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1.
Arch Esp Urol ; 73(2): 89-95, 2020 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-32124838

RESUMO

OBJECTIVE: To present the evolution in the diagnosis and treatment of urethral stricture, after performing 300 surgical procedures over urethral meatus,penile and bulbar urethra along 20 years, contrasting two surgical periods: from 1997-2006 to 2007-2016. MATERIAL AND METHODS: A retrospective review of495 medical records between 1997-2016 was conducted.All the patients treated with urethroplasty were included and those who under went internal urethrotomy,stents or dilatations plus those with strictures due to prostate cancer treatment or orthotopic neobladder were excluded. RESULTS: 300 patients were selected: 100 patients within the first period (1997-2006) and 200 within the second (2007-2016). The median follow-up was 36 months (range 12-60). In relation to the surgical techniques, among the most employed, four are outstanding so their results can be compared in both periods:termino-terminal urethroplasty, penile flap urethroplasty and the buccal mucosa in penile or bulbar urethroplasty.Other techniques were incorporated during the second period. The best outcomes were provided by end' to endurethroplasty with 90 and 92% success. Over the second period, buccal mucosa indications were consolidated with an increase use from 16% to 56%. Were considered as successful those patients that did not need any endoscopic procedure and reporting excellent urinary flow without low urinary tract symptoms. CONCLUSIONS: A trend towards an increased usage of open surgery vs urethrotomy is observed. Buccal mucosa graft has been consolidated as a reconstructive technique. End-to end urethroplasty seems to provide the best functional outcomes.


Assuntos
Uretra , Estreitamento Uretral , Procedimentos Cirúrgicos Urológicos Masculinos , Feminino , Humanos , Masculino , Mucosa Bucal/transplante , Estudos Retrospectivos , Resultado do Tratamento
2.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 55(2): 129-134, 2020 Feb 09.
Artigo em Chinês | MEDLINE | ID: mdl-32074677

RESUMO

Research have indicated that inadequate keratinized tissue has a negative effect on patient oral hygiene, resulting in peri-implant inflammation. It has been recommended that an apically repositioned flap alone or in combination with autogenous soft tissue grafts can increase the width of keratinized mucosa around dental implants, which promotes long term peri-implant health. This review summarized research progress on augmentation techniques of keratinized tissue arround implants in recent years, so as to provide reference for clinical practice and research design in the future.


Assuntos
Implantes Dentários , Queratinas , Mucosa Bucal/transplante , Retalhos Cirúrgicos/transplante , Gengiva , Humanos , Higiene Bucal
3.
Int Braz J Urol ; 46(1): 83-89, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31851463

RESUMO

PURPOSE: Obliterative urethral stenosis is a type of urethral lesion that compromises the whole corpus spongiosum's circumference. We present our experience in resolving complex long segment urethral obliteration in a single procedure using a combination of dorsal onlay oral mucosa graft (OMG) and ventral fasciocutaneous penile skin flap. MATERIALS AND METHODS: A prospectively maintained database was reviewed, which included data of men presenting long, obliterative strictures. Patients were excluded if they were lost to follow-up before one year. Failure was defined as need for further urethral instrumentation. The surgical technique used consisted on the fixation of OMG to the tunica albuginea of the corpus cavernosum, thus creating a new urethral plate. Penile or foreskin flaps were employed to complete the ventral aspect. Postoperative follow-up was done with a voiding cystourethrography at week 3. RESULTS: A total of 21 patients were included with a median age of 49 years. Mean follow-up was 25 months. Failure was found for 3 patients (2 of them needing dilations and only one required a new urethral reconstruction). CONCLUSION: Single stage combination of dorsal OMG with ventral fasciocutaneous penile flap showed good results for selected patients affected with obliterative urethral stenosis.


Assuntos
Mucosa Bucal/transplante , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/transplante , Estreitamento Uretral/cirurgia , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Prospectivos , Reprodutibilidade dos Testes , Resultado do Tratamento
4.
Urology ; 137: 205, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31883880

RESUMO

OBJECTIVE: Scrotal hypospadias still presents a challenge for reconstructive urologists. We present a novel and 1-stage technique of using a specially shaped buccal mucosa graft for simultaneous ventral tunica grafting and urethroplasty for severe hypospadias repair. METHODS: A 14-month old boy underwent repair of scrotal hypospadias with severe chordee. Penile straightening is achieved by division of short urethral plate combined with ventral grafting. Urethral reconstruction is done by combined buccal mucosa graft and longitudinal dorsal penile skin flap. Buccal mucosa graft is harvested and designed in a special "watch" shape, with the spherical part in the middle and 2 rectangular parts on both sides. The tunica albuginea is opened ventrally for penile straightening and grafted to the spherical part of the "watch-shaped" graft with "U-shape" stitches. The rectangular parts are fixed to the tip of the glans distally and native urethral meatus proximally creating new urethral plate. A longitudinal dorsal skin flap is harvested, button-holed ventrally and joined with the urethral plate. Penile skin reconstruction is performed using available penile skin. RESULTS: In period between July 2014 and December 2018, this technique is performed in 35 patients (aged from 10 to 22 months) with scrotal hypospadias. In the follow-up, ranged from 10 to 63 months (mean 29 months), satisfactory results were achieved in 30 boys (86%). Urethral fistula in 3 and meatal stenosis in 2 cases were successfully treated by minor revision and temporary meatal dilatation, respectively. Good result in curvature repair was obtained in all cases based on vacuum device checking and parents' reports. CONCLUSION: Repair of scrotal hypospadias associated with severe ventral curvature is usually done as a 2-stage procedure. A "watch" shaped buccal mucosa graft for simultaneous curvature correction and urethroplasty is a viable and reliable option for single stage repair of scrotal hypospadias with severe chordee.


Assuntos
Mucosa Bucal/transplante , Pênis , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Uretra , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Humanos , Hipospadia , Lactente , Masculino , Pênis/anormalidades , Pênis/cirurgia , Estudos Retrospectivos , Escroto/anormalidades , Escroto/cirurgia , Retalhos Cirúrgicos , Coleta de Tecidos e Órgãos/métodos , Uretra/anormalidades , Uretra/cirurgia
5.
S Afr Med J ; 109(12): 947-951, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31865957

RESUMO

BACKGROUND: Limited data are available on outcomes of the surgical management of inflammatory urethral strictures secondary to infection, a major cause of stricture. Several shortcomings that need to be addressed have been identified in the past. OBJECTIVE: To determine the impact of stricture length, position and degree of obliterative urethral lumen on the surgical outcomes of corrective procedures for inflammatory anterior urethral strictures. METHODS: This retrospective analysis used the records of patients who presented with proven infective anterior urethral strictures at an academic hospital from 2007 to 2010. All patients were followed up after 48 months. Urethroplasty outcomes were analysed according to stricture location and length and effect of urethral obliteration. RESULTS: The median age of the 174 patients in the study was 47 (range 21 - 86) years. Anastomotic urethroplasty was successful in 59/99 (59.6%) patients. Augmented anastomotic urethroplasty was successful in 11/15 (73.3%) patients. Dorsal onlay buccal mucosa graft urethroplasty was successful in 23/32 (71.9%) patients, significantly higher than in 2/9 (22.2%) patients who underwent ventral onlay buccal mucosa graft urethroplasty (p=0.017; hazard ratio 3.4; 95% confidence interval 1.29 - 9.40). The one-stage circular pedicled penile skin-flap urethroplasty was successful in 1/12 (8.3%) patients. Two-stage urethroplasty was successful in 5/7 (71.4%) patients. A primary component analysis of the 73 failed procedures showed that stricture length was the main contributor to failure (eigenvalue 1.79; 45%). CONCLUSIONS: Urethroplasty remains a challenge in inflammatory urethral strictures, where stricture length was the main reason for treatment failure.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/patologia , Uretra/cirurgia , Estreitamento Uretral/patologia , Estreitamento Uretral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Seguimentos , Humanos , Inflamação/microbiologia , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/transplante , Estudos Retrospectivos , Fatores de Risco , Retalhos Cirúrgicos , Falha de Tratamento , Estreitamento Uretral/microbiologia , Infecções Urinárias/complicações , Adulto Jovem
6.
Curr Urol Rep ; 20(11): 74, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31705324

RESUMO

PURPOSE OF REVIEW: In this review, we describe the incidence, diagnosis, and management of urethral strictures in women. RECENT FINDINGS: Definitive repair of urethral strictures in women traditionally utilizes vaginal and labial flaps. Oral mucosal buccal graft urethroplasty also has high success rates, with larger series demonstrating feasibility and durability. Urethral strictures in women are very rare. When they do occur, they are often difficult to diagnose, requiring a high index of suspicion. Women with urethral strictures often present with symptoms of obstructed urinary flow, such as incomplete emptying, straining, and elevated postvoid residual. First line, minimally invasive treatment consists of urethral dilation and urethrotomy, though urethrotomy is rarely performed. Repeat urethral dilation has low success rates compared with urethroplasty, which is a more definitive treatment.


Assuntos
Mucosa Bucal/transplante , Uretra/cirurgia , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/terapia , Dilatação , Feminino , Humanos , Retalhos Cirúrgicos , Estreitamento Uretral/etiologia , Vagina/cirurgia
7.
Int Braz J Urol ; 45(5): 981-988, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31626521

RESUMO

OBJECTIVES: To compare and assess various outcomes and success of buccal mucosal graft urethroplasty (BMGU) in patients with CKD versus patients having normal renal function. MATERIAL AND METHODS: This was a retrospective, single centre study, during period 2013 to 2017. Patients were grouped into two groups. Group 1 had patients with estimated Glomerular Filtration Rate (eGFR)>60mL/min/1.73m2 while group 2 had patients with eGFR <60mL/min/1.73m2. eGFR was calculated according to the MDRD equation. The two groups were compared with regard to various outcomes like length, location of stricture, technique of graft placement, intra-operative blood loss (haemoglobin drop), duration of hospital stay, post-operative complications and recurrence. RESULTS: A total of 223 patients were included in study with group 1 had 130 patients and group 2 had 93 patients. Mean age of patients with CKD were higher (47.49 years versus 29.13 years). The mean follow-up period was comparable between both groups (23.29 months and 22.54 months respectively). Patients with CKD had more post-operative Clavien Grade 2 or higher complications (p=0.01) and a greater recurrence rates (p<0.001) than in non-CKD patients. On multivariate analysis, age and CKD status was significant predictor of urethroplasty success (p=0.004) (OR= 14.98 (1.952-114.94, 95% CI). CONCLUSIONS: CKD patients are more prone to post-operative complications in terms of wound infection, graft uptake and graft failure and higher recurrence rates following BMGU.


Assuntos
Mucosa Bucal/transplante , Insuficiência Renal Crônica/fisiopatologia , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Adulto , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Recidiva , Insuficiência Renal Crônica/complicações , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Adulto Jovem
9.
Cornea ; 38(10): 1273-1279, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31356413

RESUMO

PURPOSE: To evaluate the outcomes of autologous cultivated oral mucosal epithelial transplantation (COMET) in ocular surface reconstructive procedures. METHODS: Twenty-five eyes of 24 patients who underwent COMET for ocular surface reconstruction were studied retrospectively from April 2011 to March 2014. Oral mucosal biopsy of 2 mm was harvested from all patients and cultured on amniotic membrane for 14 days. COMET was performed as a means to achieve corneal epithelization (group 1) and for fornix reconstruction (group 2). The extent of epithelization achieved (group 1) and the depth of the fornix reconstructed (group 2) were the primary outcome measures. RESULTS: Six eyes of 5 patients [2 chemical injury (CI), 3 Stevens-Johnson Syndrome (SJS)] underwent COMET for nonhealing of an epithelial defect within a month after insult or had a nonhealing defect since insult despite maximal medical/surgical therapy. Group 2 included 19 eyes of 19 patients (10 CI, 8 SJS, 1 ocular cicatricial pemphigoid) which underwent COMET for fornix reconstruction. Postsurgery, the cornea was fully epithelized in 66.67% of the eyes (n = 4) and partially epithelized in 33.33% of the eyes (n = 2). The overall improvement in surface epithelization was statistically significant (P = 0.046). Reconstruction of an anatomically deep fornix was achieved in 57% of the eyes (4 CI, 6 SJS and 1 ocular cicatricial pemphigoid). The fornix was partially formed in 26% of the eyes (4 CI and 1 SJS). The overall improvement in fornix reconstruction was considered statistically significant (P = 0.024). The follow-up ranged from 1 to 5 to 27 months with a mean follow-up of 18 months SD ±8.9. CONCLUSIONS: COMET, by providing an alternate source of epithelium, aids in faster epithelization and thus can be considered as an option in management of severe grade CI or SJS in the acute stage as well as in fornix reconstructive procedures in chronic stage of ocular surface disorders.


Assuntos
Córnea/cirurgia , Doenças da Córnea/cirurgia , Células Epiteliais/transplante , Mucosa Bucal/transplante , Procedimentos Cirúrgicos Oftalmológicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Acuidade Visual , Adolescente , Adulto , Idoso , Células Cultivadas , Criança , Pré-Escolar , Córnea/patologia , Doenças da Córnea/diagnóstico , Células Epiteliais/citologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/citologia , Reepitelização , Estudos Retrospectivos , Transplante Autólogo , Adulto Jovem
10.
Plast Reconstr Surg ; 144(1): 115-123, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31246813

RESUMO

BACKGROUND: In immunologic research, mice have advantages over other animals, such as low costs, easy handling, suitable life cycle, and adequate laboratory resources. However, vascularized composite allotransplantation surgery using mice is not popular, partly because of technical difficulties and high mortality rates. The authors' goal was to demonstrate a face transplantation model in mice that includes skin, mandible, and oral mucosa. METHODS: The authors developed a new syngeneic face transplantation model composed of skin, mandible, teeth, and oral mucosa in C57BL/6 mice. The following assessment included measuring the length of the right incisor on the transplanted mandibles, computed tomographic scan in one mouse for mandibular structure evaluation, and histologic examination of different tissue samples in another mouse for viability evaluation. RESULTS: The authors performed five consecutive transplantations. The donor vessels were the common carotid artery (approximately equal to 0.4 mm) and the anterior facial vein (approximately equal to 0.2 mm), and the recipients were the common carotid artery and the posterior facial vein (approximately equal to 0.4 mm). The mean operative time was 80 minutes for the donor and 123 minutes for the recipient. There were neither flap failures nor animal deaths. The follow-up was 6 months. The right incisor of the transplant grew at different rates in all cases. Histologic samples showed viability in all tissues, including mandibular bone marrow. Computed tomography demonstrated normal structure of the transplanted bone. CONCLUSION: The authors' syngeneic partial face transplantation model in mice, which included skin, oral mucosa, and mandible with teeth, should be useful for future face allotransplantation research, as the myriad of tissues it provides, of different immunomodulatory functions, is similar to that in the clinical scenario.


Assuntos
Transplante de Face/métodos , Mandíbula/transplante , Mucosa Bucal/transplante , Animais , Sobrevivência de Enxerto/fisiologia , Camundongos Endogâmicos C57BL , Modelos Animais , Transplante de Pele/métodos , Tomografia Computadorizada por Raios X , Sítio Doador de Transplante , Transplante Heterotópico
12.
J Pediatr Surg ; 54(10): 2125-2129, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31079867

RESUMO

BACKGROUND: There are only a few publications in the medical literature reporting on complication rates in proximal hypospadias surgery, particularly with regard to long-term follow-up. METHODS: Over a 17.5-year period, we operated 100 patients with penoscrotal, scrotal and perineal hypospadias. Sixty-four had a single-stage repair, including 15 who received a buccal mucosa inlay "Snodgraft" repair. Thirty-six had a two-stage Bracka repair of which 19 received buccal or lower lip grafts and 17 had preputial grafts. Overall, 34 patients received buccal grafts. The median follow-up was eight years (range 1-16 years). Three patients were operated for residual chordee years later. RESULTS: Urethral fistulae occurred in a total of 26/100 (26.0%) cases, meatal stenosis in 16/100 (16.0%), wound breakdown in six (6.0%) and graft failure in one (1.0%). The fistula rate after the single-stage approach was 15/64 (23.4%), whereas it was 11/36 (30.6%) following two-stage repair (P = 0.4811). CONCLUSIONS: Proximal hypospadias remains a challenging condition to treat. It is possible to perform a single-stage repair in 64.0% of cases. This brings down the median number of operations to only two. Lower lip grafts were used in 34.0% but are now used in redo-surgeries only. Our fistula rate was 26.0% but has decreased significantly in recent years. LEVEL OF EVIDENCE: Level III.


Assuntos
Hipospadia/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Criança , Pré-Escolar , Prepúcio do Pênis/cirurgia , Humanos , Lactente , Masculino , Mucosa Bucal/transplante , Complicações Pós-Operatórias , Estudos Prospectivos , Escroto/cirurgia , Deiscência da Ferida Operatória , Resultado do Tratamento , Uretra/cirurgia , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
13.
Urology ; 130: 210, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31039367

RESUMO

OBJECTIVE: To introduce a new technique using dorsal buccal mucosal graft (BMG) for the repair of refractory vesico-urethral anastomotic stricture/stenosis (VUAS) postopen radical prostatectomy. METHODS: Patients demographics, preoperative continence status, number of dilations, and urine flow preoperatively and postoperatively were collected. Using perineal incision, after dissection of bulbar urethra, a dorsal dissection carried out underneath the pubic bone. The urethra was opened dorsally till the bladder neck. BMG was harvested and sutured to the bladder neck at 11, 12, and 1 o'clock. Interrupted dorsal quilting of the graft was done using 4-0 Vicryl through the periosteum over the pubic bone. The graft was sutured to the urethra using 4-0 Vicryl in a continuous fashion. Patients were discharged home in 2 days. Trial of void and retrograde urethrogram were done after 3 weeks. Flow and postvoid residual were done at 3 months. RESULTS: A total of 4 patients between July and August 2018. The mean age was 67 (59-72). Three out of 4 patients (75%) had received adjuvant radiotherapy. The mean number of preop endoscopic procedures including dilations and incisions was 7 (4-10). The mean stricture length was 2.5 cm (2-3). All patients were incontinent preoperatively with mean preop flow of 5 mL/s (3-7 mL/s). Mean operative time and blood loss were 177 minutes and 250 mL, respectively. Mean postoperative urine flow at 3 months was 20 mL/s (17-23 mL/s). All patients were incontinent postoperatively. Success rate was 100% at 3 months. CONCLUSION: BMG urethroplasty in vesico-urethral anastomotic stricture/stenosis is a new technique that can provide a safe perineal approach while eliminating the potential risk of rectal injury, and urethral atrophy from extensive urethral mobilization.1 It can also decrease the need for laparotomy or the need to perform a combined abdominal-perineal approach. Long-term follow-up is warranted with a larger cohort of patients.


Assuntos
Mucosa Bucal/transplante , Complicações Pós-Operatórias/cirurgia , Prostatectomia , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Bexiga Urinária/cirurgia , Idoso , Anastomose Cirúrgica , Humanos , Masculino , Pessoa de Meia-Idade , Prostatectomia/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
14.
BMC Urol ; 19(1): 38, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096965

RESUMO

BACKGROUND: Long anterior urethral stricture due to variable etiological factors constitutes a challenge for reconstruction. We evaluated our centers experience with cases of long anterior urethral stricture due to different etiologies that were managed by 2-stage substitution urethroplasty using buccal mucosal graft procedure. METHODS: During the period between November 2009 and November 2016. All cases with long anterior urethral stricture that were planned for substitution urethroplasty in our department were enrolled in this study. The first stage was excision of most fibrotic areas of the urethral plate, the remaining of the urethra is laid open and augmented with buccal mucosal graft for second stage closure after 6-9 months. RESULTS: The study included 123 patients who underwent first stage, 105 patients of them underwent second stage urethroplasty. Eighteen cases were missed after first stage. The mean (range) age was 38.4 (17-60 years). The mean (range) stricture length was 8.3 (4-13 cm). The cause of stricture was idiopathic in 47, inflammatory in 15, lichen sclerosus in 26 and post failed hypospadias repair in 35 patients. First stage was complicated by graft contracture in 11 (8.9%) patients that needed re-grafting, 5(4.1%) patient had bleeding from the buccal mucosa site that needed haemostatic sutures, oral numbness was reported in 7 (5.7%) patients. Second stage was complicated by wound dehiscence in 2(1.9%) patients, restricture in 11 (10.5%), fistula in 6 (5.7%) patients, meatal stenosis in 3 (2.9%). The overall success rate was 79.1% (83 cases out of 105) with a mean (range) follow-up of 34.7 (10-58 months). CONCLUSIONS: Staged urethroplasty using buccal mucosal graft procedure is an effective surgical option for patients with long anterior urethral strictures especially for patients with lichen sclerosus and those with failed previous surgical repair.


Assuntos
Mucosa Bucal/transplante , Transplantes , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/cirurgia , Adolescente , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
15.
Urology ; 130: 209, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31063762

RESUMO

OBJECTIVE: To describe a novel surgical technique for reconstruction of a case of refractory bladder neck contracture (BNC) using a robotic-assisted laparoscopic (RAL) transvesical approach for subtrigonal inlay of buccal mucosal graft. BNC is a well-described yet uncommon adverse event after BPH surgery. Endoscopic management is successful in many patients but refractory cases may require reconstructive surgery. MATERIALS AND METHODS: A 70-year-old male presented with a history of prior photovaporization of the prostate 2 years prior to our initial consultation. He developed a refractory BNC that did not resolve after multiple endoscopic interventions. For definitive treatment of the BNC, he underwent RAL repair with subtrigonal inlay of buccal mucosal graft. The surgical approach is demonstrated in our video. RESULTS: The patient underwent RAL subtrigonal inlay of buccal mucosal graft without intraoperative complication or need to convert to an open procedure. The graft harvested for repair measured 5 × 5 × 4 cm. He was discharged home on postoperative day 2. Urethral catheter was left in place for 2 weeks and suprapubic catheter was removed 4 weeks postoperatively. Voiding cystourethrogram at time of suprapubic catheter removal demonstrated no evidence of obstruction or extravasation. Uroflow qmax improved from 2 to 27 mL/s. Postvoid residual urine volume improved from 200 to 3 mL. At last follow-up, there was no evidence of recurrence. CONCLUSION: Refractory cases of BNC can be successfully managed with reconstructive surgery. In this case report, we describe a novel technique for RAL reconstruction with subtrigonal inlay of buccal mucosal graft.


Assuntos
Laparoscopia/métodos , Mucosa Bucal/transplante , Procedimentos Cirúrgicos Robóticos , Obstrução do Colo da Bexiga Urinária/cirurgia , Idoso , Humanos , Masculino , Procedimentos Cirúrgicos Urológicos/métodos
17.
Graefes Arch Clin Exp Ophthalmol ; 257(6): 1253-1263, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31004182

RESUMO

PURPOSE: The purpose of this study was to compare the efficacy of allogeneic cultured limbal epithelial transplantation (ACLET) and cultivated oral mucosal epithelial transplantation (COMET) in treating total limbal stem cell deficiency (LSCD). METHODS: In this retrospective cohort study, 73 patients (76 eyes) with total LSCD, including 41 patients (42 eyes) treated with ACLET and 32 patients (34 eyes) receiving COMET, were evaluated. The age, gender and injury cause of all patients were recorded. RESULTS: The mean follow-up was 23.3 ± 9.9 months in the ACLET group and 16.1 ± 5.8 months in the COMET group. A higher incidence of persistent epithelial defect was observed after COMET (P = 0.023). The overall ocular surface grading scores were all lower in the ACLET group than in the COMET group at 3, 6, and 12 months after surgery and the last follow-up. Kaplan-Meier survival curve analysis demonstrated a significantly higher success rate of ACLET (71.4%), compared with that of COMET (52.9%; P = 0.043). The risk of graft failure was higher in patients with entropion and trichiasis, incomplete eyelid closure and treated with COMET. The graft failure risk rate after COMET was 3.5 times higher than that of ACLET. CONCLUSIONS: For total LSCD patients, ACLET should be prioritized, since limbal epithelial cells have better ability to maintain corneal epithelial integrity and ocular surface stability and benefit the ocular surface when compared with oral mucosal epithelial cells. Preoperative and postoperative eyelid abnormalities should be corrected as early as possible.


Assuntos
Doenças da Córnea/cirurgia , Limbo da Córnea/patologia , Mucosa Bucal/transplante , Transplante de Células-Tronco/métodos , Acuidade Visual , Adolescente , Adulto , Células Cultivadas , Doenças da Córnea/patologia , Células Epiteliais/citologia , Células Epiteliais/transplante , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/citologia , Estudos Retrospectivos , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
18.
BMC Urol ; 19(1): 18, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30885184

RESUMO

BACKGROUND: To evaluate outcome of buccal mucosa graft urethroplasty (BMGU) for the treatment of urethral stricture disease, including a detailed analysis of success, morbidity and quality of life (QoL). METHODS: Between 12/05/2008 and 07/21/2010, 187 patients with urethral stricture disease, who were treated with BMGU at our University Medical Center, received a standardized questionnaire, evaluating postoperative success, morbidity and QoL. The primary endpoint was the success, i.e., stricture recurrence-free survival plus patients' satisfaction with surgery. Secondary endpoints included erectile function, voiding symptoms, pain and health-related QoL, which were assessed with a modified Urethral Stricture Surgery Patient Reported Outcome Measure (USS PROM), including the Erectile Function domain of the International Index of Erectile Function (IIEF-EF), Incontinence Questionnaire Male Lower Urinary Tract Symptoms Module (ICIQ-MLUTS) and EuroQol-5 dimensions (EQ-5D). RESULTS: In total, 83 patients (51.9%) completed the questionnaire. Bulbar, penile and panurethral strictures were found in 69 patients (83.1%), 13 patients (15.7%) and one patient (1.2%), respectively. The median length of the stricture was 5 cm (range: 1-16). At a median follow-up of 46 months (range: 36-54), 65 patients (78.3%) had no stricture recurrence and were satisfied with BMGU. Median scores for ICIQ-MLUTS, IIEF-EF and EQ-5D visual analogue scale were 6, 22 and 80, respectively. Based on USS PROM, postoperative improvement of QoL and satisfaction with BMGU was found in 67 patients (80.7%) and 68 patients (81.9%), respectively. CONCLUSIONS: In patients with urethral stricture disease, BMGU offers excellent success, morbidity and QoL.


Assuntos
Mucosa Bucal/transplante , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Centros de Atenção Terciária , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adolescente , Adulto , Idoso , Estudos de Coortes , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Estudos Prospectivos , Resultado do Tratamento , Estreitamento Uretral/diagnóstico , Adulto Jovem
19.
Plast Reconstr Surg ; 143(4): 1179-1183, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30921142

RESUMO

Furlow palatoplasty is increasingly used both for primary palatoplasty and for secondary correction of velopharyngeal insufficiency. Although Furlow palatoplasty offers the advantage of lengthening the palate, the most tenuous component of the oral mucosal repair is anterior transposition of the oral mucosal Z-plasty flap, with superficial separation of the oral mucosa observed in up to 53 percent of cases of secondary Furlow palatoplasty. To mitigate this problem, the authors prophylactically placed pedicled buccal fat pad flaps to provide an additional vascular layer to promote healing of the overlying oral mucosal Z-plasty flap. The authors report their experience comprising seven patients who underwent Furlow palatoplasty with buccal fat flap augmentation. Four of these patients had secondary Furlow palatoplasty procedures; one of them experienced oral mucosal separation that healed uneventfully. No patients developed an oronasal fistula. The authors' experience suggests that buccal fat flaps may minimize vascular compromise and dehiscence of the oral mucosal Z-plasty following Furlow palatoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Assuntos
Tecido Adiposo/transplante , Mucosa Bucal/transplante , Palato Mole/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Retalhos Cirúrgicos , Insuficiência Velofaríngea/cirurgia , Criança , Pré-Escolar , Fissura Palatina/cirurgia , Feminino , Humanos , Lactente , Masculino
20.
Urology ; 129: 217-222, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30779891

RESUMO

OBJECTIVES: To explore the use of neo-vaginal advancement flaps in the treatment of distal urethral strictures with description of the techniques and preliminary results in transwomen. METHODS: Five patients were treated. A 7-flap was used in 2 patients and an inverted U-flap in 3 patients. In 1 patient with an inverted U-flap, the urethra was further enlarged using buccal mucosa because of Lichen Sclerosus. Three out of 5 patients already underwent previous interventions. RESULTS: Median patient age was 67 years (range: 41-74) and median stricture length was 2.0 cm (range: 1.5-2.0). Median operation time was 41 minutes (range: 38-70). One low-grade complication (bladder spasms) was reported. No patient suffered a recurrence after a median follow-up of 37 months (range: 6-97). All patients were satisfied with the result. CONCLUSION: Neo-vaginal advancement flaps can be safely used in transwomen with distal urethral strictures. The success rate and patient's satisfaction are encouraging.


Assuntos
Mucosa Bucal/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Pessoas Transgênero , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Vagina/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos
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