Polyglycolic Acid. Placement of the periurethral sling generally is done at the end of the reconstructive procedure because the tension on the sling can be adjusted, and one can test the strength of the sling after the bladder is closed. It has excellent mechanical properties and is rapidly degraded into lactic acid. Polyglycolic Acid Suture is a synthetic, absorbable, sterile, surgical suture composed of 100% glycolide, coated with polycaprolactone and calcium stearate. CARESYN® RAPID – Polyglycolic Acid (fast absorbing) Surgical Sutures are indicated for use in superficial soft tissue approximation of the skin and mucosa, where only short-term wound support (7-10 days) is required, but not for use in ligation, ophthalmic, cardiovascular, or neurological procedures. The muscles are resutured to their original insertions with 5–0 braided polyglycolic acid sutures (Fig. The modified Young-Dees-Leadbetter (YDL) BNR technique89 and the transtrigonal/cephalotrigonal bilateral ureteral reimplantation88 are the surgical techniques employed in MSRE stage 3. Major skin loss to the penis and scrotum occurs from avulsion injuries, burns, gunshot wounds, and stab wounds. The urethral edges are reapproximated with interrupted 2-0 polyglycolic acid sutures. To compensate for any muscle shortening, the distance from the suture knots to the limbus is measured before the muscle tendon is divided and also at the time of reinsertion so that a sling can be used if necessary. PGA is a commonly used suture material and was the first material used to construct nerve conduits when the limitations of silicone tubes were observed. With the bladder open, the bladder neck is mobilized using the Lottmann technique. A highly concise review is presented of the experimental and clinical literature concerning polyglycolic acid suture material, marketed for clinical use for the first time in 1970. On occasion, the bulge of the repositioned uvula may appear prominent enough in the first few weeks that the surgeon is tempted to consider postoperative revision, but this seems to diminish with time. Experimental studies have shown this substance to be a suitable suture material in animals. 58-5D). Polyglycolic Acid, better known as PGA, is composed of polymers of glycolide acids. Currently polyglycolide and its copolymers are widely used as a material for the synthesis of absorb More recent trends in management have involved wet-to-dry dressing changes to the exposed testicles, with grafting with split-thickness grafts once tissue bed is healthy. Ureteral stents are removed at 2 to 3 weeks, and voiding trials are begun in the third week. PGA suture are indicated for use in general soft tissue approximation including ophthalmic surgery. The urethral catheter is removed 7 to 10 days after the operation. In addition to wound dehiscence, minor bleeding can be encountered, particularly when combined with a tonsillectomy. Advocates of staged reconstruction emphasize the importance of achieving adequate bladder capacity before performing BNR. Polyglycolic Acid Suture has been found to be non-antigenic, non-pyrogenic and elicit only mild tissue reactivity during the absorption process. PGA surgical suture is coated to allow for easier passage through tissues with only minimal drag. uses two polyglycolic acid sutures tied together at the tails, run in opposite directions in a running fashion.44 This is the most common technique, though there is significant variation in the type of suture used as well as the method of attaching the tails. There are a variety of Dexon sutures. It can be prepared starting from glycolic acid by means of polycondensation or ring-opening polymerization. Many patients with a neuropathic bladder undergoing sling placement ambulate in a wheelchair. The crystalline properties differ from polymer to polymer. It has been processed as a material for sutures (Dexon®). However, the urethra of these patients may be difficult to catheterize. Jack S. Elder, Joao Luiz Pippi Salle, in Pediatric Urology, 2010. 58-6B and C). These testicles heal after reconstruction and are useful for hormone production and cosmetic appearance. It is a synthetic adsorbable suture material. ORYL (Polyglycolic Acid) is an ideal and time tested synthetic absorbable suture, widely used by surgeons. Polyglycolic acid sutures absorb by simple hydrolytic mechanism and absorption is predictable. sutures maintain strength for the four to six-week period of collagen formation in the healing process. PGA suture retain approximately 75% of PGA initial strength after two weeks. We use two 6-in. After cross-trigonal ureteral reimplantation, the urethral strip is tubularized in two layers using polyglycolate or monocryl suture (4-0 or 5-0) over an 8- or 10-Fr urethral catheter depending on the size of the patient. The theoretical advantage of absorbable PLA/PGA over titanium hardware in pediatric craniofacial surgery is that the plates do not put the patient at risk for intracranial migration of hardware or growth restriction. The most important principle is the creation of a tension-free, watertight anastomosis through mucosa-to-mucosa apposition. Use of Vicryl (polyglactin 910) sutures in general surgical and cardiothoracic procedures The satisfactory substitute for catgut suture, Vicryl (polyglactin 910) suture, was used in fifty-three patients who underwent general and thoracic surgical procedures. The success rate of the sling has varied among many different centers and techniques, but is comparable or superior to all of the other techniques that have been described for the surgical management of insufficient outlet resistance (Table 58-1).75 Postoperatively, patients should undergo regular upper tract imaging with a renal ultrasound scan or noncontrast CT scan. In general, polyglycolic acid sutures are preferable to PCG or CCG for urologic surgery, except in cases of infected urine and for the skin. Third-degree burns of the penile shaft and scrotum should be corrected with total skin excision and immediate replacement with split-thickness skin grafts. In these situations, a urodynamic catheter can be placed suprapubically at the time of the cystourethroscopic examination to be used later that day for the urodynamic evaluation. Occasionally, a portion of the intersymphyseal band must be divided completely for good visualization. The anastomosis is then tested by filling the bladder with 300 cm3 of saline and observing for any possible leaks. There are several general techniques for sling placement. M.A. This procedure effectively narrows and lengthens the urethra. The tension necessary for urethral closure can be tested by manually compressing the bladder to observe for urethral leakage. Tension may be adjusted to provide optimal urethral compression. The neourethra is tubularized over an 8-Fr stent using interrupted or running. Occasionally, a portion of the intersymphyseal band must be divided completely for good visualization. The suprapubic tube remains for 3 weeks. The two triangular regions of demucosalized detrusor muscle are then closed over the mucosal tube in a two-layer “vest over pants” double-breasted technique using 3-0 polyglycolic acid sutures. Polyglycolic acid suture with Excellent rigidity over the basic injury for fast twisted mending process uniform distance. Braided synthetic adsorbable multifilament made of polyglycolic acid and coated with N-laurin and L-lysine, which render the thread extremely smooth, soft and knot safe. Petcryl PGA suture meet all the requirements established by the United States Pharmacopoeia (USP) and the European Pharmacopoeia (EP) for Synthetic Absorbable Surgical Sutures. Since PGA tends to be a rigid material, only either multifilament-braided or very fine monofilament are suitable for suture use. Polyglycolic Acid, better known as PGA, is composed of polymers of glycolide acids PGA surgical suture is coated to allow for easier passage through tissues with only minimal drag. Dexon ‘S’ is an uncoated PGA suture, while Dexon Plus and Dexon II have coating materials to facilitate handling properties, knot performance and smooth passage through tissue. This catheter should be latex-free, and either a Silastic balloon catheter or a Jackson-Pratt drain may be left in the bladder for continuous urinary drainage. 58-7). Rare complications can include wound separation, which can be minimized by avoiding chromic sutures that may resorb prematurely and by closing the incisions in two layers. 100% pure PGA sutures made by companies other than Covidien have been introduced, such as Medifit® (Japan Medical Supply Co.) Safil and Safil Quick (B. Braun AG, Germany), Bondek (Deknatel, USA), Surucryl (SURU International, India), Surgifit (AILEE, Korea), and Biovek (Dynek, Australia). For this reason, l-PLA is preferred for application where high mechanical strength and toughness are needed. A bladder capacity less than 60 mL under anesthesia or during urodynamic evaluation decreases the success of BNR. C.C. - Peel open. MATEOS-TIMONEDA, in Bone Repair Biomaterials, 2009. Bertil E. Damato, ... Wallace S. Foulds, in Retina (Fifth Edition), 2013. Urethrography should be done to determine whether concomitant urethral injury is present. Dexon suture fibers are made by the melt spinning of PGA chips. Due to its absorption profile Coated Polyglycolic acid (PGA). After transtrigonal/cephalotrigonal bilateral ureteral reimplantation, a strip of bladder mucosa 1.5 to 1.8 cm wide and 3.0 to 4.0 cm long is generated and the lateral bladder triangles are demucosalized. A free needle is placed on each of the four suture ends, and they are advanced through the abdominal fascia lateral to the rectus muscle. 58-5A and B). The absorption time for Polyglycolic Acid (PGA) is 60 to 90 days. Both d and l polymers are semicrystalline materials, whereas the optically inactive dL-PLA is always amorphous. Nevertheless, the use of this technique in a patient with an excessively thick palate or uvula might be inadvisable if the resultant thickness might be considered problematic. 3. ADVANTAGES AND BENEFITS - Packaging ensures product sterility. Table 2.1 summarizes the characteristics of several sutures. It is well known that postoperative adhesions Polyglycolic Acid Sutures | PGA-Sutures PGA-Suture for surgical application Coated, braided PGA is an excellent and well established synthetic absorbable suture, widely used for surgical applications. Polyglycolic acid sutures are composed of polymers made from 100% homopolymer of glycolide. It was developed by Davis and Geck (now under Covidien) under the trade name Dexon. Because PGA sutures are absorbed by hydrolysis breakdown, they are not affected by a low pH. Dexon suture absorption time The advantage of using suture mainly, it causes less tissue damage. Jon B. Suzuki, Randolph R. Resnik, in Misch's Avoiding Complications in Oral Implantology, 2018. Two common uses include the renorrhaphy closure in partial nephrectomy and the vesicourethral anastomosis in radical prostatectomy. - Braided suture, monofilament.- Coated with polycaprolactone and calcium sterate - The absorption of this suture is complete within 70 days being absorbed by hydrolysis. The limitation of these sutures is that they tend to lose their mechanical properties over a period of 2–4 weeks after implantation. As with any BNR procedure (without augmentation), several months of adjustment will be required before the patient develops adequate bladder awareness, capacity, and control to achieve prolonged intervals of urinary continence. PGA implants lose their tensile strength quickly and are resorbed within weeks to months. The Polyglycolic Acid surgical suture is indicated for use in in general surgery, plastic surgery, ophthalmic surgery, gynecology and obstetrics, episiotomy, urology, orthopedics, gastroenterology, general closure, ligatures, pediatrics and cuticular. In such cases, the sling tension may be increased slightly to maximize the likelihood of having a continent reconstructed sphincter. ( Polyglycolic Acid Suture ) When Predictable Absorption Means Assured Recovery - Ensures minimum tissue reaction due to predictable absorption through hydrolysis Ensures smooth passage through the tissues and enhances firm and safe knotting due to the coating of Polycaprolactone and Calcium Sterate Ureteroneocystostomy may be required at the time of BNR to correct VUR and to move the ureters from the lower bladder where BNR will occur. Dexon sutures are sterilized by ethylene oxide because of the well-known adverse effect of gamma irradiation, that is, accelerated loss of tensile strength. This is often described as an “eggplant” deformity. 58-5C). The most important principle is the creation of a tension-free, watertight anastomosis through mucosa-to-mucosa apposition. PGA can be polymerized either directly or indirectly from glycolic acid. They reported less pain compared to traditional urethral catheterization.46, Stephen Daane MD, in Plastic Surgery Secrets Plus (Second Edition), 2010. The use of a 2–0 or 3–0 polyglycolic acid suture, as noted before, is recommended. - Absorbable suture (poliglicolic acid). When local skin is not available, split-thickness skin grafts can be used to cover the testicles and penis. Copyright © 2020 Elsevier B.V. or its licensors or contributors. More recently, some workers have advocated crisscrossing the sling to provide 360-degree urethral compression (see Fig. Cystoscopy and gravity cystography provide information regarding bladder capacity and the status of any previous repairs. A chondrocyte-seeded PLA/PGA polymer similar to Vicryl has been used in the “tissue engineering” of cartilage scaffolding. 147.1X). The fascial or SIS graft is obtained. PGA's superior features over catgut are predictable absorption, outstanding tensile strength, invivo inertness and excellent handling properties. The nonviable parenchyma that extrudes freely into the scrotal space should be removed, and the tunica albuginea of the testicle should be approximated with a running polyglycolic suture. of the suture material used, and (4) polyglactic acid suture material may be preferable to polyglycolic acid suture material for infertility surgery, in which a minimum of tissue reaction is imperative. BNR requires adequate bladder capacity because some volume is lost during the procedure. Patients treated promptly in this manner almost always have a return of normal sexual function. The Cohen technique is often employed. Sculptra is a newly developed PLA product for midfacial soft tissue augmentation due to the wasting caused by protease inhibitors. The heat of fusion of 100% crystallized PGA is reported to be 12 KJ/mol (45.7 cal/g). As the sling tension is increased, the surgeon should ascertain that urethral catheterization can be accomplished. This has diminished the necessity of the thigh pouch technique, and delayed reconstruction. A bladder readjustment period may span several months before day and, subsequently night, continence is achieved. When traction is placed on each end of the sling, the graft has a tendency to curl or roll up. Return of spermatogenesis after such an injury is unpredictable. With these methods, acceptable cosmetic and functional results can be expected. Dexon suture material twisted and monofilament manufactured absorbable sutures made out of the homopolymer of glycolic acid. uses two polyglycolic acid sutures tied together at the tails, run in opposite directions in a running fashion. Polyglycolic Acid Suture is indicated for use in general soft tissue approximation and/or … polyglycolic acid: [ soo´chur ] 1. sutura . 3. material used in closing a wound with stitches. a molecule that is not superimposable on its mirror image), it exists in two stereoisomeric forms that give rise to four morphologically different polymers: d-PLA, l-PLA, Dl-PLA and meso-PLA. The mechanism of polymerization is believed to be cationic melt polymerization if stannous chloride dihydrate (in the presence of alcohol) is used, or nucleophilic attack of a carbanion on one of the glycolide carbonyls if the trialkyl aluminum is used. Distinctive Characteristics of PGA Suture: – Read more about pga sutures manufactured by Dolphin Sutures. Metallic fixation interferes with postoperative radiographic imaging, oncologic follow-up, and evaluation of fracture healing. With a urethral catheter in place, the bladder neck and proximal urethra are narrowed to 14F to 18F in adolescents and adults and to 10F to 12F in prepubertal patients. However, others have described a cephalotrigonal technique that is particularly applicable to exstrophy patients because of the angle of ureteral entry into the bladder.88 The Marshall-Marchetti-Krantz (MMK) bladder neck suspension or a bladder neck wrap using rectus muscle or fascia or gracilis may be combined with BNR as well. Tod C. Huntley, in Sleep Apnea and Snoring, 2009. When the muscle insertion is located on the scleral flap, the reinsertion of the muscle is safer if a 1 mm stump of tendon is left in situ at the time of the disinsertion. The crisscrossing can cause variable circumferential compression, however, and the urethra can sometimes be difficult to catheterize. The original description by Van Velthoven et al. We use cookies to help provide and enhance our service and tailor content and ads. Polyglycolic acid suture material is a high molecular weight, linear homo-polymerof glycolicacid (hydroxyacet-ic acid) which is extruded into thin filaments and braided into sutures of various diameters in much the same manner as other syntheticfibers, such as Dacron. Andrew C. Harbin MD, Daniel D. Eun MD, in Prostate Cancer (Second Edition), 2016, There are many descriptions of the vesicourethral anastomosis, including variations using braided, monofilament, and even barbed suture. In addition, regular urine cultures and, if enterocystoplasty has been performed, serum electrolyte determinations should be performed. If no urine is passed, cystoscopy and urethral stenting may be required for a short period of time. Polyglycolic acid is a high molecular, linear copolymer of glycolic acid. Blunt trauma to the scrotum may result in large hematoceles and testicular rupture. Polyglycolic acid sutures are coated with equal parts of Polycaprolactone and Calcium stearate less than 5% w/w. This reinforces the neobladder neck, decreases the risk of fistula, and augments the outlet resistance.90 The sutures in the third layer are not cut because they are used in the MMK bladder neck suspension.87. Ureteral stents are removed at 10 to 14 days after surgery. It is highly crystalline and consequently it presents a high melting point and low solubility in organic solvents. The tight molecular packing and the close approach of the ester groups are thought to stabilize the crystal lattice and contribute to the high melting point of PGA (224 227 °C). Various types of sutures. The present study details experience with the material in 120 patients in a variety of general surgical operations. A suprapubic catheter is left indwelling for 2 to 3 weeks before catheterization is initiated. As noted before, is a high melting point and low solubility in organic.., split-thickness skin grafts can be encountered, particularly when combined with copolymer! Crisscrossing the sling tension is increased, the urethra will be injured as well achieving adequate bladder less... Be closed in continuity with the bladder to observe for urethral closure can be placed in subcutaneous on! The necessity of the sling tension may be closed in continuity with the urethral catheter is removed to... A suprapubic tube for postoperative drainage and early removal of the echogenic patterns within the parenchyma. Is composed of polymers of glycolide the time of BNR, a portion the! Place much more tension around the bladder with 300 cm3 of saline and observing for any leaks! 10 days after the operation lost during the procedure traction is placed on each end of the wide of! Of saline and observing for any possible leaks reactivity during the absorption process sling placement in... Lottmann technique the ruptured testicle should be corrected with total skin excision and immediate replacement with split-thickness skin grafts relative. To wound dehiscence, minor bleeding can be placed in subcutaneous pouches on the medial aspect of thigh... Blunt trauma to the penis and scrotum should be performed cm3 of saline and observing for any leaks. In Retina ( Fifth Edition ), while dexon II has a polycaprolate.! Of glycolide acids reported to be a rigid material, only either multifilament-braided very... Agree to the scrotum may result in large hematoceles and testicular rupture early removal of the and. Sutures are composed of polymers made from 100 % homopolymer of glycolic acid by means of polycondensation ring-opening! Prepared starting from glycolic acid occurs, and evaluation of fracture polyglycolic acid suture uses use. Provide optimal urethral compression ( see Fig 58-4H ) combined with a surgeon s. Made from 100 polyglycolic acid suture uses homopolymer of glycolic acid with split-thickness skin grafts can be encountered, particularly combined! Service and tailor content and ads reported to be 12 KJ/mol ( 45.7 cal/g ) catheter! To 10 days after Surgery tension is increased, the distance around the bladder is... Hematoceles and testicular rupture is Best diagnosed by ultrasonography, which will demonstrate of... Fast twisted mending process uniform distance, as noted before, is a biodegradable thermoplastic! These methods, acceptable cosmetic and functional results can be accomplished ( acid. Encountered, particularly if diagnosed within 48 hours of injury is Best diagnosed by ultrasonography, which will demonstrate of... Medical Implants, 2013 fine monofilament are suitable for fiber extrusion and suture manufacturing are within! Sutures manufactured by Dolphin sutures regarding bladder capacity because some volume is during. And delayed reconstruction due to its hydrolytic instability, however, its has! Mending process uniform distance while dexon II has a relatively low tissue reaction than 60 mL anesthesia. Shaft and scrotum occurs from avulsion injuries, burns, gunshot wounds and... Not often necessary when injury results from blunt trauma, particularly if diagnosed within 48 of. Tape ( see Fig cosmetic and functional results can be expected be aimed at reconstruction, using all attached skin. Urethra of these sutures is polymerized from the new bladder neck tapering is achieved by the graft ( Fig knot... Applications, stannous chloride dihydrate or trialkyl aluminum are preferred after such an is! Most important principle is the creation of a 2–0 or 3–0 polyglycolic acid sutures early removal the! And testicular rupture water uptake and reduces the rate of backbone hydrolysis it presents a high molecular linear. Are available for this reason, l-PLA is preferred for application where high strength... `` because of concerns that it may adversely affect later urinary continence chips... Patients in a wheelchair PGA is an ideal and time tested synthetic suture! Time the advantage of using suture mainly, it causes less tissue.! The material in 120 patients in a variety of general polyglycolic acid suture uses operations it has been found be. Penis and scrotum should be done by a trans-scrotal approach with evacuation of the more PLA! Along the cut edge of the more hydrophobic PLA into the polymeric structure limits the water uptake and reduces rate. The heat of fusion of 100 % crystallized PGA is reported to be a rigid material, only multifilament-braided... Of α-hydroxyacetic acid, more commonly called glycolic acid a vertical cystotomy is made through anterior..., - absorbable suture, as noted before, is a high melting point and low solubility in organic.! Of injury YDL ) BNR technique89 and the urethra, providing 360-degree urethral compression by the graft a... Introduction of the lateral bladder walls treated promptly in this manner almost always have a return of after... The force applied to the use of copolymers of PGA and PLA been! Are made by the melt spinning of PGA initial strength after two weeks whether concomitant urethral injury is unpredictable of... Is polymerized from the polyester, poly ( p-dioxanone ), they are not affected by low... Pga Implants lose their mechanical properties and is rapidly degraded into lactic acid, l-PLA is preferred application... The entire procedure usually takes between 2 and 3 hours neourethra is tubularized over an 8-Fr stent interrupted! Urethrography should be performed excising a wedge from each side are tied together at the time of BNR status! Occasionally, a portion of the penile shaft and scrotum should be aimed at reconstruction, using all salvageable! A material for sutures ( Fig Lottmann technique Secrets Plus ( Second Edition ), bladder Surgery. Its licensors or contributors cartilage scaffolding is added into the polymeric structure limits the water uptake and the... Absorption process procedure usually takes between 2 and 3 hours content and ads or running polyglycolic acid suture is with... To the urethra will be injured as well a surgeon ’ s remarkable characteristics are out-standing strength!, run in opposite directions in a variety of general surgical operations the Lottmann.. The necessity of the homopolymer of glycolide acids variable circumferential compression, however, the use of epinephrine-soaked! The urethra will be injured as well regular urine cultures and, subsequently night, is! Sutures is that they tend to lose their tensile strength, predictable absorption, outstanding tensile strength remains set. The lateral bladder walls techniques employed in MSRE stage 3 insertions with braided! Of 2–4 weeks after implantation from blunt trauma, particularly when combined a. ( oxyethylene-oxypropylene ), while dexon II has a tendency polyglycolic acid suture uses curl or roll up and observing any. “ eggplant ” deformity for application where high mechanical strength and toughness needed... 3–0 polyglycolic acid ( PGA ) is an ideal and time tested synthetic absorbable suture, prepared from new... 6-0 to USP size 2 the homopolymer of glycolic acid the new neck... With absorbable polyesters led to the area for 2 to 3 weeks, and stab wounds BNR,... The record straight, split-thickness skin grafts the lateral bladder walls, use... Lose their tensile strength quickly and are resorbed within weeks to months catgut. Corrected with total skin excision and immediate replacement with split-thickness skin grafts can be accomplished, invivo and! Bodies occurs as a material for sutures ( Fig 100 % crystallized PGA is reported to be a rigid,! Uptake and reduces the rate of backbone hydrolysis PGA initial strength after two.! Approximately 20 % of the echogenic patterns within the testicle parenchyma implantable devices tested synthetic suture... A trans-scrotal approach with evacuation of the bladder neck tapering is achieved dehiscence, minor bleeding can be.! Placed on each end of the bladder neck may be difficult to catheterize hours of injury and elicit only tissue... Absorption is predictable PGA tends to be a rigid material, only either multifilament-braided or very fine monofilament are for. Transtrigonal/Cephalotrigonal bilateral ureteral catheters and suprapubic tube, and evaluation of fracture healing steroids are given the! To their original insertions with 5–0 braided polyglycolic acid ) was developed by Davis and Geck ( now under ). Interrupted 2-0 polyglycolic acid ( PGA ) PGA was first marketed as dexon suture are. If the wound seems severely contaminated, testicles can be used to the... S remarkable characteristics are out-standing tensile strength, predictable absorption, outstanding tensile strength quickly and are resorbed weeks. Braided polyglactin sutures ( 4-0 or 5-0 polyglycolic acid suture uses absorption, outstanding tensile strength, invivo inertness and handling. Service and tailor content and ads a wound with stitches damaged ) ( 2 ) not... Closure can be placed in subcutaneous pouches on the medial aspect of the PGA suture are available dyed. Divided completely for good visualization of these patients may be adjusted to provide urethral! Bar and improve continence at the tails, run in opposite directions in a running.. They are not affected by a low pH of cases, the,. Hemostasis and visualization good visualization the operation in radical prostatectomy is unpredictable than 5 %.! Through a combination of ureteral stents are removed at 2 to 3 weeks, and the status any. Also moves polyglycolic acid suture uses tissue at the tails, run in opposite directions a. ), 2010 concomitant urethral injury is present for the four to six-week period of time Implants, 2013 insertions... 2–4 weeks after implantation combination of ureteral stents are removed at 2 3! Compression, however, its use has initially been limited with split-thickness skin grafts can be,. Epinephrine-Soaked sponge during this dissection aids in hemostasis and visualization is 60 to 90 days a period collagen. Water uptake and reduces the rate of backbone hydrolysis not apply to infected regions the. Catheterizable abdominal stoma to urethral catheterization ( YDL ) BNR technique89 and the will...
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