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'Minipatch' penile skin graft urethroplasty in the era of buccal mucosal grafting.

Hudak SJ, Hudson TC, Morey AF - Arab J Urol (2012)

Bottom Line: However, despite careful preoperative planning, the unanticipated need for a small graft is occasionally recognised intra-operatively, and in such cases we have found that harvesting a minipatch is an efficient alternative to harvesting a buccal mucosal graft.The mean (range) stricture length was 2.4 (2-3) cm and the mean graft length was 2.1 (1.5-2.5) cm.At a mean follow-up of 18 months all repairs were patent with no need for further procedures or instrumentation.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.

ABSTRACT

Objectives: To describe our experience with 'minipatch' penile skin graft (PSG) urethroplasty, as at our institution we prefer excision and primary anastomosis (EPA) urethroplasty whenever feasible, as it gives better outcomes than substitution urethroplasty. However, despite careful preoperative planning, the unanticipated need for a small graft is occasionally recognised intra-operatively, and in such cases we have found that harvesting a minipatch is an efficient alternative to harvesting a buccal mucosal graft.

Patients and methods: Bulbar urethroplasty using a <3 cm PSG was performed via either a ventral onlay or augmented anastomotic technique. In each case the PSG was required to repair an unanticipated urethral defect recognised intra-operatively during various scenarios of challenging urethroplasty. We retrospectively reviewed our experience with this technique.

Results: Among a total of 425 urethral reconstructions over a 4-year period at our institution, four patients (1%) underwent minipatch PSG urethroplasty to repair either urethral strictures that were discovered intra-operatively to be too complex for EPA (two patients) or for intra-operatively identified, unanticipated synchronous strictures (two patients). The mean (range) stricture length was 2.4 (2-3) cm and the mean graft length was 2.1 (1.5-2.5) cm. At a mean follow-up of 18 months all repairs were patent with no need for further procedures or instrumentation.

Conclusion: Minipatch PSG urethroplasty is an efficient alternative to a buccal mucosal graft repair, especially when the unanticipated need for short-segment tissue transfer arises during complex urethral reconstruction.

No MeSH data available.


Related in: MedlinePlus

(A) A retrograde urethrogram (patient 2) showing a 3.0-cm distal bulbar stricture (bracket) which could not be completely reconstructed via excision and primary anastomosis alone. (B) A postoperative voiding cystourethrogram at 3 weeks of follow-up, showing a widely patent lumen after minipatch PSG augmented anastomotic urethroplasty.
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f0010: (A) A retrograde urethrogram (patient 2) showing a 3.0-cm distal bulbar stricture (bracket) which could not be completely reconstructed via excision and primary anastomosis alone. (B) A postoperative voiding cystourethrogram at 3 weeks of follow-up, showing a widely patent lumen after minipatch PSG augmented anastomotic urethroplasty.

Mentions: We observed that many recently trained urologists are unfamiliar with the use of penile skin for urethral reconstruction. Although EPA is our preferred reconstructive technique for bulbar urethroplasty, because of its high success rate and efficiency [2], preoperative imaging might not always definitively ascertain which patients are appropriate candidates for EPA (Fig. 2). We sometimes encounter an unexpected need for a small graft, due to equivocal or outdated imaging, dense periurethral fibrosis, and/or those patients with synchronous strictures not recognised before surgery.


'Minipatch' penile skin graft urethroplasty in the era of buccal mucosal grafting.

Hudak SJ, Hudson TC, Morey AF - Arab J Urol (2012)

(A) A retrograde urethrogram (patient 2) showing a 3.0-cm distal bulbar stricture (bracket) which could not be completely reconstructed via excision and primary anastomosis alone. (B) A postoperative voiding cystourethrogram at 3 weeks of follow-up, showing a widely patent lumen after minipatch PSG augmented anastomotic urethroplasty.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4442938&req=5

f0010: (A) A retrograde urethrogram (patient 2) showing a 3.0-cm distal bulbar stricture (bracket) which could not be completely reconstructed via excision and primary anastomosis alone. (B) A postoperative voiding cystourethrogram at 3 weeks of follow-up, showing a widely patent lumen after minipatch PSG augmented anastomotic urethroplasty.
Mentions: We observed that many recently trained urologists are unfamiliar with the use of penile skin for urethral reconstruction. Although EPA is our preferred reconstructive technique for bulbar urethroplasty, because of its high success rate and efficiency [2], preoperative imaging might not always definitively ascertain which patients are appropriate candidates for EPA (Fig. 2). We sometimes encounter an unexpected need for a small graft, due to equivocal or outdated imaging, dense periurethral fibrosis, and/or those patients with synchronous strictures not recognised before surgery.

Bottom Line: However, despite careful preoperative planning, the unanticipated need for a small graft is occasionally recognised intra-operatively, and in such cases we have found that harvesting a minipatch is an efficient alternative to harvesting a buccal mucosal graft.The mean (range) stricture length was 2.4 (2-3) cm and the mean graft length was 2.1 (1.5-2.5) cm.At a mean follow-up of 18 months all repairs were patent with no need for further procedures or instrumentation.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.

ABSTRACT

Objectives: To describe our experience with 'minipatch' penile skin graft (PSG) urethroplasty, as at our institution we prefer excision and primary anastomosis (EPA) urethroplasty whenever feasible, as it gives better outcomes than substitution urethroplasty. However, despite careful preoperative planning, the unanticipated need for a small graft is occasionally recognised intra-operatively, and in such cases we have found that harvesting a minipatch is an efficient alternative to harvesting a buccal mucosal graft.

Patients and methods: Bulbar urethroplasty using a <3 cm PSG was performed via either a ventral onlay or augmented anastomotic technique. In each case the PSG was required to repair an unanticipated urethral defect recognised intra-operatively during various scenarios of challenging urethroplasty. We retrospectively reviewed our experience with this technique.

Results: Among a total of 425 urethral reconstructions over a 4-year period at our institution, four patients (1%) underwent minipatch PSG urethroplasty to repair either urethral strictures that were discovered intra-operatively to be too complex for EPA (two patients) or for intra-operatively identified, unanticipated synchronous strictures (two patients). The mean (range) stricture length was 2.4 (2-3) cm and the mean graft length was 2.1 (1.5-2.5) cm. At a mean follow-up of 18 months all repairs were patent with no need for further procedures or instrumentation.

Conclusion: Minipatch PSG urethroplasty is an efficient alternative to a buccal mucosal graft repair, especially when the unanticipated need for short-segment tissue transfer arises during complex urethral reconstruction.

No MeSH data available.


Related in: MedlinePlus