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State-of-the-Art in Genitourinary Reconstruction

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (15 September 2022) | Viewed by 7235

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Special Issue Editors

Dr. Tamsin Greenwell

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Guest Editor

Department of Urology, University College London Hospital, 16-18 Westmoreland Street, London W1G 9PH, UK
Interests: vesicovaginal and other urinary tract fistulae; female urethral diverticulum; male and female urethral stricture; complex male and female urinary incontinence and lower urinary tract reconstruction

Dr. Luis Gómez Pérez

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Guest Editor

1. Department of Pathology and Surgery, Universidad Miguel Hernández, Elche, Spain
2. Department of Urology, Hospital General Universitario de Elche, Elche, Spain
Interests: genitourinary reconstruction; functional urology; kidney trasplant

Special Issue Information

Dear Colleagues,

The practice of genitourinary surgical reconstruction is challenging and rapidly changing. Techniques are constantly evolving to improve outcomes. Our mental plan for a particular surgery can change intraoperatively and different skills are needed to perform these operations.

Surgery to restore normal function by repairing, rerouting, or recreating areas of the upper or lower urinary tract and genitalia is not enough. Furthermore, we are now paying more attention to patient-reported quality of life. In addition, the milestones in regenerative surgery, biotechnology, and new materials have not been completely translated into clinical practice.

The aim of this Special Issue is to highlight recent advances in the context of diagnosis, treatment, and prognosis for various genitourinary reconstructive procedures.

Dr. Tamsin Greenwell
Dr. Luis Gómez Pérez
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

genitourinary reconstruction
male urethral stenosis
female urethral stenosis
urinary fistula
penile reconstruction
penile implant
vaginoplasty
transgender surgery

Published Papers (3 papers)

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Research

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10 pages, 2745 KiB

Open AccessArticle

Repair of Traumatic Urethral Strictures: La Paz University Hospital Experience

by Cristina Ballesteros Ruiz, Carlos Toribio-Vázquez, Esaú Fernández-Pascual, Emilio Ríos, Andrea Rodríguez Serrano, J. M. Alonso Dorrego, Manuel Girón de Francisco, J. A. Moreno, Paloma Cárcamo Valor and Luis Martínez-Piñeiro

J. Clin. Med. 2023, 12(1), 54; https://doi.org/10.3390/jcm12010054 - 21 Dec 2022

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Abstract

Introduction: The management of traumatic urethral strictures remains a challenge for urologists. Alteration of the pelvic anatomy and the significant fibrosis generated by the trauma make surgical repair complex. In most cases, the existing defect between the urethral ends is small, and the ideal treatment is end-to-end perineal urethroplasty. Cases of extensive strictures that are left with long gap defects may require the use of different sequential maneuvers to achieve a tension-free anastomosis. Objective: To describe the experience at our center with urethral strictures induced by closed perineal trauma. Materials and methods: A retrospective analysis of 116 patients who underwent urethroplasty for urethral stricture after blunt perineal trauma at our center between 1965 and 2020 was conducted. Demographic data, date, mechanism of action of the trauma, emergency management, previous urethral interventions, surgical technique carried out in our center, complications, presence of erectile dysfunction, and urinary incontinence were collected. Results: 82 patients (70.7%) presented with pelvic fractures. The most frequent etiology of trauma was traffic accidents (68%), followed by crushing injuries (24%). Suprapubic cystostomy was placed in 50.2% of patients, and urethral realignment was performed in 25.3%. The mean stricture length was 2.2 cm, affecting mostly the membranous urethra (67%). During surgery, it was necessary to perform crural separation in 61.5% and partial pubectomy in 18.8% of the cases. Erectile dysfunction developed after trauma in 40.5% of cases, while new erectile dysfunction was noted in 4.3% of patients after surgery. Surgery was successful in 91.3% of cases, with a median follow-up of 16 (6–47) months. Conclusion: Delayed anastomotic urethroplasty offers a high success rate in traumatic urethral strictures. Full article

(This article belongs to the Special Issue State-of-the-Art in Genitourinary Reconstruction)

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9 pages, 784 KiB

Open AccessArticle

The Role of Multi-Staged Urethroplasty in Lichen Sclerosus Penile Urethral Strictures

by Enzo Palminteri, Andrea Gobbo, Mirko Preto, Paolo Alessio, Daniele Vitelli, Lorenzo Gatti and Nicolò Maria Buffi

J. Clin. Med. 2022, 11(23), 6961; https://doi.org/10.3390/jcm11236961 - 25 Nov 2022

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Abstract

Background: One-stage buccal mucosa graft urethroplasty (BMGU) is advised for non-obstructing, simple penile strictures due to lichen sclerosus (LS), while a multistage approach is preferred for most complex cases. Our study aims to evaluate long-term treatment outcomes and patient-reported outcomes (PROs) in patients undergoing multistage BMGU for LS-associated penile strictures. Methods: This is a retrospective analysis of prospectively collected data on multistage penile BMGU from 2001. All patients underwent a 2-stage (2St) or 3-stage (3St) BMGU with the final closure of the urethral plate. PROs were collected from a pre-defined questionnaire. Results: Twenty patients were successfully treated, while five experienced recurrence. If a first-stage Johanson was only performed, a 3St-BMGU was more likely, and higher treatment success was observed. A time course between the first and last stages shorter than 12 m was an independent predictor of treatment failure. Patients reported high overall satisfaction and urinary flow improvement. Sexual life was not significantly affected, while aesthetic appearance was the most affected dimension. Conclusions: Staged approaches have satisfactory treatment success rates, likely depending on the duration from the first to the last stage. PROs do not differ based on the number of stages performed, and overall satisfaction with the procedure is high. Full article

(This article belongs to the Special Issue State-of-the-Art in Genitourinary Reconstruction)

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Review

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11 pages, 3626 KiB

Open AccessReview

Mesh Graft Urethroplasty—Still a Safe and Promising Technique in Mostly Unpromising Complex Urethral Strictures

by Mathias Reichert, Maurizio Aragona, Ahmad Soukkar and Roberto Olianas

J. Clin. Med. 2022, 11(20), 5989; https://doi.org/10.3390/jcm11205989 - 11 Oct 2022

Viewed by 3511

Abstract

Long urethral strictures or even recurrent urethral strictures, mostly with scar tissue showing insufficient healing tendencies, are defined as complex and represent a big challenge in modern reconstructive urology. Initially, the treatment of complicated urethral strictures was associated with a high failure rate (20–40%) due to the growth of hair in the neourethra and a lack of sufficient suitable epithelium when scrotal skin was used. Although much effort was put into tissue engineering recently, harvesting and transplanting autologous tissue represent the standard of care for urethral substitution or augmentation. Since 1977, two-staged urethroplasty with the usage of free foreskin or 0.1 mm thick meshed skin from the upper leg was performed in complicated cases and was initially described in 1984 and 1989 by Schreiter and Schreiter and Noll, respectively. In stage 1, the graft is harvested by cutting the skin thinly above the hair follicles and transplanted as a plate around the opened urethra. In stage 2, after 8–12 weeks, the neourethra is formed. Success rates of up to 84% are described. Considering the complexity of the strictures in which mesh graft urethroplasty is usually performed, the reachable success rates are outstanding, especially considering that this surgery is most likely the last opportunity to prevent perineostomy or even urinary diversion. This article describes the surgical technique and embeds the mesh graft urethroplasty in today’s literature to underline its importance in the surgical management of complex urethral strictures. Full article

(This article belongs to the Special Issue State-of-the-Art in Genitourinary Reconstruction)

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