Improved outcomes after technical modifications in tubularized incised plate urethroplasty for mid-shaft and proximal hypospadias

Purpose

To investigate and compare the outcomes after tubularized incised plate (TIP) urethroplasty in mid-shaft and proximal hypospadias using a standard and a modified technique.

Methods

We conducted a retrospective study in 104 consecutive children who underwent mid-shaft or proximal TIP repairs from Jan 2007 to Sept 2015. Patients in Cohort One had dorsal dartos (DD) neourethral coverage while patients in Cohort Two had either de-epithelialized split preputial (DESP) or tunica vaginalis (TV) flap coverage. TV flap was used only when DESP flap was not sufficient to cover the neourethra.

Results

There were 52 patients each in Cohort One (DD, n = 52) and Cohort Two (DESP, n = 38; TV, n = 14) with no difference in ratio of mid-shaft/proximal between the two cohorts. At a median follow-up of 28 months, 36 patients (34.6 %) developed 47 complications including fistula (n = 19; 18.3 %) and neourethral dehiscence (n = 4; 3.8 %). Cohort One patients had significantly more fistula (28.8 vs 7.7 %; p = 0.005) and neourethral dehiscence (7.7 vs 0 %; p = 0.04) than Cohort Two. There was no difference between the two cohorts in the complication rates of meatal stenosis, recurrent ventral curvature and neourethral stricture.

Conclusions

Both DESP and TV flap appear to be superior to DD in preventing fistula and neourethral dehiscence in non-distal TIP repairs.

     

Increased poly(ADP-ribose) polymerase activity during porcine hemorrhagic shock is transient and predictive of mortality

AIM OF THE STUDY: The aim of our study was to compare poly(ADP-ribose) polymerase (PARP) activity levels in a porcine model of hemorrhagic shock and resuscitation. MATERIALS AND METHODS: We designed a prospective, comparative randomized survival study of hemorrhagic shock using 20 male Yorkshire-Landrace pigs (15-25 kg). In 16 pigs after splenectomy, we induced hemorrhagic shock to a mean arterial pressure of 50 mm Hg ( approximately 35% bleed). Pigs were randomized to receive normotensive resuscitation (SBP 90 mm Hg), mild hypotensive resuscitation (SBP 80 mm Hg), moderate hypotensive resuscitation (SBP 65 mm Hg), or no resuscitation (n=4 in each group). We also included a group of sham animals that were instrumented and had a splenectomy but not bled (n=4). Muscle and liver biopsies were taken prior to hemorrhage, after 45 min of shock, and 8, 24, and 48 h after resuscitation. PARP activity levels in biopsies were measured using chemical quantitation of NAD+. RESULTS: Irrespective of our resuscitation strategy or outcome, both muscle and liver PARP activity levels rose after 45 min of shock and then returned to baseline. Excluding our control animals, PARP activity levels were significantly higher during shock in non-survivors compared to survivors. CONCLUSIONS: In our model of porcine hemorrhagic shock, PARP activity levels increased during hemorrhagic shock. However, this increase in PARP activity levels was transient as they returned to baseline regardless of resuscitation strategy. Interestingly, PARP activity levels were significantly higher during hemorrhagic shock in non-survivors compared to survivors. These findings suggest that PARP activity may be a part of initial pathways leading from hemorrhagic shock to death.     

ASO Visual Abstract: Male Breast Cancer Patients and Surgeon Experience: The Male WhySurg Study

Annals of Surgical Oncology -