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      A new option to prevent fistulas in anterior urethroplasty in patients with kippered urethra: the tunica vaginalis flap

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          ABSTRACT

          The objective of this study is describing a technique with the use of a tunica vaginalis flap (TVF) to cover the suture line during anterior urethroplasty in patients with kippered urethra due to chronic indwelling catheterization (CIC). We studied 5 patients (mean age=50.2) with a neurogenic bladder that developed urethral erosion after a long period of CIC. Foley catheter was removed on the 14th postoperative day. One patient developed wound infection and utethrocutaneous fistula, which was conservatively managed and after 12 months of follow-up all the patients didn't report difficulties in intermittent self-catheterization. In conclusion, a urethroplasty with TVF technique may be a viable method for repairing penile urethral erosions, but further studies are required with a bigger sample to confirm our results.

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          Failed hypospadias repair presenting in adults.

          Enzo Palminteri, Sheryn M Angelis, Guido Barbagli … (2006)
          To evaluate the results of one-stage and multistage urethroplasty in adults with complications following multiple failed hypospadias repairs. Sixty adults underwent reconstructive surgery of the following complications after hypospadias repair: stricture (34), residual hypospadias (26), fistula (18), meatal stenosis (11), penile curvature (9), hair (4), diverticula (2), and stone (1). A total of 36% of the patients had one complication and 64% had two or more complications. Twenty-nine patients underwent one-stage repair with buccal or skin grafts or direct repair, and 31 underwent multistage repairs with buccal or skin grafts. Mean follow-up was 33.8 mo. Of the 60 cases, 45 (75%) had a final successful outcome and 15 (25%) failed. One-stage repair provided 24 (82.7%) successes and 5 (17.3%) failures. Multistage repair provided 21 (67.7%) successes and 10 (32.3%) failures. Buccal mucosa grafts provided 81% of success in one-stage procedures and 82.3% in multistage procedures. Penile skin grafts provided 80% of success in one-stage procedures and 50% in multistage procedures. Adults with complications following childhood hypospadias repair are still a difficult population to treat with a high failure rate for reoperative surgery.
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            Complications of Foley catheters--is infection the greatest risk?

            Anne-Marie Leuck, Deborah Wright, LeAnn Ellingson … (2012)
            Foley catheters cause a variety of harms, including infection, pain and trauma. Although symptomatic urinary tract infection and asymptomatic bacteriuria are frequently discussed, genitourinary trauma receives comparatively little attention. A dedicated Foley catheter nurse prospectively reviewed the medical records of inpatients with a Foley catheter at the Minneapolis Veterans Affairs Medical Center from August 21, 2008 to December 31, 2009. Daily surveillance included Foley catheter related bacteriuria and trauma. Data were analyzed as the number of event days per 100 Foley catheter days. During 6,513 surveyed Foley catheter days, urinalysis/urine culture was done on 407 (6.3%) days. This testing identified 116 possible urinary tract infection episodes (1.8% of Foley catheter days), of which only 21 (18%) involved clinical manifestations. However, the remaining 95 asymptomatic bacteriuria episodes accounted for 39 (70%) of 56 antimicrobial treated possible urinary tract infection episodes (for proportion of treated episodes with vs without symptomatic urinary tract infection manifestations, p = 0.005). Concurrently 100 instances of catheter associated genitourinary trauma (1.5% of Foley catheter days) were recorded, of which 32 (32%) led to interventions such as prolonged catheterization or cystoscopy. Trauma prompting an intervention accounted for as great a proportion of Foley catheter days (0.5%) as did symptomatic urinary tract infection (0.3%) (p = 0.17). In this prospective surveillance project, intervention triggering Foley catheter related genitourinary trauma was as common as symptomatic urinary tract infection. Moreover, despite recent increased attention to the distinction between asymptomatic bacteriuria and symptomatic urinary tract infection in catheterized patients, asymptomatic bacteriuria accounted for significantly more antimicrobial treatment than did symptomatic urinary tract infection. Elimination of unnecessary Foley catheter use could prevent symptomatic urinary tract infection, unnecessary antimicrobial therapy for asymptomatic bacteriuria and Foley catheter related trauma. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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              Urethral reconstruction in patients with neurogenic bladder dysfunction.

              Jessica Casey, Bradley A. Erickson, Neema Navai … (2008)
              There is limited literature examining urethral reconstruction in patients with neurogenic bladder dysfunction. We describe our experience of urethral reconstruction in men with concurrent neurogenic bladder. A prospectively maintained database of all urethral reconstruction procedures performed by 1 surgeon was analyzed for patients with neurogenic bladder dysfunction. Patient characteristics including the etiology of neurogenic bladder, urethral pathology, urethral reconstructive technique, complications and recurrences were evaluated. A total of 23 patients were included in the analysis. Urethral pathology included erosions (10), strictures (7), diverticula (3), urethrocutaneous fistulas (2), and a combination of diverticular and stricture disease (1). Median length of the urethral pathology was 5.0 cm (range 2.0 to 10.0). Overall urethral reconstruction was successful in 16 of 23 patients (69.6%) at a mean followup of 24.7 months (range 2 to 79). Success rates differed among the types of pathology with 60% for urethral erosions, 85.7% for urethral strictures, and 66.6% for urethral diverticula and fistulas. Of those cases of recurrence 4 of 7 (57%) were after urethral erosion repair. There was 1 (4.3%) postoperative complication and no patient underwent urinary diversion after recurrence. When identified at an early stage, urethral reconstruction in patients with neurogenic bladder dysfunction offers acceptable outcomes with limited morbidity. Men undergoing reconstruction for urethral erosion had inferior outcomes compared to those with other urethral pathology.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int Braz J Urol
                Journal ID (iso-abbrev): Int Braz J Urol
                Journal ID (publisher-id): ibju
                Title: International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology
                Publisher: Sociedade Brasileira de Urologia
                ISSN (Print): 1677-5538
                ISSN (Electronic): 1677-6119
                Publication date (Electronic, pub): 20 April 2021
                Publication date (Electronic, collection): Sep-Oct 2021
                Volume: 47
                Issue: 5
                Pages: 1032-1036
                Affiliations
                [1 ] orgnameHospital Federal da Lagoa Rio de Janeiro RJ Brasil originalHospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil
                [2 ] orgnameUniversidade do Estado do Rio de Janeiro orgdiv1Unidade de Pesquisa Urogenital Rio de Janeiro RJ Brasil originalUnidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro, UERJ, Rio de Janeiro, RJ, Brasil
                [3 ] orgnameUniversidade do Estado do Rio de Janeiro orgdiv1Departamento de Urologia Rio de Janeiro RJ Brasil originalDepartamento de Urologia, Universidade do Estado do Rio de Janeiro, UERJ, Rio de Janeiro, RJ, Brasil
                Author notes
                Correspondence address: Fernando Salles da Silva Filho, MD Rua Vinicius de Moraes, 161/801 Rio de Janeiro, RJ, 22411-010, Brasil. Fax: +55 21 2521-3715 E-mail: fernandosallessf@ 123456gmail.com

                CONFLICT OF INTEREST

                None declared.

                Author information
                https://orcid.org/0000-0003-1562-6068
                Article
                Publisher ID: S1677-5538.IBJU.2020.1058
                DOI: 10.1590/S1677-5538.IBJU.2020.1058
                PMC ID: 8321442
                PubMed ID: 34260180
                SO-VID: 66bc9bc5-94ec-41f2-adfc-f33741d72893
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 04 December 2020
                Date accepted : 09 January 2021
                Page count
                Figures: 2, Tables: 1, Equations: 0, References: 11, Pages: 5
                Categories
                Subject: Surgical Technique

                Keywords: urethra,fistula,tunica intima
                Data availability:
                Keywords: urethra, fistula, tunica intima

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