Iatrogenic or recurrent bladder neck contracture treated by the Palminteri-Ferrari technique: a new way to approach a frustrating condition.

PURPOSE: Bladder neck stricture (BNS) is a bothersome disease which may affect patients after trauma or prostatic surgery. It is frustrating due to the low durable success rate of currently available surgical techniques. The aim of the study is to explore the efficacy of a novel technique. MATERIALS & METHODS: The surgical protocol was developed by two high case-volume surgeons. The technique consists of Holmium laser incisions at 3-6-9-12 o'clock. Subsequently, triamcinolone acetonide 40 mg is injected. Two months later, the BNS is endoscopically checked in operatory room and re-procedure take place, if necessary (max 3 times). Failure was defined as the need of definitive urinary diversion. Subjective satisfaction was measured through PGI-I Questionnaire. RESULTS: A total of 45 patients were enrolled. Median age was 63 (IQR 59-69) years and BNS developed by different causes. Naïve BNS procedure patients were 12 (26.7%), others 33 (73.3%) underwent median 2 (IQR 1-4) previous urethrotomies, including 16 other surgeries. Suprapubic bladder catheter was present in 34 patients (75.6%). No complications were registered. Re-procedure at control was necessary in 24 patients (53.3%) for a median of 1 (IQR 1-3) procedures. At median follow-up of 18 months, failures were 4 (8.9%) and urinary incontinence was reported in 2 patients (4.5%) who required incontinence surgery. Median PGI-I was 2. CONCLUSIONS: Our technique of BNS treatment allows good outcomes and high rate of subjective improvement amongst patients. Moreover, naïve patients seem to have better results. However, longer follow-up and higher sample size are mandatory to further assess these data.

Small intestinal submucosa graft bulbar urethroplasty is a viable technique: results compared to buccal mucosa graft urethroplasty after propensity score matching.

PURPOSE: Small intestinal submucosa (SIS) graft urethroplasty has been employed to decrease buccal mucosa morbidity and facilitate the procedure. The first published series had a short follow-up, inhomogeneous patient selection, and a lack of a control group. Our purpose is to report treatment outcomes at 13 years in a propensity score-matched cohort comparing bulbar urethroplasty with SIS (SISU) or buccal mucosa (BMU). METHODS: From our institutional database of 1132 bulbar urethroplasties, we used propensity score matching with the nearest-neighbor method without replacement to generate a study sample of 25 BMU and 25 SISU. Failure was defined as any treatment after urethroplasty. Survival analyses were used to analyze treatment failure occurrence with data censored at 156mo. RESULTS: Matching resulted in a complete correction of bias between the two samples except for the follow-up duration, which was slightly longer in the SIS group. The cumulative treatment success probability of BMU and SISU at 156mo was 83.4% and 68%, respectively. At multivariable Cox regression, SIS graft, previous urethrotomy, stricture length, and lower postoperative Qmax (within 2mo after catheter removal) were predictors of failure. Stricture length had a more remarkable effect in SISU, with estimated survival probabilities from the Cox model lower than 80% in strictures > = 3 cm. CONCLUSION: SIS has poorer outcomes compared to BM but may still be useful when BM grafting is not possible. The best candidates for SISU, with similar success to BMU, are patients with strictures shorter than 3 cm, preferably without a history of DVIU.

Non-transecting dorsal mucosal anastomosis plus ventral oral graft for the treatment of urethral bulbar strictures: single surgeon experience.

PURPOSE: To report our experience with the non-transecting dorsal mucosal anastomosis plus ventral oral graft urethroplasty (NTAVOG) for the repair of tight bulbar urethral strictures. METHODS: Data of 68 men with tight bulbar strictures underwent NTAVOG urethroplasty between 2012 and 2019 were retrospectively revised. The urethra was opened ventrally; the dorsal scarred mucosa was excised preserving the spongiosum; the mobilized mucosal edges were anastomosed to recreate the dorsal urethral plate; the repaired urethral plate was augmented by the ventral oral graft and the spongiosum was closed over it. Successful urethral reconstruction was defined as normal voiding without the need for any postoperative procedure. Sexual function was investigated using a validated questionnaire. RESULTS: Median follow-up was 58 months (IQR 38-63) and mean stricture length was 1 cm (IQR 1-1.5). Of 68 cases, 56 (82.4%) were successful and 12 (17.6%) were failures requiring re-treatment. At multivariable analysis, no preoperative factor was significantly associated with recurrence. None of the preoperatively sexually active 53 patients reported postoperative erectile impairment and all were satisfied with their sexual life. The main limitation is the retrospective design. CONCLUSIONS: In cases of tight bulbar stricture, the NTAVOG urethroplasty provides adequate urethral augmentation by preserving the spongiosum and avoiding postoperative sexual complications. We presented a series of patients undergone non-transecting dorsal anastomosis plus ventral oral graft urethroplasty for tight bulbar stricture. This treatment seems to be safe and with limited postoperative complications thanks to the preservation of the corpus spongiosum.

Primary versus Redo Urethroplasty: Results from a Single-Center Comparative Analysis.

OBJECTIVES: To explore the differences between primary and redo urethroplasty and to directly compare according stricture-free survival (SFS). Materials and Methods. Data of all male patients who underwent urethroplasty at Ghent University Hospital were collected between 2000 and 2018. Exclusion criteria for this analysis were age <18 years and follow-up <1 year. Two patient groups were created for further comparison: the primary urethroplasty (PU) group (no previous urethroplasty) and redo urethroplasty (RU) group (≥1 previous urethroplasty), irrespective of prior endoscopic treatments. A comparison between groups was performed using the Mann-Whitney U test and Fisher's Exact test. SFS was calculated using Kaplan-Meier statistics. A functional definition of failure, being the need for further urethral manipulation, was used. Uni- and multivariate Cox regression analyses were performed on the entire patient cohort. RESULTS: 805 patients were included. Median (IQR) follow-up of the PU (n = 556) and RU (n = 556) and RU (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (. CONCLUSIONS: Several differences between primary and redo urethroplasties exist. Redo urethroplasty entails a distinct patient population to treat and is, in general, associated with lower stricture-free survival than primary urethroplasty, although more homogeneous series are required to corroborate these results. Prior urethroplasty and diabetes are independent risk factors for urethroplasty failure.

Kulkarni Dorsolateral Graft Urethroplasty Using Penile Skin.

OBJECTIVES: To investigate the safety, efficacy, and versatility of dorsolateral graft urethroplasty using penile skin. MATERIALS AND METHODS: Between 2010 and 2013, 37 men with anterior urethral strictures underwent dorsolateral graft urethroplasty using penile skin by a single surgeon (EP). Inclusion criterion was patients with anterior urethral strictures. Exclusion criteria were lichen sclerosus-related strictures, absence of available penile skin because of previous surgery, and obliterative urethral strictures. Clinical outcome was considered a failure when any postoperative instrumentation was needed, including dilatation. RESULTS: Mean (± standard deviation) patients age was 51 (±15.4) years. Stricture etiology was iatrogenic in 25 cases (67%), unknown in 10 (27%), trauma in 2 (6%). Stricture site was penile in 21 (57%) and peno-bulbar in 16 (43%). Median (range) stricture length was 5 cm (1-15). Of 37 patients, 30 (81%) had received previous treatments. Median (range) follow-up was 21 months (12-47). Of 37 patients, 34 (92%) had successful treatment and 3 (8%) had failed treatment. The 3 patients with failed treatment were treated with urethrostomy and are awaiting further reconstruction. Study limitations include the small sample size and the limited follow-up. CONCLUSION: With a mid-term follow-up time, the dorsolateral graft urethroplasty using penile skin is shown to be a safe, efficient, and versatile technique for the repair of short-mid-long anterior urethral strictures.

Two-sided urethra-sparing reconstruction combining dorsal preputial skin plus ventral buccal mucosa grafts for tight bulbar strictures.

OBJECTIVES: To report our initial experience with urethra-sparing reconstruction combining dorsal preputial skin and ventral buccal mucosa grafts for tight bulbar urethral strictures. METHODS: Between November 2006 and September 2012, 26 patients with tight bulbar strictures underwent urethroplasty. Using a ventral urethrotomy approach, the two-sided urethral reconstruction was carried out avoiding the transection of urethra and augmenting the preserved urethral plate by dorsal preputial skin plus ventral buccal mucosa grafts. The primary outcome was the objective urinary result, defined as the absence of stricture recurrence. The outcome was considered a failure when any postoperative instrumentation was required. Postoperative sexual dysfunctions were investigated using a validated questionnaire. RESULTS: Mean follow up was 30.1 months (range 12-79 months). Mean stricture length was 3.3 cm (range 1.5-6 cm). Mean length for dorsal preputial skin and ventral buccal mucosa grafts was 3.2 cm (range 2-7 cm) and 4.9 cm (range 4-6 cm), respectively. Of 26 cases, 23 (88.5%) were successful and three (11.5%) were failures with stricture recurrence. Failures were treated with perineal urethrostomy in one case, ventral buccal graft urethroplasty in one case and internal urethrotomy in one case. Among 12 sexually active men preoperatively, none reported postoperative penile curvature/shortening, impaired erection or dissatisfaction regarding erection; sexual activity was unaltered pre- and post-surgery. CONCLUSIONS: In tight bulbar urethra strictures, the two-sided urethroplasty combining dorsal preputial skin and ventral buccal mucosa grafts provides a safe and effective semi-circumferential reconstruction by augmenting the preserved urethral plate, with no impact on sexual function.

[Surgery of male infertility: an update]. / Chirurgia dell'infertilità maschile: update.

Surgery for male infertility includes three main areas: varicocele surgery, recanalization of seminal tract, sperm retrieval.Varicocele treatment in infertily is still controversial. Recent scientific evidence appears to demonstrate that in selected cases varicocele treatment is beneficial in improving semen parameters and pregnancy rate. The key for the success of treatment seems to be a correct indication. It is our opinion that varicocele should be treated in presence of abnormal semen parameters, when clinically significant, and in adolescents with atrophy of the affected testis. So far, no specific technique, either surgical, microsurgical or sclerotherapic, can be considered the gold standard. Good results in our hands have been obtained with the microsurgical lymphatic sparing high ligation of internal spermatic vein.Innovations in surgery for seminal tract obstructions include the new tubular invagination techniques for epididimovasostomy, which showed excellent results with a simplified and time-saving microsurgical approach. In distal obstructions, a new transperineal ultrasound-guided approach has been proposed for the diagnostic work-up and treatment. Advantages of this technique and of the TURED must be balanced with those of immediate sperm retrieval for ART.In sperm retrieval, microTESE represents the most important surgical evolution in non-obstructive azoospermia. We have recently proposed a new stepwise approach starting with a minimal equatorial incision for conventional testicular biopsy which is extended to perform microTESE only when no sperm is retrieved. In this way microTESE is offered only to patients who really need it. Another field of innovation is sperm retrieval for ICSI in patients with Klinefelter Syndrome.

Male genital reconstruction for the penile cancer survivor.

PURPOSE OF REVIEW: Malignant penile lesions are uncommon but represent a challenge for reconstructive surgeons because their treatment has a profound effect on appearance and quality of life of the patient. RECENT FINDINGS: Partial or total penectomy remains the gold standard in the treatment of penile carcinoma. However, less invasive options that may improve quality of life are being considered, based on stage and grade of the tumor. SUMMARY: A variety of surgical options exist for penile cancer treatment. In this article, we review various reconstructive approaches after initial surgical management of penile carcinoma. Regardless of reconstruction method, the goals remain the same: creating a functional and aesthetically acceptable phallus with the ability to void standing and to achieve sexual function.

[Urethral injuries secondary to implantation of penile prosthesis. Analysis of the causes, prevention and treatment]. / Lesioni uretrali da impianto di protesi peniena. Analisi delle cause, prevenzione e trattamento.

Urethral injuries due to penile prosthesis implant represent a rare complication of the intervention to position penile prosthesis, but unfortunately scientific literature about this is poor. This rare complication may occur during surgery and in the postoperative period, both early and late. It recognizes a variety of causes that may include anatomical or functional conditions, for example cavernosal fibrosis or outcomes of inflammations or previous urethral lesions and pathological sensibility due to diabetic neuropathy or other forms of neuropathy including those from spinal cord injury or myelopathy. This review evaluates the possible predisposing conditions, the clinical presentations, and the devices in the surgical procedures to use to minimize the risk of onset of this lesions and the measures to take if they occur.

Dorsal plus ventral oral mucosal graft bulbar urethroplasty.

Traditionally, anastomotic procedures with transection and urethral excision are suggested for short bulbar strictures, while longer strictures are treated by patch graft urethroplasty preferably using the buccal mucosa as gold-standard material due to its histological characteristics. However, anastomotic urethroplasties may cause sexual complications related to vascular damage of the spongiosum following the urethral section or to excessive urethral shortening. On the other hand, one-sided graft procedures, using either dorsal or ventral graft location, could be insufficient in providing a lumen of adequate width in strictures with a particularly narrow area. The double buccal graft urethroplasty is a new technique that aims to obtain a sufficient "two-sided" augmentation of the urethra avoiding its transection and preserving the urethral plate. In this chapter we discuss the rationale for utilizing our procedure. In addition, the surgical technique is described in detail.

Male urethral strictures: a national survey among urologists in Italy.

OBJECTIVE: To determine national practice patterns in the management of male urethral strictures among Italian urologists. METHODS: We conducted a survey using a nonvalidated questionnaire mailed to 700 randomly selected Italian urologists. Data were registered into a database and extensively evaluated. Analysis was performed using SAS statistical software (version 9.2). Statistical significance was defined as P ≤.05. RESULTS: A total of 523 (74.7%) urologists completed the questionnaire. Internal urethrotomy and dilatation were the most frequently used procedures (practiced by 81.8% and 62.5% of responders, respectively), even if most urologists (71.5%) considered internal urethrotomy appropriate only for strictures no longer than 1.5 cm; 12% of urologists declared to use stents. Overall, minimally invasive techniques were performed more frequently that any open urethroplasty (P = .012). Particularly, 60.8% of urologists did not perform urethroplasty surgery, 30.8% performed 1-5 urethroplasties yearly, and only 8.4% performed >5 urethroplasty surgeries yearly. The most common urethroplasty surgery was one-stage graft technique, particularly using oral mucosa and ventrally placed. Diagnostic workup and outcome assessment varied greatly. CONCLUSION: In Italy, minimally invasive procedures are the most commonly used treatment for urethral stricture disease. Only a minimal part of urologists perform urethroplasty surgery and only few cases per year. The most preferred techniques are not traditional anastomotic procedures but graft urethroplasties using oral mucosa; the graft is preferably ventrally placed rather than dorsally. There is no uniformity in the methods used to evaluate urethral stricture before and after treatment.

The impact of ventral oral graft bulbar urethroplasty on sexual life.

OBJECTIVE: To evaluate the pre- and postoperative aspects of sexual life (SL) in patients with bulbar urethral stricture who underwent ventral oral graft urethroplasty. METHODS: Between 2009 and 2010, 52 men (mean age 36 years) were enrolled in our prospective study to ascertain sexual disorders before and after surgery. The validated Male Sexual Health Questionnaire-Long Form (MSHQ-LF) was completed pre- and postoperatively; the unvalidated but adapted Post-Urethroplasty Sexual Questionnaire (PUSQ) was completed postoperatively. Data were compared using the non parametric Wilcoxon test. RESULTS: Before urethroplasty, most of the patients reported sexual disorders, in particular reduced ejaculatory stream (85%); many of them (35%) feared the risk of a postoperative worsening in the quality of SL. After urethroplasty, nobody reported a worsened erection, while most of the patients noticed a significant improvement in erection, ejaculation, relationship with their partner, sexual activity, and desire. Modifications in the scrotoperineal sensitivity were reported by 42% and 15% noticed esthetic changes without impact on SL. All patients reported an improvement in quality of life (QOL) and were satisfied with the outcome of urethroplasty. CONCLUSION: Urethral stricture disease may be responsible for sexual disorders that have a significant impact upon SL. Patients confessed a marked anxiety tackling urethroplasty and declared that one of their deepest fears regarded a potential further deterioration in the quality of SL. At short-term follow-up, the minimally invasive ventral graft urethroplasty does not cause sexual complications, apart from the post-ejaculation dribbling. On the contrary, this technique showed to restore SL in all its aspects.

The advantages of the ventral approach to bulbar urethroplasty.

BACKGROUND: Several surgical techniques have been described for the treatment of bulbar urethral strictures, and the main goal of modern surgery is to reduce morbidity and obtain the best outcome with the fewest complications. Currently, the superiority of one surgical technique over another has not yet been clearly defined. METHODS: We analysed the historical background, advantages and disadvantages of several urethral approaches and graft placements, with the aim of focusing on the advantages of the ventral approach. CONCLUSIONS: For short bulbar strictures (<2 cm) the traditionally advocated method is excision and end-to-end anastomosis, whilst for longer strictures, in the last decade, the patch graft urethroplasty has been used, with buccal mucosa advocated as the standard material of substitution. Our analysis showed that the approach (dorsal vs. ventral) to the bulbar urethral lumen and the location of the patch (dorsal vs. ventral) are contentious issues. Overall, surgeons tend to use techniques that are easy, quick and give excellent outcomes with few complications. The graft urethroplasty using the ventral approach fulfils these requirements.

Contemporary urethral stricture characteristics in the developed world.

OBJECTIVE: To assess the current etiology, features, and natural history of urethral stricture disease in the developed world. MATERIALS AND METHODS: We analyzed the data from 1439 male patients with urethral stricture, who had undergone surgical treatment in our referral urethral center from 2000 to 2010. The preoperative evaluation included a detailed clinical history of stricture, uroflowmetry, retrograde and voiding cystourethrography, and urethroscopy. Statistical analysis was done for the stricture site, length, and etiology, patient age, and previous treatments. RESULTS: Strictures were posterior in 112 (7.8%) and anterior in 1327 (92.2%). In the anterior group, 439 were penile (30.5%), 675 bulbar (46.9%), 71 penile plus bulbar (9.9%), and 142 panurethral (4.9%). The main causes were iatrogenic in 556 (38.6%), unknown in 515 (35.8%), lichen sclerosus in 193 (13.4%), and trauma in 156 (10.8%). The main iatrogenic strictures were from catheterization in 234 (16.3%), hypospadias repair in 176 (12.2%), and transurethral surgery in 131 (9.1%). The stricture distribution increased until about 45 years and then decreased. Strictures were uncommon in those<20 and >70 years old. The mean length was 4.15 cm; longer strictures were found in those with lichen sclerosus (7.45 cm) or after hypospadias repair (4.42 cm) and catheterization (4.40 cm). The mean length was also greater in the pretreated (4.34 cm) than in the untreated (3.64 cm) strictures. CONCLUSION: Urethral stricture in developed countries mainly involves the anterior urethra, in particular the bulbar tract. The most common cause was iatrogenic. Hypospadias repair and lichen sclerosus represent emerging important causes. Finally, urethral stricture is not a disease of the elderly but involves all ages.

Urethral reconstruction in lichen sclerosus.

PURPOSE OF REVIEW: Lichen sclerosus is a chronic skin disease that shows a predilection for the anogenital area and may involve anterior urethra causing stenosis. Surgical options in the management of urethral strictures caused by lichen sclerosus still represent a challenging issue. RECENT FINDINGS: Depending on the length and severity of urethral involvement, surgical management of lichen sclerosus urethral strictures can range from a simple meatotomy to a single or complex staged long repair using oral mucosa. Skin grafts or flaps are not recommended because skin could be involved by the disease. Perineal urethrostomy may represent the salvage solution in severe panurethral strictures. SUMMARY: One-stage or staged repairs using oral mucosa grafts are the most recommended procedures for the treatment of lichen sclerosus urethral strictures, but derivative perineal urethrostomy may play an important role in severe situations. Patients require long-term follow-up and extensive counseling that enables them to fully grasp the chronic and progressive nature of the disease and to deal with it.

[Preliminary resultson the use of autologous cell culture grafts of buccal mucosa in urethral repairs]. / Risultati preliminari sull'impiego di colture cellulari autologhe di mucosa buccale nelle ricostruzioni uretrali.

OBJECTIVE: We present our preliminary experience with the use of autologous cell cultures of buccal mucosa (BM) in urethral repair. PATIENTS AND METHODS: Five patients with urethral stenosis underwent staged urethral reconstruction with MB autologous cell culture grafts. MB biopsies were obtained from each patient. Keratinocytes and fibroblasts were isolated. This cellular suspension was seeded into Petri dishes. The cultures were kept in chemically specific ground for keratinocyte cultures. Once they reached the proper confluence and extension for urethral reconstruction, the cultures were transplanted in the patients. During the first stage of surgery, after the removal of healing tissues, the MB culture grafts were transplanted in order to recreate a neo-urethral plate. Six months later, the neo-urethral plate was re-tubularized. RESULTS: Average follow-up was 24 mo. We reported successful staged reconstruction in 2 cases (40%). Three cases (60%) were unsuccessful. One patient developed a scar retraction of the grafts after the first stage of surgery, which prevented broad urethral reconstruction. Two patients who had completed the staged reconstructive process,developed a re-stenosis. There were no reported graft site infections and none of the grafts was rejected. CONCLUSIONS: We report the procedure in order to obtain and use an MB homologous cell culture. Using autologous material reduced the surgical time and wiped out the risk of rejection; on the other hand, the tissue was so thin and with no adequate scaffold that the healing retraction of the graft was increased, thus compromising the urethral reconstruction. Preliminary results confirm that bio- engineering applied to urethral surgery is far from obtaining adequate tissue with reference to extension, thickness and biological features.

Versatility of the ventral approach in bulbar urethroplasty using dorsal, ventral or dorsal plus ventral oral grafts.

OBJECTIVES: To investigate the versatility of the ventral urethrotomy approach in bulbar reconstruction with buccal mucosa (BM) grafts placed on the dorsal, ventral or dorsal plus ventral urethral surface. PATIENTS AND METHODS: Between 1999 and 2008, 216 patients with bulbar strictures underwent BM graft urethroplasty using the ventral-sagittal urethrotomy approach. Of these patients, 32 (14.8%; mean stricture 3.2 cm, range 1.5-5) had a dorsal graft urethroplasty (DGU), 121 (56%; mean stricture 3.7, range 1.5-8) a ventral graft urethroplasty (VGU), and 63 (29.2%; mean stricture 3.4, range 1.5-10) a dorsal plus ventral graft urethroplasty (DVGU). The strictured urethra was opened by a ventral-sagittal urethrotomy and BM graft was inserted dorsally or ventrally or dorsal plus ventral to augment the urethral plate. RESULTS: The median follow-up was 37 months. The overall 5-year actuarial success rate was 91.4%. The 5-year actuarial success rates were 87.8%, 95.5% and 86.3% for the DGU, VGU and DVGU, respectively. There were no statistically significant differences among the three groups. Success rates decreased significantly only with a stricture length of >4 cm. CONCLUSIONS: In BM graft bulbar urethroplasties the ventral urethrotomy access is simple and versatile, allowing an intraoperative choice of dorsal, ventral or combined dorsal and ventral grafting, with comparable success rates.

Two-sided bulbar urethroplasty using dorsal plus ventral oral graft: urinary and sexual outcomes of a new technique.

PURPOSE: Repair of bulbar strictures using anastomotic techniques may cause sexual complications, while 1-side graft urethroplasties may not be sufficient to provide an adequate lumen in narrow strictures. We evaluated the urinary and sexual results of a 2-sided dorsal plus ventral graft urethroplasty by preserving the narrow urethral plate in tight strictures. MATERIALS AND METHODS: Between 2002 and 2010, 105 men with bulbar strictures underwent dorsal plus ventral graft urethroplasty. The results are reported in a homogeneous group of 73 of 105 cases in which buccal mucosa was used as a graft with findings after 1 year or more of followup. The urethra was opened ventrally, and the exposed dorsal urethra was incised in the midline to create a raw area over the tunica albuginea where the first graft was placed dorsal-inlay. Thereafter the urethra was augmented by the ventral-onlay second graft and the spongiosum was closed over itself. Successful urethral reconstruction was defined as normal voiding without the need for any postoperative procedure. Postoperative sexual dysfunction was investigated using a validated questionnaire. RESULTS: Mean followup was 48.9 months and mean stricture length was 3.3 cm. Of these 73 cases 64 (88%) were successful and 9 (12%) were treatment failures with re-stricture. Furthermore, of 49 of 73 cases who were preoperatively sexually active, none reported postoperative erectile impairment and all were satisfied with their sexual life. CONCLUSIONS: In cases of tight bulbar stricture the dorsal plus ventral buccal mucosa graft provides adequate urethral augmentation by preserving the urethral plate and avoiding postoperative sexual complications.

Aesthetic neo-glans reconstruction after penis-sparing surgery for benign, premalignant or malignant penile lesions.

PURPOSE: To describe the technique and results of penis-sparing surgery combined with a cosmetic neo-glans reconstruction for benign, pre-malignant or malignant penile lesions. PATIENTS AND METHODS: Twenty-one patients (mean age 61 years) with penile lesions with a broad spectrum of histopathology underwent organ-sparing surgery with neo-glans reconstruction, using a free split-thickness skin graft harvested from the thigh. Three patients were treated by glans-skinning and glans-resurfacing, 10 by glansectomy and neo-glans reconstruction, four by partial penectomy and a neo-glans reconstruction, and four by neo-glans reconstruction after a traditional partial penectomy. RESULTS: The mean follow-up was 45 months; all patients were free of primary local disease. All patients were satisfied with the appearance of the penis after surgery, and recovered their sexual ability, although sensitivity was reduced as a consequence of glans/penile amputation. CONCLUSION: In benign, premalignant or malignant penile lesions, penis-sparing surgery combined with a cosmetic neo-glans reconstruction can be used to assure a normally appearing and functional penis, while fully eradicating the primary local disease.