Dorsal onlay buccal mucosal graft or penile skin graft substitution urethroplasty in bulbar urethral stricture: compare the outcome and review

Background: Authors describe their experience with dorsal onlay urethroplasty using Buccal mucosal graft or penile skin graft through dorsal sagittal urethrotomy for bulbar urethral stricture.Methods: From 2014 to 2017, 29 male patients with bulbar urethral stricture have been treated by one stage dorsal onlay substitution urethroplasty using buccal mucosal graft and penile skin graft. Patients with balanitis xerotica obliterans, unhealthy penile skin, oral mucosa pathology or those who had undergone more than one urethral dilation/internal urethrotomy or urethroplasty were excluded from study. Results were analyzed at 6th and 12th month follow up with clinical history and uroflowmetry. Clinical outcome was considered a failure when any postoperative instrumentation was needed, including dilation or optical internal urethrotomy.Results: A total of 16 men age between 21 to 56 years for buccal mucosa graft (BMG) urethroplasty and 13 men age between 18 to 59 years underwent dorsal onlay substitution urethroplasty using BMG and penile skin graft (PSG). Mean stricture length was 4.2 cm (3.8-6) for BMG urethroplasty and 4.1 cm (3.2-5) for PSG urethroplasty. Mean length and width of graft were 4.2 cm and 2.6 cm respectively in BMG urethroplasty while 4.6 cm and 2.5 cm in PSAG urethroplasty. Average follow up months were 13.4 months with overall success rate 87.5% in BMG urethroplasty while average follow up months were 14.6 months with overall success rate 82.3% in PSG urethroplasty.Conclusions: On short term follow up substitution urethroplasty using both penile skin and buccal mucosa graft have comparable results.

Dorsal Onlay Substitution Urethroplasty using Buccal Mucosa and Penile Skin Grafts - Our Experience

Introduction: Urethral stricture is the term used for anteriorurethral disease, or spongiofibrosis. Current research aimed tostudy buccal mucosal graft and penile skin grafts for dorsalonlay urethroplasty.Material and methods: This was a prospective studyconducted at the department of Surgery, R.I.M.S., Ranchifrom November 2010 to October 2012 in urethral stricturecases in male adults. Detail history taking and imagingprocedures were done for all patients. Patients were dividedinto two groups. The first group underwent buccal mucosalgraft and the second group underwent penile skin graft.Result: A total of 43 patients were included in the study.We found that urethral stricture was most common in theage group of 31-40 years. On follow-up, one patient (5%) inthe BMG group and 3 patients (15%) in the PSG group hadthinning of stream/failure.Conclusion: For substitution urethroplasty, buccal mucosashould be the preferred substitute but penile skin can be usedin cases when the buccal mucosa is unavailable as in cases ofsub mucosal fibrosis.

Povidone-iodine versus the benzethonium chloride wipe for penile skin disinfection before semen collection from sperm donors / 中华男科学杂志

<p><b>Objective</b>To study the influence of povidone-iodine (PI) versus that of the benzethonium chloride wipe (BCW) on semen collection and semen quality of sperm donors undergoing penile skin disinfection and provide some evidence for the selection of disinfection methods for semen collection.</p><p><b>METHODS</b>We used PI from August to December 2015 and BCWs from January to July 2016 for penile skin disinfection before semen collection, with two samples from each donor, one collected with and the other without penis skin disinfection (the blank control group). After semen collection, we conducted a questionnaire investigation on the influence of the two disinfection methods on semen collection and compared the semen parameters between the two groups of sperm donors.</p><p><b>RESULTS</b>Totally, 185 sperm donors were included in this study, of whom 63 underwent penile skin disinfection with PI and the other 122 with BCWs before semen collection. Statistically significant differences were found between the PI and BCW groups in the adaptability to the disinfectant and rigid disinfection procedures (P <0.05), but not in the other items of the questionnaire (P >0.05). Compared with the sperm donors of the blank control group, those of the PI group showed statistically significant difference in the percentage of progressively motile sperm (PMS) (［63.02 ± 3.18］% vs ［61.45 ± 4.78］%, P<0.05), but not in the abstinence time (［4.97 ± 1.79］ vs ［4.7 ± 0.94］ d, P >0.05), semen volume (［4.11 ± 1.54］ vs ［4.15 ± 1.61］ ml, P >0.05), sperm concentration (［110 ± 29.6］ vs ［107.5 ± 31.79］ ×10⁶/ml, P >0.05), or total sperm count (［439.10 ± 170.13］ vs ［434.02 ± 186.91］ ×106/ejaculate, P >0.05), while those of the BCW group exhibited no remarkable difference in any of the above parameters (P >0.05). Among the samples with abnormal semen quality, significantly fewer were found with abnormal PMS in the BCW than in the PI group (1.64% ［2/122］ vs 9.68% ［6/62］, P <0.05). However, there were no significant differences between the PI and BCW groups in the abnormal semen volume, abnormal sperm concentration, or the rate of semen bacterial contamination (P >0.05).</p><p><b>CONCLUSIONS</b>Before semen collection from donors, penile skin disinfection with povidone-iodine may affect both the semen collection process and the quality of donor sperm, while the benzethonium chloride wipe can reduce the influence on the semen collection process and does not affect the semen parameters.</p>

Long-term efficacy of penile skin flaps for reconstruction of anterior urethral stricture / 中华泌尿外科杂志

Objective To evaluate the long-term efficacy of using penile skin flaps for urethroplasty in the treatment of anterior urethral strictures.Methods Between Jan 2006 and Dec 2012,138 patients with anterior urethral stricture were treated by using penile skin flaps for urethroplasty.The mean age was 38 years (range,7-82 year).The etiology of stricture included trauma in 78 cases,iatrogenicity in 41 cases,infection in 17 cases,unknown reason in 2 cases.The penile urethral stricture was found in 110 cases and the bulbourethral stricture was found in 28 cases.The mean length of anterior urethral stricture was 6.5 cm (range 3-14 cm).Among them,the length of urethral stricture was more than 10 cm in 48 patients.Basing on location,length of stricture and condition of penile skin,different penile skin flaps were chosen,including vertical pedicle skin flap,pedicle circular flap,L-flap,Q-flap.Three different techniques were used for urethroplasty,such as lateral patch flap urethroplasty (group1,n=80),dorsal and ventral inlaid flap urethroplasty (group 2,n =42) and tubularized flap urethroplasty (group 3,n =16).Results 4 patients were lost during follow-up.The mean duration of follow-up in the remaining 134 patients was 39 months (range,8-84 months).Complications developed in 29 of 134 patients (21.6％),including strictures recurrence in 17 (group 1,n =12,group 2,n=2 and group 3,n =3),urethrocutaneous fistulas in 7 (group 1,n =5,group 2,n=1 and group 3,n =1) and urethral diverticulum in 5 (group1,n =4,and group 3,n =1).105 cases voided well and the urinary peak flows ranged from 13-49 ml/s (mean 25 ml/s),The overall success rate was 78.4％ (105/134).Conclusions Penile skin is thinner,rich in blood supply and easy to be manipulated,which is one of the excellent materials for the urethral reconstruction.Q-flap or L-flap urethroplasty is an effective technique for the treatment of long-segment urethral strictrues (≥ 10 cm).

Mucoid Cyst of Penile Skin: A case report

A rare case of mucoid cyst of the penile skin in a 23 year-old man is reported, which has been presented as a movable, superficial and no tender nodule, measuring 0.8 cm in maximum diameter at the periurethral meatus of the glans for 6 months. This nodule was removed by simple excision and proved to be a mucoid cyst of penile skin, which was lined by pseudostratified columnar epithelium with occasional mucous epithelium and glands, suggesting its origin is most likely from sequestrated periurethral glands.

New Technique of Plastic Reconstruction Using Scrotal Skin Pedicle Graft in Penile Skin Defect / 대한비뇨기과학회지

A new technique of plastic reconstruction of penile skin using scrotal skin pedicle graft was devised This technique was applied in 6 patients who were admitted to the Department of Urology, Korea University Hospital during the period of 5 years and 6 months from January 1974 to June 1979 and the results were excellent in all cases. The primary causes of penile skin defect in these patients were injection of paraffin into the subcutaneous tissues of the penile shaft(4 Pts.) and tissue necrosis resulted from infiltration of local anesthetics for performing circumcision (2 Pts.). The procedure was as follows: 1st stage; With the patient in supine position, under general orspinal anesthesia, the removal of paraffin or fibrotic tissues and necrotic tissues were carried out After the length of penile skin defect was measured and the same length was applied in making three parallel transverse incisions over the scrotal skin and the skin between these incisions was undermined to from two tunnels underneath. The penis was drawn downward through the proximal tunnel to cover the denuded area over the dorsal side of the penis and the glans was exposed. Both the proximal and distal borders of the proximal tunnel were approximated to healthy skin borders of dorsal aspect of the penis. The scrotal skin flap forming distal tunnel was then reversed inside out inwardly and upwardly and approximated the proximal and distal borders with healthy skin borders of distal and proximal borders of ventral aspect of the penis so that the ventral denuded area of the penis could be covered. Then the denuded scrotal skin was closed by approximation of remained scrotal skin edges. Sutures. were carried out in interrupted manner with 4-O Nylon except the ventral side of proximal portion of the penis and closure of the scrotal skin, where 3-0 catgut were used. 2nd stage; After healing had taken place the penis was freed by simple dissection of two lateral pediclcs from the scrotum under local anesthesia. Then simple closure was performed on every dissected borders. The advantages of this technique are as follows: 1. Indwelling of urethral catheter or urinary diversion such as suprapubic cystostomy isnot necesssry in first stage operand and the patient can void urine without difficulty. 2. No discomfort or pain is complained on erection of the penis because the penis is lifted away from the scrotum by the reversed scrotal skin flap. 3. The second stage of this operation is so simple that the procedure is performed under local anesthesia. 4. There isono danger of urethral injury in second stage operation

A Case Report of Total Penile Skin Graft / 대한비뇨기과학회지

A case of complete loss of penile skin treated with scrotal skin graft was presented in a 26 year old male. This case was noted to be a complete loss of penile skin which was developed under local anesthesia with formalin 30 cc during circumcision. The implantation of the penis in the scrotum was performed by the scrotal tunnel method. Complete logs of penile skin was restored by implanting the denuded surface under the subcutaneous tissue of the scrotum.

Penile Skin Graft: Report of Two Cases / 대한비뇨기과학회지

Two cases of necrotic penile skin treated with scrotal skin graft are hereby reported. These cases revealed scrotal swelling and complete loss of penile skin which might have been due to ischemic tissue necrosis under local anesthesia withmixed solution of 1% procaine HC1. 2% Lidocain HCl and 0.5% epinephrine. Epinephrine was administered with over dosage to control bleeding during circumcision implantation of the penis into the scrotum for the purpose of plastic reconstruction of penile skin, i.e. scrotal tunnel method, was performed successfully under spinal anesthesia.