V06-07 ROBOTIC ASSISTED BUCCAL MUCOSA GRAFT POSTERIOR URETHROPLASTY

Abstract

You have accessJournal of UrologyLower-Tract Reconstruction I: Sling/ Sphincter/ Penile & Urethral Reconstruction (V06)1 Apr 2020V06-07 ROBOTIC ASSISTED BUCCAL MUCOSA GRAFT POSTERIOR URETHROPLASTY Min Suk Jun*, Michael Siev, and Lee Zhao Min Suk Jun*Min Suk Jun* More articles by this author , Michael SievMichael Siev More articles by this author , and Lee ZhaoLee Zhao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000885.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic-assisted posterior urethral reconstruction has shown great promise in early series with excellent patency rates. While Y-V or T plasty remains useful for short supra-sphincteric stenoses, longer stenoses, especially those that are trans-sphincteric, pose a great surgical challenge. The standard approach usually involves urethral transection, often including the bulbar arteries. This increases the risk for incontinence, bulbar urethral necrosis, and future AUS erosion. A buccal mucosa graft posterior urethroplasty may obviate the need for urethral transection, potentially avoiding the aforementioned complications. We present our technique of robotic assisted buccal mucosa graft posterior urethroplasty (RBMGPU). METHODS: This is a retrospective chart review of men who underwent RBMGPU by a single surgeon with the Da Vinci SP robot during 2019. Indications included vesicourethral anastomotic stenosis, radiation induced stenosis, and fistula. Nonobliterative stenoses were approached retropubically or transvesically, while obliterative stenoses were approached posteriorly. A simple prostatectomy was performed if the prostate was in situ. If the stenosis spanned both sides of the sphincter, a perineal dissection was performed. When a well-vascularized flap was required for graft backing or interposition, a rectus or omental flap was used. The primary endpoint was surgical success defined by the absence of obstructive voiding symptoms or urethral patency >16 French. The secondary endpoint was de novo incontinence. RESULTS: 7 men with mean age of 65 years (range 49-72) underwent RBMGPU. Mean operative time was 512 minutes with mean estimated blood loss of 185 mL. Average length of stay was 1.4 days. At a mean of 2.2 months follow up (range 0.8-4.5), 6 of 7 patients reached the primary endpoint while 1 patient experienced de novo incontinence. There was 1 major complication (Clavien > 2), which was a Richter hernia related to the rectus flap. CONCLUSIONS: RBMGPU is a feasible approach to posterior urethroplasty, while minimizing known risk factors for future incontinence surgery. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e557-e558 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Min Suk Jun* More articles by this author Michael Siev More articles by this author Lee Zhao More articles by this author Expand All Advertisement PDF downloadLoading ...