V04-01 NOVEL UTILIZATION OF INDOCYANINE GREEN TO ASSESS BLADDER PLATE AND PENILE PERFUSION DURING BLADDER EXSTROPHY CLOSURE

Abstract

You have accessJournal of UrologyCME1 Apr 2023V04-01 NOVEL UTILIZATION OF INDOCYANINE GREEN TO ASSESS BLADDER PLATE AND PENILE PERFUSION DURING BLADDER EXSTROPHY CLOSURE Amanda Raines, Nicolas Fernandez, Jennifer Ahn, Margarett Shnorhavorian, Hailey Silverii, and Paul Merguerian Amanda RainesAmanda Raines More articles by this author , Nicolas FernandezNicolas Fernandez More articles by this author , Jennifer AhnJennifer Ahn More articles by this author , Margarett ShnorhavorianMargarett Shnorhavorian More articles by this author , Hailey SilveriiHailey Silverii More articles by this author , and Paul MerguerianPaul Merguerian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reconstruction of bladder exstrophy poses a unique challenge to urologic surgeons. At our institution the current practice is to perform complete primary repair of bladder exstrophy (CPRE). However, there have been concerns about compromise of penile perfusion using this technique with reports of penile or glans loss due to ischemia. Currently, one method of penile perfusion assessment after closure is completed is a needlestick to the glans to observe for bleeding, however, this provides limited and subjective information. Indocyanine green or ICG is a fluorescent dye which has been in use since the 1950s. With a short half-life and favorable safety profile, it is ideal for intraoperative use. It has been widely used throughout the surgical community to assess tissue perfusion, but its use within pediatric urology has been limited and not standardized. To our knowledge, ICG use in bladder exstrophy has not been previously described. We aim to describe our approach to CPRE with use of ICG and detail our intraoperative findings. METHODS: An otherwise healthy four month old male with classic bladder exstrophy was taken to the operating for bladder closure with CPRE. ICG was given in three doses first after complete penile degloving, next after complete mobilization of the corpora and take down of intersymphyseal bands, and finally after osteotomy and pubic symphysis approximation. Quantification software is used to measure ICG uptake at each stage. RESULTS: ICG uptake in the glans remained symmetric and around 100% at the time of the first and second doses. However, uptake on the third dose was significantly decreased and asymmetric with the right glans having an uptake of 20-30% and the left 40-50%. CONCLUSIONS: The current standard of penile perfusion assessment with a needle stick to the glans is subjective and limited in the detail it provides. More updated methods like ICG can generate an objective quantitative and more detailed assessment which could be useful in complex reconstructions such as bladder exstrophy closure. While more data is currently needed than this single experience, future applications of ICG may alter surgical decision making such as loosening of the symphyseal sutures to improve penile perfusion. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e338 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Raines More articles by this author Nicolas Fernandez More articles by this author Jennifer Ahn More articles by this author Margarett Shnorhavorian More articles by this author Hailey Silverii More articles by this author Paul Merguerian More articles by this author Expand All Advertisement PDF downloadLoading ...