Abdelwahab Elkassaby

Modified Tubularized Incised Plate Urethroplasty for Hypospadias Repair : A Long-Term Results of 764 Patients

OBJECTIVES To present our experience with a modification of tubularized incised plate (TIP) urethroplasty for treatment of anterior penile hypospadias. METHODS A total of 764 children with primary anterior penile hypospadias (462 subcoronal and 302 coronal) underwent hypospadias repair by using modified TIP urethroplasty. The technique involves, in addition to the standard TIP, the use of the dorsal prepuce which was divided in 2 flaps. The right flap was de-epithelialized on both the outer and inner sides and transferred as interposing layer between the neourethra and the coverings. The left flap was de-epithelialized on the inner side and transferred ventrally as skin coverage. The follow-up ranged between 3 and 52 months with a mean of 17 months. RESULTS Excellent functional and cosmetic results were achieved in 738 patients (96.6%). Urethral fistulae were encountered in 16 cases (2%) and were repaired successfully. Meatal stenosis was noted in 8 cases (1%) and successfully treated. Two patients had complete disruption of the wound (0.2%), which was corrected. CONCLUSIONS Excellent functional and cosmetic results can be achieved after repair of anterior penile hypospadias by using TIP urethroplasty with the modification of using double breasted de-epithelialized skin flap.

Corrigendum to “Twin penile skin flap, is it the answer for repair of long anterior urethral strictures?” [Arab J. Urol. 16(2) (2018) 224–231]

[This corrects the article DOI: 10.1016/j.aju.2017.12.006.].

Twin penile skin flap, is it the answer for repair of long anterior urethral strictures?

Abstract Objective To present our twin ventral penile skin flap technique for the management of complex long anterior urethral strictures not caused by lichen sclerosis (LS), with evaluation of surgical outcome and complications. Patients and methods We retrospectively reviewed patients diagnosed with long complex anterior urethral strictures who were all referred to Ain Shams University hospital and operated on by three reconstructive surgeons. The surgical procedure was carried out as follows: exposure of the urethra through a ventral longitudinal penile skin incision and another perineal incision; two ventral longitudinal dartos-based penile skin flaps are used for urethral augmentation as onlay flaps. Clinical data were collected in a dedicated database. Preoperative, intraoperative, and postoperative follow-up data for each patient were recorded and analysed. A descriptive data analysis was performed. Results Between January 2012 and February 2015, 47 patients diagnosed by urethrograms as having long anterior urethral strictures, with a mean (SD, range) length of 17.56 (2.09; 14–21) cm, were managed by twin penile skin flap repair. Four patients were lost to follow-up, thus 43 patients constituted the study cohort. The mean (range) follow-up period was 31 (22–36) months. The overall success rate was 95.35% (41/43). At 12-months postoperatively, the 41 successful cases had a mean (SD, range) peak urinary flow rate of 20.26 (3.06, 14–25) mL/s and American Urological Association Symptom Score of 5.6 (1.85, 3–8). Postoperative complications included urethrocutaneous fistula in three patients (6.97%), mild sacculation of the flap in seven patients (16.52%), post-micturition dribbling in 34 patients (79.07%), decreased penile girth in two patients (4.65%), and chordae of <15° with no need for repair in three patients (6.97%). Conclusions In the presence of a favourable urethral plate and ample non-hirsute penile skin, one-stage twin penile skin flap urethroplasty provides excellent results for non-LS related complex strictures, with minimal acceptable complications. It proved to be especially efficient in circumcised patients.

Regenerative medicine for the urethra

Abstract Replacement of damaged or diseased tissues represents one of the most challenging aspects of medicine. Within the urinary tract, tissue replacement is a technically demanding procedure. In particular, urethral reconstruction has posed a continuing challenge to the reconstructive urologist. Various surgical techniques utilizing flaps or grafts (genital/extragenital), whether single or multistage, have been used for urethral reconstruction with satisfactory results. Genital skin, however, is not always readily available and most graft harvesting procedures are technically demanding and time consuming. The development of an ’off-the-shelf’ graft material may be the answer to this old urological dilemma. In this chapter, we review the current materials, whether synthetic or natural, that have been used in clinical or preclinical studies for the purpose of urethral reconstruction.