. Preoperative evaluation consisted of uroflowmetry and retrograde urethrogram. Etiology was Lichen sclerosis (BXO) in 5 and post catherisation (ischaemic) in 8 patients. Full length strictures were seen in 11; 2 patients had bulbar strictures. A 2 cm wide and 30 cm long strip of SIS (Cook) was tailored to the required length for the patient. For full length strictures, full length dorsal onlay technique described by us previously was used, while bulbar strictures underwent Barbagli’s dorsal onlay. The urethra was reconstituted over 16 F Silastic Foley. The catheter was removed after 3 weeks. Uroflowmetry was repeated at 3 months, 6 months and one year. Results: Mean maximum flow rate at 3 months was 15.15 ml/s. On follow up, only one patient voided with a satisfactory stream at 6 months and at one year. The remaining 12 patients had deterioration of the urinary stream within six months to one year. Out of these, 4 patients required a redo dorsal onlay buccal mucosa urethroplasty, one patient underwent stage 1 urethroplasty with a perineal urethrostomy and 4 patients require intermittent self calibration, while 3 patients were lost during followup. Conclusions: SIS is an acellular matrix and acts as a scaffolding for the urothelium to grow. Although SIS avoids the additional insult of harvesting 2-3 six cm BMG strips, the post operative results obtained are far from optimal. At follow up of one year, our five patients required a redo procedure, while four patients are on regular dilation. Our results show that the results of SIS are not comparable to that of buccal mucosa urethroplasty.
POS-02.136 Dorsal onlay small intestinal submucosa urethroplasty : our experience Kulkarni SB, Lambe S, Bapat A, Kamat D, Dhumavat A, Kulkarni J Kulkarni Urethroplasty Center and SRS Hospital, Pune, India
POS-02.137 The role of cotton padding and elastic bandage in imobilizing the extremity after closure of bladder exstrophy Watya S1, Kaggwa S1, Kajja I2, Muwazi S2 1 Department of Surgery, Urology Unit, Mulago Hospital, Makerere University Medical School, 2Department of Orthopaedics, Mulago Hospital, Makerere University Medical School, Kampala Ugand
Introduction: Buccal Mucosa Graft (BMG) as Dorsal or ventral Onlay is increasingly used in urethral substitution. We present our experience of substitution urethroplasty with Small Intestinal Submucosa of a pig (SIS) in selected patients with unhealthy buccal mucosa and those refusing BMG.
Introduction: The method used to immobilize the pelvis and extremity in primary closure of bladder exstrophy is important for the success of this procedure. Use of a method that allows effective immobilization and patient’s early return home is
UROLOGY 70 (Supplment 3A), September 2007
Conclusions: This study demonstrates that ureteral reimplantation with psoas hitch can be performed safely and effectively to treat distal ureteral disease using the da Vinci Surgical System. POS-02.134 Ureteral substitution by an isolated ileal segment via novel antireflux technique Hinev A, Paunov S, Raikov R, Chankov P, Anakievski D, Dyakov S, Balev B “St. Marina” University Hospital, Varna Medical University, Varna, Bulgaria Introduction: With an aim to provide an optimal solution for the management of large defects of the distal ureter we developed a novel antireflux technique of ileal ureteral substitution. Methods: The new method was applied in 5 female patients (mean age 49.4 years, range 29 - 53 years) with iatrogenic injury to the distal ureter that occurred as a complication after total hysterectomy and pelvic irradiation for gynaecological malignancies. Reconstructive surgery was done, and the damaged ureter was replaced by an isolated ileal segment. The ureteroileal anastomosis was created in an antireflux manner by the implementation of the serous-lined extramural tunnel technique, originally described in orthotopic bladder substitutes. To avoid mucus retention, the distal end of the isolated ileal segment was widely anastomosed with the bladder. Results: Surgery was performed without any major perioperative complications. The follow up ultrasound and radiological studies confirmed that the procedure efficiently provided a nonobstructed unidirectional flow of urine. Optimization of the renal function and restoration of the previous patient quality of life were recorded in all cases treated by the new technique. Conclusion: Ureteral substitution by an isolated ileal segment via antireflux ureteroileal and reflux ileovesical anastomosis could be a viable option when large defects of the distal ureter are encountered. POS-02.135 Penile fractures: immediate surgical approach with a midline dorsal incision Livadas K, Mazaris E, Chalikopoulos D, Skolarikos A, Bisas A, Kastriotis I 2nd Department Of Urology, University of Athens, Sismanoglio Hospital, Athens, Greece Objectives: The choice of immediate surgical either conservative treatment in penile fractures is even today controversial.
270
We present our experience with the immediate surgical treatment of penile fractures with a midline dorsal incision. Materials & Methods: In a period of 4 years (2002-2005) 6 patients were treated in our department with penile fracture. All patients developed acute penile pain and associated crackle during sexual intercourse. They all arrived at our hospital within 2 to 48 hours from the incident. Diagnosis was established by history and clinical examination in all patients, while in 5 of them it was confirmed by ultrasonography located in the right corpora cavernosa distally from the penoscrotal junction. All patients were immediately surgically treated and followed-up postoperatively for a mean period of one year. Results: All penile fractures were associated with penile hematoma, in 4 of them scrotal and in the other 2 perineal. In 1 patient there was concomitant anterior urethral rupture (penile). All patients had a midline dorsal incision performed at the raphea of the penis, distally from the penoscrotal junction, with a maximum length of 5cm. Clinical diagnosis was confirmed intra-operatively in all patients with rupture of one of the corpora cavernosa occurring in 5 patients and bilateral rupture in one of them concomitantly with urethral rupture. Suturing of the defect in the fascia followed in all patients and an end-to-end anastomosis was performed in the case of urethral rupture. The postoperative period was without complications. Nobody experienced a late complication while tumescence was not affected during follow-up. Conclusion: Immediate intervention for penile fractures with a midline dorsal incision achieves good early and late postoperative results. Our technique has the advantage of direct access to both corpora cavernosa and anterior urethra with a minimal skin incision.
Methods: Between September 1999 to December 2001, 13 patients underwent substitution urethroplasty with SIS. Preoperative evaluation consisted of uroflowmetry and retrograde urethrogram. Etiology was Lichen sclerosis (BXO) in 5 and post catherisation (ischaemic) in 8 patients. Full length strictures were seen in 11; 2 patients had bulbar strictures. A 2 cm wide and 30 cm long strip of SIS (Cook) was tailored to the required length for the patient. For full length strictures, full length dorsal onlay technique described by us previously was used, while bulbar strictures underwent Barbagli’s dorsal onlay. The urethra was reconstituted over 16 F Silastic Foley. The catheter was removed after 3 weeks. Uroflowmetry was repeated at 3 months, 6 months and one year. Results: Mean maximum flow rate at 3 months was 15.15 ml/s. On follow up, only one patient voided with a satisfactory stream at 6 months and at one year. The remaining 12 patients had deterioration of the urinary stream within six months to one year. Out of these, 4 patients required a redo dorsal onlay buccal mucosa urethroplasty, one patient underwent stage 1 urethroplasty with a perineal urethrostomy and 4 patients require intermittent self calibration, while 3 patients were lost during followup. Conclusions: SIS is an acellular matrix and acts as a scaffolding for the urothelium to grow. Although SIS avoids the additional insult of harvesting 2-3 six cm BMG strips, the post operative results obtained are far from optimal. At follow up of one year, our five patients required a redo procedure, while four patients are on regular dilation. Our results show that the results of SIS are not comparable to that of buccal mucosa urethroplasty.
POS-02.136 Dorsal onlay small intestinal submucosa urethroplasty : our experience Kulkarni SB, Lambe S, Bapat A, Kamat D, Dhumavat A, Kulkarni J Kulkarni Urethroplasty Center and SRS Hospital, Pune, India
POS-02.137 The role of cotton padding and elastic bandage in imobilizing the extremity after closure of bladder exstrophy Watya S1, Kaggwa S1, Kajja I2, Muwazi S2 1 Department of Surgery, Urology Unit, Mulago Hospital, Makerere University Medical School, 2Department of Orthopaedics, Mulago Hospital, Makerere University Medical School, Kampala Ugand
Introduction: Buccal Mucosa Graft (BMG) as Dorsal or ventral Onlay is increasingly used in urethral substitution. We present our experience of substitution urethroplasty with Small Intestinal Submucosa of a pig (SIS) in selected patients with unhealthy buccal mucosa and those refusing BMG.
Introduction: The method used to immobilize the pelvis and extremity in primary closure of bladder exstrophy is important for the success of this procedure. Use of a method that allows effective immobilization and patient’s early return home is
UROLOGY 70 (Supplment 3A), September 2007