CURRENT CONCEPTS OF URETHROPLASTY Edited by Ivo Donkov Current Concepts of Urethroplasty Edited by Ivo Donkov Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published articles. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Sandra Bakic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright evv, 2011. Used under license from Shutterstock.com First published October, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Current Concepts of Urethroplasty, Edited by Ivo Donkov p. cm. ISBN 978-953-307-392-7 Contents Preface IX Chapter 1 Tunica Albuginea Urethroplasty 1 RK Mathur Chapter 2 Two-Stage Urethroplasty for Severe Primary Hypospadias 9 Yun-Man Tang and Shao-Ji Chen Chapter 3 Versatility of Tubularized Incised Plate Urethroplasty in Management of Different Types of Hypspadias 25 Gamal Al-Saied Chapter 4 Urethroplasty; Wide Range of Therapeutic Indications and Surgical Techniques 33 Mahmoud Mustafa, Dina Abugaber, Sacit Nurigorgel, Ertugrul Sefik, Ozan Horsanali and Wael Sadaqah Chapter 5 Management of Post Hypospadias Urethral Fistula 47 Sherif Shehata and Mohamed Hashish Chapter 6 The Treatment of Panurethral Strictures 61 Yue-Min Xu and Chao Feng Chapter 7 Complex Posterior Urethral Stricture 77 Ying-Long Sa and Yue-Min Xu Chapter 8 Oral Mucosa Graft: An Ideal Substitute for Urethroplasty 97 Maged Ragab and Hossam Haroun Chapter 9 Mechanism of Penile Prosthesis Induced Urethral Stricture: Treatment and Prevention 111 Jong Kwan Park and Chen Zhao Chapter 10 Genital Skin Flap Urehtroplasty 119 Abimbola O. Olajide VI Contents Chapter 11 The Use of Buccal Mucosa in Bulbar Stricture Repair: Morbidity and Functional Outcome 139 Frank Van der Aa, Kathy Vander Eeckt and Steven Joniau Preface Urethral reconstructive surgery has always been challenging part for urologist since the dawn of our speciality. The urethral strictures and defects in development of the urethra (hypospadias and epispadias) are the main issues for urologists, dealing with lower urinary tract reconstructions. A urethral stricture is a scarred or hardened area that causes narrowing of the caliber of the urethra, and is the commonest problem encountered by adult urology reconstructive surgeons.The stricture eventually reduces or obstructs the flow of urine out of the bladder, making it difficult to urinate. A urethral stricture can occur anywhere in the urethra. Urethroplasty is a surgical procedure conducted to correct scar tissue blockage of the urethra called urethral stricture. Urethroplasty is a surgical procedure for urethral reconstruction to treat urethral stricture. Urethroplasty can be performed by 2 methods; primary repair which involves complete excision of the narrowed part of the urethra, where proximal and distal patent parts are then rejoined. The second method of Urethroplasty utilizes tissue transfer of flaps or free graft technique. In this method, tissue is grafted from genital skin, or buccal mucosa and is used to enlarge or replace the strictured (narrowed) segment of the urethra. The abundance of methods and continuing development of new approaches to the problem prove the complexity of it. In this book some of the leading experts in lower urinary reconstructions present their views and experience in that field, together with practical tips and tricks. The book is an excellent source of information for those who are already dealing with urethral surgery, and also an invaluable companion for urologists in training or those who want to dedicate themselves to this great sub-specialty. Ivo Donkov Department of Urology, Medical University of Sofia, Bulgaria Lincoln County Hospital, UK [...]... tunica albuginea urethroplasty Success of free graft apposition depends on neovascularization from the surrounding structures, failure of which leads to necrosis of graft and formation of urethroperineal 6 Current Concepts of Urethroplasty fistula Current techniques adopt graft (e.g buccal mucosa, bladder mucosa) or flap apposition (e.g pedicled skin flaps, skin island onlay flaps), but this often lacks... rates are high 2 Current Concepts of Urethroplasty 4 Tunica albuginea urethroplasty: A novel technique Presently buccal mucosal dorsal onlay grafting is considered the standard substitution urethroplasty procedure for anterior urethral strictures We introduce a technique of anterior urethroplasty by using locally available tunica albuginea of the corpora cavernosa In tunica albuginea urethroplasty (TAU),... urethroplasty (TAU), the ventral aspect of the tunica albuginea of the corpora cavernosa is used to form the roof of the neourethra The anatomical and histological similarity of the tunica albuginea of the corpora cavernosa to the covering of the urethra and its local availability prompted us to use it for urethroplasty Furthermore, it has been observed that in other cases of urethroplasties with dorsal onlay... Barbagli et al showed that the placement of buccal mucosa grafts into the ventral, dorsal or lateral surface of the bulbar urethra showed the same success rates (83–85%) and the outcome was not affected by the surgical technique (a) 7 Tunica Albuginea Urethroplasty (b) (c) Fig 2 Figures showing the urethral groove 8 Current Concepts of Urethroplasty The urethroplasty of anterior urethral stricture by using... degree, and penoscrotal angle created At completion of these steps in stage I surgery, the anomaly becames a much milder variant of hypospadias Thus reconstruction of stage II surgery is much more easier and much less risky With twice chances of cosmetic tailor, good appearance can be expected 12 Current Concepts of Urethroplasty 2.4 Indications of two-stage repair in severe primary hypospadias Two-stage... approximately 1 of 200 to 1 of 300 live births.(1) Many operations have been described for repair of hypospadias The introduction of Tubularized Incised-Plate (TIP) urethroplasty by Snodgrass in 1994 have resulted in a revolution in management of different types of hypospadias (distal and proximal either new cases or re-operative cases) as documented by many reports.(2-7) The purpose of this review... urethrogram, urethrosonogram, and uroflometry (preoperatively possible only in cases not having a supra pubic catheter) Tunica Albuginea Urethroplasty Fig 1 Technique of Tunica Albuginea Urethroplasty 3 4 Current Concepts of Urethroplasty These patients were taken for TAU, the steps of which are illustrated in the above figure Among 206 patients, 26 had membranous urethral strictures associated with anterior... mucosa (Bracka, 2008) (Fig 2.1 and Fig 2.2) 16 Current Concepts of Urethroplasty With introduction of extragenital graft, room for reconstruction of optimal function and appearance enlarges significantly The special disadvantages are concerns of donor site mobidities, graft contracture, unsound recipient wound bed, surface keratinization, and absence of long-term evidence for growth synchronism between... transected edge of the natural plate to the penile apex 18 Current Concepts of Urethroplasty Fig 3.2 PRTU procedure as stage I hypospadias repair (part II) E (upper left): A U-shaped incision with proper width is made starting form 2 mm proximal to the meatus to the level of anticipated neomeatus, the pecicle vasculature of neoplate is preserved through lateral subcutaneous dissection The design of neomeatus... Rink, R.C (1998) Etiology, management and surgical complications of congenital 22 Current Concepts of Urethroplasty chordee without hypospadias Journal of Urology, Vol.160, No.3 part 2, (September 1998), pp.1120-1122, ISSN 0022-5347 Duckett, J.W Jr (2002a) Transverse preputial island flap technique for repair of severe hypospadias 1980 Journal of Urology, Vol.167, No.2 part 2, (Febrary 2002), pp.11791182, . CURRENT CONCEPTS OF URETHROPLASTY Edited by Ivo Donkov Current Concepts of Urethroplasty Edited by Ivo Donkov Published. Urethroplasty 3 Fig. 1. Technique of Tunica Albuginea Urethroplasty Current Concepts of Urethroplasty 4 These patients were taken for TAU, the steps of which are illustrated in the above. structures, failure of which leads to necrosis of graft and formation of urethroperineal Current Concepts of Urethroplasty 6 fistula. Current techniques adopt graft (e.g. buccal mucosa,