Sava V Perovic

University of Belgrade, Belgrade, SE, Serbia

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Publications (106)204.03 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To present outcomes of a minimally invasive inguinal technique for the separation of the distal part of ureters in duplex systems and for the extravesical ureteroneocystostomy of only the pathologically involved ureter. From November 2001 to February 2007, we performed extravesical reimplantation of only the involved ureter in 21 duplex systems, of which 14 were refluxing (megaureters) and seven had obstruction of the ureterovesical junction. The mean (range) age of the patients was 39 (17-59) months. In seven patients, ureterocutaneostomy (of the involved ureter only) was performed first, with reimplantation 3-6 months later, after the diameter of the ureter had decreased, to ensure safe reimplantation. The mean (range) postoperative follow-up was 28 (12-47) months. Postoperative voiding cysto-urethrograms (VCUGs) and magnetic resonance imaging (MRI), showed an absence of vesico-ureteric reflux (VUR) or obstruction in the ureters of the first 10 patients. In the remaining 11 patients, there was no ultrasound detectable dilatation, but symptomatic urinary tract infection developed in two of these patients. Subsequent VCUG and MRI results showed no obstructions or VURs. Our results showed that the minimally invasive inguinal approach to separation of ureters in duplex systems and single ureteroneocystostomy of only the pathologically involved ureter represents a viable treatment option.
    BJU International 03/2011; 108(10):1660-3; discussion 1663-4. · 3.05 Impact Factor
  • Sava V Perovic, Rados P Djinovic
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    ABSTRACT: To report the principles of penile resculpturing of different deformities caused by M. Peyronie: restoration of penile length, girth and shape with or without penile prosthesis implantation. In the period between February 2007 and March 2009, we performed grafting surgery for M. Peyronie in 98 patients aged between 24 and 72 years (mean 52 years). Penile deformities were diferent: dorsal curvature in 54 (55%), lateral in 7 (7%), ventral in 11 (11%), and combined curvature in 21 (21%) associated corporal narrowing was present in 24 patients (24%). Four (4%) patients presented isolated penile shortening without other deformity. Isolated diffuse corporal narrowing without shortening was found in two (2%) patients. Severity of curvature ranges from 60 to 90 degrees, mean 72. Thirty one (31%) patients had associated ED. Surgical options for severe Peyronie's disease were: single grafting in 26 pts (26%), complex grafting including circular tunical incision in 36 pts (36%), and in patients with ED the same procedures combined with penile prosthesis implantation (37 pts, 38%). Surgical correction was based on measurement of the tunical defect and precise calculation of graft size and shape. Penile straightening and lengthening was achieved by equalizing of shortened penile side/s with the longest one (convex) and grafting. Penile width is reestablished with additional longitudinal incision/s and grafting; graft width is determined by measurement of difference in circumference between normal and narrowed part of the corpora. We used Intexen LP (AMS) as a grafting material in all cases. The mean follow-up was 15 months (6-25). Mean penile length gain without prosthesis was 2.8cm (1.5-4.2) and with prosthesis 3.2cm (2-4.5cm). Insuficient straightening was in 5 patients (>15 degree) where Neuro Vascular Bundle (NVB) was limiting factor. Twenty four patients reported hypoesthesia and reduced orgasmic sensitivity that recovered spontaneously after 3-6 months. De-novo ED occurred in 6 pts and progression of disease in 6 patients. Infection occurred only in one patient with penile prosthesis implantation. Overall patients' satisfaction was 95%. Complete tunical reconstruction in IPP can be performed as a safe procedure by transversal, longitudinal and circular grafting with or without simultaneous penile prosthesis implantation. Maximum penile length, girth and shape restoration can be achieved using geometrical calculation, regardless of type of deformity.
    Archivos españoles de urología 11/2010; 63(9):755-70.
  • Sava V. Perovic, Rados P. Djinovic
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    ABSTRACT: Objetivo: Informar sobre los principios de la cirugía reconstructiva de diferentes deformidades del pene causadas por la enfermedad de Peyronie: restauración de la longitud, perímetro y forma con o sin implante de prótesis de pene. Métodos: En el período comprendido entre febrero 2007 y marzo de 2009, se realizó cirugía con parche por enfermedad de Peyronie en 98 pacientes con edades comprendidas entre 24 y 72 años (media 52 años). Las deformidades en el pene eran diferentes: curvatura dorsal en 54 (55%) pacientes, lateral en 7 (7%), ventral en 11 (11%), y curvatura combinada en 21 (21%); 24 pacientes presentaban estrechamiento en el cuerpo cavernoso (reloj de arena) (24 %). Cuatro (4%) pacientes presentaban acortamiento de pene aislado, sin otras deformidades, y en dos (2%) pacientes se encontró un estrechamiento cavernoso difuso aislado sin acortamiento. La gravedad de la curvatura varió de 60o-90o, media 72. Treinta y un (31%) pacientes padecían disfunción eréctil asociada. Las opciones quirúrgicas para los casos graves de enfermedad de Peyronie fueron: injerto simple en 26 (26%) pacientes, injertos complejos incluyendo incisión circular de la túnica albugínea en 36 (36%), y los mismos procedimientos en pacientes con disfunción eréctil combinados con implante de prótesis de pene en 37 pacientes (38%). La corrección quirúrgica se basó en la medición del defecto de la túnica y el cálculo preciso del tamaño del injerto y la forma. El enderezamiento y alargamiento del pene se logró, mediante la nivelación del lado/s acortados del pene con el más largo (convexo) y el injerto. El ancho del pene se restablece con incisión/es longitudinal/es adicionales e injertos; el ancho del injerto se determina mediante la medición de la diferencia en la circunferencia entre las partes normal y reducida del cuerpo cavernoso. En todos los casos, se utilizó InteXen LP (AMS) como material de injerto. Resultados: El seguimiento medio fue de 15 meses (6-25). El incremento de longitud del pene fue de 2,8 cm sin prótesis (1,5-4,2 cm) y 3,2 cm (2-4,5cm) con prótesis. En 5 pacientes (<15 grados), la corrección de la curvatura fue insuficiente, debido a que el haz neurovascular fue un factor limitante. Veinticuatro pacientes informaron de hipoestesia y sensibilidad orgásmica reducida que se recuperó espontáneamente al cabo de 3-6 meses. Seis pacientes presentaron una disfunción eréctil de novo y 6 pacientes progresión de la enfermedad. Sólo un paciente con implante de prótesis de pene sufrió infección. El índice de satisfacción general de los pacientes fue del 95%. Conclusiones: La reconstrucción de la túnica albugínea completa en la enfermedad de Peyronie puede realizarse como un procedimiento seguro por medio de injertos transversales, longitudinales y circulares con o sin implante simultáneo de prótesis de pene. Se puede lograr, mediante el cálculo geométrico, la longitud máxima del pene, el grosor y la recuperación de la forma, independientemente del tipo de deformidad.
    Archivos españoles de urología 11/2010; 63(9):755-770.
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    ABSTRACT: Autologous tissue engineering with biodegradable scaffolds is a new treatment option for real penile girth enhancement. The aim of this article is to evaluate tissue remodeling after penile girth enhancement using this technique. Between June 2005 and May 2007, a group of 12 patients underwent repeated penile widening using biodegradable scaffolds enriched with expanded autologous scrotal dartos cells. Clinical monitoring was parallel to histological investigation of tissue remodeling. During second surgical procedure, biopsies were obtained 10-14 months after first surgery (mean 12 months, N=6) and compared with those obtained after 22-24 months (mean 23 months, N=6), and control biopsies from patients who underwent circumcision (N=5). Blind evaluation of histomorphometrical and immunohistochemical finding was performed in paraffin sections. Penile girth gain in a flaccid state ranged between 1.5 and 3.8 cm (mean 2.1 ± 0.28 cm) and in full erection between 1.2 and 4 cm (mean 1.9 ± 0.28 cm). Patients' satisfaction, defined by a questionnaire, was good (25%) and very good (75%). In biopsies obtained 10-14 months after first surgery, highly vascularized loose tissue with collagen deposition associated with small foci of mild chronic and granulomatous inflammation surrounding residual amorphous material was observed. Fibroblast-like hyperplasia and small vessel neoangiogenesis occurred intimately associated with the progressive growth of vascular-like structures from accumulation of CD34 and alpha-smooth muscle actin-positive cells surrounding residual scaffold-like amorphous material. Capillary neoangiogenesis occurred inside residual amorphous material. In biopsies obtained after 22-24 months, inflammation almost disappeared and tissue closely resembled that of the dartos fascia of control group. Autologous tissue engineering using expanded scrotal dartos cells with biodegradable scaffolds is a new and promising method for penile widening that generates progressive accumulation of stable collagen-rich, highly vascularized tissue matrix that closely resemble deep dartos fascia.
    Journal of Sexual Medicine 09/2010; 7(9):3206-15. · 3.51 Impact Factor
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    ABSTRACT: Introduction. The field of Peyronie's disease is evolving and there is need for a state-of-the-art information in this area.Aim. To develop an evidence-based state-of-the-art consensus report on the management of Peyronie's disease.Methods. To provide state-of-the-art knowledge regarding the prevalence, etiology, medical and surgical management of Peyronie's Disease, representing the opinion of leading experts developed in a consensus process over a 2-year period.Main Outcome Measures. Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate.Conclusions. The real etiology of Peyronie's disease and the mechanisms of formation of the plaque still remain obscure. Although conservative management is obtaining a progressively larger consensus among the experts, surgical correction still remains the mainstay treatment for this condition. Ralph D, Gonzalez-Cadavid N, Mirone V, Perovic S, Sohn M, Usta M, and Levine L. The management of Peyronie's disease: Evidence-based 2010 guidelines. J Sex Med 2010;7:2359–2374.
    Journal of Sexual Medicine 06/2010; 7(7):2359 - 2374. · 3.51 Impact Factor
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    ABSTRACT: Penile trauma is common with standard management options. Gender reassignment techniques are rapidly changing and penile augmentation remains a controversial topic. Consequently, there is need for a state-of-the-art information in this area. This study aims to develop an evidence-based state-of-the-art consensus report on the management of penile trauma, gender, reassignment and penile augmentation. The study provides state-of-the-art knowledge regarding the prevalence, etiology, medical and surgical management of penile trauma, gender reassignment and penile augmentation, representing the opinion of leading experts developed in a consensus process over a 2-year period. Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. Penile fracture should be managed surgically. Information should be readily available to patients to help them decide the surgical technique desired for gender reassignment and to justify any form of penile augmentation.
    Journal of Sexual Medicine 04/2010; 7(4 Pt 2):1657-67. · 3.51 Impact Factor
  • Journal of Pediatric Urology 04/2010; 6. · 1.37 Impact Factor
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    ABSTRACT: We present a new, 2-stage functional and cosmetic reconstruction of concealed penis in adults with short-term subjective outcomes. Patients with excess penile skin removal, shaft tissue scarring and penile retraction with poor functional and cosmetic results underwent 2-stage repair. At stage 1 after a coronal incision and penile degloving an intrascrotal tunnel was formed and the penis was transposed through the scrotum. Three or 4 zero or 2-zero nonresorbable sutures were applied ventral to the penis, crossing through the entire scrotum to ensure complete scrotal skin adhesion to the penis (penile scrotalization). At stage 2 after 6 to 12 weeks the scrotal skin at the penile base was incised bilaterally to separate the skin around the penis from the remaining scrotal skin (penile descrotalization). Evaluation was scheduled 3, 6 and 9 months postoperatively, and annually thereafter. Ten men with concealed penis underwent this 2-stage penile repair, including 8 who were circumcised and 2 who underwent conservative surgery for penile cancer. Mean +/- SD operative time was 75 +/- 15 minutes for stage 1 and 45 +/- 10 minutes for stage 2. No major intraoperative or perioperative complications occurred except superficial scrotal hematoma in 1 patient. At a median followup of 20 months (range 6 to 72) all men were in satisfactory clinical condition and the median patient satisfaction visual analog score was 97 (range 85 to 100). All patients recovered normal spontaneous erection with regular sexual intercourse 4 to 8 weeks after operation 2. This simple, new 2-stage technique seems feasible and effective, and it is well accepted by patients. Further studies are mandatory to confirm preliminary results.
    The Journal of urology 03/2010; 183(3):1060-3. · 3.75 Impact Factor
  • Journal of Pediatric Urology. 01/2010; 6.
  • Journal of Urology - J UROL. 01/2010; 183(4).
  • P. H. Eavdio, S. V. Perovic, S. Sansalone
    European Urology Supplements - EUR UROL SUPPL. 01/2010; 9(2):182-183.
  • Journal of Urology - J UROL. 01/2010; 183(4).
  • European Urology Supplements - EUR UROL SUPPL. 01/2010; 9(2):182-182.
  • Journal of Urology - J UROL. 01/2010; 183(4).
  • Journal of Urology - J UROL. 01/2010; 183(4).
  • Journal of Pediatric Urology. 01/2010; 6.
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    ABSTRACT: To our knowledge epidemiological data on the incidence of failed hypospadias repair and the number of patients seeking further surgical treatment remain unknown. We report an observational, descriptive survey of patients who were evaluated and treated for urethral stricture disease and/or penile defects after primary hypospadias repair. We performed a retrospective observational chart analysis of patients evaluated and treated for urethral stricture disease and/or penile defects at 2 tertiary European centers from January 1998 to December 2007. In each case we investigated the primary abnormal meatal site, the number of operations needed to repair primary hypospadias and complications of this primary repair. Patients were offered surgical repair for previous failed hypospadias treatment. After surgery evaluation was scheduled at 3, 6 and 9 months. Success was defined as a functional urethra without fistula, stricture or residual chordee and a cosmetically acceptable glanular meatus after the completion of all secondary procedures. A total of 1,176 patients with a mean age of 31 years were evaluated and treated. To treat failed hypospadias repair 760 (64.6%) and 416 patients (35.4%) underwent 1-stage and staged repair, respectively. Mean followup was 60.4 months. Of 1,176 cases 1,036 (88.1%) were classified as successful and 140 (11.9%) were considered failures. Failed hypospadias repair may be corrected by multiple and complex surgeries. Its effects are experienced during the lifetime of the patient and parents.
    The Journal of urology 11/2009; 183(1):207-11. · 3.75 Impact Factor
  • Sava Perovic, Rados Djinovic
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    ABSTRACT: Feminizing genitoplasty in male-to-female transsexuals is gaining significant importance within society. Our aim is to evaluate current articles and assess scientific validity of the recent literature (January 2008 to June 2009) of male-to-female gender-reassignment surgery. This is a very difficult and demanding field of surgery, often followed by many complications that have an impact on long-term results, quality of life and general patient satisfaction. In the last 18 months, there were only a few articles that deserve attention. Small advances are made in surgical technique, especially of aesthetics of external genitalia, which now closely resemble a natural woman, in creation of mons veneris using albugineal strip and some useful anatomical remarks regarding surgical procedure. Two articles evaluate long-term and medium-term surgical outcomes and one describes surgical complications. One study deals with body composition, volumetric and areal bone density 3 years after surgery. In the last 18 months, there are only several works regarding surgical technique in male-to-female feminizing genitoplasty, which may have impact on clinical practice, whereas one work researches negative implications of hormonal treatment and surgery on bone and body composition.
    Current opinion in urology 09/2009; 19(6):571-6. · 2.50 Impact Factor
  • Sanja Sindjic, Sava V Perovic, Rados P Djinovic
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    ABSTRACT: Urethral duplication and megalourethra are very rare anomalies and their concomitant presence is extremely rare, with only a few published cases. We present a complex case of complete urethral duplication with dorsal megalourethra that was severely stenotic in its bulbar part and meatus, with the ventral urethra atretic distally and dilated proximally. Both the corpus spongiosum and the cavernosum were missing. He had associated upper urinary tract abnormalities. Urethral patency was restored successfully by meatoplasty, staged buccal mucosa graft urethroplasty, and tailoring of the megalourethra. This report is unique regarding the use of a buccal mucosa graft for urethral reconstruction in patients with associated urethral duplication and megalourethra.
    Urology 08/2009; 74(4):903-5. · 2.42 Impact Factor
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    ABSTRACT: To develop a technique for urethral reconstruction using a combined labia minora flap and buccal mucosa graft. Urethral lengthening is the most difficult part in female transsexuals and poses many challenges. From April 2005 to February 2008, 38 patients (aged 19-53 years) underwent single-stage metoidioplasty. The technique starts with clitoral lengthening and straightening by division of both clitoral ligaments dorsally and the short urethral plate ventrally. The buccal mucosa graft is quilted to the ventral side of the corpora cavernosa between the native orifice and the tip of the glans. The labia minora flap is dissected from its inner surface to form the ventral aspect of the neourethra. All suture lines are covered by the well-vascularized subcutaneous tissue originating from the labia minora. The labia majora are joined in the midline and 2 silicone testicular implants are inserted to create the scrotum. The neophallus is covered with the remaining clitoral and labial skin. The median follow-up was 22 months (range 11-42). The median neophallic length was 5.6 cm (range 4-9.2). The total length of the neourethra was 9.4-14.2 cm (median 10.8). Voiding while standing was reported by all 38 patients, and temporary dribbling and spraying were noted by 12. Two fistulas and one urethral erosion resulted from the testicular implant and required secondary revision. A combined buccal mucosa graft and labia minora flap present a good choice for urethral reconstruction in female-to-male transsexuals, with minimal postoperative complications.
    Urology 07/2009; 74(2):349-53. · 2.42 Impact Factor

Publication Stats

776 Citations
204.03 Total Impact Points

Institutions

  • 1998–2011
    • University of Belgrade
      • School of Medicine
      Belgrade, SE, Serbia
  • 2009–2010
    • Serbian Academy of Sciences and Arts
      Beograd, Central Serbia, Serbia
  • 1991–2007
    • University Children's Hospital, Belgrade, Serbia
      Beograd, Central Serbia, Serbia
  • 2002
    • University of Iowa Children's Hospital
      Iowa City, Iowa, United States
  • 2001
    • Ginekolosko Akuserska Klinika Narodni Front
      Beograd, Central Serbia, Serbia

Disciplines