Page 75 - Read Online

El-Ghoneimi et al. Plast Aesthet Res 2022;9:39 https://dx.doi.org/10.20517/2347-9264.2021.101 Page 3 of 11

Table 1. Patient data and results
Number of Lenght of
Case Indication previous Age urethroplasty Fu Complications Treatment of complications
(months)
(years)
surgeries (cm)
1 Multiple operated 7 11.3 12 97 None
perineal
hypospadias
2 12 12.9 15 62 Meatal stenosis, stone Stone laser fragmentation, self-
dilatation 3 years, no recurrence
3 Ovotesticular 1 12.5 14 61 Proximal fistula Fistula closure, no further
46XX DSD surgery
4 1 10.5 12 106 Proximal fistula Fistula closure, no further
surgery
5 Perineal 0 1.7 8 160 Proximal stenosis Onlay buccal mucosal graft, no
hypospadias further surgery
staged repair
6 0 7.1 9 41 none
7 0 2 7 30 stricture Total redo, staged buccal
mucosal graft complicated by
proximal fistula needed closure
without recurrence
8 0 6.6 8 6 Lost of FU (follow-up)
(after 6 months free of
complications)
9 Urethral 2 1.7 8 71 none
duplication
10 Circumcision 2 16.3 16 18 none Preventive self-dilatation 12
complication months

DSD: Disorder of sex development.

cases had severe curvature > 45°; treatment was done by removal of all fibrous tissues and ventral
corporoplasty when needed. (A ventral transverse incision was made at the point of greatest curvature
through the tunica albuginea, extending from the 3 o’clock to the 9 o’clock position.) A flap of tunica
vaginalis was used to cover the corpora defect. In cases of unavailable tunica vaginalis (ovotesticular DSD),
multiple fairy cuts were done. All reconstructed or fibrous urethra was removed until obtaining a healthy
native urethra; all of them were perineal [Figures 1 and 2].

In redo cases, penile skin was reconstructed either by local flaps or by free skin grafts. A minimum delay of
one year was respected before TBMG.

Bladder mucosa graft harvesting by minimal detrusotomy
A short suprapubic transversal skin incision was done. The bladder was filled with saline and accessed by
midline facial incision. A short (2 cm in length) transversal detrusotomy was done on the anterior wall of
the bladder [Figure 3]. The exposed mucosa was incised vertically and retracted by 5/0 stich. Two parallel
perpendicular incisions were done to isolate 2 cm width of the mucosa. Blunt and sharp dissection was done
at the submucosal plane with mild retraction and progressive incision of the two parallel lines. These
incisions were limited to the needed length for the urethra [Supplementary Video 1]. The mucosal defect
was sutured by a running 5/0 absorbable suture, and the detrusotomy was closed after insertion of a supra
pubic catheter.

Tubularization of the graft
The graft was tubularized by interrupted 6/0 absorbable polydioxanone (PDS, Ethicon) round needle. The
tabularization was done around a Foley catheter of at least Ch 12 according to the age of the child. The graft