Læknablaðið : fylgirit - 01.06.2009, Blaðsíða 30

2 7 T H CONGR SCAND ASSOC UROL
F Y L G I R I T 6 1
62 Martius flap and its isiand cutaneous variant in
urethro-vaginal reconstruction
FE Martins, JP Marcelino, AF Sandul, TM Lopes
Department ofUrology, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
faemartins@gmail.com
Introduction: The need for tissue interposition in vaginal repair,
particularly in severely damaged urethrovaginal tissues, gives
the Martius flap a major role in pelvic reconstructive surgery.
Material and methods: We demonstrate the Martius flap and
its island cutaneous variant harvesting and transfer technique
in a step-by-step fashion in 27 patients operated on for
complex urethrovaginal fistulae due to obstetric trauma and
for prosthetic/sling erosions that involved complex vaginal
reconstructions.
Results: The procedures were well tolerated and healed
uneventfully in the overwhelming majority of the patients.
1 patient developed infection of the donor site, 1 developed
necrosis of the flap, and 3 had delayed serous-bloody discharge
from the vaginal wound.
Conclusion: The techniques described are feasible, simple,
surgical procedures and have limited complications. They
remain a useful adjunct in the pelvic reconstructive surgeon's
armamentarium.
63 Single-stage perineal repair of panurethral stricture
disease with buccal mucosa grafting
FE Martins, JP Marcelino, RN Rodrigues, AF Sandul, TM Lopes
Department ofUrology, Hospital Pulido Valente, and Division ofUrology,
Hospital S.A.M.S., Lisbon, Portugal
faemartins@gmail.com
Objective: Strictures involving the full length of anterior urethra
(panurethral) are a demanding reconstructive challenge. The
use of buccal mucosal grafts for dorsal onlay patching of the
urethra has provided good functional and cosmetic results for
these strictures extending from the proximal bulbar urethra
up to the external meatus. We report our experience with the
use of buccal mucosal grafts (s2 strips) for reconstruction of
panurethral stricture disease.
Patients and methods: From January 1995 to December 2008, a
total of 116 patients underwent urethroplasty in our institutions,
11 of whom had a one-stage buccal mucosal dorsal onlay graft
procedure through a perineal approach (1 single strip in 9
patients and 2 strips in 2). In those patients in whom the stricture
involved the external meatus, a small ventral subcoronal
incision was added to repair the most distal segment of the
urethra. Penile shaft degloving was avoided in all 11 patients.
Buccal mucosal grafting varied between 12 and 17cm. in length.
Results: The median follow-up was 54 months (range 11 to 168).
The overall complication rate both at the donor and recipient
sites were acceptably low, the main complications being oral
numbness in 33% (3 in 11), and delayed difficulty in mouth
opening in 18% (2 in 11). No patient developed oral wound
infections or experienced changes in salivary function. The
stricture recurrence was 11% (1 in 11). Slight ventral curvature
on erection occurred in 27% (3 in 11). None developed erectile
or ejaculatory dysfunction. No fistula or diverticulum formation
occurred.
Conclusion: The single-stage dorsal onlay buccal mucosal
grafting procedure through a perineal approach is a good,
feasible and reproducible technique for the treatment of
panuerthral stricture disease. However, complications are not
negligible. Further experience with a larger patient population
is needed.
64 Pelvic floor muscle training with and without
functional electrical stimulation as a treatment of SUI
H Eyjólfsdóttir’, M Ragnarsdóttir1, G Geirsson2
’Department of Rehabilitation and 2Department of Urology, Landspitali
University Hospital, Reykjavik, lceland
halldey@landspitali.is
Aim: To compare the effectiveness of pelvic floor muscle
training with and without electrical stimulation in treatment of
stress urinary incontinence.
Material and methods: Participants were 24 women, 27-73 years
of age, diagnosed with stress urinary incontinence. Exclusion
criteria were pregnancy and urge urinary incontinence. The
participants were randomly divided into group 1 and 2.
The pelvic floor muscles were evaluated using the Oxford scale,
vaginal palpation, and by electromyogram, (Myomed 930, Enraf
Nonius). The quantity and frequency of urinary incontinence
episodes was evaluated using a questionnaire and a VAS scale
before and after the treatment.
Both groups trained twice a day for 15 min. Group 2 used
simultaneously intermittent electrical stimulation.
Results: The groups were demographically similar, except
group 2 was significantly younger. Both groups had significantly
increased pelvic floor muscle strength (p=0.007; p=0.005) after
the treatment and 70% of all the women had reduced or no stress
urinary incontinence. Group 2 had significantly (p=0.013) better
relaxation post treatment.
Conclusion: Pelvic floor muscle training was an effective
treatment for stress urinary incontinence, but electrical
stimulation gave no additional effect for this paíient group. The
significantly lower relaxation threshold in group 2 indicates,
that electrical stimulation could be a possible treatment for
symptoms caused by hypertensive pelvic floor muscles.
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