This document discusses stricture urethra and its management. It provides details on the epidemiology, etiology, clinical evaluation and surgical options for urethral strictures. Key points include that bulbar strictures are the most common, iatrogenic causes have increased in prevalence, clinical evaluation involves uroflowmetry, retrograde urethrogram and cystoscopy, and surgical options range from dilation and direct visual internal urethrotomy for short strictures to various types of urethroplasty using grafts or flaps for longer or complex strictures.
The surgical treatment of an injury or defect within the urethra's walls is known as urethroplasty. The three most frequent factors leading to urethral damage that needs to be repaired are trauma, iatrogenic injury, and infections. The gold standard treatment for urethral strictures is urethroplasty, which has a lower recurrence rate than dilatations and urethrotomies. Although recurrence rates are higher for this challenging treatment group, it is likely the only effective treatment option for chronic and severe strictures.
Urethroplasty is not regarded as a small procedure, taking three to eight hours on average in the operating room. Between 20% and 30% of urethroplasty patients may benefit from the ease of going under the knife for a shorter period of time and going home the same day. On average, hospital stays last two to three days. Seven to ten days may be needed for hospitalization for more complicated surgeries.
Fewer than ten percent of patients experience significant complications after urethroplasty, while complications, particularly recurrences, are more frequent in long and complex strictures.
The surgical treatment of an injury or defect within the urethra's walls is known as urethroplasty. The three most frequent factors leading to urethral damage that needs to be repaired are trauma, iatrogenic injury, and infections. The gold standard treatment for urethral strictures is urethroplasty, which has a lower recurrence rate than dilatations and urethrotomies. Although recurrence rates are higher for this challenging treatment group, it is likely the only effective treatment option for chronic and severe strictures.
Urethroplasty is not regarded as a small procedure, taking three to eight hours on average in the operating room. Between 20% and 30% of urethroplasty patients may benefit from the ease of going under the knife for a shorter period of time and going home the same day. On average, hospital stays last two to three days. Seven to ten days may be needed for hospitalization for more complicated surgeries.
Fewer than ten percent of patients experience significant complications after urethroplasty, while complications, particularly recurrences, are more frequent in long and complex strictures.
Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
URETHRAL INJURY- Trauma Surgery
#surgicaleducator #babysurgeon
Dear viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on URETHRAL INJURY- one more in Trauma Surgery. I haven’t talked elaborately but have included the essential minimum an undergraduate medical student should know. I have talked about anatomy, classification, etio-pathogenesis, symptoms, signs, investigations, grading, treatment, complications, treatment algorithm and case vignettes of urethral injuries. My aim is, after watching this video all of you should be able to arrive at a correct working diagnosis of the type of urethral injury and should also be able to institute immediate treatment to the patients if there is a need. The definitive urethroplasty should be done by a Urologist. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
Types of Urethral injury, Mechanism of Urethral injury, Classification of Urethral injury, Symptoms of Urethral injury, Signs of Urethral injury,
Investigations for Urethral injury, Grading of Urethral Injury, Treatment for Urethral injury, Complications of Urethral Injury
Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
URETHRAL INJURY- Trauma Surgery
#surgicaleducator #babysurgeon
Dear viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on URETHRAL INJURY- one more in Trauma Surgery. I haven’t talked elaborately but have included the essential minimum an undergraduate medical student should know. I have talked about anatomy, classification, etio-pathogenesis, symptoms, signs, investigations, grading, treatment, complications, treatment algorithm and case vignettes of urethral injuries. My aim is, after watching this video all of you should be able to arrive at a correct working diagnosis of the type of urethral injury and should also be able to institute immediate treatment to the patients if there is a need. The definitive urethroplasty should be done by a Urologist. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
Types of Urethral injury, Mechanism of Urethral injury, Classification of Urethral injury, Symptoms of Urethral injury, Signs of Urethral injury,
Investigations for Urethral injury, Grading of Urethral Injury, Treatment for Urethral injury, Complications of Urethral Injury
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Moderators:
Professors:
• Prof. Dr. G. Sivasankar, M.S., M.Ch.,
• Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
• Dr. J. Sivabalan, M.S., M.Ch.,
• Dr. R. Bhargavi, M.S., M.Ch.,
• Dr. S. Raju, M.S., M.Ch.,
• Dr. K. Muthurathinam, M.S., M.Ch.,
• Dr. D. Tamilselvan, M.S., M.Ch.,
• Dr. K. Senthilkumar, M.S., M.Ch.
Dept Of Urology, KMC and GRH, Chennai 2
4. Urethra
• Anterior Urethra –Penile and bulbar
urethra
• Posterior Urethra – Prostatic and
membranous urethra
Dept Of Urology, KMC and GRH, Chennai 4
5. ICUD Consensus 2010
• A urethral stricture is defined as a narrowing of the urethra
consequent upon ischaemic spongiofibrosis.
• Since only anterior urethra is covered by corpus spongiosum, the
terminology is used only for anterior urethra.
Dept Of Urology, KMC and GRH, Chennai 5
6. Consensus Conference 2016
• Stricture- Associated with anterior urethra
• Distraction defects- Membranous urethra with pelvic fracture
• Stenosis- Associated with posterior urethra
Dept Of Urology, KMC and GRH, Chennai 6
8. Epidemiology
• Prevalance 1-9 per 1000 population.
• Highest in developing countries.
Dept Of Urology, KMC and GRH, Chennai 8
9. Anatomical Incidence
• Bulbar strictures - 44–67 %,
• Penile strictures - 12–39 %,
• Mixed (bulbar and penile)- 6–28 %,
• External meatal or submeatal - (0–23 %),
Dept Of Urology, KMC and GRH, Chennai 9
10. Location and Mean Stricture Length
• Pendulous urethra - 6.1 cm,
• Bulbar urethra - 3.1 cm, and
• Fossa navicularis - 2.6 cm.
Fenton AS, Morey AF, Aviles R, et al. Anterior urethral strictures: etiology and characteristics. Urology.
2005;65(6):1055–8.
Dept Of Urology, KMC and GRH, Chennai 10
14. Iatrogenic Stricture
• Transurethral resection (41 %),
• Prolonged catheterization (36.5 %), and
• Cystoscopy (12.7 %)
Dept Of Urology, KMC and GRH, Chennai 14
15. Etiology
• Ischaemia due to
instrumentation at pressure
points and catheterization with
large lumen catheter.
• At points of bow string
compression.
Dept Of Urology, KMC and GRH, Chennai 15
16. Risk Factors
• Advanced age,
• Sexually transmitted illness,
• Socioeconomic status,
• Race,
• Lichen sclerosus, and
• A history of prostate cancer treatment.
Dept Of Urology, KMC and GRH, Chennai 16
17. Lichen sclerosis and Stricture Urethra
• Previously called Balanitis Xerotica Obliterans
• May be due to autoimmunity/oxidative stress
• Premalignant lesion – penile cancer changes 2.3 -9.3%
• Associated with anterior urethral stricture
Dept Of Urology, KMC and GRH, Chennai 17
18. • 1991-2002 study
• 925 patients underwent urethroplasty for anterior urethral stricture,
130 patients received the diagnosis of LS..
• 14% had LS.
Barbagli et al 2004
Dept Of Urology, KMC and GRH, Chennai 18
19. Lichen Sclerosis and Borrelia Burgdorferi-
Present Status
• Borrelia burgdorferi is not associated with genital lichen sclerosus in
men
Aberer E, Neumann R, Stanek G. Is localized scleroderma a Borrelia infection? Lancet. 1995;2:278.
Weide B, Waltz T, Garbe C. Is morphea caused by Borrelia burgdorferi? A review. Br J Dermatol.
2000;142:636–44.
Edmonds E, Mavin S, Francis N, Ho-Yen D, Bunker C. Borrelia burgdorferi is not associated with
genital lichen sclerosus in men. Br J Dermatol. 2009;160(2):459–60.
Dept Of Urology, KMC and GRH, Chennai 19
20. Gonococcal strictures-Present Scenario
In the previous century more than 90 % of strictures were
inflammatory due to gonococcus.
At present, due to the development of antibiotics, the incidence has
decreased drastically.
Dept Of Urology, KMC and GRH, Chennai 20
21. Mechanism
• Abscess in Paraurethral gland
• Rupture into corpus spongiosum
• Inflammation of corpus spongiosum
• Healing with fibrosis
Dept Of Urology, KMC and GRH, Chennai 21
22. • Urine extravasation
• Spongiofibrosis
• Further stricture upstream
Creep Up Phenomena
Dept Of Urology, KMC and GRH, Chennai 22
25. Symptomatology
Common presentation
• Weak urinary stream,
• Straining to void,
• Urinary hesitancy,
• Incomplete emptying,
• Nocturia,
• Frequency, and
• Urinary retention
Dept Of Urology, KMC and GRH, Chennai 25
26. Symptomatology
Less Common
• Post-void dribbling,
• Urinary tract infection,
• Genitourinary pain,
• Hematuria,
• Incontinence
Atypical
• Urethral cancer,
• Renal failure,
• Urethral abscess,
• Fournier’s gangrene,
• Ejaculatory dysfunction,
• Chordee
Dept Of Urology, KMC and GRH, Chennai 26
27. Investigation- Aims
• Location of the obstruction,
• Length of the obstruction, and
• Associated urethral pathology
Dept Of Urology, KMC and GRH, Chennai 27
28. Uroflowmetry
• Low Q max
• Saw toothed pattern
Dept Of Urology, KMC and GRH, Chennai 28
29. Retrograde Urethrogram
• Dynamic retrograde urethrogram (RUG) - Reliable method to stage
and diagnose urethral stricture or stenosis.
• Sensitivity - 75–100%
• Specificity of 72–97%.
Angermeier KW, Rourke KF, Dubey D, Forsyth RJ, Gonzalez CM. SIU/ICUD consultation on urethral strictures:
Evaluation and follow-up. Urology 2014;83 3 Suppl: S8-17.
Dept Of Urology, KMC and GRH, Chennai 29
30. Cystoscopy
• Cystoscopy - most specific test to diagnose a urethral stricture and
adjunct test for staging.
Dept Of Urology, KMC and GRH, Chennai 30
31. USG /Sonourethrography– Current Status
• Can augment contrast-enhanced studies
• Accurate in determining the length of narrow-caliber annularity
Dept Of Urology, KMC and GRH, Chennai 31
32. Conclusion:
USG is equally efficacious to RGU in detecting anterior urethral
strictures.
However, further characterization of strictures in terms of length,
diameter, etc can be performed with relatively greater sensitivity using
USG.
Choudary et al, 2004
Dept Of Urology, KMC and GRH, Chennai 32
33. Male Urethral Stricture
Guidelines – 2016
• < 2 cm stricture - urethral dilation, direct visual internal urethrotomy
(DVIU), or urethroplasty for the initial treatment.
(Conditional Recommendation; Evidence Strength Grade C)
• ≥2cm stricture – should offer urethroplasty as the initial treatment
(Moderate Recommendation; Evidence Strength Grade C)
Dept Of Urology, KMC and GRH, Chennai 33
34. • Older surgeons
• Following ‘reconstructive
surgical ladder’.
Dept Of Urology, KMC and GRH, Chennai 34
36. Stricture Excision and Primary Anastamosis
• Ideally suited for bulbar strictures 1–3 cm long,
• Can also be successful in some selected cases with proximal bulbar
strictures up to 5 cm in length.
• Not suitable for penile urethra.
Dept Of Urology, KMC and GRH, Chennai 36
39. Oral Mucosal Graft Urethroplasty
• Suitable for penile stricture
• May be ventral or dorsal onlay technique
Dept Of Urology, KMC and GRH, Chennai 39
40. Penile Skin Vs Mucosal Graft
Dept Of Urology, KMC and GRH, Chennai 40
41. Dorsal Onlay Vs Ventral Onlay
Dept Of Urology, KMC and GRH, Chennai 41
42. Lingual Grafts
BMG long term problems
• Persistent perioral numbness,
• Salivatory changes, and
• difficulty in opening the mouth
• Other complications are bleeding, scarring, and lip deviation or
retraction.
Dept Of Urology, KMC and GRH, Chennai 42
45. • Success rate of
100% in penile
strictures.
• Success rate of
81.3% in bulbar
strictures.
Dept Of Urology, KMC and GRH, Chennai 45
46. Augmented Anastomotic urethroplasty
• A combination repair that incorporates the principles of excision and
substitution urethroplasty.
Dept Of Urology, KMC and GRH, Chennai 46
51. Penile skin flaps
• Can provide upto 15 cms of length.
• But
• Avoid in cases of compromised blood flow (smoking history,
peripheral vascular disease, diabetes, radiation therapy).
• Avoid in old age, even though the results are comparable with young
adults.
• Avoid in penile skin with Lichen sclerosis changes.
Dept Of Urology, KMC and GRH, Chennai 51
52. Longitudinal Vs Transverse - Longitudinal
Pros
• Easy placement
• Ability to tailor length and width
in a straightforward manner.
• Minimal amount of dissection
required to cover the urethra
Cons
• Longer strictures, proximal
penile skin with hair must be
used.
• This can lead to infection, stone,
and obstruction.
• Flap length is contingent on
penile length.
Dept Of Urology, KMC and GRH, Chennai 52
53. Longitudinal Vs Transverse-Transverse
Pros
• Upto 15 cm length
• Excellent cosmesis
• Broad based blood supply
Cons
• More challenging dissection
Dept Of Urology, KMC and GRH, Chennai 53
54. Proximal Vs Distal
• Distal skin is preferred over proximal skin due to the absence of hair.
• It is accustomed to moist environment
Dept Of Urology, KMC and GRH, Chennai 54
55. Penile skin flap techniques
• Longitudinal Ventral Penile Skin Flap with a Lateral Pedicle (Technique
of Orandi)
• Longitudinal Ventral Penile Skin Flap with a Ventral Pedicle (Technique
of Turner-Warwick)
• Transverse Circular Penile Skin Flap with a Primarily Dorsal Pedicle
(Technique of McAninch)
Dept Of Urology, KMC and GRH, Chennai 55
59. Patient reported outcome measures (PROMs)
To measure the outcome of the procedure from Patient’s perspective.
• American Urological Association Symptom Index(Also Known as IPSS)-
For LUTS
• International Index for Erectile Dysfunction – For Erectile dysfunction
• Male sexual health questionnaire – For Ejaculatory dysfunction
• An index purely for stricture urethra is yet to be constructed.
Dept Of Urology, KMC and GRH, Chennai 59