197 / 238
197
11–14 APRIL, 2018, HELSINKI, FINLAND
MATERIAL AND METHODS
For the technique, a 0.014 inch guide-wire is endoscopically inserted through the vesicoureteral
junction (VUJ) and allowed to curl in the megaureter. A 4 or 5 mm atherotome-bladed cutting balloon
(Cutting-Balloon
®
) is inflated in VUJ under fluoroscopy or cystoscopy control. Then, a 3 Fr JJ stent
is placed for four weeks.
RESULTS
From January 2014 to January 2016, 21 patients were treated endoscopically for POM. In 3 patients
(6 months to 3 years-old), balloon dilation was not possible, so it was performed endoureterotomy
with Cutting-Balloon
®
resulting in the immediate and complete disappearance of the stenosis.
Hospital stay was 24 hours and intra or postoperative complications were not found. In evolution,
urinary tract infections disappeared and ureterohydronephrosis improved in all cases.
CONCLUSIONS
Patients with POM can be treated endoscopically by high-pressure balloon dilatation. In case
a persistent ring does not respond to balloon dilatation, endo-ureterotomy could provide a valid and
safe definitive treatment of POM.
VD-3 (VS without presentation)
URETHRAL MOBILIZATION AND PARTIAL GLANDAR
DISASSEMBLY: A STEP-BY-STEP VIDEO
Antonio MACEDO JR
1
, Tassia LOBOUNTCHENKO
2
, Felipe DINI
2
, Sergio OTTONI
2
,
Gilmar GARRONE
2
, Riberto LIGUORI
2
, Ricardo MARCONDES
2
and Marcela LEAL
DA CRUZ
2
1) UNIFESP / NUPEP-CACAU-AACD, Pediatric Urology, São Paulo, BRAZIL - 2) NUPEP-CACAU-AACD, Pediatric
Urology, São Paulo, BRAZIL
PURPOSE
We want to present in a step-by step video an alternative procedure for distal hypospadias consist-
ing of urethral mobilization and partial glandar disassembly.
MATERIAL AND METHODS
A subcoronal circumcision was performed showing distal dysplasic urethra. The entire penis shaft
was degloved and chordee tissue resected. Laterally to spongious tissue we incised the Buck's fas-
cia on both sides releasing it from the corpora and created two glandar wings keeping however
a small bridge of urethral plate to it. At this moment, the urethra advances cranially and both glandar
wings can embrace the distal urethra with a more conical and physiological aspect of the glans. We
sutured the urethra to the glans and finally performed the glans reconstruction.
RESULTS
Koff et al. published a modification of the Barcat technique known as extensive urethral mobilization
and confirmed excellent cosmetic and functional results on 168 patients with only 3.5 % of the
patients requiring reoperation. Mitchell & Blagi and Perovic et al. reported on complete penile disas-
sembly for epispadia repair as a way to complete release of the rotation of the penis and treat dorsal
chordee bringing the urethra to a more functional location. We were inspired by this procedure when
we started doing extensive partial glandar disassembly in association with urethral mobilization.
The rationale for this procedure is to avoid any suture, simply positioning the urethra distally without
tension. The partial glandar disassembly teached us that it was possible to create a more conical
and cosmetical glans.
CONCLUSIONS
We are convinced that this operation can be regarded as a genuine alternative to most cases of
primary and redo distal hypospadias.