Sava V Perovic's research while affiliated with University of Belgrade and other places

Publications (97)

Chapter
Vaginoplasty presents the main problem in male-to-female surgery. There are many operative techniques [1–3] that can be used, but none is ideal. Therefore, continual challenge exists in search for new and better solutions. We have published our contribution to operative technique in male-to-female surgery [4]. Afterwards we continuously improved th...
Article
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...
Article
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...
Article
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)....
Article
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...
Article
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 managem...
Article
Purpose Failed Hypospadias repair present difficult problem with growing number of patients needing surgical treatment which is often challenging because majority had multiple previous surgeries with lack of quality tissue for repair. Material and Methods Between January 2003 and December 2008, 223 patients aged between 18 and 59 years (mean 28) w...
Article
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 t...
Article
Purpose Mitrofanoff described the use of a nonrefluxing ureter to construct a continent stoma(CS), which sometimes involves risking the good kidney with a complicated transuretero-ureterostomy. Material and Methods During the period from 1993-2008 we performed and evaluated 74 children with CS, age from 2-7 years. Apendicovesicostomy was most freq...
Article
Purpose Satisfactory aesthetic outcome is always great challenge in the repair of external genitalia in children with CAH. We present several modifications of the technique with improved outcome. Material and Methods Hypertrophic clitoris is degloved leaving inned and partially outer praeputial layer with clitoris, preserving its vascularity. Clit...
Article
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 intra...
Article
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 performe...
Article
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...
Article
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 proxima...
Article
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 le...
Article
To report our experience of treating severe penile injuries with different causes and treatments, as penile trauma presents a difficult physical and psychological problem, and the type and extent of injury varies from mild to severe, sometimes even with total amputation. We analysed retrospectively 43 patients (mean age 28 years, range 5-52 years)...
Article
Metoidioplasty represents one of the variants of phalloplasty in female transsexuals. Its main characteristic is that it is a one-stage procedure. It involves lengthening and straightening of hypertrophied clitoris to create a neophallus, urethral lengthening to enable voiding while standing, and scrotal reconstruction with insertion of testicle pr...
Article
Different tubular structures have been used to create cutaneous catheterizable continent urinary stomas. The most common complication is stomal stenosis on the cutaneous end of the tubes. We present a variant of stomal stenosis repair that uses a buccal mucosa graft. Between January 2000 and March 2006 stenotic stomal repair was performed in 10 pat...
Article
Urethral reconstruction in severe hypospadias presents a great challenge. We have designed a method of combining a longitudinal dorsal island skin flap and buccal mucosa graft to create a neourethra in most severe hypospadias. Between January 2003 and March 2007, 17 patients (aged from 9 to 23 months) underwent severe hypospadias repair (13 penoscr...
Article
Wang and colleagues described the use of fasciocutaneous flap based on deep inferior epigastric perforator (DIEP) vessels for vaginal reconstruction. They presented four patients with congenital vaginal agenesis and one with vaginal tumor. The rhombus-shaped abdominal flap was designed according to the location of deep inferior epigastric vessels p...
Article
Surgical anatomy and histology of corporal bodies of the epispadiac penis is still not well described. Using our complete disassembly technique we revealed specific anatomical and histological features of the epispadiac penis which have a significant impact on surgical outcome.
Article
Surgical anatomy of the epispadiac penis is still not fully described. Using our complete disassembly technique, we discovered some anatomical features of epispadiac penis that may have significant impact on surgical outcome. A total of 52 patients 2 days to 19 years old (mean age 43 months) underwent primary repair of epispadias between October 19...
Article
To report our experiences of vaginal sacrospinous ligament fixation after vaginoplasty in male transsexual patients with the aim of preventing its postoperative prolapse. From August 1997 through November 2005, a total of 62 male transsexual patients (mean age 26 years, range 18 to 58) underwent sacrospinous ligament fixation for neovaginal prolaps...
Article
To present total phalloplasty in children and adults using a musculocutaneous latissimus dorsi (MLD) free flap to create a large neophallus, that allows easy urethroplasty and implantation of a prosthesis. From April 1999 to January 2006, 16 patients (mean age 24 years, range 10-34) had a total phalloplasty; the indications were congenital anomalie...
Article
Purpose Total phalloplasty in children generates a great dilemma concerning indications as well as neophallic size. Evaluating long-term results of total phalloplasty using different flaps with poor results regarding penile size, we developed a technique using a latissimus dorsi free flap in children with micro or absent penis and difficult psychol...
Article
Total phalloplasty is rarely performed in children due to the mutilation involved and the dilemma concerning neophallic size in children. We present a musculocutaneous latissimus dorsi free transfer flap for total phalloplasty in children with difficult psychological problems. Total phalloplasty was performed in eight boys aged between 10 and 15 ye...
Article
The Snodgrass technique presents the procedure of choice for distal hypospadias. Fistula formation is the most common complication with various rates. We evaluated the importance of a urethral covering using vascularized dorsal subcutaneous tissue for fistula prevention. Our study included 126 patients, aged 10 months to 16 years, who underwent hyp...
Article
We present our results with botulinum-A toxin transperineal pelvic floor/external sphincter injection combined with behavioral and biofeedback reeducation in children with voiding dysfunction who had been resistant to previously applied therapies. Eight boys and 12 girls between 7 and 12 years old (mean age 9) with recurrent urinary tract infection...
Article
To evaluate in a multicenter, prospective study preliminary aesthetic and functional results of autologous ex-vivo tissue engineering for penile girth enhancement. From July 1999 to January 2004, 204 men of mean age 26.77 (range 19-54 years) underwent this procedure. Indications for penile girth enhancement were penile dysmorphic disorder and previ...
Article
To assess the early disclosure and treatment of meatal stenosis after hypospadias repair, using calibration of the neourethral meatus at regular intervals to detect stenosis, and to assess the curative effects of dilatation with topical corticosteroids. Between 2001 and 2003, 83 boys (median age 19 months, range 12-28) had a proximal hypospadias re...
Article
We present a variation on the continent procedure using the refluxing megaureter for the Mitrofanoff channel, and its results. The Mitrofanoff procedure using the refluxing megaureter was performed in 35 patients (valve bladder syndrome 15, neurogenic bladder 10, non-neurogenic bladder 10) between 1995 and 2001. Mean patient age was 5.9 years. In 5...
Article
To evaluate the importance of urethral covering using vascularized dorsal subcutaneous tissue for preventing fistula in the Snodgrass hypospadias repair. The study included 67 children (aged 1-11 years) who had hypospadias repaired between April 1998 and May 2003, including 51 with distal and 16 with midshaft hypospadias. In all children, a standar...
Article
Correlation between lower urinary tract dysfunction, urinary tract infection (UTI) and vesicoureteral reflux (VUR) is complex and well known. The impact of lower urinary tract dysfunction treatment on frequency of UTI in children with VUR was assessed in our study. Lower urinary tract dysfunction was diagnosed in 32 girls and 4 boys; 19 (53%) of th...
Article
Peyronie's disease is a sexual medicine condition that may adversely affect male sexual function. To provide expert opinions/recommendations concerning state-of-the-art knowledge for the pathophysiology, diagnosis and treatment of Peyronie's disease. An International Consultation in collaboration with the major urology and sexual medicine associati...
Article
There are three different types of priapism: low-flow, ischemic, anoxic or veno-occlusive priapism; high-flow, arterial or nonischemic priapism; and recurrent or stuttering priapism. To provide recommendations/guidelines concerning state-of-the-art knowledge for the diagnosis and treatment of priapism. An International Consultation in collaboration...
Article
To describe a technique for repairing urethral diverticula which includes neourethral reconstruction and increasing the mechanical support of the neourethra. Between February 1995 and May 2000, 267 patients with proximal hypospadias underwent a one-stage penile skin longitudinal flap urethroplasty. The overall postoperative complication rate was 20...
Article
We investigated the morphology of the hypospadiac prepuce to develop a classification of different prepuce types in hypospadias. We also assessed the correlation between morphology and vascularization of the prepuce and their impact on results of hypospadias repair. From September 1997 to December 2001, 174 patients 18 months to 24 years old (mean...
Article
Objectives To describe a technique for repairing urethral diverticula which includes neourethral reconstruction and increasing the mechanical support of the neourethra. Patients and Methods Between February 1995 and May 2000, 267 patients with proximal hypospadias underwent a one-stage penile skin longitudinal flap urethroplasty. The overall postop...
Article
We assessed sexual behavior and sexual function in adults operated on for hypospadias. Long-term psychosexual adjustment was assessed with a standardized questionnaire which was mailed to 57 patients with hypospadias older than 18 years and 60 age matched normal control subjects. A total of 37 patients with hypospadias and 39 controls participated....
Article
Fecal incontinence is common in children with anorectal anomalies or spina bifida. If it is possible to achieve fecal control, patients are given a large volume of enema once a day. Retrograde enemas are often unpleasant in children, particularly in adolescents. Malone procedure of antegrade appendicostomy achieves antegrade colonic irrigation. Fro...
Article
Full-text available
Correlation between lower urinary tract dysfunction, urinary tract infection (UTI) and vesicoureteral reflux (VUR) is complex and well known. The impact of lower urinary tract dysfunction treatment on frequency of UTI in children with VUR was assessed in our study. Lower urinary tract dysfunction was diagnosed in 32 girls and 4 boys; 19 (53%) of th...
Article
To describe metoidioplasty, a technique for creating a neophallus from an enlarged clitoris in female transsexuals, without needing the complex, multi-staged surgical construction of a large phallus, as this reconstruction is one of the most difficult in female transsexuals. From September 1995 to April 2002 metoidioplasty was used in 22 patients (...
Article
Bladder autoaugmentation is a procedure that includes detrusoromyotomy or detrusorectomy with an aim to release intact urothelium, which then prolapses and increases bladder capacity and compliance. Covering of the prolapsed urothelium usually is done by using deepithelialized pedicled colonic or gastric patch. The authors present their first exper...
Article
Only sparse data are available on the blood supply of the hypospadiac prepuce. We investigated the development and course of the preputial blood vessels, and applied the results of this study to surgery for hypospadias. In 157 patients who underwent hypospadias surgery from October 1996 to December 2000 the prepuce was illuminated by a front and ba...
Article
Purpose: Only sparse data are available on the blood supply of the hypospadiac prepuce. We investigated the development and course of the preputial blood vessels, and applied the results of this study to surgery for hypospadias. Materials and Methods: In 157 patients who underwent hypospadias surgery from October 1996 to December 2000 the prepuce w...
Article
Bladder autoaugmentation is a procedure which includes detrusoromyotomy or detrusorectomy to release intact urothelium which than prolapses and increases bladder capacity and compliance. The prolapsed urothelium is usually covered with de-epithelialized pedicled colonic or gastric patch. We present our initial experience with bladder autoaugmentati...
Article
This review will highlight recent advances in the field of penile reconstructive surgery in the paediatric and adult population. It is based on the work published during the year 2001. Besides the anatomical and histological studies of the penis, major contributions have been described in congenital and acquired penile anomalies. Also, a few new te...
Article
To describe a technique for penile lengthening and the results achieved. The penis is completely disassembled into its anatomical parts; the glans cap remains attached dorsally to the neurovascular bundle and ventrally to the urethra and corporal bodies. A space is created between glans cap and the tip of corpora cavernosa; this space is used to in...
Article
To present an approach for treating Peyronie's disease, using the penile disassembly technique for reconstructive surgery. From November 1996 to September 2000, 74 patients with Peyronie's disease were treated surgically. The penile disassembly technique was used in 46 of the patients (mean age 51 years, range 21-63). The indications were severe pe...
Article
To describe and present the results of a one-stage vaginoplasty in male-to-female sex reassignment surgery. The present technique is based on penile disassembly and the use of all penile components for vaginoplasty (except the corpora cavernosa). The neovagina consists of two parts; a long vascularized urethral flap and a pedicled island tube skin...
Article
Megaureter represents the ideal tissue for bladder augmentation but to date ureterocystoplasty has been used only in select cases. We demonstrate that ureterocystoplasty can be used more frequently by dividing the megaureter and using its distal part for bladder augmentation and proximal part for reimplantation into the bladder. This technique can...
Conference Paper
Purpose: Megaureter represents the ideal tissue for bladder augmentation but to date ureterocystoplasty has been used only in select cases. We demonstrate that ureterocystoplasty can be used more frequently by dividing the megaureter and using its distal part for bladder augmentation and proximal part for reimplantation into the bladder. This techn...
Article
We present 2 variants of the penile disassembly technique for epispadias repair that refine some details of the Mitchell technique. In some cases the urethral plate retracts and shortens, and there may be poor vascularization at the most distal portion. In addition, when the neurovascular bundles of the separated hemicorporeal glanular bodies are i...
Article
We report our experiences with penile disassembly technique in the treatment of severe hypospadias. During a period from November 1995 to December 1997 the technique was applied to 102 patients, aged from 9 months to 32 years. The principle of the technique involves separation of the penis into its component parts: glans cap with neurovascular bund...
Article
Techniques for penile straightening generate the serious dilemma of which is most appropriate. We created and describe our penile disassembly technique to avoid penile shortening in curvature repair. From November 1995 to March 1997 we performed our penile disassembly technique in 87 patients 12 months to 47 years old (mean age 4.5 years). Indicati...
Article
To report experience and results with penile disassembly in hypospadias repair. From November 1995 to May 1997 penile disassembly was used in 92 patients aged from 9 months to 32 years. The indications for operation were hypospadias with severe penile curvature (especially with curvature in the distal third of the corpora cavernosa), chordee withou...
Article
The field of hypospadiology remains full of challenges in the search for new and better solutions. In recent years, our concept has involved being very radical in penile reconstructive surgery, using an aggressive approach. The penile disassembly technique, either complete or incomplete, is used successfully in epispadias repair. We began using pen...
Article
We report our efforts to create an ideal continent urinary catheterizable stoma. Our approach includes the creation of a continent stoma using a preputial penile island skin flap in male patients and a preputial clitoral island skin flap in female patients. The flaps are transposed suprapubically, tubularized and implanted in a nonrefluxing manner...
Article
Despite the progress made in understanding the factors regulating sexual differentiation, infants born with ambiguous genitalia face significant problems. The authors reviewed a group of 84 children with ambiguous genitalia managed surgically between 1986 and 1993. The most frequent condition was male pseudohermaphroditism (PM) (58%); 31% had femal...
Article
An operative procedure for phalloplasty is reported that uses an extended pedicle island groin flap. Forming a combined groin and lower abdominal flap based on the superficial iliac and epigastric vessels is the main characteristic of this technique. The flap consists of 3 parts: 1) the lateral narrow hairless part for the neourethra, 2) the medial...
Article
A variant of the onlay island flap urethroplasty in severe hypospadias repair is described. The principles of technique are: mobilizing of urethral plate, without dividing it, in order to release chordee; creation of pedicle island flap on the dorsal penile skin, with redundant vascularized tissue, which is transposed to the ventral side of penis b...
Article
From 1987 to 1992, 128 predominantly male patients 15 days to 19 years old (mean age 22 months) with a total of 167 megaureters underwent surgery for obstruction and/or reflux and symptomatic recurrent urinary infections. The technique consists of creating 2 holes through a muscle up to the mucosa by the detrusor splitting maneuver on the lateral b...
Article
A variant of the onlay island flap urethroplasty in severe hypospadias repair is described. The principles of the technique include mobilization of the urethral plate without dividing it, release of chordee, creation of a pedicle island flap on the dorsal penile skin with redundant vascularized tissue that is transposed to the ventral side of the p...
Article
A 1-stage surgical repair of penoscrotal transposition with hypospadias is described. The basic principles are correction of hypospadias with the best vascularized island penile skin flap used for a new urethra and 2 vascularized sliding skin flaps used for reconstruction of the penile skin, and transposition of the penis to the suprascrotal positi...
Chapter
Das Grundproblem in der chirurgischen Behandlung der Epispadien stellt die Penislänge dar. Bei dieser Mißbildung ist nämlich der Penis sehr kurz, mit ausgeprägter dorsaler Krümmung. Dies alles wird durch die Divergenz der Schwellkörper, ihre Beziehung zum Schambein, das Vorhandensein außerordentlich kurzer Harnröhre oder durch die Veränderungen der...
Chapter
Hypospadia sine Hypospadia stellt ein klinisches Syndrom dar, das drei morphologische Einheiten einbezieht, deren Eigenschaftbezeichnung ist die Peniskrümmung zu verursachen. Diese Einheiten sind: die Hautchorda, die fibröse Chorda und „congenital short Urethra“.