wietse claeys - Academia.edu (original) (raw)

Papers by wietse claeys

Research paper thumbnail of Secondary phallic prosthesis placement in transgender patients postmetoidioplasty: a case report on technique and outcome

Sexual Medicine

Introduction Gender affirming surgery is common among transgender and gender-nonconforming indivi... more Introduction Gender affirming surgery is common among transgender and gender-nonconforming individuals. Genital gender-affirming surgery is a form of surgery that involves transformation and reconstruction of the genitalia while maintaining urologic and sexual function. Masculinizing genital gender-affirming surgery can involve the removal of the female genital and reproductive organs and the creation of a more masculine appearance by using phalloplasty or metoidioplasty techniques. While metoidioplasty has advantages such as limited scarring and preserved genital sensation and clitoral erection, it may not always guarantee the ability to void while standing or even penetrate a sexual partner. Aim To describe our method of secondary phallic enhancement after metoidioplasty with a phallic prosthesis. Methods Our case is based on a 39-year-old transgender male who underwent metoidioplasty with vaginectomy, scrotoplasty, and urethral lengthening. However, the original surgery was compl...

Research paper thumbnail of HP-8-1 Antegrade or Retrograde Embolization of Cavernous Leakage in Erectile Dysfunction: An Analyzed Summary

The Journal of Sexual Medicine, Jun 1, 2020

Background and aims: Since venous surgery is no longer recommended for veno-occlusive dysfunction... more Background and aims: Since venous surgery is no longer recommended for veno-occlusive dysfunction (VOD) due to its low success rates, venous embolizations seem most promising in treating this pathology of at the moment. Access for this embolization can be granted either through antegrade or retrograde catheterization of the penile venous system. We wanted to summarize the outcomes of both of these procedures in the literature on short-and long-term follow-up. Methods: We performed a literature review that included all relevant studies describing embolization treatment in VOD. The studies were selected between 1985 and 2017. Used approaches, embolizing agents, number of patients, patient age, follow-up period and short-and long-term clinical effect were noted. Results: Clinical effect is most often assessed by means of a categorization based on the ability perform intercourse with or without the need for adjuvant therapy, or by means of a questionnaire. Both cavernosometric and cavernosographic methods are used to diagnose cavernosal leakage. Nevertheless, no guidelines on the adequate method of these procedures exist, resulting in significant variation among trials. The same degree of variation can be found in patient selection prior to diagnostic testing, types of sclerosing agents used and follow-up period. Retrograde transfemoral embolizations have been described as being technically more complex than antegrade techniques but with the advantage of less complications than the antegrade variant and without scarring the penile shaft. Conclusions: Although the technique of venous embolization has been described in the literature for over 30 years, comparison between different trials is not actually possible due to the lack of consensus in patient selection, diagnostic testing, interventional technique and follow-up period. Nevertheless, the results of these embolizations seem to be promising. Since no randomized controlled trials on antegrade versus retrograde venous embolization exist, it is difficult to conclude that any approach is better.

Research paper thumbnail of ALT phalloplasty: The Ghent technique

Research paper thumbnail of Response to Commentary re ‘Barriers in transitioning urologic patients from pediatric to adult care’

Journal of Pediatric Urology, Apr 1, 2021

Research paper thumbnail of Female Urethroplasty: Outcomes of Different Techniques in a Single Center

Journal of Clinical Medicine, Aug 31, 2021

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of Barriers in transitioning urologic patients from pediatric to adult care

Journal of Pediatric Urology, Apr 1, 2021

As the advances in medicine continue to emerge, more children with congenital or pediatric-onset ... more As the advances in medicine continue to emerge, more children with congenital or pediatric-onset chronic urologic conditions are surviving well into adulthood. This imposes an ever rising there is a need for adequate transition of these patients from pediatric to adult care. Despite position statements from multiple heath care organizations and several models proposed in literature, different issues and gaps in urologic transition continue to exist. Major barriers in this transition are adolescence, a challenging time that is characterized by impulsive behavior and risk taking, and the longstanding relation between both patients and paediatric providers. Both pediatric and adult care providers need to be aware of the special needs of maturing youth with chronic care problems related to education, self-management, legal issues and psychological support during care transition. Furthermore, they need to understand and address the currently existing obstacles for adequate transition. There is need for active communication with each other and the patient to develop sustainable relationships that can support the transitioning process. It is therefore in the greatest interest of the care provider to make this transition as smooth as possible. This paper aims to point out the currently perceived barriers in care transition within the urological context, reflect on previous implemented models for care transition and present proposals for improvement.

Research paper thumbnail of The Role of Cytoreductive Radical Prostatectomy in the Treatment of Newly Diagnosed Low-volume Metastatic Prostate Cancer. Results from the Local Treatment of Metastatic Prostate Cancer (LoMP) Registry

European urology open science, Jul 1, 2021

Background: Radiotherapy to the prostate (RTp) prolongs survival for patients with low-volume, ne... more Background: Radiotherapy to the prostate (RTp) prolongs survival for patients with low-volume, newly diagnosed metastatic prostate cancer (ndmPC). Objective: to evaluate whether cytoreductive radical prostatectomy (cRP) is equally beneficial as RTp in low-volume ndmPC. Design, setting, and participants: A multicenter prospective registry was established in 2014 to observe patients with ndmPC. Eligible patients were offered cRP or RTp. For this study we selected only patients with low-volume ndmPC (n = 109). Of these, 48, 26, and 35 patients underwent cRP, RTp, and no local therapy (NLT), respectively. Median follow-up was 32 mo (interquartile range 16-49). Intervention: cRP was compared with RTp and NLT. Outcome measurements and statistical analysis: Overall survival (OS), cancerspecific survival (CSS), and local event-free survival (LEFS) were calculated using the Kaplan-Meier method. Factors prognostic for OS were identified using univariate and multivariate Cox regression analysis. Results and limitations: The 2-yr OS was 93%, 100%, and 69%, and 2-yr CSS was 93%, 100%, and 75% for cRP, RTp, and NLT, respectively. The cRP and RTp groups had better OS compared to NLT and there was no significant difference between cRP and RTp. The 2-yr LEFS was 92%, 77%, and 60% for cRP, RTp, and NLT, respectively. The

Research paper thumbnail of The self‐assessment of genital anatomy, sexual function, and genital sensation (SAGASF‐M) questionnaire in a Belgian Dutch‐speaking male population: A validating study

International Journal of Andrology, Dec 9, 2022

Research paper thumbnail of V04-09 Undoubled Bladder in the Sagittal Plane with One Exstrophic Bladder: A Case Report on Reconstructive Technique

The Journal of Urology, May 1, 2022

ventrally incomplete, first the left sided part is opened and dissected of the urethra until the ... more ventrally incomplete, first the left sided part is opened and dissected of the urethra until the level of the dorsal “tunnel”. This procedure is repeated on the right side. After threading a vessel loop through the dorsal tunnel, both parts are removed, leaving the dorsal tunnel intact. Any urethral defect is now reconstructed and a Martius flap is pulled through the tunnel and wrapped around the urethra. CONCLUSIONS: Surgical excision of near-circular female urethral diverticulum leaving a short dorsal tunnel in situ, followed by circular urethral wrap with Martius flap, minimizes damage to the rhabdosphincter which is thickest dorsally. The Martius flap pullthrough plugs the dorsal tunnel and in this way prevents recurrence. The vascularized Martius flap supports the urethral reconstruction and serves as bulk material in case a fascia sling would be necessary in the presence of de novo stress incontinence.

Research paper thumbnail of The SAGASF-M Questionnaire, at home or in the office? A validation study

Research paper thumbnail of Metoidioplasty without urethral lengthening in a transgender male patient

Research paper thumbnail of MP24-10 Newly-Diagnosed Low-Volume Metastatic Prostate Cancer; is There a Place for Cytoreductive Radical Prostatectomy?

The Journal of Urology, Sep 1, 2021

INTRODUCTION AND OBJECTIVE:Radiotherapy to the prostate (RTp) has recently been shown to prolong ... more INTRODUCTION AND OBJECTIVE:Radiotherapy to the prostate (RTp) has recently been shown to prolong survival in patients with low-volume newly-diagnosed metastatic prostate cancer (ndmPC). Therefore i...

Research paper thumbnail of PS-7-13 Retrograde Embolization of Cavernous Leakage in Erectile Dysfunction: A Single Center Experience

The Journal of Sexual Medicine, Jun 1, 2020

Introduction: Injection of exogenous material into the penis and scrotum has been performed by bo... more Introduction: Injection of exogenous material into the penis and scrotum has been performed by both individuals and physicians for augmentation purposes. There is often a delay in presentation, with complications ranging from cosmetic dissatisfaction to penile necrosis and genital lymphoedema. This study reports the complications and outcomes from a large single centre. Patients and methods: A retrospective review of all cases presenting with foreign substance injection into the genitalia, between 2006 and 2018 was performed. Data included patient demographics, type of substance, injection site, symptoms, sexual function, management and complications. Results: A total of 30 patients were identified with median age 34 years (range 22-59) at presentation. The time between injection and presentation ranged from 1 day to 22 years. Presenting features included penile deformity, pain, phimosis, painful intercourse and necrosis. Injected substances included silicone (n¼14), liquid paraffin (n¼6), Vaseline (n¼5), baby oil (n¼4), autologous fat (n¼1). Common injection sites included penile shaft (93.1%), foreskin (34.5%), scrotum (27.6%), suprapubic area (6.9%), frenulum (3.4%). Surgical intervention was required in 27 cases, 16 underwent local excision and primary closure, 7 underwent circumcision and 4 required skin grafting. Sixteen patients required additional surgical procedures. Two patients required emergency debridement, with one developing penile necrosis. Conclusions: The practice of injecting foreign materials into the genitalia is becoming more common. Complications can be serious, with life-changing functional and cosmetic consequences. The commonest complication is lymphoedema with granuIomatous reaction. Surgical intervention is often required with poor cosmetic outcomes. Increased patient education and awareness is needed.

Research paper thumbnail of Treatment of Urethral Strictures in Transmasculine Patients

Journal of Clinical Medicine, Aug 30, 2021

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of ALT phalloplasty: The Ghent technique

Research paper thumbnail of Exstrophic bladder duplication in the sagittal plane: Surgical management of a rare case

Journal of Pediatric Urology

Research paper thumbnail of PD12-12 EXCISION and Primary Anastomosis or Staged Urethroplasty for Anastomotic Strictures After Phalloplasty?

Research paper thumbnail of Complete bladder duplication presenting in adulthood: A case report on reconstructive technique and reflections on translational urology in refugees

Frontiers in Urology

Introduction and aim of studyThe bladder-Exstrophy-Epispadias (BEEC) complex is a spectrum of con... more Introduction and aim of studyThe bladder-Exstrophy-Epispadias (BEEC) complex is a spectrum of congenital malformations with many variations. A never operated political refugee with BEEC was referred to our center for management upon arrival in Europe. Our aim is to report the technique and outcomes on a never operated on BEEC adult, highlighting the importance of transitional urologic care for congenital malformations in adult patients.Materials and methodsA 27-year old female patient was referred to our center for complete incontinence since birth by the General practitioner from the refugee center who suspected BEEC. Upon further investigation, an exstrophic bladder with blind ending ureteral orifices and a urethral meatus caudal to the exstrophic bladder plate were highlighted. A second non-exstrophic bladder with two orthotopic ureters was demonstrated, thereby a bladder duplication in the sagittal plane was diagnosed, presenting a wide-open bladder neck and a 7 cm pubic diastas...

Research paper thumbnail of The self‐assessment of genital anatomy, sexual function, and genital sensation (SAGASF‐M) questionnaire in a Belgian Dutch‐speaking male population: A validating study

Research paper thumbnail of V04-09 Undoubled Bladder in the Sagittal Plane with One Exstrophic Bladder: A Case Report on Reconstructive Technique

The Journal of Urology, May 1, 2022

ventrally incomplete, first the left sided part is opened and dissected of the urethra until the ... more ventrally incomplete, first the left sided part is opened and dissected of the urethra until the level of the dorsal “tunnel”. This procedure is repeated on the right side. After threading a vessel loop through the dorsal tunnel, both parts are removed, leaving the dorsal tunnel intact. Any urethral defect is now reconstructed and a Martius flap is pulled through the tunnel and wrapped around the urethra. CONCLUSIONS: Surgical excision of near-circular female urethral diverticulum leaving a short dorsal tunnel in situ, followed by circular urethral wrap with Martius flap, minimizes damage to the rhabdosphincter which is thickest dorsally. The Martius flap pullthrough plugs the dorsal tunnel and in this way prevents recurrence. The vascularized Martius flap supports the urethral reconstruction and serves as bulk material in case a fascia sling would be necessary in the presence of de novo stress incontinence.

Research paper thumbnail of Secondary phallic prosthesis placement in transgender patients postmetoidioplasty: a case report on technique and outcome

Sexual Medicine

Introduction Gender affirming surgery is common among transgender and gender-nonconforming indivi... more Introduction Gender affirming surgery is common among transgender and gender-nonconforming individuals. Genital gender-affirming surgery is a form of surgery that involves transformation and reconstruction of the genitalia while maintaining urologic and sexual function. Masculinizing genital gender-affirming surgery can involve the removal of the female genital and reproductive organs and the creation of a more masculine appearance by using phalloplasty or metoidioplasty techniques. While metoidioplasty has advantages such as limited scarring and preserved genital sensation and clitoral erection, it may not always guarantee the ability to void while standing or even penetrate a sexual partner. Aim To describe our method of secondary phallic enhancement after metoidioplasty with a phallic prosthesis. Methods Our case is based on a 39-year-old transgender male who underwent metoidioplasty with vaginectomy, scrotoplasty, and urethral lengthening. However, the original surgery was compl...

Research paper thumbnail of HP-8-1 Antegrade or Retrograde Embolization of Cavernous Leakage in Erectile Dysfunction: An Analyzed Summary

The Journal of Sexual Medicine, Jun 1, 2020

Background and aims: Since venous surgery is no longer recommended for veno-occlusive dysfunction... more Background and aims: Since venous surgery is no longer recommended for veno-occlusive dysfunction (VOD) due to its low success rates, venous embolizations seem most promising in treating this pathology of at the moment. Access for this embolization can be granted either through antegrade or retrograde catheterization of the penile venous system. We wanted to summarize the outcomes of both of these procedures in the literature on short-and long-term follow-up. Methods: We performed a literature review that included all relevant studies describing embolization treatment in VOD. The studies were selected between 1985 and 2017. Used approaches, embolizing agents, number of patients, patient age, follow-up period and short-and long-term clinical effect were noted. Results: Clinical effect is most often assessed by means of a categorization based on the ability perform intercourse with or without the need for adjuvant therapy, or by means of a questionnaire. Both cavernosometric and cavernosographic methods are used to diagnose cavernosal leakage. Nevertheless, no guidelines on the adequate method of these procedures exist, resulting in significant variation among trials. The same degree of variation can be found in patient selection prior to diagnostic testing, types of sclerosing agents used and follow-up period. Retrograde transfemoral embolizations have been described as being technically more complex than antegrade techniques but with the advantage of less complications than the antegrade variant and without scarring the penile shaft. Conclusions: Although the technique of venous embolization has been described in the literature for over 30 years, comparison between different trials is not actually possible due to the lack of consensus in patient selection, diagnostic testing, interventional technique and follow-up period. Nevertheless, the results of these embolizations seem to be promising. Since no randomized controlled trials on antegrade versus retrograde venous embolization exist, it is difficult to conclude that any approach is better.

Research paper thumbnail of ALT phalloplasty: The Ghent technique

Research paper thumbnail of Response to Commentary re ‘Barriers in transitioning urologic patients from pediatric to adult care’

Journal of Pediatric Urology, Apr 1, 2021

Research paper thumbnail of Female Urethroplasty: Outcomes of Different Techniques in a Single Center

Journal of Clinical Medicine, Aug 31, 2021

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of Barriers in transitioning urologic patients from pediatric to adult care

Journal of Pediatric Urology, Apr 1, 2021

As the advances in medicine continue to emerge, more children with congenital or pediatric-onset ... more As the advances in medicine continue to emerge, more children with congenital or pediatric-onset chronic urologic conditions are surviving well into adulthood. This imposes an ever rising there is a need for adequate transition of these patients from pediatric to adult care. Despite position statements from multiple heath care organizations and several models proposed in literature, different issues and gaps in urologic transition continue to exist. Major barriers in this transition are adolescence, a challenging time that is characterized by impulsive behavior and risk taking, and the longstanding relation between both patients and paediatric providers. Both pediatric and adult care providers need to be aware of the special needs of maturing youth with chronic care problems related to education, self-management, legal issues and psychological support during care transition. Furthermore, they need to understand and address the currently existing obstacles for adequate transition. There is need for active communication with each other and the patient to develop sustainable relationships that can support the transitioning process. It is therefore in the greatest interest of the care provider to make this transition as smooth as possible. This paper aims to point out the currently perceived barriers in care transition within the urological context, reflect on previous implemented models for care transition and present proposals for improvement.

Research paper thumbnail of The Role of Cytoreductive Radical Prostatectomy in the Treatment of Newly Diagnosed Low-volume Metastatic Prostate Cancer. Results from the Local Treatment of Metastatic Prostate Cancer (LoMP) Registry

European urology open science, Jul 1, 2021

Background: Radiotherapy to the prostate (RTp) prolongs survival for patients with low-volume, ne... more Background: Radiotherapy to the prostate (RTp) prolongs survival for patients with low-volume, newly diagnosed metastatic prostate cancer (ndmPC). Objective: to evaluate whether cytoreductive radical prostatectomy (cRP) is equally beneficial as RTp in low-volume ndmPC. Design, setting, and participants: A multicenter prospective registry was established in 2014 to observe patients with ndmPC. Eligible patients were offered cRP or RTp. For this study we selected only patients with low-volume ndmPC (n = 109). Of these, 48, 26, and 35 patients underwent cRP, RTp, and no local therapy (NLT), respectively. Median follow-up was 32 mo (interquartile range 16-49). Intervention: cRP was compared with RTp and NLT. Outcome measurements and statistical analysis: Overall survival (OS), cancerspecific survival (CSS), and local event-free survival (LEFS) were calculated using the Kaplan-Meier method. Factors prognostic for OS were identified using univariate and multivariate Cox regression analysis. Results and limitations: The 2-yr OS was 93%, 100%, and 69%, and 2-yr CSS was 93%, 100%, and 75% for cRP, RTp, and NLT, respectively. The cRP and RTp groups had better OS compared to NLT and there was no significant difference between cRP and RTp. The 2-yr LEFS was 92%, 77%, and 60% for cRP, RTp, and NLT, respectively. The

Research paper thumbnail of The self‐assessment of genital anatomy, sexual function, and genital sensation (SAGASF‐M) questionnaire in a Belgian Dutch‐speaking male population: A validating study

International Journal of Andrology, Dec 9, 2022

Research paper thumbnail of V04-09 Undoubled Bladder in the Sagittal Plane with One Exstrophic Bladder: A Case Report on Reconstructive Technique

The Journal of Urology, May 1, 2022

ventrally incomplete, first the left sided part is opened and dissected of the urethra until the ... more ventrally incomplete, first the left sided part is opened and dissected of the urethra until the level of the dorsal “tunnel”. This procedure is repeated on the right side. After threading a vessel loop through the dorsal tunnel, both parts are removed, leaving the dorsal tunnel intact. Any urethral defect is now reconstructed and a Martius flap is pulled through the tunnel and wrapped around the urethra. CONCLUSIONS: Surgical excision of near-circular female urethral diverticulum leaving a short dorsal tunnel in situ, followed by circular urethral wrap with Martius flap, minimizes damage to the rhabdosphincter which is thickest dorsally. The Martius flap pullthrough plugs the dorsal tunnel and in this way prevents recurrence. The vascularized Martius flap supports the urethral reconstruction and serves as bulk material in case a fascia sling would be necessary in the presence of de novo stress incontinence.

Research paper thumbnail of The SAGASF-M Questionnaire, at home or in the office? A validation study

Research paper thumbnail of Metoidioplasty without urethral lengthening in a transgender male patient

Research paper thumbnail of MP24-10 Newly-Diagnosed Low-Volume Metastatic Prostate Cancer; is There a Place for Cytoreductive Radical Prostatectomy?

The Journal of Urology, Sep 1, 2021

INTRODUCTION AND OBJECTIVE:Radiotherapy to the prostate (RTp) has recently been shown to prolong ... more INTRODUCTION AND OBJECTIVE:Radiotherapy to the prostate (RTp) has recently been shown to prolong survival in patients with low-volume newly-diagnosed metastatic prostate cancer (ndmPC). Therefore i...

Research paper thumbnail of PS-7-13 Retrograde Embolization of Cavernous Leakage in Erectile Dysfunction: A Single Center Experience

The Journal of Sexual Medicine, Jun 1, 2020

Introduction: Injection of exogenous material into the penis and scrotum has been performed by bo... more Introduction: Injection of exogenous material into the penis and scrotum has been performed by both individuals and physicians for augmentation purposes. There is often a delay in presentation, with complications ranging from cosmetic dissatisfaction to penile necrosis and genital lymphoedema. This study reports the complications and outcomes from a large single centre. Patients and methods: A retrospective review of all cases presenting with foreign substance injection into the genitalia, between 2006 and 2018 was performed. Data included patient demographics, type of substance, injection site, symptoms, sexual function, management and complications. Results: A total of 30 patients were identified with median age 34 years (range 22-59) at presentation. The time between injection and presentation ranged from 1 day to 22 years. Presenting features included penile deformity, pain, phimosis, painful intercourse and necrosis. Injected substances included silicone (n¼14), liquid paraffin (n¼6), Vaseline (n¼5), baby oil (n¼4), autologous fat (n¼1). Common injection sites included penile shaft (93.1%), foreskin (34.5%), scrotum (27.6%), suprapubic area (6.9%), frenulum (3.4%). Surgical intervention was required in 27 cases, 16 underwent local excision and primary closure, 7 underwent circumcision and 4 required skin grafting. Sixteen patients required additional surgical procedures. Two patients required emergency debridement, with one developing penile necrosis. Conclusions: The practice of injecting foreign materials into the genitalia is becoming more common. Complications can be serious, with life-changing functional and cosmetic consequences. The commonest complication is lymphoedema with granuIomatous reaction. Surgical intervention is often required with poor cosmetic outcomes. Increased patient education and awareness is needed.

Research paper thumbnail of Treatment of Urethral Strictures in Transmasculine Patients

Journal of Clinical Medicine, Aug 30, 2021

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of ALT phalloplasty: The Ghent technique

Research paper thumbnail of Exstrophic bladder duplication in the sagittal plane: Surgical management of a rare case

Journal of Pediatric Urology

Research paper thumbnail of PD12-12 EXCISION and Primary Anastomosis or Staged Urethroplasty for Anastomotic Strictures After Phalloplasty?

Research paper thumbnail of Complete bladder duplication presenting in adulthood: A case report on reconstructive technique and reflections on translational urology in refugees

Frontiers in Urology

Introduction and aim of studyThe bladder-Exstrophy-Epispadias (BEEC) complex is a spectrum of con... more Introduction and aim of studyThe bladder-Exstrophy-Epispadias (BEEC) complex is a spectrum of congenital malformations with many variations. A never operated political refugee with BEEC was referred to our center for management upon arrival in Europe. Our aim is to report the technique and outcomes on a never operated on BEEC adult, highlighting the importance of transitional urologic care for congenital malformations in adult patients.Materials and methodsA 27-year old female patient was referred to our center for complete incontinence since birth by the General practitioner from the refugee center who suspected BEEC. Upon further investigation, an exstrophic bladder with blind ending ureteral orifices and a urethral meatus caudal to the exstrophic bladder plate were highlighted. A second non-exstrophic bladder with two orthotopic ureters was demonstrated, thereby a bladder duplication in the sagittal plane was diagnosed, presenting a wide-open bladder neck and a 7 cm pubic diastas...

Research paper thumbnail of The self‐assessment of genital anatomy, sexual function, and genital sensation (SAGASF‐M) questionnaire in a Belgian Dutch‐speaking male population: A validating study

Research paper thumbnail of V04-09 Undoubled Bladder in the Sagittal Plane with One Exstrophic Bladder: A Case Report on Reconstructive Technique

The Journal of Urology, May 1, 2022

ventrally incomplete, first the left sided part is opened and dissected of the urethra until the ... more ventrally incomplete, first the left sided part is opened and dissected of the urethra until the level of the dorsal “tunnel”. This procedure is repeated on the right side. After threading a vessel loop through the dorsal tunnel, both parts are removed, leaving the dorsal tunnel intact. Any urethral defect is now reconstructed and a Martius flap is pulled through the tunnel and wrapped around the urethra. CONCLUSIONS: Surgical excision of near-circular female urethral diverticulum leaving a short dorsal tunnel in situ, followed by circular urethral wrap with Martius flap, minimizes damage to the rhabdosphincter which is thickest dorsally. The Martius flap pullthrough plugs the dorsal tunnel and in this way prevents recurrence. The vascularized Martius flap supports the urethral reconstruction and serves as bulk material in case a fascia sling would be necessary in the presence of de novo stress incontinence.