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Penile Skin Flap, as a Dorsal Onlay or Tubularized Flap: A Versatile Substitute for Complex Anterior Urethral Stricture
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DIAGNOSTIC UROLOGY, URINARY DIVERSION AND PERIOPERATIVE CARE
While I have not done penile revascularization, my own 18-year experience with urethroplasties in several hundred similar patients indicates that the risk of ischemia of the urethra is negligible. Coupled with the simplicity and high reliability of penile prosthesis implantation, I do not believe I will be incorporating revascularization into my practice anytime soon. Allen F. Morey, M.D.
Re: Preputial/Penile Skin Flap, as a Dorsal Onlay or Tubularized Flap: A Versatile Substitute for Complex Anterior Urethral Stricture A. Srivastava, S. Vashishtha, U. P. Singh, A. Srivastava, M. S. Ansari, R. Kapoor, M. R. Pradhan and R. Kapoor Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India BJU Int 2012; 110: E1101–E1108.
Abstract available at http://jurology.com/ Editorial Comment: A 7-year experience with penile skin flap urethroplasty in 144 patients is presented from Lucknow, India. This is clearly a challenging group of patients (average stricture length 7 to 8 cm) from a high volume center. But what is staggering to me is the large number of cases involving bulbar strictures (26%). I stopped using penile flaps for bulbar strictures long ago because of the magnitude of the genital dissection involved (developing the flap and then tunneling it under the scrotum), along with the obvious efficiency and reliability of buccal mucosa grafts. Other salient outcomes include the relatively high numbers of patients with superficial penile skin necrosis (roughly 20%), extensive skin loss requiring penile skin grafting (5%), penile torsion (roughly 5%) and penile hypoesthesia (roughly 10%). All of these complications are extremely uncommon after buccal graft procedures, and they occurred commonly here, even in experienced hands. Although the authors claim their dorsal flap placement to be superior, their results are no better than ventral flap placement studies. I am doing fewer penile skin flap procedures these days, reserving this strategy for men with normal healthy penile skin and long, nonobliterative strictures of the penile urethra. Allen F. Morey, M.D.
Diagnostic Urology, Urinary Diversion and Perioperative Care Re: The Effect of the WHO Surgical Safety Checklist on Complication Rate and Communication A. Fudickar, K. Hörle, J. Wiltfang and B. Bein Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Germany Dtsch Arztebl Int 2012; 109: 695–701.
Abstract available at http://jurology.com/ Editorial Comment: The authors present findings from a selective literature review covering the period 2009 to 2012, following the recommendation of the World Health Organization regarding the use of surgical checklists in the operating room. The findings not only support the use of checklists, but also strongly suggest that their use has provided the impetus for a culture change in the operating room, resulting in better communication, teamwork and patient safety, with a significant impact on decreasing complications. Richard K. Babayan, M.D.
DIAGNOSTIC UROLOGY, URINARY DIVERSION AND PERIOPERATIVE CARE
While I have not done penile revascularization, my own 18-year experience with urethroplasties in several hundred similar patients indicates that the risk of ischemia of the urethra is negligible. Coupled with the simplicity and high reliability of penile prosthesis implantation, I do not believe I will be incorporating revascularization into my practice anytime soon. Allen F. Morey, M.D.
Re: Preputial/Penile Skin Flap, as a Dorsal Onlay or Tubularized Flap: A Versatile Substitute for Complex Anterior Urethral Stricture A. Srivastava, S. Vashishtha, U. P. Singh, A. Srivastava, M. S. Ansari, R. Kapoor, M. R. Pradhan and R. Kapoor Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India BJU Int 2012; 110: E1101–E1108.
Abstract available at http://jurology.com/ Editorial Comment: A 7-year experience with penile skin flap urethroplasty in 144 patients is presented from Lucknow, India. This is clearly a challenging group of patients (average stricture length 7 to 8 cm) from a high volume center. But what is staggering to me is the large number of cases involving bulbar strictures (26%). I stopped using penile flaps for bulbar strictures long ago because of the magnitude of the genital dissection involved (developing the flap and then tunneling it under the scrotum), along with the obvious efficiency and reliability of buccal mucosa grafts. Other salient outcomes include the relatively high numbers of patients with superficial penile skin necrosis (roughly 20%), extensive skin loss requiring penile skin grafting (5%), penile torsion (roughly 5%) and penile hypoesthesia (roughly 10%). All of these complications are extremely uncommon after buccal graft procedures, and they occurred commonly here, even in experienced hands. Although the authors claim their dorsal flap placement to be superior, their results are no better than ventral flap placement studies. I am doing fewer penile skin flap procedures these days, reserving this strategy for men with normal healthy penile skin and long, nonobliterative strictures of the penile urethra. Allen F. Morey, M.D.
Diagnostic Urology, Urinary Diversion and Perioperative Care Re: The Effect of the WHO Surgical Safety Checklist on Complication Rate and Communication A. Fudickar, K. Hörle, J. Wiltfang and B. Bein Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Germany Dtsch Arztebl Int 2012; 109: 695–701.
Abstract available at http://jurology.com/ Editorial Comment: The authors present findings from a selective literature review covering the period 2009 to 2012, following the recommendation of the World Health Organization regarding the use of surgical checklists in the operating room. The findings not only support the use of checklists, but also strongly suggest that their use has provided the impetus for a culture change in the operating room, resulting in better communication, teamwork and patient safety, with a significant impact on decreasing complications. Richard K. Babayan, M.D.