Boomerang Technique, The Buccal Mucosal Grafting Harvesting Model for Long Urethral Stricture Urethroplasty; A Case Series.

PURPOSE: Currently, three methods are implicated in cases of long urethral stricture including harvesting buccal mucosa of inner cheeks, harvesting lip mucosa and finally lingual mucosal graft. This study evaluated the feasibility, safety and morbidity of our "Boomerang shape" technique used for graft retrieval from the inner cheeks to repair long urethral defect cases which are usually 12-15 cm in length and 2.5 cm in width. MATERIALS AND METHODS: The Kilner-Doughty mouth retractor is inserted to give access to the donor site. Initially, the internal surface of the right/left cheek is cleaned with a solution containing 10% povidone-iodine. Then, Stensen's duct, located at the level of the second molar is identified and the desired size of the graft is measured and marked in a boomerang shape, 1.5 cm from the Stensen's duct and 1.5 cm from the edge of the cheek. To decrease submucosal bleeding from the harvest site, 1% lidocaine combined with a 1:100,000 epinephrine solution is injected using a 25-gauge long needle. The outlines of the graft are drawn by using a scalpel through the mucosa. Then, the outlined graft is sharply dissected and removed, leaving the muscle intact. A 5-0 polyglactin continuous suture is used for the closure of the harvest site. The standard graft harvested from the cheek should be 12-15 cm in length and 2.5 cm in width. RESULTS: Between 2017-2019, five adults have had their mucosal grafts harvested by the "Boomerang shape" technique in our center. No donor site complications were observed. Moreover, no urethral strictures or diverticulum occurred and the functional outcomes were satisfactory in all patients. CONCLUSION: Our routine technique of harvesting the buccal mucosa from the cheek is secure and easily performable by any surgeon. It has minimal incidence of intra and post-operative complications.

How is the association between urinary prostate cancer antigen 3 (PCA3) levels and Gleason scores in patients suspicious of prostate cancer?

INTRODUCTION: Prostate cancer is one of the most common cancers in men which is mostly slow growing and responses well to treatments if early diagnosed. Urinary prostate cancer antigen 3 (PCA3) assay is a new method with effective results in diagnosing prostate cancer. The aim of this present study was evaluate the correlation between urinary PCA3 and Gleason scores in patients who are suspicious of prostate cancer and undergo tissue biopsies. METHODS: This is a cross-sectional study which was performed in 2017-2018. The patients included this study complain of prostate problems and were selected from Nour hospital, Ali-Asghar hospital and Ordibehesht clinic in Tehran, Iran. Urinary PCA3 levels were checked in all patients and then they went under prostate biopsies. Amounts of PCA3 and Gleason scores were collected and analyzed using SPSS software. FINDINGS: We evaluated a total number of 80 patients. 40 patients had prostate cancer and 40 had no cancer. We indicated that no significant relation was reported between Gleason scores and urinary PCA3 levels. Levels of urinary PCA3 were higher in patients with prostate cancer than in patients with no cancer (P=0.007). DISCUSSION: Generally, urinary PCA3 test is indicated as a non-invasive method to improve the specificity of prostate cancer diagnosis and its potential predictive value was studied in numerous clinical researches, but here we found higher PCA3 levels in patients with prostate cancer than in patients with and other prostate problems. We conclude that PCA3 functions as a diagnostic test and its changes in prostate cancer need to be further studied in different populations and races.

Feasibility, complication and long-term follow-up of the newly nelaton based urethral dilation method, retrospective study.

Introduction: Current methods for Urethral dilatation include filiforms and followers, metal sounds, balloon dilators, catheters of increasing size, introduction of a Council catheter over a guidewire, and coaxial dilators of increasing size. These methods however are effective but expensive and use of them is limited in many third world countries. In this retrospective study, we report the feasibility, complication and long-term follow-up of the newly Nelaton based urethral dilation method following by self calibration plan as a single referral center experience. Method: We reviewed the records of 333 men with urethral stricture longer than 1 cm over a 16-year period between March 2001 to December 2018. In this method the straight flexi-tip guide-wire is introduced through the urethra and advanced under cystoscopic vision. This wire then was used to guide the dilatation after withdrawal of the cystoscope. The tip of well-lubricated Nelaton urethral catheters incised and then advanced gently over the guide-wire serially from the smallest to the largest appropriate sizes. The patients were followed up regularly after the dilatation 1, 3, 6, 12 months and then annually postoperatively with taking history, PVR and uroflowmetry and all underwent retrograde urethrography at the 6th and 12th months of follow-up. Result: The mean age of patients was 39.19±16.9 years old (10 to 86 years). The mean period of the follow-up was 3.6±1.1 years (range, 3 to 4.3 years). Success rate after first attempted was 58.5% and after two attempted was 77.7% in two years follow up. After one year 51 (15.3%), two years 23 (6.9%) and after three years 11 (3.3%) cases required continued self dilatation once a month. Conclusion: Guide wire-assisted urethral dilatation is shown to be acceptable, cost-effective, simple, safe and feasible techniques for urethral dilation. Our technique may be the choice manner in selected patients with short memberanous urethral stricture, because of decrease the risk of incontinency.