Mehmet Bahadır ÇALIŞKAN, İlhami SÜRER, Ömer GÜNHAN

Kriple Hipospadias Tedavisinde Otolog Serbest Ters Inlay Ven Greftini; Deneysel Bir Tavşan Modeli

Amaç: Çalışmanın amacı hipospadias sakatlı olgularda defektif üretranın yerine juguler venin serbest reverse greft olarak getirilmesi ve bu dokunun üretral plak ile olan uyumunun incelenmesidir. Hipospadias sakatlı olgular, daha önce hipospadias nedeni ile tamir edilmeye çalışılmış, fonksiyonel ve anatomik komplikasyonları devam eden hipospadias grubu olarak tanımlanabilir. Bu hastalarda defektif üretral plak onarımında tübülarize edilecek lokal yada destek dokusunun bulunmayışı hemen daima sorun oluşturmaktadır. Gereç ve Yöntemler: Çalışmada on dört adet genç erişkin, ortalama ağırlığı dört kilo olan, 8-10 aylık, erkek New Zealand cinsi tavşan; yedi tavşandan oluşan iki gruba bölündü. Birinci gruptan juguler ven grefti, ikinci gruptan bukkal mukoza grefti alındı ve alınan greftler üretral plakta oluşturulan defekte serbest flep olarak aktarıldı. Bulgular: Histopatolojik incelemede grup içi ve gruplar arası epitelizasyon, fibrozis ve inflamasyon değerlendirildi. Juguler ven grefti kullanılan grubun (Grup 1) histopatolojik incelemesinde üroepitelizasyonunun tam veya tama yakın olduğu, fibrotik (+) ve inflamasyonun minimal olduğu izlendi. Bukkal mukoza grefti uygulanan grupta (Grup 2) ise üroepitelizasyonun yirmi birinci gün sonunda greft üzerinde yüzde otuz civarında olduğu, fibrotik aktivitenin (++) ve inflamasyonun minimal olduğu izlendi. Sonuç: Çalışmamızın sonucunda hipospadias sakatlı olgularda defektif üretranın onarımında reverse serbest juguler ven greftinin uzun zamandır kullanılagelen bukkal mukozaya alternatif olarak kullanılabileceği sonucuna varılmıştır.

Anahtar Kelimeler:

Greft alımı, Hipospadiyas, Uretra

Autologous Free Reverse Inlay Vein Graft in the Treatment of Cripple Hypospadias; an experimental rabbit model

Objective: The aim of this study is using the autologous reverse inlay jugular vein graft as a substitute for defective urethral plate and the incorporation of the graft to the urethral plate. Cripple hypospadias are the patients who have a history of previous multiple unsuccessful hypospadias surgery and still having anatomical and functional complications. Insufficient local or support tissue for the repair of defective urethral plate is always a problem. Material and Methods: In the study fourteen male 8-10 months old which is weighting four kg, New Zealand type rabbit are divided into two equal groups. Juguler vein graft (1st group) and buccal mucosal graft (2nd group) harvested and transferred to defective area in the urethral plate as a free flap. Results: In the histopatologic examination, epithelization, fibrosis and inflammation degrees were evaluated between the groups and in-groups. In the histopatological examination of the 1st group, uroepithelization is complete or nearly complete, fibrotic activity is (+) and the inflammation was found minimal. In the second group after 21st day, the uroepithelization on the graft is nearly thirty percent, fibrotic activity is (++) and the inflammation is also found minimal. Conclusion: From the results of the study, in the treatment of defective urethra in cripple hypospadias cases, reverse free juguler vein graft can be used as an alternative for buccal mucosa graft as a substitution material which has been used for a long time.

Keywords:

Cripple hypospadias, urethral reconstruction, vein graft,

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Ballardini E, Armaroli A, Finessi N, Maietti E, Astolfi G, Neville AJ. Hypospadias prevalence in the Emilia Romagna Region registry: Increasing or methodology? J Pediatr Urol 2020;16:448.e1-e7.
Baskin L. What Is Hypospadias? Clin Pediatr (Phila) 2017;56:409-18.
Karakan T, Bagcioglu M, Germiyanoglu C. History of hypospadias. Turk Urol Sem 2011;2:162–9.
Snodgrass W, Bush NC. Re-operative urethroplasty after failed hypospadias repair: how prior surgery impacts risk for additional complications. J Pediatr Urol 2017;13:289.e1-e6.
Söylet Y, Gundogdu G, Yesildag E, Emir H. Hypospadias reoperations. Eur J Pediatr Surg 2004;14:188-92.
Manasherova D, Kozyrev G, Nikolaev V, Abdullaev F, Abdulkarimov G, Kushnir B, et al. Bracka’s Method of Proximal Hypospadias Repair: Preputial Skin or Buccal Mucosa? Urology 2020;138:138-43.
Turkyilmaz Z, Karabulut R, Atan A, Sonmez K. Redo Hypospadias Repair: Comparison of Three Different Methods. Urol Int 2020;104:391-5.
Li D, Shen Z, Xu Y. Tubularized urethral reconstruction using everted saphenous vein graft in a beagle model. BMC Urol 2021;21:63.e1-e6.
Ozcan R, Emre Ş, Kendigelen P, Elicevik M, Emir H, Soylet Y, et al. Results of a Two-stage Technique for Treatment of Proximal Hypospadias with Severe Curvature: Creation of a Urethral Plate Using a Vascularized Preputial Island Flap. Urol J 2016 ;13: 2629-34.
Loloi J, Harrington S, Boltz S, Decter RM. Ingrafts in hypospadias surgery: Longer-term outcomes. J Pediatr Urol 2020;16:555.e1-.e5.
Lanciotti M, Betti M, Elia A, Landi L, Taverna M, Cini C, et al. Proximal hypospadias repair with bladder mucosal graft: Our 10 years experience. J Pediatr Urol 2017;13:294.e1-e6.
Wani SA, Baba AA, Mufti GN, Rashid KA, Bhat NA, Buch M, et al. Bracka verses Byar’s two-stage repair in proximal hypospadias associated with severe chordee: a randomized comparative study. Pediatr Surg Int 2020;36:965-70.
Favorito LA, Conte PP, Sobrinho UG, Martins RG, Accioly T. Double inlay plus ventral onlay buccal mucosa graft for simultaneous penile and bulbar urethral stricture. Int Braz J Urol 2018;44:838-9.
Coguplugil AE, Ebiloglu T, Sarikaya S, Yilmaz S, Topuz B., Gurdal M. Ventral onlay buccal mucosa graft urethroplasty for female urethral stricture. Int J Urol 2021;28: 538-43.
Talab SS, Cambareri GM, Hanna MK. Outcome of surgical management of urethral stricture following hypospadias repair. J Pediatr Urol 2019;15:354.e1-e6.
Farrell MR, Campbell JG, Zhang L, Nowicki S, Vanni AJ. Transurethral reconstruction of fossa navicularis strictures with dorsal inlay buccal mucosa graft urethroplasty. World J Urol 2022;40: 1523-8.
Manasherova, D, Kozyrev G, Nikolaev V, Abdullaev F, Abdulkarimov G, Kushnir B, Gazimiev M. Bracka’s Method of Proximal Hypospadias Repair: Preputial Skin or Buccal Mucosa? Urology 2020;138:138-43.
Wu M, Chen F, Xie H, Lv Y, Huang Y, Liu Y, et al. Management of failed hypospadias: choosing the right method and achieving optimal results. Int Urol Nephrol 2018;50:1795-800.
Horton CE, Sadove RC, Devine CJ Jr. Reconstruction of male genital defects: Congenital. in: McCarthy JG, ed. Plastic Surgery. Philadelphia: WB Saunders 1990: 4153-79.
Xu Y, Shen Z, Liu G, Liu B, Hua X, Xiang Y. Urethral Reconstruction Using Everted Saphenous Vein Graft in a Rabbit Model: One-Year Outcomes. Urol Int 2017;99:110-7.
Kim BS, Kwon TG. Urethral reconstruction using autologous vein grafts for the management of urethral strictures. Curr Urol Rep 2015;16:467
Misra D, Elbourne C, Vareli A, Banerjee D, Joshi A, Friedmacher F. Challenges in managing proximal hypospadias: A 17-year single-center experience. J Pediatr Surg 2019;54:2125-9.
Hübner W, Rurka I, Porpaczy P, Miko I. Autologous everted vein graft for repairing long-section urethral defects. Urol Res 1991;19:131-4.
Kahveci R, Kahveci Z, Sirmali Ş, Özcan M. Urethral reconstruction with autologous vein graft: an experimental study. Br J Plast Surg 1995;48:500-3.
Akhtar A, Khattar N,Goel H, Rao S, Tanwar R, Sood R. Looking beyond oral mucosa: Initial results of everted saphenous vein graft urethroplasty (eSVGU) in long anterior urethral strictures. Arab J Urol 2017; 15: 228–35.
Rao SN, Khattar N, Akhtar A, Goel H, Varshney A, Sood R. Everted saphenous vein graft for long anterior urethral strictures in men with tobacco-exposed oral mucosa: A prospective nonrandomized study. Indian J Urol 2019;35:134-40.