Transpubic Posterior Urethroplasty via Perineal Approach in Children : A New Technique

12

THE JOURNAL OF UROLOGY®

Vol. 179, No. 4, Supplement, Saturday, May 17, 2008

30

Source of Funding: None

FUNCTIONAL OUTCOME OF COLPOPLASTY USING SIGMOID COLON Amr Noweir*, Ehab A Eltahawy, Alaa Abdelmaksoud, Mohammed Wael. Cairo, Egypt. INTRODUCTION AND OBJECTIVE: Different replacement procedures are available for vaginal substitution either as tubularised JUDIWVRUIURPORFDOÀDSV7KHVLJPRLGFRORQRIIHUVDUHDGLO\DYDLODEOH well vascularised tissue that is functionally appealing as it has a wet surface. METHODS: 38 patients were evaluated during 1988 to 2006. 18 patients were genetic females with congenitally absent vagina (Rokitanski syndrome), or had traumatic or iatrogenic injury that resulted in small vagina. 20 patients were genetic males with ambiguous genitalia, GHFLVLRQZDVPDGHIRUJHQLWDOIHPLQL]DWLRQ3UHRSHUDWLYHSHOYLF&7DQG colon preparation was done in all cases. A segment of the sigmoid colon 10-15 cm was harvested, and primary closure of the colon was done. A plane between the bladder and the colon was developed starting perineally, then continued from the abdomen. The proximal end of the QHRYDJLQD ZDV FORVHG DQG ¿[HG WR VDFUXP LQ RQH SDWLHQW WKLV ZDV anastomosed to the uterus. The distal end was anastomosed to the introitus. A vaginal pack was left for 10 days. RESULTS: Mean age was 22 years (12-42), mean follow XSZDVPRQWKV ,QDOOSDWLHQWVDQDGHTXDWHVL]HQHRYDJLQD was achievable. 12 patients are sexually active. 15 patients developed introital narrowing and use regular dilatation, 8 patients required introital incision. 2 patients had prolonged ileus that resolved spontaneously. One patient presented with acute abdomen due to ruptured neovagina and was explored for repair. CONCLUSIONS: The use of pelvic colon in vaginal reconstruction has several advantages. It is available, wet, and adequate VL]H FDQ EH UHFRQVWUXFWHG 3DWLHQW VDWLVIDFWLRQ ZDV KLJK ZLWK WKLV technique, though some patients need frequent introital dilatation. Source of Funding: None

29 VESICOVAGINAL FISTULA REPAIR WITH RECTUS ABDOMINIS MYOFASCIAL INTERPOSITION FLAP W Stuart Reynolds*, Laurence J Gottlieb, Alvaro Lucioni, David E Rapp, David H Song, Gregory T Bales. Chicago, IL. INTRODUCTION AND OBJECTIVE: Complex, recurrent YHVLFRYDJLQDO¿VWXODV99) FDQEHYHU\FKDOOHQJLQJWRUHSDLUDQGRIWHQ UHTXLUHLQWHUSRVLWLRQRIQRQLUUDGLDWHGZHOOYDVFXODUL]HGWLVVXHEHWZHHQ the urinary system and the vagina. We report on our experience using a UHFWXVDEGRPLQLVP\RIDVFLDO5$0 LQWHUSRVLWLRQÀDSIRU99)UHSDLU. METHODS: A retrospective analysis was performed to identify patients who had undergone VVF repair with RAM interposition. Data was collected focusing on preoperative patient characteristics, etiology of VVF, intraoperative parameters, including surgical techniques, and postoperative patient outcomes. 5(68/76:HKDYHXVHGD5$0LQWHUSRVLWLRQÀDSIRU99) UHSDLU LQ  SDWLHQWV$OO 99) ZHUH SRVWVXUJLFDO QR SDWLHQW UHFHLYHG radiation therapy. VVF developed after total abdominal hysterectomy (TAH) or radical cystectomy in 3 and 2 cases, respectively. Both cases of VVF after radical cystectomy occurred in conjunction with orthotopic GLYHUVLRQ QHREODGGHUYDJLQDO ¿VWXOD  ,Q  SDWLHQWV ZLWK SRVW7$+ VVF, a total of 5 previous failed repairs were attempted prior to RAM LQWHUSRVLWLRQ ,Q RQH SDWLHQW ZLWK QHREODGGHUYDJLQDO ¿VWXOD ZKR KDG received adjuvant chemotherapy, RAM interposition failed and the patient ultimately required cutaneous urinary diversion after two subsequent failed attempts at repair (68 months follow-up). The remaining 4 patients (80%) have had no evidence of recurrent VVF or voiding abnormalities, with a mean follow-up of 19 months (range 8-32 months). CONCLUSIONS: Rectus abdominis muscle can be a VXFFHVVIXOLQWHUSRVLWLRQÀDSGXULQJUHSDLURIFRPSOH[UHFXUUHQW99) In our experience, this has been successful in the majority of cases, particularly in younger patients with nonmalignant processes. Financial disclosures: none. Source of Funding: None

31 TRANSPUBIC POSTERIOR URETHROPLASTY VIA PERINEAL APPROACH IN CHILDREN: A NEW TECHNIQUE Samir S Orabi*. Alexandria, Egypt. INTRODUCTION AND OBJECTIVE: Many authors demonstrated abdominal and abdomino-perineal transpubic urethroplasty as a line of treatment of pelvic fracture urethral distraction defect in children. Objective: Is to evaluate a new technique of transpubic urethroplasty via perineal approach for managment of PFUDD in children. METHODS: A prospective study was performed on 52 children undergoing posterior urethroplasty for pelvic fracture urethral distraction GHIHFW$IWHUSHULQHDOPLGOLQHDSSURDFKDQGH[FLVLRQRIDOO¿EURXVWLVVXHV , 6 out of 52 children had a short urethra that could not bridge the gap ( more than 5 cm ) to do tension free anastomosis. For the latter group , transpubic posterior urethroplasty via perineal approach was performed. Firstly, the upper border of the symphysis pubis was palpated and the corporal separation was done distally till this level (peno-scrotal junction). Dissection of one crus was started from Medial to lateral edge. After complete separation from the bone, the same was done for the other crus. Two crura was hold laterally with tape and two longitudinal lines were performed over the pubic bone, the distance in between about 4 cm. By cutting diathermy over these lines, separation of the pubic bone from lateral attachment was performed. The separated bone was hold by nipple forceps and complete separation from the bladder was done by cutting diathermy. Easy bulbo-prostatic anastomosis was performed. RESULTS: All six children had a good urinary stream without any post-operative complication related to the technique. CONCLUSIONS: Transpubic urethroplasty via perineal approach in children is a feasible easy technique with very minimal morbidity and can be done safely in children when indicated. Easy Bulboprostatic anastomosis can be done through the perineal exposure. Source of Funding: None