Using Buck's Fascia as an Integral Covering in Urethroplasty to Restore the Anatomical Structure of the Penis in One-Stage Hypospadias Repair: A Multicenter Chinese Study Comprising 1,386 Surgeries

Objectives: The objective of the study is to investigate the feasibility and efficacy of urethroplasty with a Buck's fascia integral-covering technique (BFIC) to wrap and restore the normal anatomical structure of the penis in one-stage hypospadias surgery.Methods: One-stage surgeries for hypospadias management were performed using BFIC from January 2016 to September 2020 at four high-volume medical centers in China. The technique integrates Buck's fascia with glans wings to mobilize and wrap the urethra and restore penile anatomical relationships. The clinical data, postoperative follow-up data, and complications were recorded, and the results were analyzed.Results: A total of 1,386 patients were included in the study: 1,260 cases of primary hypospadias and 126 cases of re-operations; distal in 382 cases (27.6%), mid-shaft in 639 (46.1%), proximal in 365 (26.3%); tubularized incised plate (TIP) in 748 cases, inlay-graft in 124, onlay-graft in 49, Mathieu in 28, free-tube graft urethroplasty in 406, and 31 of hybrid procedures. One thousand one hundred forty-two patients (82.4%) were found to have penile curvature (>10°) after artificial erection and all corrected by dorsal plication/s or transection of the urethra plate (UP) simultaneously. The median followed-up time was 27 months (6–62). A total of 143 (10.3%) complications were recorded: 114 (9.0%) in the primary operations and 29 (23%) in the re-operations, 15 (3.9%) in distal hypospadias, 61 (9.5%) in mid-shaft, and 67 (18.4%) in proximal. The complication rate in UP preservation and transection was 10.1 and 10.8%, respectively. Of all case complications, there were 73 (5.2%) of fistula, 10 (0.6%) of dehiscence, 22 (1.6%) of meatal stenosis, 21 (1.5%) of stricture, 6 (0.7%) of diverticulum, and resident curvature in 11 cases (1.2%). The overall complication rate in TIP and free-tube procedure was 9.8 and 9.9%, respectively, and fistula occurred in primary TIP of 33 cases (4.9%).Conclusions: Buck's fascia with the glans can be used as an integral covering technique in one-stage distal to proximal hypospadias and primary or re-operative hypospadias repair. It is safe, feasible, and effective for the repair of hypospadias.

The effectiveness of the use of various techniques of amniotic membrane (AM) transplantation in the corneal degenerative processes

The amniotic membrane – the innermost of the three membranes, it develops from the fetal ectoderm, it is transparent, avascular and consists of an epithelial cell layer located on the basement membrane and connective tissue stroma. The application efficiency of the amniotic membrane transplantation technique in rabbits with experimental bacterial keratitis has been investigated. The animals were simulated with moderate bacterial keratitis (with preliminary exposure to long-wavelength mercury lamp beams) by the administration to each eye of the Staphylococcus aureus pathogenic strain. On the 14th day, the amniotic membrane was transplanted using two methods: by biological covering with episcleral fixation using simple interrupted sutures and layer-by-layer transplantation with fixation of the membrane within the damage of the cornea with simple interrupted sutures. The degree of the inflammatory process was assessed according to the author’s point scale, which included eight signs. On the 7th, 14th, and 30th days, the experimental animals were euthanized and microscopic examination of the cornea was performed. It was found that on the 7th day of application, complete epithelization of the corneal surface occurred, and on the 30th day, differentiation of its cells into layers. When using the layer-by-layer technique of amniotic membrane transplantation with using simple interrupted sutures, a more pronounced inflammatory reaction was observed in comparison with the biological covering technique. During all observation periods, most experimental animals did not show clinical and morphological signs of inflammatory infiltration. The obtained effect of both methods of amniotic membrane transplantation indicates the effectiveness of using this biological material as the main or supportive in the treatment of severe eye pathologies

Squat and Jump: A Rare Case of Stent-Graft Migration During Deployment

While treating vascular aneurysms with endovascular technique, short neck and severe bending of the artery are one of the biggest challenges, whether choosing coil embolization or stent-graft (SG) deployment. Here, we report a case with large aneurysm of the splenic artery, which had anomalistically arisen from the superior mesenteric artery and had very severe bending. Because the proximal neck was too short to exclude with SG only, we decided to treat with a combination of coil embolization and SG. At the time of deploying the VIABAHN (self-expandable SG) at the ostium of the splenic artery, the VIABAHN started to deform as the strings were pulled and finally jumped away from the start position. A second VIABAHN was deployed using the sheath-covering technique, which involved alternating short deployment of the VIABAHN with short pullback of the sheath. This report highlights the tricks and traps of deploying VIABAHN at the arteries with very severe bending.