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Urethroplasty history and advancements.pptx
- 1. 1
- 2. • Diamond-shaped outlet bounded • Anteriorly by the pubic arch and the arcuate ligaments of the pubis, • Posteriorly by the tip of the coccyx and laterally by the inferior rami of the pubis and ischium. • A transverse line between the ischial tuberosities divides the perineum into 1. Anterior triangle containing the external urogenital organs and 2. Posterior anal triangle. SURGICAL ANATOMY
- 3. URETHRA • Contained within the vascular corpus spongiosum and the glans penis. CLASSIFICATION: 1. The anterior urethra • Fossa Navicularis • Penile Urethra • Bulbous urethra 2. The posterior urethra • Membranous urethra • Prostatic urethra • Bladder neck
- 4. ORIGIN OF SKIN GRAFTING ‘SUSHRUTA SAMHITA’: PERFORMED BY ANCIENT HINDU AROUND 3000 YRS AGO. NASAL RECONSTRUCTION USING SKIN GRAFT. SKIN FROM CHEEK OR FOREHEAD CREATE PEDICLE FLAP
- 5. • EBERS PAPYRUS • OLD PAPYRUS • ANCIENT EGYPTIAN EMPIRE(1500 BC) • MENTIONED THE PRACTICE OF SKIN GRAFTING IN ANCIENT EGYPT. • KAMMA CASTE • SUBCUTANEOUS FAT AND SKIN FROM GLUTEAL REGION AS FREE SKIN GRAFT. • AURELIUS CORNELIUS CELSUS AND CLAUDIUS GALEN • USED SKIN GRAFTS TO REPAIR FACIAL DEFECTS • CELSUS • OPEN METHOD TO RECONSTRUCT THE FORESKIN OF JEWISH
- 6. • PINCH GRAFT • JAQUES-LOUIS REVERDIN • A SWISS SURGEON • SUCCESSFUL EXPERIMENT OF FREE SKIN GRAFTING. • HARVESTED SMALL EPIDERMAL BITS FROM THE ARM AND FIXED THEM INTO MIDDLE OF WOUND • KNOWN AS ‘PINCH GRAFT’ TODAY.
- 7. • THIERSCH (1869) AND DUPLAY (1874) • URETHROPLASTY FROM PENILE SKIN IN SITU • LAUENSTEIN (1892) • ADDITIONAL COVERING SKIN FLAPS WERE DEVELOPED • KIRILL M SAPEZHKO (1891) • FIRST PERSON TO USE ORAL MUCOSA AS URETHRAL REPLACEMENT KIRILL M SAPEZHKO
- 8. GRAFTS IN URETHROPLASTY • AUA 2016 URETHRAL STRICTURE GUIDELINES • BUCCAL MUCOSA AS THE FIRST CHOICE GRAFT FOR UREHTROPLASTY. • BUCCAL MUCOSAL GRAFT HAS RECENTLY EXP ANDED TO URETERAL RECONSTRUCTION
- 9. • 9 ANASTOMOTIC SCROTAL OR PENILE ISLAND FLAP BUCCAL MUCOSA GRAFT
- 10. • 10 ANASTOMOTIC EXCISION AND SUBSTITUTION URETHROPLASTY BULBAR STRICTURES STRICTURE 2-3 CM PERINEAL INCISION SPATULATION: PROXIMALLY – VENTRAL DISTALLY- DORSAL
- 11. • 11 ANASTOMOTIC SCROTAL OR PENILE ISLAND FLAP BUCCAL MUCOSA GRAFT
- 12. • 12 SCROTAL OR PENILE ISLAND FLAP GENITAL SKIN ISLAND FLAPS MOBILIZED ON DARTOS FASICA OF PENIS TUNICA DARTOS OF SCROTUM 2CM WIDE FLAP
- 13. • 13 ANASTOMOTIC SCROTAL OR PENILE ISLAND FLAP BUCCAL MUCOSA GRAFT
- 14. • 14 Cosmetically superior incision Hairless Accustomed to wet environment Resistance to infection BUCCAL MUCOSA GRAFT
- 15. • 15
- 16. • 16 Dorsal Onlay Augmentation Urethroplasty 1996
- 17. URETHRA IS MOBILIZED ALONG THE LEFT SIDE LEAVING BULBOSPONGIOSUM MUSCLE INTACT • 17
- 18. ▪ 87.5% to 100% success rate • 18
- 19. • Extensive mobilization • Longer operation time • Ischemic damages secondary to the dissection • 19
- 20. • 20
- 21. • 21
- 22. • 22
- 23. ▪ eliminates out pouching and ballooning ▪ blood supplies from circumflex and perforating vessels ▪ pooling of urine and semen minimized • 23
- 24. • urethral plate need to be more than 1cm wide • graft is narrower • 24
- 25. • 25
- 26. • 26
- 28. ▪ avoid excessive circumferential mobilization ▪ reduces vascular damage ▪ complex panurethral strictures ▪ Kulkarni et al. reported success rate of 83.7% • 28
Editor's Notes
- ACCORDING TO ‘SUSHRUTA SAMHITA’, ONE OF THE EARLY TEXTS OF AYURVEDA, SKIN GRAFTING WAS PERFORMED BY THE ANCIENT HINDU SOMEWHERE AROUND 3000 YRS AGO. SUSHRUTA DESCRIBED A METHOD FOR NASAL RECONSTRUCTION USING SKIN GRAFT. IN CASE A PERSON HAD LOST THEIR NOSE DUE TO AMPUTATION (AS A FORM OF PUNISHMENT), HE TOOK SKIN FROM CHEEK OR FOREHEAD, TO CREATE A PEDICLED FLAP, WHICH RETAINED THE BLOOD SUPPLY FROM DONOR’S SITE DURING GRAFTING.
- EBERS PAPYRUS, AN OLD PAPYRUS ROLE FROM ANCIENT EGYPTIAN EMPIRE(1500 BC) MENTIONED THE PRACTICE OF SKIN GRAFTING IN ANCIENT EGYPT. MEMBERS OF KAMMA CASTE USED SUBCUTANEOUS FAT AND SKIN FROM GLUTEAL REGION AS FREE SKIN GRAFT. IN 1ST AND 2ND CENTURY, AURELIUS CORNELIUS CELSUS AND CLAUDIUS GALEN USED SKIN GRAFTS TO REPAIR FACIAL DEFECTS. CELSUS ALSO DEVELOPED A OPEN METHOD TO RECONSTRUCT THE FORESKIN OF JEWISH MEN IN HISTORICAL ROMAN EMPIRE, AS CIRCUMCISION WAS CONSIDERED BARBARIC IN GREEK AND ROMAN SOCIETY.
- IN 1869, JAQUES-LOUIS REVERDIN, A SWISS SURGEON, PRESENTED A SUCCESSFUL EXPERIMENT OF FREE SKIN GRAFTING. BY USING THE TIP OF LANCET, HE HARVESTED SMALL EPIDERMAL BITS FROM THE ARM OF THE PATIENT AND FIXED THEM INTO THE MIDDLE OF WOUND, WHICH IS KNOWN AS ‘PINCH GRAFT’ TODAY.
- URETHROPLASTY FROM PENILE SKIN IN SITU WAS WELL DESCRIBED BY THIERSCH IN 1869 AND DUPLAY IN 1874; ADDITIONAL COVERING SKIN FLAPS WERE DEVELOPED IN 1892 BY LAUENSTEIN. KIRILL M SAPEZHKO WAS THE FIRST PERSON TO USE ORAL MUCOSA AS URETHRAL REPLACEMENT AS EARLY AS 1891. HOWEVER, DESPITE THE EARLY DESCRIPTION OF USE, TECHNIQUES DID NOT BECOME MORE COMMON UNTIL TOWARDS THE END OF 19TH CENTURY.
- THA AUA 2016 URETHRAL STRICTURE GUIDELINES SPECIFY BUCCAL MUCOSA AS THE FIRST CHOICE GRAFT FOR UREHTROPLASTY. GIVEN ITS SUCCESS IN URETHRAL RECONSTRUCTION, THE APPLICATION OF BUCCAL MUCOSAL GRAFT HAS RECENTLY EXPANDED TO URETERAL RECONSTRUCTION.