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In This Article

  • Summary
  • Abstract
  • Introduction
  • Protocol
  • Representative Results
  • Discussion
  • Acknowledgements
  • Materials
  • References
  • Reprints and Permissions

Summary

This article introduces a surgical method using a pedicled tunica vaginalis to treat long-segment urethral stricture resulting from lichen sclerosus. The tunica vaginalis is an excellent substitute for the urethra, leading to quick postoperative recovery for patients.

Abstract

Urethroplasty for the management of long-segment urethral strictures associated with lichen sclerosus presents considerable clinical challenges. Oral mucosal grafts are commonly employed but are vulnerable to posttransplantation infection and recurrent stricture formation. Furthermore, the necessity for anesthesia and oral graft harvesting restricts their application in primary healthcare settings.

The single layer of flattened epithelium of the tunica vaginalis can serve as a potential alternative to oral mucosa. Animal experiments have demonstrated that the tunica vaginalis can readily form a tight connection with the multilayered urothelium of the urethra. Utilizing the tunica vaginalis as a scaffold for urethral re-epithelialization may help reduce the risk of recurrence of urethral stricture after surgery. Over a 19 year period, pedicled tunica vaginalis urethroplasty has been used for successfully treating 86 cases.

The surgical procedure involves dorsally incising the urethral stricture segment, then covering it with a pedicled tunica vaginalis patch followed by suturing. Postoperatively, the pedicled tunica vaginalis graft exhibits good vascularization and take rate, facilitating urethral re-epithelialization. The surgical procedure is conducted in a sterile environment to mitigate the potential for infectious complications. Moreover, the operation can be executed under spinal anesthesia, which facilitates its implementation in primary healthcare settings.

Introduction

Lichen sclerosus (LS) of the penis is a chronic inflammatory dermatological condition mediated by lymphocytes, and it is considered an acquired dermatosis1. Hallmark symptoms of LS of the penis include chronic inflammation of the glans penis, abnormal dryness in the appearance of the affected skin, and endarteritis in the subcutaneous arteries supplying the glans penis2. Most patients with LS of the penis have a history of phimosis, with lesions primarily occurring on the foreskin, glans penis, external urethral meatus, or anterior urethra. Some patients may be asymptomatic throughout the disease course, while others can....

Protocol

The study cohort comprised 86 male patients aged between 20 and 66 years, with a mean age of 40. Each patient received a single-stage tunica vaginalis graft, with 70 cases involving a unilateral tunica vaginalis graft and 16 cases involving a bilateral tunica vaginalis graft. The patients provided informed consent to use and publish their data.

1. Preoperative preparation

Ensure that patients with concurrent urethral infection undergo preoperative cys.......

Representative Results

See Supplemental Table S1 for patients' clinical history and preoperative measures. Preoperatively, all 86 patients underwent retrograde urethrography and uroflowmetry examinations. Each patient received a single-stage tunica vaginalis graft, with 70 cases involving a unilateral tunica vaginalis graft and 16 cases involving a bilateral tunica vaginalis graft. Postoperative follow-up ranged from 6 to 48 months, with a mean of 24 months. Among these individuals, 84 exhibited unimp.......

Discussion

Numerous urological researchers have investigated a diverse range of graft materials for urethral reconstruction, including genital and extragenital flaps or free grafts17. These materials include preputial graft, bladder mucosa, oral mucosa, tunica vaginalis, and colonic mucosa.

Oral mucosal grafts have achieved high success rates for the treatment of anterior urethral strictures caused by LS, with Xu et al. reporting a success rate of 88.9%18. .......

Acknowledgements

In the writing process of this manuscript, the authors utilized the Claude language model developed by Anthropic AI as an assistive tool for grammar checking and correction. Claude provided valuable feedback and suggestions, but the final content was thoroughly reviewed and verified by the authors to ensure accuracy and originality. The authors take full responsibility for the content and views expressed in this manuscript.

....

Materials

NameCompanyCatalog NumberComments
2-0/T non-absorbable sutureEthicon IncSA845GSterile, radiation sterilization, disposable
22F silicone catheterUROVISIONG2219043A disposable Foley Catheter
3-0 non-absorbable sutureEthicon IncSA84GSterile, radiation sterilization, disposable
5-0 absorbable sutureEthicon IncVCP1433Sterile, radiation sterilization, disposable
Digital X-ray Radiography Fluoroscopy SystemBeijing Shimadzu Madical Equipment Co.,LtdZS-200Retrograde urethrograms use
Iohexol InjectionSTARRY PHARMACEUTICALH20203258Sterile, disposable,Retrograde urethrograms use
SPSS 20.0statistical software
Urodynamic AnalyzerWBL MEDICALNidoc 970AMaximum flow rate detection

References

  1. Pugliese, J. M., Morey, A. F., Peterson, A. C. Lichen sclerosus: Review of the literature and current recommendations for management. J Urol. 178 (6), 2268-2276 (2007).
  2. Powell, J. J., Wojnarowska, F. Lichen sclerosus.

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UrethroplastyPedicled Tunica VaginalisLong segment Urethral StrictureLichen SclerosusOral Mucosal GraftsRe epithelializationSurgical ProcedureInfection RiskVascularizationSpinal AnesthesiaPrimary Healthcare SettingsPostoperative Outcomes

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