Management options for penile urethral strictures.
\r\n\tThe purpose of the book is to bring together the latest knowledge about genetic diversity by presenting the studies of some of the scientists who are engaged in development of new tools and ideas used to reveal genetic diversity, often from very different perspectives. The book should prove useful to students, researchers and experts in the area of biology, medicine and agriculture.
",isbn:"978-1-80356-945-1",printIsbn:"978-1-80356-944-4",pdfIsbn:"978-1-80356-946-8",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"0b1e679fcacdec2448603a66df71ccc7",bookSignature:"Prof. Mahmut Çalışkan and Dr. Sevcan Aydin",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11643.jpg",keywords:"PCR Based Methods, Protein Based Methods, Sequencing, Conservation of Genetic Resources, Natural Variation, Molecular Markers, Genetic Manipulation in Animals, Resistance to Disease, Genetic Manipulation in Plants, Use of Microorganisms in Biotechnology, Genetic Differentiation, Gene Therapy and Gene Editing",numberOfDownloads:16,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 7th 2022",dateEndSecondStepPublish:"June 16th 2022",dateEndThirdStepPublish:"August 15th 2022",dateEndFourthStepPublish:"November 3rd 2022",dateEndFifthStepPublish:"January 2nd 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Professor of genetics and molecular biology and Head of Biotechnology division at İstanbul University in Turkey whose main research areas include plant molecular genetics, microbial biotechnology and characterization and biotechnological use of halophilic archaeal strains.",coeditorOneBiosketch:"Associate Professor of Biotechnology Division in Department of Biology at Istanbul University in Turkey whose main research areas include genetics, environmental biotechnology and bioengineering.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"51528",title:"Prof.",name:"Mahmut",middleName:null,surname:"Çalışkan",slug:"mahmut-caliskan",fullName:"Mahmut Çalışkan",profilePictureURL:"https://mts.intechopen.com/storage/users/51528/images/system/51528.png",biography:"Mahmut Çalışkan is a Professor of Genetics and Molecular Biology in the Department of Biology, Biotechnology Division, Istanbul University, Turkey. He obtained a BSc from Middle East Technical University, Ankara, and a Ph.D. from the University of Leeds, England. His main research areas include the role of germin gene products during early plant development, analysis of genetic variation, polymorphisms, and the characterization and biotechnological use of halophilic archaea.",institutionString:"Istanbul University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"8",institution:{name:"Istanbul University",institutionURL:null,country:{name:"Turkey"}}}],coeditorOne:{id:"462767",title:"Dr.",name:"Sevcan",middleName:null,surname:"Aydin",slug:"sevcan-aydin",fullName:"Sevcan Aydin",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003QRfRpQAL/Profile_Picture_2022-03-24T08:49:06.jpg",biography:"Sevcan Aydın is an Associate Professor of Biotechnology Division in Department of Biology at Istanbul University in Türkiye. 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Knowledge was gathered about the treatment of urethral stricture disease by ancient Egyptians and other civilizations more than two millennia ago. Nonetheless, little has changed until about 60 years ago. Since then, the management of urethral strictures, including the penile urethral segment, has been in continuous and rapid evolution. Although various reconstructive techniques are available for the treatment of penile urethral stricture, no single technique has been identified as the method of choice. An understanding of the penile urethral anatomy is important for the diagnosis and treatment of penile urethral stricture disease.
\nUrethral strictures, in general, are associated with significant impact on patients’ quality of life. Penile urethral strictures, in particular, due to their exposed anatomic location and their surgical treatment, may cause significant impact on patients’ sexual function and perception of (un)satisfactory penile cosmesis.
\nThe anatomical and physical characteristics of the penile urethra are associated with additional challenges when compared to other urethral locations, especially due to its unsuitability for anastomotic repair and its relatively thinner corpus spongiosum. The choice of penile urethroplasty technique is largely influenced by etiology, location, length of the stricture, as well as prior surgical treatments. There are a number of challenges and controversies in the surgical reconstruction of penile urethral strictures, such as the use of grafts vs. flaps, use of skin vs. oral mucosa graft (OMG) tissue for augmentation or substitution techniques, the most appropriate indications for a single or a staged (at times, multiple) reconstruction, and, lastly, the management of particularly complex cases such as panurethral stricture disease and hypospadias “cripples” to achieve the best possible outcome.
\nAlthough penile urethral strictures can be managed by any of the above-mentioned procedures individually, they can also be more adequately treated by a combined approach. Among the various procedures available for treating urethral stricture, one-stage buccal mucosal graft urethroplasty is the current standard practice. The selection of technique for penile urethroplasty for an individual patient largely depends not only on the expertise of the surgeon but also upon the stricture’s etiology, pathological characteristics, and location. Therefore, contemporary reconstructive urologists working in this field should be aware of, and permanently keep themselves updated on, the numerous surgical techniques required to deal with any condition of the urethra that might surface at the time of surgery.
\nThis review provides a brief update of the options for the surgical reconstruction of different types and sites of penile urethral stricture as well as discussing current controversies, innovations, and possible future research in urethral reconstruction of the penile urethra.
\nClassically, the anterior urethra is divided, at the level of the penoscrotal junction inferiorly and the suspensory ligament superiorly, into bulbar and penile segments, the penile part consisting of the external meatus, fossa navicularis, and the penile shaft urethra. The penile urethra extends from the distal margin of the bulbospongiosus (or penoscrotal junction) to the external meatus. The bulbar (proximal) segment is the shorter of the two and is located in the midline between both the penile crural and the cavernosal bodies. The penile urethra (distal segment of the anterior urethra), also called pendulous, lies in a dorsal groove between the two corpora cavernosa and extends from the penoscrotal junction to the tip of the glans penis. It is surrounded in its full length by the corpus spongiosum; it is mobile and stretches during penile erection; and its length varies according to the penile length. The caliber of the anterior urethral lumen is relatively uniform, widening distally to form the fossa navicularis, and narrowing again to end at the external meatus (Figure 1).
\nSagittal sectional view of the male urethra. The areas in blue and yellow represent the corpus spongiosum and lumen of the anterior urethra, respectively. The penile urethra extends distally from the penoscrotal junction or pubourethral ligaments (reproduced with permission from Dr. Enzo Palminteri).
Histologically, the penile (distal anterior) urethra is surrounded by five tissue layers: urethral epithelium and lamina propria (urethral mucosa), corpus spongiosum, tunica albuginea, and Buck’s fascia [1]. Most of the penile shaft urethra is lined by a stratified and pseudostratified columnar epithelium, except for the distal penile urethra, including the fossa navicularis, which is lined by ciliated stratified columnar epithelium or stratified nonkeratinizing squamous epithelium. The lamina propria of the penile urethra is a fibroconnective tissue with elastic fibers and scattered, longitudinally oriented smooth muscle fibers. Multiple mucus-secreting glands drain into the anterior urethral lumen, known as Cowper’s glands in the bulbar urethra and Littre’s glands in the penile urethra.
\nThe anterior urethra obtains its blood supply from the first of three penile branches of the internal pudendal artery, which in turn is a branch of the internal iliac artery. The internal pudendal artery travels through the Alcock canal and gives the inferior rectal artery, posterior scrotal artery and perineal artery, and then terminates as the common penile artery. Three branches arise from the common penile artery: the paired urethral or, most commonly, bulbourethral arteries that pierce the perineal body at a posterolateral location and supply the urethra, spongiosum, and the glans. The other branches are the paired cavernosal arteries that pierce the penile hilum to travel in the center of the erectile tissue, and the deep dorsal penile artery that travel between the crura and beneath the pubic bone to run under the Buck’s fascia sending multiple circumflex branches to the corpus spongiosum and terminal branches to the glans penis, thus providing in a retrograde fashion a dual blood supply to the corpus spongiosum and urethra. It also sends cavernosal branches to contribute to the hemodynamics of the erection (Figure 2A and B). The venous drainage is through the emissary veins into the circumflex branches of the deep dorsal penile vein as well as through the urethral and bulbar veins into the internal pudendal vein. The anterior urethra is innervated by the urethrobulbar nerve, a branch of the perineal nerve derived from the pudendal nerve. The bulbocavernosus nerve, which is a branch of the pudendal nerve, gives off two branches that penetrate the rhabdosphincter at the three and nine o’clock positions. The pudendal nerve, gathering fibers from the second, third and fourth sacral spinal nerve, is both motor to the urethral rhabdosphincter and sensory to the urethra and glans penis (Figure 3). The lymphatic drainage of the anterior urethra is via the superficial and deep inguinal nodes, whereas the lymphatic drainage of the more proximal (the bulbar, membranous, and prostatic) urethra can take three routes: to the external iliac nodes, to the obturator and internal iliac nodes, or to the presacral nodes [2].
\nSchematic illustration of vascularization of the penis and urethra: (A) arterial blood supply and (B) venous blood drainage.
Schematic illustration of autonomic and somatic innervation of the penis and urethra (reproduced with permission from Dr. Enzo Palminteri).
Understanding the penile anatomy and, in particular, the penile skin arterial blood supply is an important resource for penile urethral surgical reconstruction. The penis is covered with an elastic layer of skin that has no subcuticular adipose tissue: the dartos fascia, a layer of loose areolar subcutaneous connective tissue in the penis and scrotum. It lies immediately beneath the penile skin, allowing the skin to move freely over the shaft of the penis and is contiguous with Colles fascia in the perineum. The dartos, also with no adipose tissue, slides freely over the underlying Buck’s fascia and is an extension of Scarpa’s fascia of the abdominal wall, carrying superficial nerves, lymphatics, and blood vessels, which make this fascia extremely useful in bringing blood supply and preventing fistulation in urethral reconstruction. Beneath the dartos fascia lies the Buck’s fascia, which surrounds the tunica albuginea of the two corpora cavernosa and the corpus spongiosum.
\nThe development of fasciocutaneous penile skin island flaps, either as a vertical flap (as in Orandi flap) or as a circular transverse flap (as in McAninch/Quartey flap), takes advantage of the natural anatomical, relatively avascular cleavage planes between the skin and the dartos fascia and another between the dartos fascia and Buck’s fascia.
\nThe blood supply to the penile skin and anterior scrotal wall comes from the external pudendal arteries, whereas the inferior and posterior aspect of the scrotum derives its blood supply from the posterior scrotal arteries, which are branches of the perineal artery, which in turn is a further branch of the internal pudendal artery (Figure 4). The superficial/superior branches of the external pudendal artery travel from medially and across the femoral triangle and within Scarpa’s fascia to enter the base of the penis. After giving off anterior scrotal branches, they arborize to form an arterial network within the dartos fascia. Also, at the base of the penis, branches from the axial penile artery form a subdermal plexus to supply the distal penile skin and prepuce. Because the communicating vessels between the subcutaneous and subdermal arterial plexuses are minimal, a relatively avascular plane can be developed between the dartos and Buck’s fascia. This fascial plexus, that is considered axial, is the true blood supply to the penile island skin flaps used in urethroplasty and, therefore, they can be mobilized widely and transposed aggressively and reliably.
\nSchematic illustration of the superficial arterial supply and venous drainage of the penis and scrotum.
The venous drainage of the penis includes the superficial dorsal vein, the deep dorsal vein, and the crural veins. The superficial dorsal vein drains the skin of the penis and empties into the superficial external pudendal vein and then into the saphenous vein. The deep dorsal vein begins at the base of the glans and retro coronal area and then travels deep to the Buck’s fascia between the paired deep dorsal arteries. Along its course, it receives circumflex veins from the spongiosum until it passes under the pubic bone to join the periprostatic venous complex. The cavernosal veins drain into a subtunical venous plexus; then through emissary veins, they join the circumflex veins, which in turn empty into the crural vein and the periprostatic plexus or the internal pudendal veins. The lymphatic drainage of the penis is primarily to the superficial inguinal nodes.
\nA detailed understanding of the anatomy of the anterior urethra is a critical prerequisite for the accurate diagnosis and successful management of urethral strictures.
\nThe etiology of contemporary urethral stricture disease involves a traumatic, iatrogenic, inflammatory, and idiopathic origin [3, 4]. Pathophysiology differs with age. The major causes of anterior urethral stricture in children are more likely to be trauma, mainly straddle injury, and complications from hypospadias surgery. Congenital and idiopathic strictures may also occur in children. In adult patients, most urethral strictures have an iatrogenic origin, mainly traumatic catheterization or transurethral manipulation or instrumentation. In the <10-year-old age group, strictures are mainly localized in the penile urethra, whereas in the >10-year-old age group, the bulbar urethra is the most common location [5].
\nUrethral dilatation |
Internal urethrotomy |
Laser urethrotomy |
Grafts |
Flaps |
Combination of grafts and flaps |
One-stage urethroplasty |
Staged urethroplasty |
Management options for penile urethral strictures.
In the past, inflammatory urethral strictures were predominantly associated with gonococcal urethritis, which has been effectively eradicated with penicillin-based antimicrobial agents. However, the emergence of resistant strains of
Stricture etiology is of particular significance in the penile urethra, as they tend to be more diffuse in nature (averaging 6.1 cm), especially if associated with LS, and shorter in the bulbar urethra (averaging 3.1 cm). Urethral strictures can be classified by their most common urethral location. Strictures involving the external meatus and fossa navicularis are predominantly inflammatory and iatrogenic in origin in 33–47% [3]. In the series reported by Fenton et al., globally, the etiology of anterior urethral strictures was idiopathic in 34%, iatrogenic in 32%, inflammatory in 20%, and traumatic in 14% [3].
\nIatrogenic strictures are typically associated with instrumentation, such as transurethral resection, prolonged catheterization, and cystoscopy, totaling 90% of all penile strictures. Prior hypospadias repair and radical prostatectomy contributed to 6.3 and 3.2%, respectively [3, 8]. Such strictures are mainly the result of an ischemic injury secondary to traumatic urethral manipulation or instrumentation, particularly when a large bore catheter or resectoscope is used. Therefore, whenever relatively prolonged catheterization is necessary, smaller caliber/Fr catheters are recommended. For more extended periods of time, a suprapubic catheter is a better option.
\nMalignant strictures should be approached in a different clinical context and most likely require mutilating radical surgery.
\nAny relevant past history of urethral instrumentation, hypospadias surgery, and genital trauma should be obtained. Obstructive voiding symptoms should be assessed with a validated questionnaire. Presence of risk factors and comorbidities that may provoke ischemia or impair wound healing should be probed for. These include obesity, diabetes mellitus, severe peripheral vascular disease, cigarette smoking, long-distance bicycle riding, horseback riding, and sexually transmitted infections.
\nPhysical examination should include palpation of the penile shaft for nodules or dense urethral scarring or constriction. The urethral meatus should be examined for narrowing and the surrounding glans for signs of LS. The penis should be examined to assess whether the patient has been circumcised, or there is sufficient shaft skin to allow development of a penile skin flap. The bladder should be assessed for potential detrusor hypocontractility, distention, and presence of an abdominal scar from a previous suprapubic cystostomy.
\n“En plateau” obstructive uroflow in a patient with anterior urethral stricture.
Retrograde urethrogram of long, irregular, “saw-toothed” penile urethral stricture typical of lichen sclerosus.
Any appropriate treatment plan needs accurate identification of the stricture characteristics: location, length, depth, and thickness of fibrotic tissue (spongiofibrosis). It is critical that both the proximal and distal ends of a urethral stricture are completely and accurately assessed with endoscopy and bougienage during reconstruction as to not miss any diseased segment of the urethra. Both patient and urethral reconstructive surgeons must understand completely the goal(s) of treatment before a decision is made. The decision to choose urethroplasty over another approach to a specific urethral stricture depends on patient expectations, goals, and comorbidities. In elderly or frail patients, an expectant or conservative management is more likely to be offered. Therefore, treatment options and their individual potential outcomes in terms of cure, or simply palliation, and complications should be carefully discussed with the patients and their family. On the other hand, urethral reconstructive surgeons need to keep themselves updated and abreast regarding the vast array of treatment options and their precise and specific indications and, therefore, should be flexible enough to intraoperatively adapt and/or adopt a different strategy for a specific scenario, which was not anticipated preoperatively. Thus, it is only legitimate and ethical to embark on urethral reconstruction if one can master and offer the patient all necessary surgical options to treat his specific urethral problem. It is very important to bear in mind that the penile urethra is the most exposed segment of the male urethra, and any surgical procedure or technique should achieve not only a satisfactory functional outcome but also a cosmetic one.
\nThe key techniques include mainly urethral dilatation, endoscopic urethrotomy, anastomotic repairs (rarely in the penile urethra), substitution repairs (ventral, dorsal, double-faced), free grafts of skin (full thickness and split thickness skin), oral mucosa, lingual mucosa, bladder mucosa, retroauricular skin (Wolf’s graft), and skin flap repairs (circumferential, longitudinal and variants) from penile and (less commonly) scrotal skin, as well as the use of adjunctive maneuvers such as the use of advancement flaps for additional blood supply or defect coverage (Table 1).
\nA meta-analysis of outcomes and complications of laser versus cold-knife urethrotomy compared unfavorably regarding laser: 12 versus 6.5%, respectively [21]. Laser urethrotomy may look appealing for the anterior urethra but with no definitive benefit over cold-knife urethrotomy.
\nOral mucosal graft is currently the graft of choice, owing to their short harvest time, easy harvest technique, and the physical characteristics including resistance, durability, immunogenic properties, excellent vascularity, hairlessness, low oral morbidity, concealed donor site and high success rates [24, 25]. For these reasons, over the past 20 years, oral mucosal grafts have shown better handling characteristics and long-term stricture-free outcomes, and have replaced both penile skin grafts and flaps. However, patients with long and complex urethral abnormalities or with contraindications to oral mucosal graft use, such as those with leukoplakia, systemic skin disease of the oral cavity or history of chronic tobacco chewing may still necessitate split or full thickness skin grafts.
\nOne controversy in anterior urethral grafting is related to dorsal or ventral placement of the graft on the urethra. Some urethral surgeons favor dorsal placement in both bulbar and urethral strictures, whereas others opt for ventral placement [26, 27, 28, 29, 30, 31]. Although several studies have demonstrated comparable success rates for dorsal and ventral onlay grafting, the author of this chapter favors the use of dorsal placement of the graft in the penile urethra because the spongiosal vascularity in the ventral urethra is thinner and the graft support is less reliable when compared to the dorsal urethral surface.
\nVarious penile skin flaps have been described, which can be raised ventrally or dorsally on the penile shaft and taken longitudinally or circumferentially [37, 38, 39]. These flaps are fasciocutaneous in nature and are based on dartos fascia pedicle. The ventral, longitudinal flap, as described by Orandi, is best suited for penile shaft urethral strictures that do not reach the base of the penis or any part proximal to the penoscrotal angle because hair-bearing skin will inevitably be involved in the reconstruction. On the contrary, the transverse, circumferential preputial/distal penile skin flaps are long enough to bridge defects of the entire penile urethra and most of the bulbar urethra for example in panurethral defects. Ideally, flaps should be hairless, adapted to a moist environment, with a reliable vascular pedicle, mobile, and cosmetic. In general, anterior urethral reconstruction with the use of flaps has become less prevalent due to the increased popularity of oral mucosa grafts. A rise in prevalence of genital and urethral LS has also contributed to the near abdication of the use of flaps. Nonetheless, island skin flaps still find an important indication in reoperative cases with extensive spongiofibrosis and ischemic urethral mucosal plates where chances of graft take are minimal. These circumstances occur after irradiation, severe trauma, or infection.
\nRepairs in adults who failed hypospadias repair in childhood pose a particular reconstructive challenge because of dense scarring, tissue inelasticity, inflammation, impaired blood supply, and penile and urethral shortening from previous, often multiple, operations [44, 45, 46, 47]. Penile urethroplasty should be performed in a single stage, whenever feasible, to avoid discomfort and disability to the patient from a multistage repair. Most strictures associated with trauma, infection, or instrumentation, where the penile skin, dartos fascia and spongiosum are not significantly damaged, can be approached through a single-stage procedure. On the other hand, presence of local infection or inflammation associated with a specific underlying disease process obliterated urethral segments with dense surrounding fibrosis, and a history of prior interventions, especially prior flap or hypospadias repairs, are contraindications for single-stage repairs and, therefore, should not be advised. The two-stage reconstruction involves surgical opening of the stricture, augmentation, or substitution (more commonly with use of oral mucosa grafting) of the diseased urethral segment and creation of temporary urethrostomy for drainage (first stage), followed between 4 and 6 months later by neourethral tubularization (second stage). Therefore, it should be confined to situations where it is inappropriate to maintain the axial integrity of the urethral plate and a full circumference urethral reconstruction is mandatory.
\nIn order to facilitate description and discussion of the various surgical procedures used for adult penile urethral reconstruction, we will group them according to stricture location in the urethra: (1) external meatus and fossa navicularis and (2) penile shaft urethra. Furthermore, a separate section will be devoted to procedures used for previously failed repairs or reoperative procedures (Table 2).
\n• Meatotomy/meatoplasty • Longitudinal skin flap techniques \n• Transverse ventral/circumferential fasciocutaneous skin island flaps \n• Graft techniques \n• Combination of grafts and flaps [65] • Endourethroplasty techniques \n
\n
\n
• Flap reconstruction \n• Graf reconstructions \n
\nTissue engineering/stem cell therapy |
Urethral reconstruction by stricture location.
Strictures involving exclusively the external meatus may be treated with
In 2004, Malone described a technique to relieve stenosis of the external urinary meatus resulting from LS [48]. The procedure is rapid and easy to perform on an outpatient basis, providing good cosmesis and functional voiding without spraying. The meatotomy is carried out dorsally avoiding a hypospadiac meatus. If the stricture extends into the fossa navicularis, oral mucosa graft reconstruction is performed. The final result is a slit-shaped with good caliber meatus at the tip of the glans. The procedure has been successfully reproduced by others [49].
\nSeveral variants have been reported. Cohney in 1963 described a penile flap procedure based on a circumferential elevated random penile skin flap. The distal urethra is well open, but the patient is left with a less appealing cosmetic result and a retrusive meatus (Figure 7A and B). Blandy-Tresidder in 1967 developed a flap procedure based on dartos fascia vascularity. It also provides good functional outcomes, but only modest improvement of the cosmetic final appearance. The meatus is usually left at the coronal level (Figure 7C and D). The Brannen flap repair [52], a modification of Blandy’s procedure, was described in 1976 to try to create a better cosmetic appearance of the glans and distal penile segment [53]. However, some mechanical problems associated with the flap advancement make this procedure inefficient and, therefore, offer marginal improvement in terms of cosmesis (Figure 7E and F). Designed to create a cosmetically normal meatus and glans penis, De Sy in 1984 further modified the Blandy and Brannen techniques using an advancement midline skin island flap [54]. However, the proximal portion of the flap is de-epithelialized leaving a distal skin island on dartos fascia (Figure 7G and H). Again, the mechanics of the flap advancement is inefficient.
\nSchematic illustration of several techniques for surgical reconstruction of strictures of the urethral meatus and fossa navicularis. (A, B) Cohney’s meatoplasty: an eccentric, transversely oriented, subcoronal flap is developed, and the urethrotomy is extended to normal urethra. The transverse flap is rotated into the urethrotomy defect. (C, D) Blandy’s meatoplasty: creation of a midline flap. Urethrotomy is extended till normal urethral lumen. The flap is advanced into the urethrotomy defect. (E, F) Brannen’s meatoplasty: a longer midline dartos-based flap is developed and is then widely advanced. (G, H) De Sy’s meatoplasty: a midline flap similar to Brannen’ technique is mobilized. The proximal portion of the flap is de-epithelialized leaving a distal skin island attached to a dartos pedicle. The de-epithelialized surface of the flap is anastomosed, and the ventral glans is reapproximated over the reconstruction (from Jordan and McCammon [
Schematic illustration of Jordan’s ventral transverse skin island flap procedure. (A–C) After urethrotomy is made till normal urethra, a ventral skin island flap is elevated above Buck’s fascia, and the lateral glans wings are exposed. The skin island is rotated, transposed, and inverted into the urethrotomy defect. The glans wings are sutured ventrally. Inset shows details of the rotation, transposition, and inversion of the flap (from Jordan and McCammon [
Fasciocutaneous distal penile flap urethroplasty as described by McAninch. (A–H) Urethral exposure followed by ventral longitudinal urethrotomy. The fossa navicularis is exposed with either a glans-cap or a glans-wings technique. A fasciocutaneous distal, transverse, ventral penile flap is developed. The urethral stricture can be corrected by either a ventral onlay or a neourethral tube. The glans wings or cap is sutured to cover the flap reconstruction (from Armenakas and McAninch [
Two-stage distal urethra reconstruction as described by Bracka. (a–b) Marsupialization of the urethra and placement of the oral mucosal graft after excision of the diseased urethral mucosa at the first stage. Aspect of the graft 6 months later, which is then prepared for tubularization at the second stage.
Transurethral ventral buccal mucosa graft inlay urethroplasty for reconstruction of fossa navicularis and distal urethral meatus as described by Nikolavsky. (a-e) Transurethral ventral shallow resection of scar tissue. Placement of double-armed suture through buccal graft and through apex of urethrotomy (inside out). External apical suture tying, meatal BMG edge fixation, and additional inside-out quilting of the graft with double-armed sutures (reproduced with permission from Springer Science + Business Media Dordrecht, Ref. [
Intraoperative demonstration of the procedure described in
Schematic illustration of single-stage, combined flap graft technique as described by Gelman. (A–C) Oral mucosal graft is placed and quilted dorsally followed by closure of the urethrotomy defect by a penile skin flap (from Gelman and Sohn, Ref. [
For penile shaft urethral strictures, a stricturotomy and onlay or inlay patch graft, or alternatively a flap reconstruction, can be used for simple strictures. More complex cases may eventually require total excision of the strictured area and circumferential reconstruction with OM grafts or penile skin flap. In more complex situations, such as after previous failed repairs and compromised or obliterated urethras, a staged reconstruction is preferable. Penile urethral strictures are rarely cured by dilatation or DVIU. If either of these procedures fail once, the chance of a better outcome with a second attempt is almost nil, making urethroplasty the only curative option. Anastomotic urethroplasty should be avoided in the penile urethra, even in short strictures, as ventral curvature usually occurs.
\nPatient advanced age and comorbidities may steer the urologist away from open surgery. In these circumstances, periodic urethral (self)-dilatation or definitive urethrostomy should be strongly considered.
\nWith the penis on stretch, a longitudinal nonhair-bearing skin island is marked on the ventral aspect of the penis. The description of the surgical technique is outlined in Figure 14. The penis is snugly dressed to avoid hematoma. Drains are rarely required. Patients are kept on strict bed rest for 3–5 days to minimize swelling. Intravenous antibiotics are administered for at least 48 h, followed by oral antibiotic prophylaxis for one additional week. Erections should be avoided. The use of a suprapubic catheter for urinary drainage is not mandatory but preferable, which should be kept for 2 weeks. The urethral catheter is left plugged to act as a stent only. After 2–3 weeks, the urethral catheter is removed and the patient is sent home with the suprapubic tube occluded, allowing the patient to resume urethral voiding. The suprapubic tube is removed after a few days of normal urethral voiding. If a fistula develops, the urethral catheter is not reinserted and the suprapubic diversion is maintained for another week. If still persistent, then it should be repaired after 4–6 months.
\nOrandi flap procedure. (A–C) Deep skin incision is made over the strictured urethra. Dotted line indicates skin incision. Dartos pedicled flap is created lateral to the superficial skin incision, which will cover the urethrotomy defect. The skin is closed in the midline (from Elliott and McAninch [
The Orandi flap is a reliable and relatively easy flap to harvest. It is a useful solution for a single-stage reconstruction of penile urethral strictures.
\nQuartey flap procedure. (A, B) Hockey stick skin island flap is fashioned. The length of the flap may be tailored as needed. After ventral longitudinal urethrotomy, the flap is anastomosed similar to the Orandi technique.
McAninch fasciocutaneous circular distal penile island flap. (A–D) Flap harvesting followed by ventral division of flap and pedicle, and then, it is rotated and anastomosed to the urethrotomy defect (from McAninch [
(A-B) Asopa technique used in long penile urethral stricture approached through a ventral incision.
Kulkarni’s one-sided dorsal onlay graft for anterior urethroplasty for long urethral strictures. (a-c) The penile shaft has been inverted into the perineum where the entire reconstruction is performed. This technique can be used to repair the entire length of the anterior urethra (reproduced with permission from Sanjay Kulkarni, MD).
Johanson’s two-stage procedure. (A–C) The anastomosis of the skin edges and the longitudinal urethrotomy is performed at the first stage. The urethrotomy is fashioned as a neourethral tube at the second stage. Modification with use of oral mucosal graft has been described.
Mesh graft urethroplasty as described by Schreiter. Meshed skin graft has been placed on the wound ground and quilted to the host bed (first stage). The prepared urethral plate is tubularized approximately 6 months later (second stage).
Algorithm of surgical reconstruction of strictures of the meatus, fossa navicularis, and penile urethral shaft. FN = fossa navicularis, LS = lichen sclerosus, TIP = tubularized incised plate, and OMG = oral mucosal graft.
To generate new tissues, biomedical engineering investigators have utilized three basic tools: cells, scaffold, and growth factor. The earliest use of human cells dates back to approximately 30 years ago [81]. Several different tissue-engineered grafts have been used for urethral reconstruction. There are two types of urethral grafts: (1) those that contain living autologous cells and (2) those that are cell free. The latter include grafts obtained from cadaveric or animal sources. This tissue undergoes treatment to become completely cell free. The resultant biological matrix is then implanted. A good vascular bed is needed to allow take and infiltration of host cells. As a rule, these techniques would only be expected to be particularly successful for substituting short urethral defects. In contrast, cellularized grafts contain a matrix populated with autologous cells, which are obtained from a small biopsy from the patient. The cells are cultured, expanded, and seeded onto the matrix. The matrix containing cells is then implanted onto the host bed [82].
\nA critical element required for successful tissue engineering is the cell source. Cells can be isolated from autologous urine-derived stems cells, smooth muscle cells, adipogenic, chondrogenic, and neural lineages [83]. Because simple cell injection to a target site is rarely feasible, a scaffold, or a template, also called artificial extracellular matrix, is necessary. The major function of a scaffold is to assist proliferation, differentiation, and biosynthesis of cells [84, 85].
\nScar modulation represents another potential development that may revolutionize urethral reconstruction. Antifibrotic injectables, acting as scar inhibitors, may be placed into the stricture after stricturotomy. Stents impregnated with tacrolimus or paclitaxel have been tried in animal and human models with apparently promising early results [86, 87].
\nRegenerative medicine (cell therapy and tissue engineering) has made solid progress over the last three decades. We cautiously hope that these technologies will finally enter the routine clinical environment and be applicable in the treatment of urethral strictures/stenosis.
\nThe spectrum of lower urinary tract symptoms (LUTS) at initial presentation for urethral stricture disease (USD) is well described. Anterior urethral stricture disease most commonly presents as urinary obstruction and may occasionally present as acute urinary retention. However, there is little data addressing these symptoms in patients after urethroplasty. LUTS after urethroplasty for anterior USD and the relationship of these symptoms to USD recurrence has also been observed [93]. It was reported that men with a successful outcome after urethroplasty tend to remain asymptomatic, whereas those who recur have LUTS, typically with weak urinary flow but without dysuria and hematuria. The authors supported the need for a USD-specific validated questionnaire to be used for follow-up after urethroplasty.
\nAll men being evaluated for lower urinary tract symptoms (LUTS) should include urethral stricture in the differential diagnosis and include a combination of patient-reported symptom measures, uroflowmetry to assess severity of obstruction, and postvoid residual volume by ultrasound to determine degree of urinary retention. Patients with urethral stricture typically present a weak flow rate. However, evaluation of urethral stricture requires further specific testing to delineate the location, length of the stricture, and degree of narrowing such as urethroscopy and retrograde urethrogram with or without voiding cystourethrogram. LUTS are the usual clinical manifestation of urethral strictures, regardless of location, etiology, and severity. However, LUTS after urethral stricture repair are not uncommon. Urgency has been reported in 40% of men and urge incontinence in 12% of men after anterior urethroplasty. De novo urgency and urge incontinence is seen in 9 and 5% of men, respectively, after urethroplasty. Once a complication of urethroplasty (such as recurrent urethral stricture or diverticulum) has been excluded as a cause, evaluation of LUTS in such patients should focus on the differential diagnosis between bladder dysfunction (overactive bladder and underactive bladder) and other outlet obstructions (such as benign prostatic obstruction), dysfunctional voiding, or medical causes (such as nocturnal polyuria). Management of overactive bladder has different treatment options, which may include behavioral modification, physical therapy, anticholinergic, and/or beta-3 agonist medications. In more severe cases, intravesical onabotulinum toxin, sacral neuromodulation, or peripheral tibial nerve stimulation may be indicated. Definitive treatment for underactive bladder is limited in number and success. Although management of LUTS for patients after urethral stricture repair can usually proceed similarly as for patients without prior history of urethral reconstruction, special consideration and alterations in management need to be made when instrumenting the urethra, as the urethral lumen may be narrower in these patients.
\nRecently, an analysis of risk factors leading to postoperative urethral stricture and bladder neck contracture (BNC) following transurethral resection of prostate (TURP) has been performed [94]. The authors have found that lower resection speed, intraoperative urethral mucosal rupture, and postoperative continuous infection were associated with a higher risk of urethral stricture, whereas more severe storage symptoms and smaller prostate volumes were associated with a higher risk of BNC after TURP.
\nPenile urethroplasty has evolved significantly over the last eight decades, since the first attempts at reconstruction using preputial tubes or a staged approach using penile skin [95]. An improved understanding of the pathophysiology of LS and a high complication rate following skin-based reconstructions favored a shift to the use of oral mucosal grafts, particularly in LS strictures. To date, very little advances have been achieved with conservative/pharmacological therapeutic options to stabilize or modulate the scarring process of this recalcitrant cutaneous disease.
\nCurrently, one of the critical limitations of penile urethroplasty is the common need for a staged reconstruction with all the inconveniences for the patient, and a 20–31% incidence of graft failure following the first stage, which leads to further revision(s) prior to the final tubularization [95]. Insufficient oral mucosal grafts for panurethral stricture reconstruction, especially in redo cases, add serious problems.
\nConsiderable research has been done in the areas of biomaterials, regenerative medicine, including scar modulation, and tissue engineering to overcome the limitations of current penile urethral stricture management. These experimental technologies appear exciting, revolutionary, and ripe with potential. The main goals of these research areas would be to produce scar inhibitors that might be placed into the stricture after urethrotomy, on the one hand, and to generate an ideal biomaterial in unlimited quantities, easily cultured in laboratory, readily available “off the shelf” and without the morbidity associated with graft harvesting, on the other hand. Unfortunately, we are not quite there yet.
\nThe surgical treatment of penile urethral stricture is continually evolving. No one technique is appropriate for all situations, and the successful reconstructive urologist needs to be comfortable with a repertoire of different, versatile techniques in order to best treat each individual patient’s problem. Since the early 1990s, OMG was introduced in urethral reconstructive surgery and has become the first choice of most urethral surgeons.
\nAlthough all are grouped as anterior urethral strictures, penile urethral strictures are different from bulbar urethral strictures. Flaps are still preferred to grafts in long, recurrent penile urethral strictures by some surgeons. Recently, one-stage dorsal OMG urethroplasty via perineal approach has been suggested for the management of most strictures of the penile shaft urethra with both good functional and remarkable cosmetic outcomes. However, in patients who have experienced failed hypospadias repair or in whom the penile skin and urethral plate are not suitable for urethroplasty, two-stage (usually multistage) urethroplasty is recommended. Management of some lengthy, complex strictures remains a great challenge even for experienced reconstructive surgeons. Staged urethroplasty, such as the Johanson’s technique with or without the use of grafts, is still a good surgical option. Regenerative medicine continues to show promise, but further investigation is needed to reach clinical application in the future. All in all, these great improvements in penile urethral surgical technique should lead to optimization of the surgical treatment algorithm.
\nTextile is an ancient industry that goes back to the beginning of the history of humanity, and its products range from products of daily usage to technical ones. All kinds of garments obtained by processing knitted, woven and nonwoven fabrics are categorized as the apparel sector. Actually, textile production is one of the main industries that affect global environmental pollution, as both the production and the processing of the necessary raw materials are contributing factors to pollution. Another important aspect of the problem is the waste that results from both production and consumption of the textile goods. Though technically all waste in the textile and garment sector can be recycled, unfortunately, only a small amount is recycled. As long as the linear system currently utilized in the production goes on, it seems that we will not be able to use the resources efficiently and reduce the environmental pollution.
Given that the current global trends persist, by 2050, the textile sector is expected to represent a quarter of the world carbon budget—26%, to be precise. The figures are colossal: If the current trends do not shift, the textile and apparel sector’s nonrenewable raw material usage will reach 300 million tons and the amount of microplastic released to the oceans will reach 22 million by 2050 [1].
One key concept to analyze and understand the situation is the linear economy. As the dominant model of production at least since the Industrial Revolution, linear economy basically works as “subtract the raw material from the source, convert it into a product, sell the product to the consumer, which eventually gets disposed of by the consumer after usage.” Under this model, products discarded by the consumer become waste and are generally disposed of ending up in landfills or by incineration [2].
The basis of the linear economy approach is the consumption of the raw material required for production. It seems that the limited resources available to us in the world will not provide the conditions for the current dominant economic model to go on as today. The actual perception of raw materials is not sustainable. Moreover, linear economy-oriented production and business models become a burden for the environment—the environmental aspect, the damages they cause and the waste that results from them are generally not considered.
An alternative to this traditional production model is what is called a “circular economy”: “A circular economy is based on the principles of designing out waste and pollution, keeping products and materials in use, and regenerating natural systems” [3].
In contrast to the negative aspects of the linear economic approach, the circular economy is seen as a sustainable development model for the future and increasingly stands out as an approach that is becoming widespread in the world. The circular economy is a systems model in which every part of a product is considered as a valuable resource that should be handled with care and resources are circulated again and again through closed loops.
The basis of the circular economy model is to expand the life-span of a product via repair, reuse, remanufacturing and recycling, so that resources are used more efficiently and the need for new products and virgin raw material is reduced or ideally eliminated [2].
In order to ensure sustainability and reduce environmental impacts in the textile and apparel sector, utilizing a circular economy model is of utmost importance. Recycling of textile waste is a requirement for the implementation of a circular model. This study presents a general evaluation of recycling of textile wastes, in terms of ensuring sustainability and minimizing environmental impacts.
Decisions of consumption have obtained a significant role in today’s world—the choice of what you eat, where you go, what you wear and so on has become decisive factors of showing who you are and what you want to be, of displaying one’s social identity. When one talks about consumer behavior in the textile sector, fashion is the key concept. Fashion presents the markers for social differentiation, mobility and identity, and allows a person to present one’s identity—moreover, this dynamism and speed of fashion allow people to change their conceived identity [4, 5, 6].
Certain historical, social and cultural changes can be said to have shaped contemporary fashion. The first big leap was the Industrial Revolution—the possibility of producing
Although the modern concept of “consumer culture” goes as far back as three centuries, the last few decades have witnessed unprecedented growth of purchasing and disposal of textile goods. The emergence of fashion as a defining force in consumer behavior resulted in overconsumption. The logic of fashion constantly pushes forward the need for change, which results in generating more and more requests to supply newer, fresher and more contemporary goods [9, 10]. Until the 1990s, the general tendency of fashion retailers was to release two main collections—spring/summer and autumn/winter—each year; however, during the 1990s, drastic changes occurred: The so-called era of “super cheap and super fast” arrived [11]. The increasing ability to outsource production to low-cost regions of a globalized world and thus to produce much cheaper clothes, combined with the inherent dynamism of fashion, paved the way for the emergence of what we nowadays conceive as the “modern fashion business” [12].
This fundamental role of dynamism inevitably positioned time as a crucial factor for the competitiveness of fashion companies. Consumers are conditioned to expect newness; thus, brand new products need to arrive at the stores with short time intervals constantly. This objective is accompanied by limited ranges and rapid stock turnaround for the companies [13].
The dominance of fast fashion and just-in-time production in the textile industry has led to more frequent seasons and minicollections in-between seasons, which has led to the arrival of new cheap items to the stores every week, even, in some cases, every day. It is a chain reaction: increase in the creation of new fashion trends, desires to experience the new spurring out of control, consumers buying more and more, and eventually overconsumption. This new concept of seasonal new collection brings about more incentives of buying for the consumer and, thus, increases the rate of textile consumption. However, the fashion industry not only has an impact on people but also has a big impact on the environment [10, 14].
The concerns about the environment are rapidly growing in today’s world and are shared by the fashion firms and the consumers. Textile production is an important source of human-made adverse impact on the environment, as the sector uses huge amounts of water, pesticides and chemicals. Attempts to establish guidelines for sustainability in the production phase, such as ISO 14000, are a reflection of this fact, and this aspect is quite relevant for fashion firms. On the other hand, the consumers are getting more and more conscious about the social and environmental problems, which have a direct effect on the consumption choices of the consumers, as in eco-fashion consumption [15, 16, 17].
Even though this burning issue is gaining more importance in all sectors, it can be said that textile lags behind other sectors, for example the industrial design, in terms of research and development about modes of production that would be more efficient for the conservation of the environment or ways to get the consumers more engaged in topics of sustainability. The industry needs more innovation in the aspects of design, manufacture, consumption and business within a sustainable framework [18, 19].
Sustainability is indeed a burning issue, and the following data demonstrate how important it is for the world to achieve greater success in the textile sector. Textile production, a sector that goes back to ancient times and has always maintained its pivotal role in human life, still has a paramount place in industry if one takes a look at the global output and employment numbers [20]. According to the Zion Market Research’s report, the textile market was approximately valued at USD 858 billion in 2018 globally and is estimated to generate around USD 1207 billion by the year 2025, at a CAGR of around 5% between 2019 and 2025 [21]. The global garment and textile industries employ 60 million to 75 million people worldwide [22]. The total volume of the production of the sector around the world is expected to exceed 99 million tons annually. These numbers are evidence to the importance of the applications of the industry for environment [23].
Clothing is an essential human need, and the textile and clothing industry delivers goods to satisfy this basic necessity. But this vital sector presents serious social and ecological problems in many instances of the supply chain—from fiber production, spinning, fabric production, dyeing and finishing, to clothing production [24, 25]. However, the increasing price pressure over fashion companies in the last decades does not help the companies in developing more sustainable production models. The price pressure has led many textile companies to outsource their production, which caused the bulk of the European and US clothing production shift to developing economies in Asia. The part of the value creation chain that remains in the Western countries is mostly limited to value-added services such as design and overall brand management. This production shift, with the relocation of a big part of the value chain in lower labor cost countries, presents a new challenge for sustainability, as the surveillance and control over labor and ecological practices in the production sites of the supply chain have become much more complicated [25, 26].
Sustainability, a word more frequently used every day nowadays, may sound very familiar, but it is difficult to define, understand and adopt in industrial practices. An apt definition for the term sustainable development, coined by Brundtland (formerly the World Commission on Environment and Development), is as follows: “The development that meets the needs of the present without compromising the ability of future generations to meet their own needs” [27]. Below is a list of the main obstacles for an environmentally sustainable textile and apparel sector:
Studies show that, in terms of consumption and pollution of clean water, textile and related industries are only surpassed by agriculture [28]. The sheer amount of water used during textile production, especially wet processing, tells a lot: to process a kilogram of fabric, 80 to 150 liters of water is used, along with other chemicals [29]. About 4% of global freshwater withdrawal, which corresponds to 93 billion cubic meters of water, is utilized annually by the textile sector, if cotton farming is included. Clothing is responsible for more than 60% of this amount [1].
The average temperature on Earth is constantly increasing, but especially since the Industrial Revolution, the rate at which the average temperature on Earth has been rising is too rapid—the phenomenon known as global warming. Various estimates put the rise at 0.6–0.8°C, which corresponds to a rise 10 times faster than the calculated normal. This man-made global warming is due to the amount of greenhouse gases released, such as carbon dioxide and chlorofluorocarbon, of the use of fossil fuels as well as of other developments [30].
Textile and apparel production has a major role in this global phenomenon. In 2015, greenhouse gas (GHG) emissions from textile production were responsible for 1.2 billion tons of CO2 equivalent of greenhouse gas (GHG). This figure exceeds the emissions that result from all international flights and maritime shipping combined—two fundamental means of transportation [1]. Transferring final products produced in developing countries to the shops in the developed ones necessitates long-distance maritime transportation, which further increases the total consumption of nonrenewable fuel [31].
Given that the actual trends of the sector do not alter, by 2050, 26% of the carbon budget and 300 million tons of crude oil will be consumed by the textile industry—a significant change compared with 2% and 98 million tons, respectively, in 2015 [1].
The textile industry utilizes much energy with little efficiency. The chemical processing leg of the production mostly utilizes thermal energy to heat water and dry fabrics, while spinning and weaving legs of the production mostly utilize electrical power [32, 33]. The consumption of electricity to produce 60 billion kilograms of fabrics worldwide per year is calculated to be nearly 1 trillion kilowatt hours [30].
Textile manufacture is also a source of NOx and SOx emissions, solvent release during drying of coatings or cleaning operations and volatile organic compounds (VOCs) [31].
About a quarter of chemicals produced globally are used in the textile industry [34]. Numerous chemicals are used for textile production, mainly in the wet processing. Of these nearly 2000 different chemicals, many have adverse impacts on health. Some chemicals evaporate, while others are dissolved in treatment water—which ultimately goes back to the environment—and some chemicals remain in the product [31]. Cotton clothing, which, after all, is regarded as particularly natural and healthy, calls for cotton farming, which currently needs 0.2 million tons of pesticides and 8 million tons of fertilizer globally. Although cotton cultivation accounts for only 2.5% of worldwide agricultural land, it is responsible for 16% of global pesticide utilization. Furthermore, the physical health of cotton farmers gets negatively affected from the chemicals used for cultivating cotton, and cases of acute poisoning from pesticides among cotton farmers are commonplace. About 4% of all nitrogen and phosphorus fertilizers used around the world go to cotton production, and these chemicals are a main source of clean water pollution. If merged into the rivers, these chemicals can lead to algal blooms, which starve the river of oxygen. Producing cellulose-based fibers also necessitates large amounts of chemicals and some of the chemicals used are sources of concern. However, the agricultural part of textile production is not solely responsible for the chemical use of the industry. Producing the fibers requires using chemicals too, for example for dyes or finishing treatments. This part of the production is estimated to use approximately 43 million tons of chemicals globally [1].
The microplastics contaminating the oceans are attracting more and more attention from concerned scientists, even though we still do not fully understand its long-term impacts. Microfibers discharged from textiles during washing processes add to the increasing plastic pollution in the oceans [1]. George Leonard, Chief Scientist for The Ocean Conservancy, estimates that the amount of microfibers on seafloor could have reached to the sheer figure of 1.4 million trillion [35].
The waste generated by producing and consuming textiles is another major concern. Textile consumption around the world is calculated to be over 100 million tons [23]. However, the rate of recycling is rather low: Barely 13% of the total material input is in some way recycled after usage. Of this recycled 13%, a minuscule part is used to produce new clothing—less than 1%. The rest is recycled into other, lower-value items such as insulation material, wiping cloths or mattress stuffing [1].
Additionally, odor problems and noise pollution are also negative effects of the textile industry on the environment. Odor pollution is an indicator of environmental change that affects health and human well-being. Odor impacts people by strong, unpleasant or offensive smells that can interfere with one’s enjoyment of life especially if they are frequent and/or persistent [36]. When it comes to noise pollution, there are different processes in the textile chain that can produce noise level above 90 dB(A), the allowed limit, and can cause problems especially for the workers. The dry processes produce more noise than the wet processes, due to the fast-moving parts in the processing machines, which is another danger for the workers along with the hearing problems [37].
The world population has grown tremendously in the past few decades, and the same period also witnessed improvements in living standards in general. These two developments have augmented the consumption of textiles, which in turn increased textile production [38]. The effect of the rising living standards can be seen in the fact that the worldwide consumption of textiles is growing faster than the world population. The demand is expected to grow from around 30 million tons in 1980 to more than 130 million tons in 2025. The figure translates into a growth of over 400%—or an average annual growth rate of 4.3%. In the same period, the world population has been growing by only 1.7% [39].
Global production of all apparel and textile fibers amounted to 110 million tons in 2018, according to the Discover Natural Fibers Initiative (DNFI). This number points to an increase of 4 million tons compared with the previous year and of 35 million tons compared with a decade ago. Natural fibers represent 29%—a 12% decrease since 2008. In 2018, cotton represented 81% of natural fiber production by weight, which overshadows the share of jute, coir and wool, which account for 7%, 3% and 3%, respectively. Cellulosic fiber production represented 6%, synthetic filament 45% and synthetic staple 20% of the total production in 2018. Polyester is the leading synthetic fiber, which represents almost 90% of world filament production and 70% of world synthetic staple production. The rest of the synthetic fibers are mostly composed of nylon, acrylic and polypropylene. However, the figures do not translate into a plunge in the production of natural fibers. The share of natural fibers in total fiber production has decreased in the last decade because the production of polyester has increased exponentially. Synthetic filament production, which is mainly used for the production of fast-fashion apparel, has risen from 26 million tons to 50 million in a decade after 2008, almost doubling in size. During the same period, synthetic staple production increased from 15 million tons to 22 million. Natural fiber production also increased from 2008 to 2018, but the rate was nowhere close to the others: from 31 million tons to 32 million [40].
The global market is prevailed by two types of fibers: polyester, a synthetic fiber, and cotton, a natural fiber. The trend mentioned in the previous paragraph is clearly reflected when the figures for these two fibers are examined. The demand for polyester has doubled—a significant rise that resulted in the fact that polyester has succeeded cotton, the most widely used fiber until the 2000s. Polyester fiber production is estimated to increase to be 3 times more than cotton production in order to meet the still-growing demand, while the production of cotton fibers remained stable. Increasing the production of cotton depends on the land and water resources, which are limited, and the fact that the opportunities to increase yields of cotton cultivation are narrow does not help either. These constraints on cotton production are very significant to understand the growth of the synthetic fiber market [39].
Still, it is important to point out that, despite the growth of synthetic fiber production, cotton, a product with very good fiber characteristics, remains to be considered as the most popular fiber. It is not expected that cotton would largely be replaced or eliminated in the short or medium term from the textile production. Thus, sustainability strategies for cotton will persist to be paramount for the conservation of the environment [25, 41].
Synthetic polymers are mainly produced from petroleum—a nonrenewable resource. But this is not limited to synthetic fibers: Renewable natural polymers such as cotton also depend on nonrenewable resources, because their production needs energy and chemicals that are actually produced from nonrenewable resources. The petroleum reserve of the world might last for several more centuries if the current consumption rates continue, but it does not change the fact that petroleum—like many other natural resources—cannot be replaced in practical terms [42]. Therefore, deciding if natural fibers or manufactured fibers are more eco-friendly is impossible. The production of all types of fibers comes with its own challenges. Some fibers need a lot of water, while others demand lots of energy to produce. The synthetic fibers are not fully biodegradable like the natural and cellulosic fibers, which broadens the waste aspect of the problem. Synthetic fibers are generally petroleum by-products, which makes them nonrenewable materials; however, this gives them the advantage to get conveniently recycled into a good-quality material like polyester—a contrast with cotton, which generally gets downcycled. But recently, the market has also started to receive recycled, high-quality cotton [19, 20].
Made-By, a nonprofit organization, carried out a study called “The Environmental Benchmark for Fibres.” The study focuses on the prevalent fibers in the clothing industry and compares the environmental impact of the production of these materials. The production of the fibers is analyzed from the raw material up until the preparation of the fiber to be spun, thus excluding the later stages, such as spinning itself, fabric manufacturing, dyeing and finishing, garment making, transportation of the product and consumption. The study lists 28 fibers from Class A to Class E (Class A being the most benign) not regarding their quality, durability or performance, but their direct effects on the environment: greenhouse gas emissions, human toxicity, eco-toxicity, energy input, water input and land use [43].
The results demonstrate that all mechanically recycled fibers and organic fibers score “positively,” while both natural and synthetic fibers obtained by conventional production methods are far behind in sustainability ranking. Class A materials include mechanically recycled nylon, mechanically recycled polyester, organic flax (linen), organic hemp, recycled cotton and recycled wool, while Class E materials include bamboo viscose, conventional cotton, cuprammonium rayon, generic viscose, rayon, spandex (elastane), virgin nylon and wool [43].
To protect not just human life on Earth, but Earth itself, we have to use the natural resources adequately. The rates at which natural resources are generated and consumed have to be appropriate for the sustainability of the planet. The 2011 annual report of the United Nations Environment Programme (UNEP) predicts the rate of consumption to triple the current rate by the year 2050 [44]. One alternative way to approach the solution of this problem is gradually replacing the traditional linear economy model—which relies on extraction/cultivation of raw materials, use of the product and disposal of the waste in landfills—with the circular material flow—which focuses on reusing and recycling.
Consumption of textile products has two main aspects that trigger environmental change: the pollution and waste brought about, and the natural resources expended. Pollution is generated not only during the production phase but also during the consumption of the products. The Earth has a natural system that can naturalize pollutants and stabilize a natural equilibrium to a certain extent, but the rate and degree of the release of man-made pollutants into nature challenge this natural equilibrium of the planet [45, 46].
The second factor is the depletion of limited natural resources of the planet through the consumption of goods. Conventional modes of production and consumption dictate utilizing both renewable and nonrenewable resources. Manufacturing processes required during production need natural resources such as fossil fuels (coal, oil and natural gas) to generate energy and raw materials for the actual products (as in the example of plastic, which generally is produced from petrochemicals). Furthermore, in most cases, more natural resources are used up to consume the products themselves. Unfortunately, the utilization of both nonrenewable and renewable resources has a major impact on both localized and global environmental change. As a result of the depletion of resources and generation of pollution, both producing and consuming goods by humans are important sources of environmental change [45, 46].
A significant amount of research has been conducted and published on the environmental impacts of the production and consumption of textiles. The research has helped to inform policy-makers and the public on reducing toxicity of chemicals in production stages, creating industry standards for production and promoting more sustainable ways of cleaning textiles. However, sustainability of the disposal of textiles was not paid much attention until recently.
Textile production is a burden for the environment. Textiles cost significant amounts of natural resources, and the use of toxic chemicals and generation of large quantities of carbon dioxide further augment the problem. However, despite this huge cost, millions of tons of textile products are disposed of every year. In Europe and America, 10 million tons of disposed textile products are predicted to be disposed of, while the estimation for China is double this amount. This textile waste pollutes our environment and clogs landfills around the world on top of all the natural resources used for their production.
Western lifestyle, with its dependence on the culture of consumption, amplifies landfill waste. Not only is the consumption at a high level, but also products are generally overpackaged in the West, which translates into more waste—and to the consumption of natural resources required for packaging. Landfill capacity is not growing at the pace of the increase of the generation of waste, which inevitably means that the cost of waste disposal rises further. This is a major concern for businesses as they need to reduce the overhead costs [38].
The disposal of textile wastes is crucial for the textile industry globally. Tons of textile products get discarded by the consumers and end up in landfills all over the world. Estimates suggest that a vast majority, as high as 95 percent, of the discarded product could in fact be used again—re-worn, reused or recycled, depending on their condition. Indeed, the conditions are pushing the trend, because, as natural resources are limited and cost of waste disposal is increasing, more waste is getting recycled or reused [47].
Textile wastes account for almost 5% of all landfill spaces, according to the US Environmental Protection Agency (USEPA); however, the recycled postconsumer textile wastes are barely 15% annually, and thus, a huge 85% of the waste ends up in landfills. Certain organizations, including the Council for Textile Recycling (CTR), are endeavoring to raise consciousness about keeping the postconsumer textile wastes out of the solid waste streams, with the aim of reaching the level of zero textile waste going to landfills by 2037 [44].
Textile waste is produced through a number of streams including the fiber, textile and clothing manufacturing industry, consumers and the commercial and service industries. CTR categorizes textile recycling material as pre- or postconsumer waste [48, 51].
Preconsumer textile waste, according to CTR, is the waste generated during production—by processing fibers, and the production of finished yarns and textiles, technical textiles, nonwoven, garments and footwear, including offcuts, selvages, shearings, rejected materials and/or B-grade garments. Preconsumer textile waste is usually what is considered as “clean waste.” Preconsumer textile wastes are produced by the original manufacturers and never make it to consumers [44, 48].
Postconsumer textile waste refers to textile products that the consumer disposes for any reason—they might be run-down or not liked by the consumer anymore. Generally, postconsumer textile wastes tend to be of good quality, which can be recovered or reused as second-hand clothing, and are generally sold to poorer regions of the world. Even the textile products that will most likely not be used by the consumers can potentially be shredded into fiber to be reused for manufacturing [48].
The fast fashion era has skyrocketed the rate at which textile products are discarded, as “going-out-of-fashion” has become one of the main reasons for “not liking the product anymore.” The implementation of a convenient recycling regime can turn these wastes into raw materials to be used in producing future, value-added products. This is the current aim for the ongoing development of textile waste management systems, which seek to produce value-added products through recycling [44]. Textile waste treatment strategies include reducing, reusing and recycling, as shown in Figure 1. The first and most preferred approach, reducing, is aimed at, if possible, avoiding any waste entirely. The second approach, reusing, aims literally for the item to be reused by a consumer after it has been discarded by another. The third and last approach is recycling: the materials of discarded items are transformed into new products [49]. Wastes can be recycled to products for the same purpose with their first use, or they can be upcycled or downcycled. In upcycling, wastes are converted into high-value products with different purposes than the original use, while in downcycling, valuable products are converted into lower-value materials [50].
Textile waste treatment strategies 3R concept.
Sustainability aspires to derive maximum benefit from products by extending their life. Studies conducted by economists and environmentalists on technical and economic requirements for sustainability reveal that it is imperative to reduce waste generation and increase recycling. Below are a few reasons why recycling is important [51, 52]:
Economical reasons: recycling programs cost less than waste disposal programs. The high water, energy and manufacturing consumption makes it much cheaper to recycle than to produce some new textile products. Recycling can be made financially rewarding, as people can receive money for turning in certain recyclable products.
Social reasons: recycling creates jobs. Recycling centers create four jobs for every one job in the waste disposal industry. The method can also create opportunities for small businesses.
Environmental reasons: recycling conserves natural resources such as water, oil and natural gas; saves energy as it requires less energy compared with manufacturing brand new products; produces less greenhouse gases; and prevents the destruction of natural habitats.
Recycling and recovery of textile products are not as common as the material groups such as glass, metal, plastic and paper and product groups such as electronic, packaging and automotive. Recycling activities related to the textile sector are mainly focused on the treatment of chemical wastes and polluted water—problems that arise during production processes. The number of scientific or practical studies on the recycling of solid wastes is extremely limited [53].
Even though the textile and apparel sector is one of the most intense consumption sectors, implementation of recycling throughout the sector is not satisfying. However, parallel to the increasing global awareness of environmental problems, the awareness of consumers about sustainability has also started to increase. Consumers are now demanding recycled textile products and manufacturers are seeking ways to meet this demand [53, 54].
The waste generated by the textile sector contributes to land, water and air pollution. Decomposing textiles generate greenhouse gases and thus air pollution. The vast amount of chemicals used for producing textile goods unavoidably pollutes the rivers. And discarded textile products fill up landfills, which are already scarce. All these wastes are resources that could have been used to create value-added products. Not only this potential is lost, but also more raw materials are required to be used, which in turn results in more energy to be consumed [55].
Wasted materials can be recovered through reusing a product as is and converting the waste into a product. A material should get to be reused as much as possible and the consumer finally decides to discard it, and then recycling would be a good alternative to reduce the carbon footprint [56].
Recycling technologies tend to be divided into primary, secondary, tertiary and quaternary approaches, and all these four methods are applicable to recycle fibers. Primary approaches refer to the process of recycling a material to what it was originally. Secondary recycling means melt processing a plastic product into a lower-quality but nevertheless a new one. Tertiary recycling refers to processes that convert the plastic wastes into basic chemicals or fuel, such as pyrolysis and hydrolysis. Quaternary recycling involves burning the fibrous solid waste and converting it into a source of energy exploiting the heat generated through burning [38, 57].
Obviously, the most fruitful method of recycling is the primary approach. This approach, also called closed-loop recycling, is only applicable to man-made fibers such as PET or PA. This primary approach includes collecting textile waste discarded by the user and using this in new clothing as material for the production of yarn. The most common method of recycling actually is what is called open-loop recycling. In this method, the output material does not have a high-enough level of quality to produce new clothes; thus, it gets downgraded. The study on cotton fibers by Ütebay et al. demonstrates the deterioration in fiber quality. Downgraded material can be used as mattress upholstery or isolation material in cars. Through open-loop recycling, some value is recuperated from the textile waste, which would otherwise have been incinerated. However, this does not help to reduce the necessity of raw materials to produce clothing. Therefore, closed-loop recycling remains to be an attractive alternative. A closed-loop supply chain provides the advantage to recover more value from used products [56, 58, 59].
The most recycled textile waste is thermoplastic polymer-based fibers because they are easy to process and can be given different forms and shapes afterwards. Nevertheless, natural fibers such as cotton, wool and silk are also finding their ways into the recycling stream through downcycling or upcycling [44].
Recycling of textiles today is not a wide industry. The number of companies that offer services of recycling of textile fibers is limited because it is economically not beneficial and technologically not advanced. The lack of technological innovation and the continuing supply of cheap fabrics into the markets hinder the motivation for research, development and application of recycling techniques; however, it does not totally block the development of new technologies for recycling textile waste. Soon, certain obstacles will need to be faced and resolved to further increase textile waste recycling [10, 60].
In terms of technology, the fundamental question is the fiber composition of textile materials. The current garments in today’s markets vary more in terms of design and fiber content than in the past. The other compounded factors are issues/difficulties in separating the blended components, efficiency of separation, quality of separated material and hence the recycled material’s quality and so on. As recycled fibers and fabrics still provide a low level of quality, virgin natural and synthetic fibers remain to be popular options [10, 38, 56].
There are some recycling technologies available on the market today. Others are on the way, albeit few. Other changes need to accompany these research and trial endeavors—in terms of economy, processing costs should be reduced; in terms of policy, relevant standards should be implemented; and in terms of governance, textile waste should be recollected much more efficiently. Apart from increasing the efficiency of recycling methods and processes, the market for recycled products should grow. In short, recycling needs more encouragement, wherever it is economically and technically feasible [47].
There are important benefits of recycling textiles, both environmental and economical. It reduces the need for landfill space, consumption of already scarce virgin resources, pollution as well as water and energy consumption and the demand for dyes and fixing agents [61]. However, even though recycling offers ways to reduce environmental negative impacts, it is not exempt from certain problems. Wang [38] lists the following as challenges:
The mechanical, chemical or biological processes to recycle waste still require a certain amount of energy.
The recycling processes continue to require new raw material input.
The recycling processes still generate emissions into air, water and land.
Evidently, recycling is not always the preferred approach, when not only the environmental context but also the competitiveness of the final product in the market is taken into account. The existing recycling technologies need to get better, cleaner, more energy efficient and less costly [38].
Textile recycling, a key concept for sustainability, currently faces hurdles related to cost, time and technology. But as sustainability becomes more and more important, more initiatives are getting incentivized and sponsored by both manufacturers and other organizations in the textile sector to help advance the results of textile recycling. This tendency can be seen through the fact that certain textile recycling companies have shown promising growth. Different strategies and policies were coined in different regions to promote an efficient way of recycling for conserving the environment more and increasing the economic efficiency [38].
Many voluntary and nonprofit organizations run campaigns to conserve natural resources by creating awareness of both downcycling and upcycling recycling concepts. The campaigns aim to convince the consumers that using recycled products is an esteemed way of adding value to oneself, the product and the world.
Examples of commercially available labels for recycled products are given in Figure 2 [62, 63, 64, 65, 66, 67, 68]. All these initiatives are expected to promote environmentally appropriate, socially beneficial and economically viable management systems [44].
Labels for recycled products.
In addition to these certifications, some standards such as Social Responsibility Standard (ISO 26000), Environmental Management System (ISO 14001), Occupational Health and Safety Management System (ISO 45001) and Energy Management System (ISO 50001) also support sustainability and social responsibility practices and contribute to their dissemination [69, 70, 71, 72].
An unsustainable consumption of textile goods ensures the deterioration of the environmental degradation. To achieve environmental integrity and sustainability, incentivizing the textile companies to produce more environment-friendly products is not enough—the behavior of consumers also needs to change, creating more awareness toward the conservation of the environment [45]. In this context, Connolly and Prothero [73] write: “Rather than focus on the issue of whether green consumption can work as a strategy, we should perhaps try to gain a greater understanding of the process that has led people to believe that they, as individuals, can help solve global environmental problems.”
The fibers obtained by recycling are generally evaluated in the production of lower-value products (downcycling) compared to the original product. However, nowadays, recycling fibers have started to increase their evaluation in high value-added products (downcycling). On the other hand, the perspective that focuses only on the cost aspect of the production of recycled garments is not correct. Considering water consumption as well as pesticides and artificial fertilizers used, the textile industry is known to be one of the most polluting and waste-generating sectors. From this point of view, recycling of textiles and garments is of great importance in terms of reducing the use of natural resources (e.g., water used to grow seeds or oil used in the production of synthetic fibers) and CO2 emissions. Recycling will also save energy and chemicals to produce new textiles, as well as prevent pollution from the production process. In this context, it is important for the future of our world to review all production and consumption processes and supply chains in the focus of circular economy and sustainability. Therefore, the recycling of textile industry waste is very important.
The future of textile recycling mostly depends on its implementation in the industry and gaining more experience and grounds for more innovative methods. Clothing retailers are key actors on this front, as they are uniquely positioned to be able to influence and improve consumers’ approach in favor of sustainability. Not only do clothing retailers have the potential to influence consumer decisions, but also they are in a position to alter consumption patterns. People can learn the importance of recycling as well as reuse and resales by the help of companies, and this is not limited to developing countries. Through such actions, consumer awareness about sustainable consumption would increase, leading to less environmental damage in the future.
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr.",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Rheinmetall (Germany)",country:{name:"Germany"}}},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. 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Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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Saleh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},subject:{topic:{id:"1170",title:"Crystallography",slug:"nanotechnology-and-nanomaterials-material-science-crystallography",parent:{id:"208",title:"Material Science",slug:"nanotechnology-and-nanomaterials-material-science"},numberOfBooks:3,numberOfSeries:0,numberOfAuthorsAndEditors:27,numberOfWosCitations:40,numberOfCrossrefCitations:27,numberOfDimensionsCitations:60,videoUrl:null,fallbackUrl:null,description:null},booksByTopicFilter:{topicId:"1170",sort:"-publishedDate",limit:12,offset:0},booksByTopicCollection:[{type:"book",id:"9205",title:"Electron Crystallography",subtitle:null,isOpenForSubmission:!1,hash:"9185ce16fc6f5756cf55fe6082f09fab",slug:"electron-crystallography",bookSignature:"Devinder Singh and Simona Condurache-Bota",coverURL:"https://cdn.intechopen.com/books/images_new/9205.jpg",editedByType:"Edited by",editors:[{id:"184180",title:"Dr.",name:"Devinder",middleName:null,surname:"Singh",slug:"devinder-singh",fullName:"Devinder Singh"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8506",title:"Some Aspects of Diamonds in Scientific Research and High Technology",subtitle:null,isOpenForSubmission:!1,hash:"7ab81202ec11afae75334956029ebd31",slug:"some-aspects-of-diamonds-in-scientific-research-and-high-technology",bookSignature:"Evgeniy Lipatov",coverURL:"https://cdn.intechopen.com/books/images_new/8506.jpg",editedByType:"Edited by",editors:[{id:"21254",title:"Mr.",name:"Evgeniy",middleName:null,surname:"Lipatov",slug:"evgeniy-lipatov",fullName:"Evgeniy Lipatov"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6638",title:"Handbook of Stillinger-Weber Potential Parameters for Two-Dimensional Atomic Crystals",subtitle:null,isOpenForSubmission:!1,hash:"e174b9329a7cb36d22d4e14768667ac4",slug:"handbook-of-stillinger-weber-potential-parameters-for-two-dimensional-atomic-crystals",bookSignature:"Jin-Wu Jiang and Yu-Ping Zhou",coverURL:"https://cdn.intechopen.com/books/images_new/6638.jpg",editedByType:"Authored by",editors:[{id:"228449",title:"Dr.",name:"Jin-Wu",middleName:null,surname:"Jiang",slug:"jin-wu-jiang",fullName:"Jin-Wu Jiang"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"3",chapterContentType:"chapter",authoredCaption:"Authored by"}}],booksByTopicTotal:3,seriesByTopicCollection:[],seriesByTopicTotal:0,mostCitedChapters:[{id:"57994",doi:"10.5772/intechopen.71929",title:"Parameterization of Stillinger-Weber Potential for Two- Dimensional Atomic Crystals",slug:"parameterization-of-stillinger-weber-potential-for-two-dimensional-atomic-crystals",totalDownloads:1803,totalCrossrefCites:19,totalDimensionsCites:40,abstract:"We parametrize the Stillinger-Weber potential for 156 two-dimensional atomic crystals (TDACs). Parameters for the Stillinger-Weber potential are obtained from the valence force field (VFF) model following the analytic approach (Nanotechnology. 2015;26:315706), in which the valence force constants are determined by the phonon spectrum. The Stillinger-Weber potential is an efficient nonlinear interaction and is applicable for numerical simulations of nonlinear physical or mechanical processes. The supplemental resources for all simulations in the present work are available online in http://jiangjinwu.org/sw, including a Fortran code to generate crystals’ structures, files for molecular dynamics simulations using LAMMPS, files for phonon calculations with the Stillinger-Weber potential using GULP, and files for phonon calculations with the valence force field model using GULP.",book:{id:"6638",slug:"handbook-of-stillinger-weber-potential-parameters-for-two-dimensional-atomic-crystals",title:"Handbook of Stillinger-Weber Potential Parameters for Two-Dimensional Atomic Crystals",fullTitle:"Handbook of Stillinger-Weber Potential Parameters for Two-Dimensional Atomic Crystals"},signatures:"Jin-Wu Jiang and Yu-Ping Zhou",authors:[{id:"228449",title:"Dr.",name:"Jin-Wu",middleName:null,surname:"Jiang",slug:"jin-wu-jiang",fullName:"Jin-Wu Jiang"}]},{id:"71414",doi:"10.5772/intechopen.91281",title:"Micro-/Nano-Structuring in Stainless Steels by Metal Forming and Materials Processing",slug:"micro-nano-structuring-in-stainless-steels-by-metal-forming-and-materials-processing",totalDownloads:726,totalCrossrefCites:2,totalDimensionsCites:6,abstract:"Austenitic stainless steel type AISI304 sheets and plates as well as fine-grained type AISI316 (FGSS316) substrates and wires were employed as a work material in the intense rolling, the piercing and the plasma nitriding. AISI304 sheet after intense rolling had textured microstructure in the rolling direction. Crystallographic state changed itself to have distorted polycrystalline state along the shearing plane by piercing, with the strain induced phase transformation. FGSS316 substrates were plasma nitrided at 623 K for 14.4 ks to have two-phase fine nanostructure with the average grain size of 100 nm as a surface layer with the thickness of 30 μm. FGSS316 wires were also plasma nitrided at the same conditions to form the nitrided surface down to the depth of 30 μm. This nitrided wire was further uniaxially loaded in tensile to attain more homogeneously nitrided surface nano-structure and to form the austenitic and martensitic fiber structure aligned in the tensile direction. Each crystallographic structure intrinsic to metals and metallic alloys was tailored to have preferable micro−/nano-structured cells by metal forming and nitrogen supersaturation. The crystallographic change by metal forming in a priori and posterior to nitriding was discussed to find out a new way for materials design.",book:{id:"9205",slug:"electron-crystallography",title:"Electron Crystallography",fullTitle:"Electron Crystallography"},signatures:"Tatsuhiko Aizawa, Tomomi Shiratori and Takafumi Komatsu",authors:[{id:"251217",title:"Prof.",name:"Tatsuhiko",middleName:null,surname:"Aizawa",slug:"tatsuhiko-aizawa",fullName:"Tatsuhiko Aizawa"},{id:"312068",title:"Dr.",name:"Takafumi",middleName:null,surname:"Komatsu",slug:"takafumi-komatsu",fullName:"Takafumi Komatsu"},{id:"313724",title:"Prof.",name:"Tomomi",middleName:null,surname:"Shiratori",slug:"tomomi-shiratori",fullName:"Tomomi Shiratori"}]},{id:"67682",doi:"10.5772/intechopen.86865",title:"Simulation of Diamond Surface Chemistry: Reactivity and Properties",slug:"simulation-of-diamond-surface-chemistry-reactivity-and-properties",totalDownloads:954,totalCrossrefCites:2,totalDimensionsCites:5,abstract:"The diamond material possesses very attractive properties, such as superior electronic properties (when doped), in addition to a controllable surface termination. During the process of diamond synthesis, the resulting chemical properties will depend not only on the adsorbed species but also on the type of substitutional doping element. The combination of adsorbate and dopant will thus have the ability to influence both the chemical and electronic properties of a diamond surface. All resulting (and interesting) properties of doped and terminated diamond surfaces make it clear that these types of material modifications are very important for a variety of applications that are based on photoactivated chemical processes. Theoretical modeling has been shown to act as an important scientific tool in explaining and predicting experimental results. Simulation of the dependence of, e.g. surface termination and doping on diamond material properties, is expected to give important information about various surface electronic properties (like photo-induced surface electrochemistry).",book:{id:"8506",slug:"some-aspects-of-diamonds-in-scientific-research-and-high-technology",title:"Some Aspects of Diamonds in Scientific Research and High Technology",fullTitle:"Some Aspects of Diamonds in Scientific Research and High Technology"},signatures:"Karin Larsson",authors:[{id:"292193",title:"Prof.",name:"Karin",middleName:null,surname:"Larsson",slug:"karin-larsson",fullName:"Karin Larsson"}]},{id:"66249",doi:"10.5772/intechopen.85349",title:"Development, Properties, and Applications of CVD Diamond-Based Heat Sinks",slug:"development-properties-and-applications-of-cvd-diamond-based-heat-sinks",totalDownloads:1112,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"Heat sink is an essential component to nanoelectronics, microelectronics, and optoelectronics applications because it allows the thermal management of devices such as integrated circuits (ICs), microelectromechanical systems (MEMSs), and graphic unit processing. There are different materials being employed for heat sink production. Among them, diamond has stood out due to its excellent chemical and physical properties. This book chapter focuses on the development, properties, and applications of CVD diamond heat sinks. It covers the basic concepts of heat conduction applied to CVD diamond as a heat sink material and its production as freestanding CVD wafers of polycrystalline CVD diamond, since the literature about this topic is extensive, giving the reader a comprehensive overview. We will comprise the use and potential widening of applications of in CVD diamond heat sink technology, providing the reader with a substantial background at the current development of solutions and new frontiers in the practical use of CVD diamond thermal management devices.",book:{id:"8506",slug:"some-aspects-of-diamonds-in-scientific-research-and-high-technology",title:"Some Aspects of Diamonds in Scientific Research and High Technology",fullTitle:"Some Aspects of Diamonds in Scientific Research and High Technology"},signatures:"José Vieira da Silva Neto, Mariana Amorim Fraga and Vladimir Jesus Trava-Airoldi",authors:[{id:"285413",title:"M.Sc.",name:"José",middleName:null,surname:"Vieira",slug:"jose-vieira",fullName:"José Vieira"},{id:"285414",title:"Dr.",name:"Mariana Amorim",middleName:null,surname:"Fraga",slug:"mariana-amorim-fraga",fullName:"Mariana Amorim Fraga"},{id:"285416",title:"Dr.",name:"Vladimir Jesus",middleName:null,surname:"Trava-Airoldi",slug:"vladimir-jesus-trava-airoldi",fullName:"Vladimir Jesus Trava-Airoldi"}]},{id:"72080",doi:"10.5772/intechopen.92212",title:"Transmission Electron Microscopy of Nanomaterials",slug:"transmission-electron-microscopy-of-nanomaterials",totalDownloads:901,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Structural and analytical characterization, in the nanometer scale, has become very important for all types of materials in recent years. Transmission electron microscope (TEM) is a perfect instrument for this purpose, which is summarized in this chapter. Parameters such as particle size, grain size, lattice type, morphological information, crystallographic details, chemical composition, phase-type, and distribution can be obtained by transmission electron micrographs. Electron diffraction patterns of nanomaterials are also used to acquire quantitative information containing size, phase identification, orientation relationship and crystal defects in the lattice structure, etc. In this chapter, typical electron diffraction, high-resolution transmission and scanning transmission electron microscope imaging in materials research, especially in the study of nanoscience are presented.",book:{id:"9205",slug:"electron-crystallography",title:"Electron Crystallography",fullTitle:"Electron Crystallography"},signatures:"Mohammad Jafari Eskandari, Reza Gostariani and Mohsen Asadi Asadabad",authors:[{id:"176352",title:"Dr.",name:"Mohsen",middleName:null,surname:"Asadi Asadabad",slug:"mohsen-asadi-asadabad",fullName:"Mohsen Asadi Asadabad"},{id:"177600",title:"Dr.",name:"Mohammad",middleName:null,surname:"Jafari Eskandari",slug:"mohammad-jafari-eskandari",fullName:"Mohammad Jafari Eskandari"},{id:"318141",title:"Dr.",name:"Reza",middleName:null,surname:"Gostariani",slug:"reza-gostariani",fullName:"Reza Gostariani"}]}],mostDownloadedChaptersLast30Days:[{id:"70590",title:"Strongly Fluorescent Heterocyclic Molecule: Crystallography, 3D Hydrogen-Bonded, Fluorescence Study and QTAIM/TD-DFT/MESP Theoretical Analysis",slug:"strongly-fluorescent-heterocyclic-molecule-crystallography-3d-hydrogen-bonded-fluorescence-study-and",totalDownloads:521,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"In this chapter we explored the fluorescence properties of the title compound 1–10 phenanthroline hydrate (phh), {(C12N2H8)·H2O}. The structure of phh is stabilized by strong as well as weak intermolecular interactions in the crystal. These interactions O▬H⋯O, O▬H⋯N, C▬H⋯O and C▬H⋯N hold the crystal structure in a three-dimensional network. Optical analysis (fluorescence) was performed on the test compound. The measurements in solvents of different polarities were carried out at ambient temperature (298 K). These results prompted us to investigate some photoluminescence applications for heterocyclic compounds as the sensing of blue-light luminescent materials. The time-dependent density functional theory (TD-DFT) calculations were performed on this compound, with the purpose to identify the origin of absorption and emission band, the nature of the electronic transitions. The atoms in molecules (AIM) theory and orbital analysis and molecular electrostatic potential (MESP) were applied to analyze the electron densities, their properties and the energy diagram of the molecular orbitals. The AIM and MESP analysis have been applied for part B of phh to demonstrate that the O1W▬H11W⋯N1B type of interaction has the strongest hydrogen bond.",book:{id:"9205",slug:"electron-crystallography",title:"Electron Crystallography",fullTitle:"Electron Crystallography"},signatures:"Ouahida Zeghouan, Seifeddine Sellami and Mohamed AbdEsselem Dems",authors:[{id:"308001",title:"Dr.",name:"Ouahida",middleName:null,surname:"Zeghouan",slug:"ouahida-zeghouan",fullName:"Ouahida Zeghouan"}]},{id:"68159",title:"Significance of Diamond as a Cutting Tool in Ultra-Precision Machining Process",slug:"significance-of-diamond-as-a-cutting-tool-in-ultra-precision-machining-process",totalDownloads:935,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"This chapter focuses on the purpose of using diamond as a cutting tool in various ultra-precision machining applications. The complicated structures such as resin and ceramic mold used for making optical lenses are machined by the diamond tool to improve the precision of the finished product. It is difficult to machine hard and brittle materials such as glasses, ceramics, and composites with the assistance of diamond tool due to the complexity in the aspheric surfaces. Moreover, the tool wear is a major problem in machining these hard materials to a fine dimensional accuracy and tolerances. The microscopic defect forms at the cutting edge lead to the damage of the surface finish of the workpiece material. Therefore, the discussions are associated with the achievement of machining hard materials using a diamond tool in ultra-precision applications.",book:{id:"8506",slug:"some-aspects-of-diamonds-in-scientific-research-and-high-technology",title:"Some Aspects of Diamonds in Scientific Research and High Technology",fullTitle:"Some Aspects of Diamonds in Scientific Research and High Technology"},signatures:"P. Suya Prem Anand",authors:[{id:"285029",title:"Dr.",name:"Suya Prem",middleName:null,surname:"Anand P",slug:"suya-prem-anand-p",fullName:"Suya Prem Anand P"}]},{id:"67682",title:"Simulation of Diamond Surface Chemistry: Reactivity and Properties",slug:"simulation-of-diamond-surface-chemistry-reactivity-and-properties",totalDownloads:955,totalCrossrefCites:2,totalDimensionsCites:5,abstract:"The diamond material possesses very attractive properties, such as superior electronic properties (when doped), in addition to a controllable surface termination. During the process of diamond synthesis, the resulting chemical properties will depend not only on the adsorbed species but also on the type of substitutional doping element. The combination of adsorbate and dopant will thus have the ability to influence both the chemical and electronic properties of a diamond surface. All resulting (and interesting) properties of doped and terminated diamond surfaces make it clear that these types of material modifications are very important for a variety of applications that are based on photoactivated chemical processes. Theoretical modeling has been shown to act as an important scientific tool in explaining and predicting experimental results. Simulation of the dependence of, e.g. surface termination and doping on diamond material properties, is expected to give important information about various surface electronic properties (like photo-induced surface electrochemistry).",book:{id:"8506",slug:"some-aspects-of-diamonds-in-scientific-research-and-high-technology",title:"Some Aspects of Diamonds in Scientific Research and High Technology",fullTitle:"Some Aspects of Diamonds in Scientific Research and High Technology"},signatures:"Karin Larsson",authors:[{id:"292193",title:"Prof.",name:"Karin",middleName:null,surname:"Larsson",slug:"karin-larsson",fullName:"Karin Larsson"}]},{id:"67995",title:"Polycrystalline Diamond Characterisations for High End Technologies",slug:"polycrystalline-diamond-characterisations-for-high-end-technologies",totalDownloads:955,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Characterisations of polycrystalline diamond (PCD) coatings have routinely been done over the past three decades of diamond research, but there is less number of reports on some of its very unique properties. For example, diamond is the hardest known material and, in probing such hard surfaces with any indenter tip, it may lead to damage of the instrument. Due to such chances of experimental accidents, researchers have performed very few attempts in evaluating the mechanical properties of PCDs. In the present work, some of these very special properties of diamond that are less reported in the literature are being re-investigated. PCDs were characterised by photoluminescence (PL), Fourier transform infrared (FTIR) spectroscopy, transmission electron microscope (TEM), and X-ray diffraction (XRD) techniques. The diamond surface was also polished to bring the as-grown micron level of surface roughness (detrimental for wear application) down to few hundreds of nanometer. The tribological properties of such polished and smooth surfaces were found to be appropriate for wear protective coating application. This chapter revisits some of the unreported issues in the synthesis and characterisation of PCD coatings grown on Si wafer by the innovative 915 MHz microwave plasma chemical vapour deposition (MPCVD) technique.",book:{id:"8506",slug:"some-aspects-of-diamonds-in-scientific-research-and-high-technology",title:"Some Aspects of Diamonds in Scientific Research and High Technology",fullTitle:"Some Aspects of Diamonds in Scientific Research and High Technology"},signatures:"Awadesh Kumar Mallik",authors:[{id:"178218",title:"Dr.",name:"Awadesh",middleName:null,surname:"Mallik",slug:"awadesh-mallik",fullName:"Awadesh Mallik"}]},{id:"66249",title:"Development, Properties, and Applications of CVD Diamond-Based Heat Sinks",slug:"development-properties-and-applications-of-cvd-diamond-based-heat-sinks",totalDownloads:1112,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"Heat sink is an essential component to nanoelectronics, microelectronics, and optoelectronics applications because it allows the thermal management of devices such as integrated circuits (ICs), microelectromechanical systems (MEMSs), and graphic unit processing. There are different materials being employed for heat sink production. Among them, diamond has stood out due to its excellent chemical and physical properties. This book chapter focuses on the development, properties, and applications of CVD diamond heat sinks. It covers the basic concepts of heat conduction applied to CVD diamond as a heat sink material and its production as freestanding CVD wafers of polycrystalline CVD diamond, since the literature about this topic is extensive, giving the reader a comprehensive overview. 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In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"333753",title:"Dr.",name:"Rais",middleName:null,surname:"Ahmed",slug:"rais-ahmed",fullName:"Rais Ahmed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333753/images/20168_n.jpg",biography:null,institutionString:null,institution:{name:"University of Agriculture Faisalabad",country:{name:"Pakistan"}}},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. She is a professor in the Stomatology Faculty, St. Petersburg State University. She has expertise in the development and evaluation of a wide range of live mucosal vaccines against influenza and bacterial complications. Her research interests include immunity against influenza and COVID-19 and the development of immunization schemes for high-risk individuals.",institutionString:'Federal State Budgetary Scientific Institution "Institute of Experimental Medicine"',institution:null},{id:"238958",title:"Mr.",name:"Atamjit",middleName:null,surname:"Singh",slug:"atamjit-singh",fullName:"Atamjit Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/238958/images/6575_n.jpg",biography:null,institutionString:null,institution:null},{id:"252058",title:"M.Sc.",name:"Juan",middleName:null,surname:"Sulca",slug:"juan-sulca",fullName:"Juan Sulca",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252058/images/12834_n.jpg",biography:null,institutionString:null,institution:null},{id:"191392",title:"Dr.",name:"Marimuthu",middleName:null,surname:"Govindarajan",slug:"marimuthu-govindarajan",fullName:"Marimuthu Govindarajan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191392/images/5828_n.jpg",biography:"Dr. M. Govindarajan completed his BSc degree in Zoology at Government Arts College (Autonomous), Kumbakonam, and MSc, MPhil, and PhD degrees at Annamalai University, Annamalai Nagar, Tamil Nadu, India. He is serving as an assistant professor at the Department of Zoology, Annamalai University. His research interests include isolation, identification, and characterization of biologically active molecules from plants and microbes. He has identified more than 20 pure compounds with high mosquitocidal activity and also conducted high-quality research on photochemistry and nanosynthesis. He has published more than 150 studies in journals with impact factor and 2 books in Lambert Academic Publishing, Germany. He serves as an editorial board member in various national and international scientific journals.",institutionString:null,institution:null},{id:"274660",title:"Dr.",name:"Damodar",middleName:null,surname:"Paudel",slug:"damodar-paudel",fullName:"Damodar Paudel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274660/images/8176_n.jpg",biography:"I am DrDamodar Paudel,currently working as consultant Physician in Nepal police Hospital.",institutionString:null,institution:null},{id:"241562",title:"Dr.",name:"Melvin",middleName:null,surname:"Sanicas",slug:"melvin-sanicas",fullName:"Melvin Sanicas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241562/images/6699_n.jpg",biography:null,institutionString:null,institution:null},{id:"117248",title:"Dr.",name:"Andrew",middleName:null,surname:"Macnab",slug:"andrew-macnab",fullName:"Andrew Macnab",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"322007",title:"Dr.",name:"Maria Elizbeth",middleName:null,surname:"Alvarez-Sánchez",slug:"maria-elizbeth-alvarez-sanchez",fullName:"Maria Elizbeth Alvarez-Sánchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",country:{name:"Mexico"}}},{id:"337443",title:"Dr.",name:"Juan",middleName:null,surname:"A. Gonzalez-Sanchez",slug:"juan-a.-gonzalez-sanchez",fullName:"Juan A. Gonzalez-Sanchez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico System",country:{name:"United States of America"}}},{id:"337446",title:"Dr.",name:"Maria",middleName:null,surname:"Zavala-Colon",slug:"maria-zavala-colon",fullName:"Maria Zavala-Colon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Puerto Rico, Medical Sciences Campus",country:{name:"United States of America"}}}]}},subseries:{item:{id:"5",type:"subseries",title:"Parasitic Infectious Diseases",keywords:"Blood Borne Parasites, Intestinal Parasites, Protozoa, Helminths, Arthropods, Water Born Parasites, Epidemiology, Molecular Biology, Systematics, Genomics, Proteomics, Ecology",scope:"Parasitic diseases have evolved alongside their human hosts. In many cases, these diseases have adapted so well that they have developed efficient resilience methods in the human host and can live in the host for years. Others, particularly some blood parasites, can cause very acute diseases and are responsible for millions of deaths yearly. Many parasitic diseases are classified as neglected tropical diseases because they have received minimal funding over recent years and, in many cases, are under-reported despite the critical role they play in morbidity and mortality among human and animal hosts. The current topic, Parasitic Infectious Diseases, in the Infectious Diseases Series aims to publish studies on the systematics, epidemiology, molecular biology, genomics, pathogenesis, genetics, and clinical significance of parasitic diseases from blood borne to intestinal parasites as well as zoonotic parasites. We hope to cover all aspects of parasitic diseases to provide current and relevant research data on these very important diseases. In the current atmosphere of the Coronavirus pandemic, communities around the world, particularly those in different underdeveloped areas, are faced with the growing challenges of the high burden of parasitic diseases. At the same time, they are faced with the Covid-19 pandemic leading to what some authors have called potential syndemics that might worsen the outcome of such infections. Therefore, it is important to conduct studies that examine parasitic infections in the context of the coronavirus pandemic for the benefit of all communities to help foster more informed decisions for the betterment of human and animal health.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11401,editor:{id:"67907",title:"Dr.",name:"Amidou",middleName:null,surname:"Samie",slug:"amidou-samie",fullName:"Amidou Samie",profilePictureURL:"https://mts.intechopen.com/storage/users/67907/images/system/67907.jpg",biography:"Dr. Amidou Samie is an Associate Professor of Microbiology at the University of Venda, in South Africa, where he graduated for his PhD in May 2008. He joined the Department of Microbiology the same year and has been giving lectures on topics covering parasitology, immunology, molecular biology and industrial microbiology. 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