Penile Enhancement Using Biodegradable Scaffolds Covered with Platelet-rich Plasma-Fibrin Glue, Mesenchymal Stem Cells for Micropenis.

PURPOSE: Evaluation of preliminary cosmetic and functional outcomes of biodegradable scaffolds covered with platelet-rich plasma in penile girth augmentation. MATERIALS AND METHODS: Between June 2016 and June 2018, 36 males who had a mean age of 28.91 years (range 20 - 48 years) with micropenis underwent this procedure. A mixture of platelets-fibrin glue and mesenchymal cells obtained from dermal fat tissue were prepared. Then the mixture was seeded on the pretreated tube-shaped poly lactic-co-glycolic acid scaffold and underwent a whole day of incubation. Following penile degloving, scaffolds were surgically implanted within the interface region of dartos and Buck's fascia. The 5-point Likert scoring scale was used to evaluate the patients' satisfaction with surgery. RESULTS: Patients followed up for 6-12 (8 ± 2.86) months. The penile length in an erected state before surgery was 6.5 - 12.5 cm (9.08 ± 1.6) which enhanced to 7 - 14 cm (10.59 ± 1.71) after surgery (P < .0001). The penile girth before and after surgery were 8.49 ± 1.53 and 10.91 ± 1.96 cm, respectively (P < .0001). An augment in penile length and girth of 1.5 and 2.6 cm were achieved, respectively. Patients appraised surgical intervention on a rating of one to five. The highest possible score (5) was assigned by 27 %, 33 % expressed a very good mark (4), and 19 % gave a good mark (3). CONCLUSION: Covering the scaffold with a mixture of Platelets-Fibrin glue and mesenchymal cells seems a safe and feasible method for penile reconstruction surgery. More studies should be done to determine the effect of platelets- fibrin glue and mesenchymal cells for treating micropenis.

Dorsally Placed Buccal Mucosal Graft Urethroplasty in Treatment of Long Urethral Strictures Using One-Stage Transperineal Approach.

Objectives. To evaluate the results of one-stage buccal mucosal urethroplasty in treatment of long urethral strictures. Methods. This retrospective study was carried out on 117 patients with long urethral strictures who underwent one-stage transperineal urethroplasty with dorsally placed buccal mucosal grafts (BMG). Success was defined as no need for any intervention during the follow-up period. Results. Among 117 patients with mean age of 39.55 ± 15.98 years, the strictures were located in penile urethra in 46 patients (39.32%), bulbar urethra in 33 (28.20%) and were panurethral in 38 (32.48%). The etiology of the urethral stricture was sexually transmitted disease (STD) in 17 (14.53%), lichen sclerosus in 15 (12.82%), trauma in 15 (12.82%), catheterization in 13 (11.11%), transurethral resection (TUR) in 6 (5.13%), and unknown in 51 (43.59%). The mean length of strictures was 9.31 ± 2.46 centimeters. During the mean followup of 18.9 ± 6.7 months success rate was 93.94% in bulbar strictures, 97.83% in penile strictures, and 84.21% in panurethral strictures (P value: 0.061). Conclusions. The success rate of transperineal urethroplasty with dorsally placed buccal mucosal grafts is equal in different sites of strictures with different etiologies. So reconstruction of long urethral strictures may be safely and effectively performed at a simple single operative procedure using this method of urethroplasty.

Tubularized incised plate urethroplasty using buccal mucosa graft for repair of penile hypospadias.

PURPOSE: To describe the results of penile hypospadias repair using the Snodgrass method with buccal mucosa graft (BMG), supported by double dartos flap as a second layer. MATERIALS AND METHODS: In a prospective cohort study, 21 consecutive patients underwent hypospadias repair using the Snodgrass method and BMG as the urethral plate, with the addition of double dartos flap for covering the neourethra. Patients were followed up, and outcomes and complications were recorded. RESULTS: The mean age of the patients was 6.57 ± 3.69 years (range, 2 to 15 years) and the mean follow-up period was 8.42 ± 2.19 months (range, 6 to 12 months). The following minor complications, not requiring additional intervention, were recorded: 2 subjects developed slight chordee < 30 degrees; 2 developed wound infection; and 1 had meatal stenosis postoperatively. Only one patient required additional surgical intervention resulting in a success rate of 95%. No urethrocutaneous fistula occurred in our subjects. CONCLUSION: Fortifying a combination of BMG and Snodgrass method with double dartos flap decreases the rate of complication in hypospadias repair significantly.

One-stage transperineal repair of pan-urethral stricture with dorsally placed buccal mucosal grafts: results, complications, and surgical technique.

PURPOSE: To report the surgical details and results of one-stage transperineal urethroplasty using dorsal buccal mucosal graft (BMG) in treatment of panurethral stricture. MATERIALS AND METHODS: This cohort study was carried out on 17 men with pan-urethral stricture who underwent one-stage transperineal BMG urethroplasty. Failure was defined as a need to any intervention during the follow-up period. RESULTS: The etiology of stricture was trauma in 4 (23.5%), sexually transmitted diseases in 4 (23.5%), lichen sclerosus in 2 (11.8%), and idiopathic in 7 (41.1%) patients. The mean follow-up period was 8.5 months (range, 3 to 18 months). Six (35.3%) patients developed complications; namely wound infection in 2 (11.8%), meatal stenosis in 1 (5.9%), and re-stenosis in 3 (17.6%) subjects. Complication rate in patients ≤ 43 and > 43 years old was 25% (2/8) and 44% (4/9), respectively, which did not reach statistically significant difference (P = .6). The final success rate was 88.2%. None of the patients needed open redo-urethroplasty during the follow-up period. CONCLUSION: Reconstruction of pan-urethral strictures may be safely and effectively performed at a simple single operative procedure using a transperineal approach with combinations of dorsal BMG.

Triamcinolone injection following internal urethrotomy for treatment of urethral stricture.

PURPOSE: To investigate the success rate of internal urethrotomy when combined with corticosteroid injection in urethral scar tissue for treatment of urethral stricture. MATERIALS AND METHODS: We performed a double-blind, randomized, placebo-controlled study on 70 patients with urethral stricture, who underwent internal urethrotomy from June 2003 to July 2008. Patients were randomized into 2 groups; the experimental group (34 patients) who received triamcinolone acetonide injection and the control group (36 patients) that received an injection of sterile water after internal urethrotomy. Postoperative results were compared between two groups. RESULTS: In the experimental group, 1 (2.94%), 3 (8.82%), and 2 (5.8%) patients developed infection, bleeding, and extravasation, respectively, and recurrence was noted in 12 patients. In the control group, infection, bleeding, and extravasation occurred in 2 (5.55%), 3 (8.33%), and 2 (5.55%) patients, respectively, and stricture recurred in 15 patients. There were no significant differences in stricture location as well as its etiology between the two groups (P = .672 and P = .936, respectively). Complication and recurrence rates in experimental group were lower than the control group, but the difference was not statistically significant (P = .847 and P = .584, respectively). However, time to recurrence decreased significantly in experimental group (8.08 ± 5.55 versus 3.6 ± 1.59 months) (P < .05). In our study, we did not find any complications that could be attributed to the triamcinolone acetonide injections. CONCLUSION: It seems that steroid injection after internal urethrotomy is a safe method, which may delay the recurrence of urethral stricture.

Tunica vaginalis flap as a second layer for tubularized incised plate urethroplasty.

PURPOSE: To investigate the success rate of Snodgrass method in combination with tunica vaginalis flap as the second layer for hypospadias repair. MATERIALS AND METHODS: In a prospective study, 33 patients with penile hypospadias who were treated using a Tubularized Incised Plate Urethroplasty (Snodgrass method) and vascularized tunica vaginalis flap as a second layer, were evaluated. Wound infections, meatal stenosis, and urethrocutaneous fistula were considered as treatment complications. Success rates of surgery were recorded. Failure was defined as need for re-operation. RESULTS: The mean age of the patients was 9.93 ± 4.4 years (range, 1.5 to 18 years). The mean follow-up was 8.79 ± 5.43 months (range, 6 months to 5 years). Four patients were lost to follow-up and excluded from the study. The location of hypospadias was distal penile in 17 patients (59%) and midpenile in 12 (41%). Of studied patients, 3, 2, and, 1 developed fistula, wound infection, and meatal stenosis, respectively. Two subjects with meatal stenosis and one with wound infection were managed conservatively. CONCLUSION: Snodgrass technique in combination with tunica vaginalis flap as a second layer is a reasonable procedure for hypospadias repair because of good cosmetic appearance and acceptable complication rates. Currently, fistula formation remains the most common complication of this technique, which often needs surgical repair.

Delayed retropubic urethroplasty of completely transected urethra associated with pelvic fracture in girls.

INTRODUCTION: The objective of the present study was to evaluate the results and the complications of delayed retropubic urethroplasty of completely transected urethra associated with pelvic fracture in girls. MATERIALS AND METHODS: From 2002 to 2008, a total of 7 girls with complete urethral disruption after pelvic fracture were referred to our center and all of them underwent delayed retropubic urethroplasty with end-to-end anastomosis of the urethra. RESULTS: Seven female patients with a median age of 6 years old underwent delayed end-to-end anastomosis. The median time to surgery was 6 months from the trauma. Voiding was normal after catheter removal in all of the patients. The median follow-up was 36 months. Three patients had mild stress urinary incontinence after catheter removal. CONCLUSION: There are some different strategies for management of complete urethral avulsion in females who have sustained pelvic fracture, including early realignment, bladder flaps, and end-to-end anastomosis. The strategy of delayed end-to-end anastomosis urethroplasty with retropubic approach is sound and produces acceptable results. The use of flexible cystoscope and omental flap is effective in achieving continence after urethroplasty in such cases.

Pattern of compensatory hypertrophy in contralateral testis after unilateral orchiectomy in immature rabbits.

INTRODUCTION: Our aim was to evaluate effects of hemicastration in immature rabbits on the histology of the contralateral testis after puberty. MATERIALS AND METHODS: Eighteen immature male rabbits were randomly divided into two groups. The first group underwent right or left hemicastration and the second, sham operation. After their puberty, the rabbits underwent the second operation. In the former group the contralateral testis and in the latter, the right or left testis was removed and sent for pathologic examination. The two groups were compared in terms of Leydig cell count, testis volume, and seminiferous tubule count and diameter. RESULTS: The mature rabbits' mean weight at the orchiectomy time, seminiferous tubule count, and seminiferous tubules diameter did not show significant differences between two groups. However, testis volumes and Leydig cell count were significantly higher in the first group with hemicastration prior to puberty. The mean testis volume was 3.24 +/- 2.06 mL in the first group and 1.4689 +/- 0.85701 mL in the second group (P = .03), and the mean Leydig cell count in every 5 microscopic high-power fields was 86.22 +/- 54.96 and 42.00 +/- 18.09, respectively (P = .04). CONCLUSION: Our research demonstrated that prepubertal hemicastration in rabbits led to the compensatory hypertrophy in the contralateral testis after puberty and an increase in the number of the Leydig cells.

Surgical repair of posterior urethral defects: review of literature and presentation of experiences.

INTRODUCTION: The main objective of the present review article was to study the different aspects of reconstructive surgery for posterior urethral defects by reviewing the published articles and presentation of our experiences in the reconstructive urology division at Shohada-e-Tajrish hospital. MATERIALS AND METHODS: The Medline was searched with the keywords of posterior urethroplasty, end-to-end anastomosis, excisional urethroplasty, anastomotic urethroplasty, pelvic fracture, bulboprostatic anastomosis, and urethral repair. The search was limited to papers published from 1980 to September 2008. We selected the relevant published articles in this database and also presented our experience at our reconstructive urology division. RESULTS: Of over 5000 search results, we selected 38 relevant articles with substantial contribution to the subject. Pelvic fracture due to accidents was the most common etiology of pelvic fracture urethral distraction defect that usually involved the membranous urethra. Surgical treatment of this disorder with perineal anastomotic urethroplasty was accompanied by a success rate of 82% to 95% in different studies. The most important complications of this surgery include urinary incontinence and impotence; however, the incidence of these complications has been reduced by using new surgical techniques. CONCLUSION: Complete preoperative assessment, the use of suitable reconstructive techniques, and in particular, the use of flexible cystoscopy can lead to acceptable outcomes of the surgical repair of pelvic fracture urethral distraction defects.