Evidence-Based Efficacy of Autologous Grated Cartilage in Primary and Secondary Rhinoplasty.

BACKGROUND: There are numerous methods to mold and shape cartilage grafts for use in rhinoplasty. Each technique has advantages and disadvantages. We are going to introduce a new method for cartilage shaping with long lasting effects confirmed by follow up examination and pathologic evaluation. METHODS: Grated cartilage was used in 483 patients. For 89 cases, it was wrapped in fascia and in 394 patients, used as a filler per se or in contiguity with solid structural grafts. In 51 patients, the operation was primary rhinoplasty and 432 cases, underwent secondary rhinoplasty. Postoperatively, there was a mean follow up of 2.8 years. Graft viability, and capability to maintain almost original volume, and general durability were assessed. RESULTS: Out of 483 patients, only 23 cases (4.7%) needed later correction. In 11 cases (2%), it was due to overcorrection and some minor imperfections. In the rest 12 cases (2%), there was a need for more augmentation probably due to some degree of graft resorption. Three cases of these 12 patients, were corrected by outpatient shaved cartilage injection. CONCLUSION: According to the very low revision rate (less than 5%), we strongly recommend our grated cartilage graft for use in primary and secondary rhinoplasty. Our study showed that patient and surgeon`s satisfaction can be achieved with a high degree of confidence.

Epitheliod leiomyoma of the bladder: an unusual case of irritative and obstructive voiding symptoms.

Epitheloid leiomyoma is a very rare subtype of benign mesothelial tumors of the bladder. A 46-year-old female patient presented to our hospital with prolonged dysuria, frequency, and recurrent urinary tract infections. Bimanual examination revealed a mobile, round mass in bladder. There was a round hyperdense intravesical mass near bladder neck in computed tomography (CT) scan that was compatible with her magnetic resonance imaging (MRI). A well defined 3 × 4 centimeter mass was seen in superolateral part of bladder neck during cystoscopy. The patient underwent partial cystectomy and histopathologic findings confirmed the diagnosis of epithelioid leiomyoma. The patient's followup was uneventful in a period of 2 years. Size and anatomic location of this tumor were major factors that affect on treatment.

Dorsal versus ventral oral mucosal graft urethroplasty.

PURPOSE: To evaluate success rate of dorsal versus ventral oral mucosal graft for anterior urethroplasty. MATERIALS AND METHODS: In a retrospective study, the results of the ventral and dorsal oral mucosal graft (OMG) anterior urethroplasty were assessed in 24 and 29 patients, respectively. Demographic and clinical characteristics of subjects were gathered from the medical records. RESULTS: Patients were followed up for a mean duration of 32 months (range, 25 to 51 months). The success rates of dorsal and ventral anterior OMG urethroplasty were 83.3% and 75.8%, respectively (P = .5). At penile site, dorsal and ventral OMG were done for 9 and 10 patients with stricture lengths of 3.7 ± 1.1 cm and 3.9 ± 1.2 cm, respectively (P = .7). Success rates of dorsal and ventral penile OMG were 88.9% and 70%, respectively (P = .3). At the bulbar site, dorsal and ventral OMG were performed on 15 and 19 patients with stricture lengths of 4.1 ± 1.1cm and 4.2 ± 1.5 cm, respectively (P = .7). The success rates of dorsal and ventral bulbar OMG were 80% and 79%, respectively (P = .94). CONCLUSION: Oral mucosal graft is a versatile and an effective procedure for management of strictures throughout the anterior urethra, and in experienced hands, the outcomes are similarly favorable whether a dorsal or ventral approach is taken.

Dorsal versus ventral anterior urethral spatulation in posterior urethroplasty.

PURPOSE: To compare dorsal versus ventral anterior urethral spatulation in posterior urethroplasty. MATERIALS AND METHODS: In a retrospective study, we evaluated the records of 320 posterior urethroplasties which have been done in our center over a 7-year period from January 2000 to December 2006. The results of dorsal and ventral anterior urethral spatulations were compared. RESULTS: The studied subjects consisted of 264 men and 54 prepubescent boys (≤ 15 years) with the mean age of 23 years (range, 5 to 84 years). The mean follow-up was 52 months (range, 27 to 107 months). Six o'clock (group A) and 12 o'clock (group B) anterior urethral spatulations were performed in 101 (32%) and 219 (68%) of the patients, respectively. The success rates were 96% and 87.6% in groups A and B, respectively (P = .025). There were no urethro-rectal fistula and perineal wound infection during the follow-up period. CONCLUSION: Our data suggest that the dorsal anterior urethral spatulation in urethroplasty is more efficient than ventral anterior urethral spatulation in terms of treatment success outcome.

Monti’s procedure as an alternative technique in complex urethral distraction defect

PURPOSE: Pelvic fracture urethral distraction defect is usually managed by the end to end anastomotic urethroplasty. Surgical repair of those patients with post-traumatic complex posterior urethral defects, who have undergone failed previous surgical treatments, remains one of the most challenging problems in urology. Appendix urinary diversion could be used in such cases. However, the appendix tissue is not always usable. We report our experience on management of patients with long urethral defect with history of one or more failed urethroplasties by Monti channel urinary diversion. MATERIALS AND METHODS: From 2001 to 2007, we evaluated data from 8 male patients aged 28 to 76 years (mean age 42.5) in whom the Monti technique was performed. All cases had history of posterior urethral defect with one or more failed procedures for urethral reconstruction including urethroplasty. A 2 to 2.5 cm segment of ileum, which had a suitable blood supply, was cut. After the re-anastomosis of the ileum, we closed the opened ileum transversely surrounding a 14-16 Fr urethral catheter using running Vicryl sutures. The newly built tube was used as an appendix during diversion. RESULTS: All patients performed catheterization through the conduit without difficulty and stomal stenosis. Mild stomal incontinence occurred in one patient in the supine position who became continent after adjustment of the catheterization intervals. There was no dehiscence, necrosis or perforation of the tube. CONCLUSION: Based on our data, Monti’s procedure seems to be a valuable technique in patients with very long complicated urethral defect who cannot be managed with routine urethroplastic techniques.

Fistula repair after hypospadias surgery using buccal mucosal graft.

INTRODUCTION: The aim of this study was to evaluate the success rate of urethrocutaneous fistula repair using buccal mucosal graft in patients with a previous hypospadias repair. MATERIALS AND METHODS: We reviewed records of our patients with urethrocutaneous fistula developed after hypospadias repair in whom buccal mucosal graft fistula repair had been performed. All of the patients had been followed up for 24 postoperative months. A successful surgical operation was defined as no fistula recurrence or urethral stricture. Retrograde urethrography and urethrocystoscopy would be performed in patients who had any history of decreased force and caliber of urine or any difficulty in urination. RESULTS: Fistula repair using buccal mucosa patch graft had been done in 14 children with urethrocutaneous fistula developing after hypospadias reconstruction. The mean age of the children was 8.70 +/- 1.99 years old (range, 4 to 11 years). Seven fistulas were in the midshaft, 4 were in the penoscrotal region, and 3 were in the coronal region. Repair of the fistulas was successful in 11 of 14 patients (78.6%). In the remaining children, the diameter of the fistula was smaller than that before the operation, offering a good opportunity for subsequent closure. CONCLUSION: Our findings showed that fistula repair using buccal mucosal graft can be one of the acceptable techniques for repairing fistulas developed after hypospadias repair.

Internal urethrotomy combined with antegrade flexible cystoscopy for management of obliterative urethral stricture.

INTRODUCTION: We studied the safety and efficacy of flexible cystoscopy-guided internal urethrotomy in the management of obliterative urethral strictures. MATERIALS AND METHODS: Forty-three flexible cystoscopy-guided internal urethrotomies were performed between 1999 and 2005. The indication for the procedure was nearly blinded bulbar or membranous urethral strictures not longer than 1 cm that would not allow passage of guide wire. Candidates were those who refused or were unable to undergo urtheroplasty. By monitoring any impression of the urethrotome on the monitor through the flexible cystoscope, we were able to do under-vision urethrotomy. All of the patients were started clean intermittent catheterization afterwards which was tapered over the following 6 months. Follow-up continued for 24 months after the last internal urethrotomy. RESULTS: Seventeen patients were younger than 65 years with a history of failed posterior urethroplasty, and 26 were older than 65 with poor cardiopulmonary conditions who had bulbar urethral stricture following straddle or iatrogenic injuries. Urethral stricture stabilized in 16 patients (37.2%) with a single session of urethrotomy and in 17 (39.5%) with 2 urethrotomies. Overall, urethral stricture stabilized in 76.7% of patients with 1 or 2 internal urethrotomies within 24 months of follow-up. No severe complication was reported. CONCLUSION: Flexible cystoscopy-guided internal urethrotomy is a simple, safe, and under-vision procedure in obliterative urethral strictures shorter than 1 cm. It can be an ideal option for patients who do not accept posterior urethroplasty or are in a poor cardiopulmonary condition that precludes general anesthesia.

Diagnostic application of flexible cystoscope in pelvic fracture urethral distraction defects.

INTRODUCTION: The aim of this study was to evaluate the diagnostic value of antegrade flexible cystoscopy in pelvic fracture urethral distraction defects (PFUDD). MATERIALS AND METHODS: Between 1999 and 2004, a total of 111 patients with PFUDD were evaluated by antegrade flexible cystoscopy. The flexible cystoscope was introduced into the posterior urethra and the area was evaluated for any probable fistula, false passages, or displacement of the posterior urethra. For preventing misalignment, flexible cystoscope was also used during the urethroplasty to open the posterior urethra at its exact distal point. RESULTS: Posterior urethra ended distal to the external sphincter in 16 patients (14.4%). Five (4.5%) and 9 (8.1%) patients had severe displacement of the posterior end of the urethra and bladder neck false passage, respectively. Prostatic urethrorectal fistula was detected in 1 patient. Another 1 patient had bladder rhabdomyoma. CONCLUSION: Flexible cystoscopy is a valuable procedure in the evaluation of the bladder, the bladder neck, and the posterior urethra in patients with urethral distraction defects and complements voiding cystography before the surgery. It is also helpful for showing the exact distal point of the proximal urethra during urethroplasty in cases with displaced posterior urethra.