Urethral reconstruction:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2002
|
| Schriftenreihe: | The urologic clinics of North America
29,2 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIII S., S. 267 - 498 zahlr. Ill. |
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Datensatz im Suchindex
| _version_ | 1804129593596051456 |
|---|---|
| adam_text | CONTENTS
Preface xiii
Anthony Atala and Jack W. McAninch
Principles of Tissue Transfer Techniques in Urethral Reconstruction 267
Gerald H. Jordan
Many reconstructive surgical techniques require tissue transfer, or movement of tissue
from a donor to a recipient site. The techniques of tissue transfer in reconstructive uro
logic surgery assume knowledge of skin anatomy, the basic principles of tissue transfer,
and the composition and characteristics of the donor and recipient tissues. These topics
will be addressed in this article.
Management of Chordee in Children and Young Adults 277
Gerald Mingin and Laurence S. Baskin
Penile curvature is a spectrum of disease affecting boys with and without hypospadias.
The etiology of chordee includes skin tethering, fibrotic bucks or dartos fascia, corporeal
body disproportion and rarely a fibrotic urethra. Several surgical techniques (plication,
excision, and graft insertion) are currently employed to repair penile curvature. Recent
neuroanatomical studies of the developing fetal penis have shown that the dorsal nerve
branches from the 11 and 1 o clock positions to the 5 and 7 o clock positions, being ab¬
sent in the midline. Since the neuroanatomy is similar in both the hypospadiac and nor¬
mal penis, we now recommend performing penile straightening in both hypospadiac
and non hypospadiac patients with significant curvature by the placement of plication
sutures at the 12 o clock position. Placement of dorsal midline plication sutures corrects
curvature without risk to the underlying nerve structures.
Tubularized Incised Plate (TIP) Hypospadias Repair 285
Warren T. Snodgrass
In the past 6 years TIP urethroplasty has become a preferred technique for distal hypos¬
padias repair, and has also been used for proximal lesions and reoperations. In this ar¬
ticle technical aspects of the procedure are described and published outcomes reviewed.
TIP hypospadias repair has gained widespread acceptance because of its versatility, low
complication rate and reliable creation of a vertically oriented meatus.
Glanular Hypospadias Repair 291
Mark R. Zaontz and Gregory E. Dean
Glanular hypospadias represents approximately 15% of the hypospadias variants seen.
This article will examine common surgical approaches applicable to the child with gla¬
nular hypospadias. Hypospadias repairs discussed in this article will include urethro
VOLUME 29 • NUMBER 2 • MAY 2002 v
}
meatoplasty, MAGPI, the GAP procedure, MIV glans plasty, urethral advancement ;
prodecure, and parameatal based flap variants, including the Mathieu and Barcat
procedures. Because these anomalies are cosmetically less aberrant than more proximal
variants, only those surgical techniques which assure a normal appearing penis should
be undertaken.
Midshaft Hypospadias 299
Jyoti Upadhyay, Bijan Shekarriz, and Antoine E. Khoury
Recent advances in hypospadias repair enable excellent cosmetic results in midshaft
hypospadias treatment. The authors use onlay or tubularized preputial flaps most
commonly. In this article, the authors describe their current approach to midshaft
hypospadias repair with special emphasis on the correction of chordee using ventral
lengthening procedures.
Proximal Hypospadias 311
Bartley G. Cilento, Jr and Anthony Atala
Approximately 20% of hypospadiac urethras are located proximally, anywhere from the
penoscrotal to the perinea! region. Repair of proximal defects is still one of the most chal¬
lenging surgical procedures facing the hypospadiologist. Modifications of current tech¬
niques for the correction of proximal hypospadias as well as new innovative
techniques continue to be proposed.
Complications of Hypospadias Repair 329
Alan B. Retik and Anthony Atala
Hypospadias is one of the most frequently encountered congenital malformations of the
genitourinary system. The incidence in studies of large populations has been reported to
be from 1 to 8 per 1000 male births. For centuries the imagination and creativity of sur¬
geons has been challenged to create a phallus that is both functional and cosmetic. Over
the last 30 years numerous new operations and techniques have been developed with
the objective of achieving improved cosmetic results with minimal complications.
Megalourethra and Urethral Diverticula 341
Eric A. Jones, Andrew L. Freedman, and Richard M. Ehrlich
Megalourethra and urethral diverticula encompass a diverse group of congenital and
acquired urethral defects. The appropriate management of these anomalies relies on a
keen appreciation of phallic anatomy and an understanding of urethral embryology. A
thorough history and physical examination—including a careful evaluation of the uri¬
nary tract—is necessary to identify associated congenital anomalies. Finally, satisfactory
surgical management demands meticulous attention to surgical technique.
Management of Epispadias 349
Richard W. Grady and Michael E. Mitchell
Although epispadias is considered to be the least severe defect of the exstrophy epispa
dias complex, the treatment of this anomaly is far from trivial. Epispadias does not
involve the body of the bladder or the hindgut but does affect the urethra and can
affect the bladder neck. As a consequence, it presents with a spectrum of severity that
can affect urinary continence if the epispadias anomaly is proximal enough to affect
the urinary sphincter mechanism.
vi CONTENTS
Imaging of the Male Urethra for Stricture Disease 361
Michael L. Gallentine and Allen F. Morey
A variety of imaging techniques are available for evaluating urethral strictures. Radio
graphic staging helps characterize strictures as well as periurethral pathology thus
enabling determination of appropriate therapy. Urethral imaging techniques including
retrograde and antegrade urethrography, sonourethrography, and magnetic resonance
imaging are presented.
Excision and Primary Anastomosis for Anterior Urethral Stricture 373
James R. Jezior and Steven M. Schlossberg
Excision with spatulated primary anastomosis (EPA) is an excellent reconstructive
option for short bulbar urethral strictures with success rates between 90 and 95% in ap¬
propriately selected patients. Patient selection requires a careful history, physical
examination, and radiographic staging. Failure with this reliable method is caused by
inadequate excision of urethral stricture and incomplete mobilization of the urethra with
excessive anastomotic tension. Complications that include wound and urinary tract
infections, chordee, and erectile dysfunction, are uncommon. EPA warrants strong con¬
sideration as a first line treatment due to its excellent and durable long term results.
Ventral Onlay Graft Techniques for Urethroplasty 381
Hunter Wessells
Techniques of anterior urethroplasty have evolved over the last 40 years due to advances
in tissue transfer techniques and the changing etiology of urethral stricture. The use of
free grafts has come full circle from full thickness skin grafts to the current popularity
of buccal mucosa grafts. Grafts fell out of favor due to poor results with full thickness
skin grafts and the more widespread use of pedicle flaps. Although controversy still ex¬
ists as to the appropriate use of flaps versus grafts, the evidence does not demonstrate an
advantage in outcomes: overall success rates for grafts and flaps are similar (84.3 and
85.9% respectively). Nevertheless, grafting techniques are now considered first line ther¬
apy for the majority of strictures that cannot be excised and reanastomosed.
Dorsal Onlay Techniques for Urethroplasty 389
Guido Barbagli, Enzo Palminteri, and Massimo Lazzeri
Dorsal onlay graft urethroplasty is a versatile procedure which may be combined with
various substitute materials such as preputial skin, buccal mucosa grafts or pedicled
flaps. Others substitute materials such as human urethral mucosa from corpses or col¬
lagen matrix will be possible in future. The long term results of a wide series of patients
showed a final success rate from 92% to 97%. Any kind of substitution urethroplasty de¬
teriorate over time, and in our series of patients with an extended follow up from 21.5 to
43 months the success rate of dorsal onlay graft urethroplasty decreased from 92C/J to
85%. With regard to substitute material concerns (buccal mucosa versus preputial skin)
a long term follow up is mandatory to establish if buccal mucosa is superior to foreskin
as urethral substitute material. At present, the authors currently use both according to
patient preference, status of the genital tissues or strictures characteristics.
Penile Circular Fasciocutaneous Flaps
to Reconstruct Complex Anterior Urethral Strictures 397
K. Jeff Carney and Jack W. McAninch
Long, complex strictures of the anterior urethra are a challenge for which the penile cir¬
cular fasciocutaneous flap is an appropriate solution. It provides an ample length (usu¬
ally 13 15 cm) of nonhirsute, well vascularized tissue that can be used throughout the
entire urethra. The flap can be applied as an onlay procedure or, if necessary, tubularized
CONTENTS vii
for replacement urethroplasty. Complications have been minimal and our long term cos¬
metic and functional results have been excellent.
Scrotal and Perineal Flaps for Anterior Urethral Reconstruction 411
Gerald H. Jordan
The use of scrotal and perineal flaps for anterior and posterior urethral reconstruction
has been unfairly maligned with claims of poor waterproofing qualities, formation of di
verticula, and the potential to import hair into the urethra. Actually, scrotal and perineal
skin do not appear to differ from other genital skin with regards to permeability to sur¬
face liquids, and although these islands are difficult to tailor, when properly prepared
they are no more likely to create diverticula than other genital skin islands. Similarly,
if the flap is prepared from hirsute skin, hair will be imported into the urethra; however,
hairless scrotal areas can be mobilized as skin islands, and the skin overlying the peri¬
neal artery is non hirsute or nearly non hirsute in many individuals.
Urethral Reconstruction of Strictures Resulting
from Treatment of Benign Prostatic Hypertrophy and Prostate Cancer 417
Richard A. Santucd and Jack W. McAninch
Urethral strictures commonly result from treatments for prostate disease, such as trans
urethral resection, radical prostatectomy, and radiotherapy. Treating these strictures can
be difficult: it may be complicated by previous irradiation, and endoscopy often fails. We
review the risk factors for development of strictures resulting from the treatment of pros¬
tate disease and discuss the success rates of both endoscopic and open therapies.
Reconstruction of Posterior Urethral Disruption 429
George D. Webster and Michael L. Guralnick
Posterior urethral disruption may be a devastating complication of pelvic trauma. The
acute management of these injuries is reviewed as well as the controversy surrounding
early versus delayed repair. The various approaches to delayed repair of pelvic fracture
urethral distraction defects are presented and the technique of perineal repair is dis¬
cussed in detail.
Muscular, Myocutaneous, and Fasciocutaneous Flaps
in Complex Urethral Reconstruction 443
Leonard Zinman
The ability to achieve a long term, stable, stricture free, hairless urethral lumen in
patients with complex anterior stricture and compromised genital skin is one of the
ongoing challenges of reconstructive urologic surgery. The conservative approach by
endoscopic urethrotomy or dilatation with a self catheterization schedule rarely affects
a definitive cure except in the short filmy superficial strictures of the bulbous portion
of the urethra. Genital fasciocutaneous island flaps are currently the golden standard
for definitive, reliable resolution of anterior urethral strictures in patients who have
not undergone a prior surgical procedure that may alter the penile or scrotal circulation,
or those with skin loss from trauma, decubiti, radiation, or balanitis xerotica obliterans.
Staged Urethroplasty: Indications and Techniques 467
Charles L. Secrest
There is still a place for staged urethroplasty. There are some indications for staged
urethral reconstruction such as strictures associated with chronic inflammation, fistula,
false passage, urethral stones, urethral diverticulae, abscess, failed prior repair, compli¬
cated hypospadias, severe trauma, neurologic diseases, extensive BXO strictures and
viii CONTENTS
long strictures. Staging a urethroplasty should not be considered a step backwards ra¬
ther instead we should learn from experience and realize there are some patients who
are too complex to reconstruct in a single stage.
Management of Fossa Navicularis Strictures 477
Noel A. Armenakas and Jack W. McArtinch
The fossa navicularis constitutes the distal segment of the anterior urethra, located with¬
in the glans penis and terminating at the meatus. Embryologically, the epithelium of the
fossa navicularis develops by canalization of an ectodermal cord of cells, the glanular
plate, which extends from the meatus into the glans. Strictures involving the fossa navi¬
cularis have distinct etiologic characteristics, and their management is particularly chal¬
lenging. Successful reconstruction requires the creation of a functional urethral conduit
while maintaining a cosmetically appealing glans penis.
Experimental and Clinical Experience
with Tissue Engineering Techniques for Urethral Reconstruction 485
Anthony Atala
Tissue engineering has been proposed as a strategy for urethral reconstruction. This may
involve matrices alone, wherein the body s natural ability to regenerate is used to orient
or direct new tissue growth, or the use of matrices with cells. Acellular collagen matrices
derived from donor bladder submucosa have been used both experimentally and clini¬
cally for onlay urethral replacement with good success at our center. If a tubularized ur¬
ethral repair is needed, the use of cells on the collagen matrix is essential for adequate
tissue formation. Tissue engineering techniques are useful for urethral reconstruction.
Index 493
CONTENTS ix
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| spelling | Urethral reconstruction Anthony Atala ... guest ed. Philadelphia [u.a.] Saunders 2002 XIII S., S. 267 - 498 zahlr. Ill. txt rdacontent n rdamedia nc rdacarrier The urologic clinics of North America 29,2 Urethroplastik (DE-588)4507815-4 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Urethroplastik (DE-588)4507815-4 s DE-604 Atala, Anthony 1958- Sonstige (DE-588)1059783096 oth The urologic clinics of North America 29,2 (DE-604)BV000001584 29,2 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=010028651&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
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| subject_GND | (DE-588)4507815-4 (DE-588)4143413-4 |
| title | Urethral reconstruction |
| title_auth | Urethral reconstruction |
| title_exact_search | Urethral reconstruction |
| title_full | Urethral reconstruction Anthony Atala ... guest ed. |
| title_fullStr | Urethral reconstruction Anthony Atala ... guest ed. |
| title_full_unstemmed | Urethral reconstruction Anthony Atala ... guest ed. |
| title_short | Urethral reconstruction |
| title_sort | urethral reconstruction |
| topic | Urethroplastik (DE-588)4507815-4 gnd |
| topic_facet | Urethroplastik Aufsatzsammlung |
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