1 / 21

Grafts in uretheroplasty

Grafts in uretheroplasty

iwyarimbawa
Download Presentation

Grafts in uretheroplasty

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Grafts in Urethroplasty

  2. Introduction • Repair of urethral stricture is approached with multiple different techniques : • One of which  graft placement for open reconstruction • Causes of stricture • Trauma • Iatrogenic • Lichen sclerosus • Prior surgery • etc • Open urethroplasty is gold standard for anterior urethral strictures; but there are other options/methods Brown B, Vannia A. Use of Alternative Techniques and Grafts in Urethroplasty. Urol Clin N Am 44 (2017) 127-140

  3. INJECTABLES • Used in combination of DVIU (direct vision internal urethrotomy) with injection of antiproliferative agent • To reduce recurrence • Steroid (triamcinolone) • Mitomycin C (MMC) • Hyaluronidase Mazdak & colleagues reported recurrence reduction of 21.7% with triamcinolone MMC following DVIU reduced recurrence rate of 10% There has been minimal experiment for hyaluronic acid in humans  one study showed significant lower recurrence rate Brown B, Vannia A. Use of Alternative Techniques and Grafts in Urethroplasty. Urol Clin N Am 44 (2017) 127-140

  4. INJECTABLES • Injection of 3 drugs (40 mg triamcinolone, 2 mg MMC, 3000 units of hyaluronic acid)  recurrence rate of only 19.4% of 103 patients • Other injectables : • Botox injection • Collagenase Clostridium histolyticum • Topical agents: bevacizumab, 5-fluorouracil, halofuginone Brown B, Vannia A. Use of Alternative Techniques and Grafts in Urethroplasty. Urol Clin N Am 44 (2017) 127-140

  5. Alternative grafts • Several new sources of graft material have arisen • Options : Buccal mucosal grafts, lingual mucosal grafts, bladder epithelium, colonic mucosa Brown B, Vannia A. Use of Alternative Techniques and Grafts in Urethroplasty. Urol Clin N Am 44 (2017) 127-140

  6. Buccal Mucosa Grafts • Application of buccal mucosa graft has been increasingly popular • Buccal mucosa  hairless – so it’s easy to use, with good elasticity and satisfactory survival chances • One study used buccal mucosa with “watch” technique for 26 hypospadias patients  good aesthetic result with the meatus at the top of the glans and without penile deformities was achieved in all patients. • There are severalcircumstanceswherebuccalmucosaiseitherinappropriateorinadequatetorepair a givenstricture Brown B, Vannia A. Use of Alternative Techniques and Grafts in Urethroplasty. Urol Clin N Am 44 (2017) 127-140 Djordjevic ML, Bizic M, Stojanovic B, Bencic M, Kojovic V, Korac G. Buccal mucosa graft for simultaneous correction of severe chordee and urethroplasty as a one-stage repair of scrotal hypospadias (watch technique). World Journal of Urology (2018) https://doi.org/10.1007/s00345-018-2517-y

  7. C Penis iscompletelylengthenedandstraightenedbytunica albuginea incision at the point of maximal curvature, leavingcircularventral defect. D Spherical part of “watch”-shaped buccal mucosa graft is fixed to the tunica albuginea edges with six U-shapedinterruptedsutures. Rectangular parts of the graft are fixedproximallyand distally. This way, new urethral plateiscreated Djordjevic ML, Bizic M, Stojanovic B, Bencic M, Kojovic V, Korac G. Buccal mucosa graft for simultaneous correction of severe chordee and urethroplasty as a one-stage repair of scrotal hypospadias (watch technique). World Journal of Urology (2018) https://doi.org/10.1007/s00345-018-2517-y

  8. Genital and extragenital skin • First describedbyPresmanandGreenfield usingpenileskin Brown B, Vannia A. Use of Alternative Techniques and Grafts in Urethroplasty. Urol Clin N Am 44 (2017) 127-140

  9. Genital and extragenital skin • Othersource: • Postauricularskin – optimal location: alongthelowerhalfofmastoidand posterior tothetragus • Abdominal skin – optimal location: alongtheflankandlower abdomen • Goodforpatientswithstrictures > 6 cm • But, recurrencerate in lichensclerosuspatientsishigherthanusingothergrafts. Brown B, Vannia A. Use of Alternative Techniques and Grafts in Urethroplasty. Urol Clin N Am 44 (2017) 127-140

  10. Lingual Mucosa Grafts • Lingualmucosahavethebiologicalqualitiesthatbuccalmucosa has, such as adaptationto a fluidenvironment, andresistancetolichensclerosus • Can produce 2 graftsfrom 7-16 cm long, novisiblescar • Graftharvestisquitechallenging needtoavoidWhartonductandthelingualnerve • Lingualgraftreconstructioncanbeperformedwithone-stageor 2 stageapproaches Brown B, Vannia A. Use of Alternative Techniques and Grafts in Urethroplasty. Urol Clin N Am 44 (2017) 127-140

  11. Source:https://www.google.com/search?q=lingual+mucosa+graft+urethroplasty&safe=strict&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjv-5q2x6ziAhUJ1qwKHbp4DRkQ_AUIDigB&biw=1440&bih=732#imgrc=F8ahttoQjKDhwMSource:https://www.google.com/search?q=lingual+mucosa+graft+urethroplasty&safe=strict&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjv-5q2x6ziAhUJ1qwKHbp4DRkQ_AUIDigB&biw=1440&bih=732#imgrc=F8ahttoQjKDhwM

  12. Lingual Mucosa Grafts Brown B, Vannia A. Use of Alternative Techniques and Grafts in Urethroplasty. Urol Clin N Am 44 (2017) 127-140

  13. Bladder Mucosa Grafts • Commonlyusedforhypospadiasrepair • Require open bladderdissection (invasive) • Meatalproblemsreported in 68% patients • Repeatprocedures are required in two-thirdsofpatientstoachievesuccessfuloutcomes Brown B, Vannia A. Use of Alternative Techniques and Grafts in Urethroplasty. Urol Clin N Am 44 (2017) 127-140

  14. ColonicmucosaGrafts • TubularizedcolonicmucosafirstusedbyXuetal. in 2004 • Downside: • patientsrequiredsigmoidresectiontoharvestgraft material  morbidity • The authorshavebegunusingtransanalendoscopicmicrosurgical (TEM) techniquetoreducemorbidity • 75% of 18-months successrate • Nopatientsreportedchange in bowelfunction Brown B, Vannia A. Use of Alternative Techniques and Grafts in Urethroplasty. Urol Clin N Am 44 (2017) 127-140

  15. ColonicmucosaGrafts Brown B, Vannia A. Use of Alternative Techniques and Grafts in Urethroplasty. Urol Clin N Am 44 (2017) 127-140

  16. There are differenttechniquestoovercomethis problem, includingnewsourcesofgraft material. Combined penile skin flap and buccal mucosa graft is a viable and reliable option for urethral reconstruction in one-stage repair. Conclusion

  17. Reference • Brown B, Vannia A. Use of Alternative Techniques and Grafts in Urethroplasty. Urol Clin N Am 44 (2017) 127-140 • Djordjevic ML, Bizic M, Stojanovic B, Bencic M, Kojovic V, Korac G. Buccal mucosa graft for simultaneous correction of severe chordee and urethroplasty as a one-stage repair of scrotal hypospadias (watch technique). World Journal of Urology (2018) https://doi.org/10.1007/s00345-018-2517-y

More Related