Skin grafting remains a primary modality for reconstruction of genitourinary defects. Many of these conditions are discussed and emphasis has been placed on the different indications for full-thickness, split-thickness, and dermal grafts. Complications have been few, and long-term results excellent. This experience has allowed the formulation of a number of surgical principles, which are presented. Refinements in reconstruction are currently being evaluated to obtain the optimal result.

No AccessJournal of Urology1 Jun 1987The Dermal Graft Procedure for Peyronie’s Disease Surgery Gerald H. Jordan, Patrick C. Devine, Steven M. Schlossberg, David A. Gilbert, Charles E. Horton, and Charles J. Devine Gerald H. JordanGerald H. Jordan More articles by this author , Patrick C. DevinePatrick C. Devine More articles by this author , Steven M. SchlossbergSteven M. Schlossberg More articles by this author , David A. GilbertDavid A. Gilbert More articles by this author , Charles E. HortonCharles E. Horton More articles by this author , and Charles J. DevineCharles J. Devine More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)75616-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "The Dermal Graft Procedure for Peyronie’s Disease Surgery." The Journal of Urology, 137(6), p. 220A © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 137Issue 6June 1987Page: 220A Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Gerald H. Jordan More articles by this author Patrick C. Devine More articles by this author Steven M. Schlossberg More articles by this author David A. Gilbert More articles by this author Charles E. Horton More articles by this author Charles J. Devine More articles by this author Expand All Advertisement PDF downloadLoading ...

More than 16 years' experience with approximately 1,000 cases of Peyronie's disease and a review of 110 patients evaluated more than 1 year postoperatively are presented. Peyronie's disease is difficult to treat. There is no known etiological agent, and because occasional spontaneous disappearance of the lesion occurs, the assessment of therapy is difficult. Our operation has been successful in relieving penile curvature and pain in a substantial number of patients (84%). Therefore, we recommend that in all severe, sexually disabling cases of Peyronie's disease unresponsive to conventional therapy, excision of the diseased tunica albuginea and replacement with dermal graft be considered. Organic impotence, which is occasionally seen preoperatively in association with Peyronie's disease, requires thorough investigation, sex counseling, and consideration of a penile implant.

AbstractThis paper focuses briefly on the concept of urinary bladder reinnervation. Unilaterally decentralized bladders were reinnervated using a new experimental technique, mixed nerve root crossover surgery via a nerve graft. Electrophysiologic and cystometric data indicated axonal regeneration and bladder reinnervation after a mixed suprasacral nerve root (L7) to mixed sacral root (S1) anastomosis. Similar data were obtained from anastomosis with an interposition nerve graft. The crossover nerve root anastomosis also provided for redirection of axons. By employing a similar technique to bypass a damaged segment of spinal cord, urinary bladder reinnervation and restoration of central bladder control may be achievable in select spinal cord injury or spina bifida patients.

The ability of mixed spinal nerve roots to regenerate and reinnervate the urinary bladder was examined in young adult female cats. Using microsurgical technique, a unilateral extradural spinal nerve root anastomosis of a lumbar (L7) to a sacral root (S1) either with or without a nerve graft was performed. Remaining ipsilateral sacral roots were transected. The contralateral normal sacral roots remained intact and allowed the animals adequate urination during the period necessary for axonal regeneration. At the time of restudy seven months later, stimulation of the anastomosed nerve root proximal to the anastomosis (isolated from the spinal cord) elicited a bladder contraction. Significant lumbar axonal regeneration was substantiated by compound action potentials recorded across the anastomosis. In addition, redirection of axons from a lumbar to a sacral distribution was demonstrated. The contralateral normal sacral roots provided control cystometric and electrophysiological data against which responses from the previously anastomosed nerve roots were compared. In conclusion, significant bladder reinnervation can occur after an anastomosis of a lumbar and sacral root with or without a nerve graft. This technique, or variations thereof, may have a clinical role in selected patients with neurogenic bladder dysfunction to reinnervate the bladder and restore central control.

Diverticula that occur in the neourethra following repair of hypospadias, epispadias or urethral stricture generally are associated with obstruction distal to the dilated segment. This diverticular tissue can be moderately elastic and well vascularized. We have been able to relieve the stenosis by developing and advancing a diverticular flap, simultaneously reducing the size of the diverticulum.

Early repair of hypospadias (less than age 1 year) appears to be psychologically less traumatic than reconstruction at a later age. Experience with a variety of procedures in 37 children suggests that technical considerations are not a limiting factor.

We present details of our current techniques for skin graft urethroplasty. We believe that careful attention to the details of these operative techniques is important to their success. The changes from our previous reports include: 1) preparation of patch grafts with rounded ends, 2) preparation of tube grafts with fishmouth spatulation, 3) fixation of the stent catheter to the anterior abdominal wall, 4) leaving a stent catheter inlying for 2 weeks and replacing with a smaller catheter if a voiding cystourethrogram shows extravasation, 5) fixation of the graft during preparation by dermatome adhesive, 6) irrigation of the wound with irrigant before closure and 7) urodynamic flow study for non-invasive postoperative followup.

In severe cases of hypospadias where a multiple-stage repair has been selected, a more functional repair has been selected, a more functional and cosmetic result is possible, without an associated higher complication rate, if the glans flap is incorporated into the final stage of the repair.

During the last 15 years we have repaired urethral strictures of each zone of the urethra using a free full thickness skin graft technique. We now report the details of our operative procedure and the results.

Norfolk, Va. From the Plastic and Urology Services of the Norfolk Medical Center Hospitals and the Eastern Virginia Medical School.

No AccessJournal of Urology1 Jul 1963Use of Full Thickness Skin Grafts in Repair of Urethral Strictures Patrick C. Devine, Charles E. Horton, C.J. Devine, Charles J. Devine, Hugh H. Crawford, and Jerome E. Adamson Patrick C. DevinePatrick C. Devine , Charles E. HortonCharles E. Horton , C.J. DevineC.J. Devine , Charles J. DevineCharles J. Devine , Hugh H. CrawfordHugh H. Crawford , and Jerome E. AdamsonJerome E. Adamson View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)64362-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1963 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByBarry Belman A (2018) Editorial commentJournal of Urology, VOL. 167, NO. 2 Part 2, (1175-1175), Online publication date: 1-Feb-2002.ISELIN C and WEBSTER G (2018) DORSAL ONLAY GRAFT URETHROPLASTY FOR REPAIR OF BULBAR URETHRAL STRICTUREJournal of Urology, VOL. 161, NO. 3, (815-818), Online publication date: 1-Mar-1999.LEVINE L and ELTERMAN L (2018) URETHROPLASTY FOLLOWING TOTAL PHALLIC RECONSTRUCTIONJournal of Urology, VOL. 160, NO. 2, (378-382), Online publication date: 1-Aug-1998.Wessells H, Morey A and McAninch J (2018) Single Stage Reconstruction of Complex Anterior Urethral Strictures: Combined Tissue Transfer TechniquesJournal of Urology, VOL. 157, NO. 4, (1271-1274), Online publication date: 1-Apr-1997.Wessells H and McAninch J (2018) Use of Free Grafts in Urethral Stricture ReconstructionJournal of Urology, VOL. 155, NO. 6, (1912-1915), Online publication date: 1-Jun-1996.Finkelstein L and Blatstein L (2018) Epilation of Hair-Bearing Urethral Grafts Using the Neodymium:YAG Surgical LaserJournal of Urology, VOL. 146, NO. 3, (840-842), Online publication date: 1-Sep-1991.Benet A, Abarbanel J, Lask D and Kimche D (2018) Surgical management of long urethral stricturesJournal of Urology, VOL. 143, NO. 5, (917-919), Online publication date: 1-May-1990.Schreiter F and Noll F (2018) Mesh Graft Urethroplasty Using Split Thickness Skin Graft or ForeskinJournal of Urology, VOL. 142, NO. 5, (1223-1226), Online publication date: 1-Nov-1989.Pierce J (2018) Editorial CommentsJournal of Urology, VOL. 142, NO. 5, (1226-1226), Online publication date: 1-Nov-1989.Devine C (2018) Editorial CommentsJournal of Urology, VOL. 142, NO. 5, (1226-1226), Online publication date: 1-Nov-1989.Marshall F, Chang R and Gearhart J (2018) Endoscopic Reconstruction of Traumatic Membranous Urethral TransectionJournal of Urology, VOL. 138, NO. 2, (306-309), Online publication date: 1-Aug-1987.Peterson N (2018) Perforation-Reconst1Tution of Proximal Urethral ObliterationJournal of Urology, VOL. 137, NO. 3, (507-510), Online publication date: 1-Mar-1987.Barraza M, Roth D, Terry W, Livne P and Gonzales E (2018) One-Stage Reconstruction of Moderately Severe HypospadiasJournal of Urology, VOL. 137, NO. 4, (714-715), Online publication date: 1-Apr-1987.Yachia D (2018) A New, One-Stage Pedicled Scrotal Skin Graft UrethroplastyJournal of Urology, VOL. 136, NO. 3, (589-592), Online publication date: 1-Sep-1986.Lenzi R, Barbagli G and Stomaci N (2018) One-Stage Skin Graft Urethroplasty in Anterior Middle Urethra: A New ProcedureJournal of Urology, VOL. 131, NO. 4, (660-663), Online publication date: 1-Apr-1984.Webster G, Brown M, Koefoot R and Sihelnick S (2018) Suboptimal Results in Full Thickness Skin Graft Urethroplasty Using an Extrapenile Skin Donor SiteJournal of Urology, VOL. 131, NO. 6, (1082-1083), Online publication date: 1-Jun-1984.Brannan W (2018) Editorial CommentsJournal of Urology, VOL. 131, NO. 6, (1083-1083), Online publication date: 1-Jun-1984.Devine C (2018) Editorial CommentsJournal of Urology, VOL. 131, NO. 6, (1083-1083), Online publication date: 1-Jun-1984.Lenzi R, Barbagli G, Stomaci N and di Cello V (2018) Free Full Thickness Skin Graft Urethroplasty: Indications, Technique and ResultsJournal of Urology, VOL. 128, NO. 5, (938-942), Online publication date: 1-Nov-1982.Blum J, Feeney M, Howe G and Steel J (2018) Skin Patch Urethroplasty: 5-year FollowupJournal of Urology, VOL. 127, NO. 5, (909-909), Online publication date: 1-May-1982.De Sy W, Oosterlinck W and Verbaeys A (2018) European Experience with 1-stage Urethroplasty with Free Full Thickness Skin GraftJournal of Urology, VOL. 125, NO. 4, (502-503), Online publication date: 1-Apr-1981.Hendren W and Crooks K (2018) Tubed Free Skin Graft for Construction of Male UrethraJournal of Urology, VOL. 123, NO. 6, (858-861), Online publication date: 1-Jun-1980.Mckinney D (2018) Use of Full Thickness Patch Graft in Urethrovaginal FistulaJournal of Urology, VOL. 122, NO. 3, (416-416), Online publication date: 1-Sep-1979.Gibbons M, Koontz W and Smith M (2018) Urethral Strictures in BoysJournal of Urology, VOL. 121, NO. 2, (217-220), Online publication date: 1-Feb-1979.C.J.D. (2018) Editorial CommentJournal of Urology, VOL. 121, NO. 2, (220-220), Online publication date: 1-Feb-1979.Devine P, Wendelken J and Devine C (2018) Free Full Thickness Skin Graft Urethroplasty: Current TechniqueJournal of Urology, VOL. 121, NO. 3, (282-285), Online publication date: 1-Mar-1979.Brigman J and Deture F (2018) Giant Urethral Diverticulum after Free Full Thickness Skin Graft UrethroplastyJournal of Urology, VOL. 121, NO. 4, (523-524), Online publication date: 1-Apr-1979.Betts J, Texter J and Crane D (2018) Single Stage Urethroplasty as Treatment for Stricture DiseaseJournal of Urology, VOL. 120, NO. 4, (412-413), Online publication date: 1-Oct-1978.Olsson C and Krane R (2018) The Controversy of Single Versus Multistaged UrethroplastyJournal of Urology, VOL. 120, NO. 4, (414-417), Online publication date: 1-Oct-1978.Krane R, Wysocki J and Schwartz B (2018) Dermal Patch Urethroplasty: Experimental and Clinical ExperienceJournal of Urology, VOL. 118, NO. 2, (262-265), Online publication date: 1-Aug-1977.Devine P, Fallon B and Devine C (2018) Free Full Thickness Skin Graft UrethroplastyJournal of Urology, VOL. 116, NO. 4, (444-446), Online publication date: 1-Oct-1976. (2018) CommentJournal of Urology, VOL. 116, NO. 4, (446-446), Online publication date: 1-Oct-1976.Herr H (2018) Immunobiolqgy of Human Bladder CancerJournal of Urology, VOL. 115, NO. 2, (147-147), Online publication date: 1-Feb-1976.Kibbey R (2018) Patch Graft Urethroplasty: A Review with Emphasis On Use for Strictures in the Region of the Membranous UrethraJournal of Urology, VOL. 115, NO. 2, (155-158), Online publication date: 1-Feb-1976.Brannan W, Ochsner M, Fuselier H and Goodlet J (2018) Free Full Thickness Skin Graft Urethroplasty for Urethral Stricture: Experience with 66 PatientsJournal of Urology, VOL. 115, NO. 6, (677-680), Online publication date: 1-Jun-1976.Devine C (2018) CommentJournal of Urology, VOL. 115, NO. 6, (680-680), Online publication date: 1-Jun-1976.Berger B, Sykes Z and Freedman M (2018) Patch Graft Urethroplasty for Urethral Stricture DiseaseJournal of Urology, VOL. 115, NO. 6, (681-683), Online publication date: 1-Jun-1976.Morgan C (2018) Dorsal Rectotomy and Full Thickness Skin Graft for Repair of Prostatic Urethrorectal FistulaJournal of Urology, VOL. 113, NO. 2, (207-209), Online publication date: 1-Feb-1975.Brannan W, Ochsner M and Fuselier H (2018) Anterior Urethral Strictures: Experience with Free Graft UrethroplastyJournal of Urology, VOL. 109, NO. 2, (265-267), Online publication date: 1-Feb-1973.Orandi A (2018) One-Stage Urethroplasty: 4-Year FollowupJournal of Urology, VOL. 107, NO. 6, (977-980), Online publication date: 1-Jun-1972.Bogash M and Lasky N (2018) Experience with a Two-Stage Urethroplasty for StrictureJournal of Urology, VOL. 102, NO. 4, (444-448), Online publication date: 1-Oct-1969.Devine P, Sakati I, Poutasse E and Devine C (2018) One Stage Urethroplasty: Repair of Urethral Strictures with a Free Full Thickness Patch of SkinJournal of Urology, VOL. 99, NO. 2, (191-193), Online publication date: 1-Feb-1968.Sankey N and Heller E (2018) The Results of Urethroplasty Using a Silicone Rubber PatchJournal of Urology, VOL. 97, NO. 2, (309-313), Online publication date: 1-Feb-1967.Heller E (2018) Surgical Repair of Urethral Strictures with a Silicone Rubber PatchJournal of Urology, VOL. 94, NO. 5, (576-579), Online publication date: 1-Nov-1965. Volume 90Issue 1July 1963Page: 67-71 Advertisement Copyright & Permissions© 1963 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick C. Devine More articles by this author Charles E. Horton More articles by this author C.J. Devine More articles by this author Charles J. Devine More articles by this author Hugh H. Crawford More articles by this author Jerome E. Adamson More articles by this author Expand All Advertisement Loading ...