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RECONSTRUCTION OF MALE URETHRAL DIVERTICULA: WHAT IS THE BEST APPROACH?

RECONSTRUCTION OF MALE URETHRAL DIVERTICULA: WHAT IS THE BEST APPROACH?

THE JOURNAL OF UROLOGY® Vol. 181, No. 4, Supplement, Sunday, April 26, 2009 569 LONG-TERM RESULTS OF A MODIFIED ESSED-SCHROEDER TECHNIQUE: SURGICAL ...

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THE JOURNAL OF UROLOGY®

Vol. 181, No. 4, Supplement, Sunday, April 26, 2009

569 LONG-TERM RESULTS OF A MODIFIED ESSED-SCHROEDER TECHNIQUE: SURGICAL CORRECTION OF PEYRONIE’S DISEASE ASSOCIATED WITH SEVERE DORSAL CURVATURE Bryan Bruner*, Rochester, MN; Rajeev Kumar, New Delhi, India; Santosh Kumar, Tamil Nadu, India; Ernest F McPhail, Ajay Nehra, Rochester, MN INTRODUCTION AND OBJECTIVE: Preservation of sexual function and penile length and sensation are integral to the overall subjective and objective success following surgical correction for severe penile curvature. Numerous procedures have reported on their success; however a modified Essed-Schroeder technique for severe dorsal curvature is presented with long term results including sexual function and penile length/sensation in 55 consecutive patients. METHODS: Fifty-five (n=55) patients with a mean age of 50 years(18-73 years) with a severe dorsal curvature between 45165 degrees (average 77.5) had pre-operative duplex Doppler US with re-dosing and photographs along with penile length and penile biothesiometry assessment. A modified Essed- Schroeder technique with urethral mobilization was performed in consecutive cases of severe dorsal penile curvature, and post-operative follow-up along with telephone interviews were conducted. Patient outcomes were reviewed with primary emphasis on post-operative complications and patient satisfaction evaluated with the IIEF (satisfaction) questions. RESULTS: Follow-up was obtained in 70% of patients (40/55). The average duration of disease preoperatively was between 6-50 months (average 21 months). There were 9 cases related to traumatic penile injury with intercourse. An overall success rate of 80% was based on postoperative patient satisfaction using the IIEF sexual satisfaction questions with an average increase of 8 points in the IIEF questionnaire. Eight patients complained of penile length loss and/or decreased penile sensation with no major complications or urethral injury in all cases. CONCLUSIONS: We present a safe, effective, and ideal modification of the Essed-Schroeder penile plication technique for severe dorsal penile curvature with minimal urethral mobilization. The long term postoperative results show this to be an effective surgical technique in cases of severe dorsal curvature that do not affect erectile function in the long term as well. Source of Funding: None

570 ENDOSCOPIC URETHROPLASTY WITH SMALL INTESTINAL SUBMUCOSAL PATCH IN CASES OF RECURRENT URETHRAL STRICTURE: A PRELIMINARY STUDY Yasser A Farahat*, Abd Elhameed M Elbahnasy, Osama Elgamal, Mohamad Rasheed, Shawky A Elabd, Tanta, Egypt INTRODUCTION AND OBJECTIVE: Endoscopic urethroplasty involves the endoscopic placement of a graft into the area of a urethral stricture after the stricture has been cut open by an optical urethrotomy. The aim of this study is to evaluat the feasibility and efficacy of endoscopically placed graft of small intestinal submucosa (SIS) as a scaffold for urethral regeneration after internal urethrotomy in patients with recurrent urethral stricture. METHODS: We included 7 patients with recurrent, inflammatory bulbar urethral stricture, of 1-2 cm in length. All of these cases had no dense fibrosis as shown by the pre-operative sono-urethrogram. Following the standard 12 o’clock visual internal urethrotomy, SIS patch (Surgisis® Biodesign 4s Cook Medical) was hydrated in saline for 10 minutes, fashioned in an inverted U-shape then wrapped around the balloon of 12 Fr. silicon Catheter and fixed to the catheter by 2 sutures of 4/0 plain catgut..This prepared catheter with SIS patch was introduced into the urethra over a pre-placed super-stiff guide wire. We also used a 15 Fr urethroscope to visualize the urethra during the advancement of this catheter. This enabled us to put the balloon of the catheter with its overlying SIS patch at the site of the urethral incision. Thereafter, the balloon is filled with 2 cc saline or until a good cooptation is achieved

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between the graft and the incised urethra. The catheter was then secured with a silk suture to the glans and a suprapubic cystostomy was fixed for bladder drainage. At two weeks postoperatively, the urethral catheter was removed and the suprapubic one was clamped and removed when the patient voided normally. These patients were followed up at 1, 6 and 12 months by uroflowmetry and ascending urethrogram. These investigations were also repeated biannually in successful cases. RESULTS: At the three months’ follow up only 2 cases showed mild recurrent stricture and the rest of cases showed clinical improvement with significant improvement in uroflowmetry. The follow up studies of successful cases (range 12 -18 months) revealed no evidence of recurrent stricture and no more interventions were required in any of them. On the other hand, the two cases with recurrent stricture showed good response with regular dilatation. CONCLUSIONS: Endoscopic urethroplasty with SIS patch can be considered as a minimally invasive solution in some selected cases of recurrent urethral stricture. However, larger controlled randomized studies with long term follow-up are still needed Source of Funding: None

571 RECONSTRUCTION OF MALE URETHRAL DIVERTICULA: WHAT IS THE BEST APPROACH? Hannah H Alphs*, Joshua J Meeks, Jessica T Casey, Christopher M Gonzalez, Chicago, IL INTRODUCTION AND OBJECTIVE: Diverticula of the urethra are rare in men and can be classified as either congenital or acquired. As a rare disorder, the most effective method of surgical reconstruction has not been described. METHODS: From 2003 to 2008, we retrospectively identified 13 men with a mean (± standard deviation) age of 38.4 (±13.0) years treated surgically for urethral diverticulum. Mean follow-up for this group of patients was 32.2 (±28.7) months. Four (30.8%) of 13 diverticula were classified as congenital while the remaining 9 (69.2%) were acquired secondary to previous urethral stricture, failed hypospadias repair or traumatic catheterization. Eight (61.5%) of 13 diverticula were located along the penile urethra while the remaining 5 (38.5%) were located along the bulbar urethra. RESULTS: Six (46.2%) of the 13 patient in our series had accompanying urethral defects measured to be less than 4 cm and underwent excision of diverticulum with primary reanastamosis. The remaining 7 (53.8%) patients had urethral defects greater than 4 cm received complex urethroplasty with skin or buccal mucosal grafting in either one or two stages. Mean graft surface area used in this group was 16.9 cm2 (±10.5 cm2). Neither age at the time of surgery, length of follow-up, nor diverticulum volume were significantly different between men who underwent primary repair versus substitution urethroplasty [Table 1]. Complications were similar for both groups [Table 1]. There was only one small recurrence of diverticulum in a patient who received urethroplasty with buccal mucosal grafting. CONCLUSIONS: Urethral diverticula are uncommonly encountered in the male patient population. While there is no current consensus on how to best approach the repair of urethral diverticula, here we present one of the largest series of patients treated with reconstruction for diverticulum. We demonstrate that either excision with primary repair is equally as effective in our small series for urethral reconstruction in men with urethral diverticulum.

Source of Funding: None