Dartos flap coverage of the neourethra following repair for primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas: it is a safe approach / Emprego de um retalho pediculado do músculo dartos para cobertura da neouretra na cirurgia primária de hipospádias, reoperações de hipospádias e correção de fístulas uretrocutâneas

Purpose: Urethrocutaneous fistula and neourethral dehiscence are frequently seen complications of hypospadias surgery requiring reoperation. In this study we report the experience of one surgeon with dartos flap coverage in primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas repair. Methods: A total of 23 patients underwent hypospadias and urethrocutaneous fistulas repair from January 2006 to May 2009. Fourteen patients were operated on for primary hypospadias repair at our institution and 9 patients were admitted for hypospadias complications such as failed hypospadias repair and urethrocutaneous fistula. In all the patients, the dartos flap was dissected and transposed to cover the neourethra. Operative results were recorded. Results: The primary surgical procedure was a one-stage repair in 61 percent (n = 14); tubularised incised plate (TIP) urethroplasty in 43 percent (n = 6) and a Mathieu procedure in 57 percent (n = 8). Urethrocutaneous fistulas complicating the previous initial hypospadias repair were anterior in 33 percent (n = 2), middle in 33 percent (n = 2) and proximal in 33 percent (n = 2). Repair of the fistula was successful on the first attempt in all patients. The reason for redo surgery in 3 patients was complete dehiscence and the patients had distal shaft hypospadias. COconclusion: Dartos flap coverage of the neourethra seems to be an effective method of reducing the fistulous complication rate following primary and secondary hypospadias repair.

Objetivo: Fístulas uretrocutâneas e deiscências são complicações frequentes na cirurgia das hipospádias necessitando reoperações. Este estudo é baseado na experiência pessoal de um cirurgião utilizando um retalho pediculado do músculo dartos para cobertura da neouretra na correção primária de hipospádias, reoperações de hipospádias e correção de fístulas uretrocutâneas. Métodos: Vinte e três pacientes foram operados sendo 14 submetidos a cirurgia primária de hipospádia e 9 a reoperações por insucesso da correção primária ou por fístulas uretrocutâneas. Em todos os pacientes, um retalho pediculado do músculo dartos foi mobilizado e utilizado para recobrir a neouretra. Resultados: Para a cirurgia primária da hipospádia foi utilizada técnica de correção em um só tempo (n=14): uretroplastia tubularizada com incisão da placa (TIP) em 43 por cento (n=6) e técnica de Mathieu em 57 por cento (n=8). As fístulas uretrocutâneas resultantes de correções primárias anteriores eram de localização anterior em 33 por cento (n=2), média em 33 por cento (n=2) e proximal em 33 por cento (n=2). A correção das fístulas uretrocutâneas resultou em sucesso em todos os pacientes. Três pacientes necessitaram de reoperação por deiscência completa e em todos a hipospádia era distal. Conclusões: O emprego do retalho pediculado do músculo dartos para recobrir a neouretra é um método eficaz que reduz a incidência de fístulas em cirurgias primárias e nas reoperações de hipospádias.

Dartos flap coverage of the neourethra following repair for primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas. It is a safe approach.

PURPOSE: Urethrocutaneous fistula and neourethral dehiscence are frequently seen complications of hypospadias surgery requiring reoperation. In this study we report the experience of one surgeon with dartos flap coverage in primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas repair. METHODS: A total of 23 patients underwent hypospadias and urethrocutaneous fistulas repair from January 2006 to May 2009. Fourteen patients were operated on for primary hypospadias repair at our institution and 9 patients were admitted for hypospadias complications such as failed hypospadias repair and urethrocutaneous fistula. In all the patients, the dartos flap was dissected and transposed to cover the neourethra. Operative results were recorded. RESULTS: The primary surgical procedure was a one-stage repair in 61% (n = 14); tubularised incised plate (TIP) urethroplasty in 43% (n = 6) and a Mathieu procedure in 57% (n = 8). Urethrocutaneous fistulas complicating the previous initial hypospadias repair were anterior in 33% (n = 2), middle in 33% (n = 2) and proximal in 33% (n = 2). Repair of the fistula was successful on the first attempt in all patients. The reason for redo surgery in 3 patients was complete dehiscence and the patients had distal shaft hypospadias. CONCLUSION: Dartos flap coverage of the neourethra seems to be an effective method of reducing the fistulous complication rate following primary and secondary hypospadias repair.

Evaluation of renal defect healing, hemostasis, and urinary fistula after laparoscopic partial nephrectomy with oxidized cellulose.

BACKGROUND AND PURPOSE: Laparoscopic partial nephrectomy (LPN) has been performed at several institutions using oxidized cellulose (OC) as a means of bleeding and urinary fistula (UF) prevention. However, a foreign-body reaction mimicking either abscess or tumor recurrence has been associated with the use of OC. We evaluated renal-defect healing after LPN with and without OC. MATERIALS AND METHODS: Sixteen female Landrace pigs underwent lower-pole excision; all the collecting systems were entered and then closed with absorbable running suture. In group 1, hemostatic U-shaped stitches were the only method of hemostasis. In group 2, a bolster of OC was added to the renal defect. The pigs were sacrificed at 1, 4, 7, or 21 days, and gross findings such as perirenal collection were observed. A catheter was advanced up to the kidney, and methylene blue was injected with collecting system pressure observation; burst pressure was defined as the appearance of extravasation. High risk for UF was defined as burst pressure <10 mm Hg. RESULTS: Neither hemorrhage nor urinoma was observed during sacrifice. One pig from group 2 had a burst pressure of 4 mm Hg At 7 days (high risk for UF). At 21 days in group 2, the tissue was grossly solid, apparently a granuloma. Suppuration tended to be greater in group 2. The foreign-body reaction was more intense in group 2 and was strongly present at 4, 7, and 21 days. CONCLUSIONS: The use of OC is associated with higher scores of suppuration and foreign-body reaction. After LPN with OC, postoperative day 7 might be a critical time for the development of urinary leakage.

Nova abordagem do ureter na cirurgia de Wertheim Meigs / New access of the ureter in the Wertheim Meigs surgery

Os autores fazem um histórico da cirurgia de Wertheim Meigs, sua indicaçao precípua e sua consecuçao. Relatam as complicaçoes decorrentes principalmente do descolamento excessivo do ureter de seu leito peritoneal. Mostram a evoluçao da cirurgia e a diminuiçao das fístulas uretero-vaginais. O intuito principal do trabalho é demonstrar uma nova abordagem do ureter nesta cirurgia, individualizando o ligamento pubo-vésico cervical inicialmente, permitindo uma adequada visualizaçao do trajeto ureteral.