Chromic Sutures Research Articles

(282) Penile Crural Dysplasia is a New Identified Factor for Erectile Dysfunction

Abstract Introduction Given the penile fibro-vascular assembly was just thoroughly interpreted recently and inspired by impotent patients' questions during daily practice, so does the penile venous stripping (PVS), which is deemed controversial thus far. Despite primary impotence (PI) being ascribed to psychogenic origin, in the large repository of PVS treating PI, some 5 % remain refractory in the last decade, an analysis deemed required. Objective We sought to report penile crural dysplasia or hypoplasia that prevents sustainability compared to most PVS males thus far. Methods A retrospective analysis was conducted internationally on 45 consecutive young men with PI from 2013 to 2023. They were allocated into the crural dysplasia group (CDG, n=8), defined as a 50% diameter difference between the largest penile crus and corresponding corpus cavernosum or a 25% diameter difference of bilateral penile crura, and no crural-dysplasia group (NCG, n=37). On an ambulatory basis under acupuncture-aided local anesthesia, neither electrocautery nor a suction apparatus is used, with a circumferential or semi-circumcision followed by a pubic longitudinal approach, the PVS entailed the erection-related vein, including stripping a deep dorsal vein, two cavernosal veins after each emissary's vein was firmly ligated closest to the outer tunic layer with a 6–0 nylon suture. In contrast, the four para-arterial veins were only segmentally ligated. The overlying fascia layers and skin were approximated with a 6–0 nylon and 5–0 chromic suture for the skin, as did the semi-circumcision wound if it existed. The abridged 5-item version of the International Index of Erectile Function (IIEF-5) score system and the erection hardness scale (EHS) were used to assess erection restoration; preoperative data were based on masturbation; additionally, a radio-opacity index was used for comparison of the femoral cortex and that of penile crus preoperative and postoperative, respectively. Follow-up was primarily made via either INTERNET or telephone yearly. After this May, we introduced an autologous venous patch to augment the crural hypoplasia with a promising outcome on two new patients. Statistically, IBM SPSS 21.0 was used. Results The follow-up time was from 0.1 to 10.0 years, averaging 5.7 ± 1.1 years in the CDG and NCG groups, respectively. The blood loss is negligible. There is no difference between the operation time (4.9−0.8 hours vs. 4.8 ± 0.7 hours, p> 0.88) for the CG and EG group, respectively. In both groups, there is a significant of IIEF-5 scores, EHS (5.7±2.0 vs. 15.9±2.1, 1.8±0.8 vs. 2.5±0.6; 5.8 ±2.1 vs. 22.4±1.1, 1.8±0.9 vs. 3.6±0.3; both P<0.001) between the CDG and NCG. The preoperative radio-opacity of penile crura was unexceptionally enhanced postoperatively. In the NCG, 89.1% (33/37) are gratified; in contrast, 37.5% are satisfied in the CDG five years postoperatively, although surgery benefit is unexceptional reported. A close follow-up is going on with the two new males. Conclusions Penile crural hypoplasia is an unidentified contributor to primary impotence, although a larger sample size and longer-term follow-up are warranted. Disclosure No.

Effects of swimming exercise on neuropathic pain in a rat model: role of glutamate

ABSTRACT Objective The pain-reducing effects of the exercise were exerted through different mechanisms. Knowing more clear mechanisms helps to find more approach that is therapeutic. The objective of the present study is the evaluation of cerebrospinal fluid (CSF) glutamate level alteration in neuropathic pain rats and whether physical activity could modulate it. Methods In the present study 104 male Wistar rats weighing 180–220 g were randomly divided into 4 groups (Sham, Sham + Exe, Neuropathy, and Neuropathy + Exe) which in turn each group subdivided into 4 groups according to time points for behavioral testing and CSF sampling (Baseline, 2 weeks, 3 weeks, and 4 weeks). To induction of neuropathy (by chronic constriction injury,), after anesthetizing with a mixture of ketamine (80 mg/kg) and xylazine (10 mg/kg), the animal’s right sciatic nerve was exposed and was ligated using four movable catgut chromic suture 4/0. The exercise protocol included 25 min of daily swimming, 5 days a week for 4 weeks. Thermal hyperalgesia and mechanical tactile threshold were detected using the plantar test and Von Frey filaments, respectively. CSF glutamate level was determined using high-performance liquid chromatography. Results Findings indicated that mechanical and thermal thresholds significantly (p < 0.01, p < 0.05 respectively) decreased in the neuropathy group against that in sham groups. On the other hand, exercise significantly increased mechanical tactile threshold (p < 0.0012) and thermal threshold (p < 0.05) compared to the neuropathy group. Moreover, CSF glutamate level prominently (p < 0.01) was increased in the neuropathy group compared to the sham group, and swimming exercise significantly (p < 0.001) reduced it. In conclusion The present findings provide new evidence showing that medium-intensity swimming exercise attenuates pain-like behaviors in neuropathic pain animals, which is possibly due to decreasing CSF glutamate level and its neurotransmission.

Anterior Ear Reconstruction with the Posterior Pull-through Flap.

Defects of the central ear after skin cancer removal remain a common problem for the reconstructive surgeon. The experience with a one-stage, postauricular, skin-island flap passed through the cartilage to reconstruct ear defects is reported. Patients with an intact ear helix and an anterior full-thickness defect (cartilage defects included) were reconstructed with a skin-island flap based on posterior subcutaneous tissue deep to the flap base. The flap was passed through a generous aperture created in the ear cartilage. The skin at the base was incised superficially after the flap was passed through the cartilage to create a skin-island and avoid burial of epithelium. The flap periphery and postauricular harvest site were sutured with absorbable chromic sutures. Twenty-two patients (six women, 16 men) with ear defects underwent single-stage reconstruction over a 9-year period. The defects reconstructed measured in diameter from 2 cm to 4.5 cm. Six patients required a second skin flap from the preauricular area to close ear canal defects. The pull-through flap added structural support, and prevented ear distortion. No flap necrosis occurred. Venous congestion was common and self-limiting. No epithelial cysts developed. A one-stage postauricular skin-island flap can reliably reconstruct anterior ear defects without distorting shape or position of the ear. Care is needed to provide a generous aperture through the ear cartilage to accommodate the flap. Healing proceeds predictably, and minimal complications are associated with this posteriorly-based, pass-through, skin-island flap in ear reconstruction.

Comparison of Mini Tightrope Intermetatarsal Fixation and Inter-Cuneiform Screw Fixation in Lapidus

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: First metatarso-cuneiform joint arthrodesis for treatment of metatarsus primus varus was originally introduced by Lapidus in 1934. In his technique, fixation was achieved using heavy chromic sutures between the first and second metatarsals to achieve parallel alignment. Since then, the indications and technique for Lapidus procedure have considerably evolved and many modifications have been introduced to Lapidus’s original description. Despite these modifications, recurrence of hallux valgus remains relatively common, either due to malunion at the TMT arthrodesis or through intercuneiform instability. This has informed the approach for additional fixation between the 1st and 2nd rays. This study aims to compare outcomes of inter-cuneiform screw fixation (ICS) and suspensory intermetatarsal fixation (SIM) using a mini-tightrope in terms of deformity correction and maintaining the correction over time. Methods: This was a retrospective comparative study of prospectively collected data for patients who have underwent a Lapidus procedure for hallux valgus between 2012-2022. The electronic medical records were reviewed for demographics, radiologic parameters, and operative data. Radiographic parameters were intermetatarsal angle (IMA), hallux valgus angle (HVA), and sesamoid station on preoperative, 3 months postoperatively and final follow-up. Hallux valgus station was graded from normal, mild, moderate, and severe based on the method used by Agrawal et al. Using a multivariate regression model, a comparison was conducted between suspensory intermetatarsal fixation(SIM) and inter-cuneiform screw fixation(ICS). Univariate linear regression analysis was conducted with the inclusion of covariates' age, smoking, diabetes, and BMI. Comparison of HVA and IMA was conducted using t-test. Results: 65 patients met the inclusion criteria; 20 had ICS, and 45 had SIM. The pre-op IMA improved from 13.57 (3.84) to 6.14 (2.41) degrees postoperatively in the ICS group (p), and from 13.37(3.84) to 6.16 (2.74) degrees postoperatively in the SIM group (p). The final follow-up IMA was 5.9 (2.1) in the ICS group and 6.84 (2.31) in the SIM group, with no difference from post-op values, p=0.123 and, respectively. There was no statistically significant difference between ICS and SIM groups in IMA at pre-op (p=0.41), post-op (p=0.49), and final follow up (p=0.62). There were no statistically significant differences between SIM and ICS groups in HVA preoperatively [37.47(12.21) vs. 40.38(13.59), p=0.19], postoperatively [18.2(10.82) vs. 18.95(10.1),p=0.36] or at final follow up [20.12(9.72) vs 19.33(9.16) ,p=0.38]. Conclusion: Lapidus procedure remains the procedure of choice for severe hallux valgus with predictable correction. Supplementing the first tarsometatarsal arthrodesis with suspensory intermetatarsal fixation using a mini-tightrope achieved similar deformity correction and preservation of correction to intercuneiform screw fixation.

(130) Marsupialization of the Bartholin Duct Cyst and Recanalization for Symptomatic Recurrent Bartholin Cysts

Abstract Introduction Bartholin glands (BGs) are located posteriorly on each side of the vaginal introitus. During sexual arousal, BGs release mucinous secretions into the vestibule at the 5:00 and 7:00 positions via a 2.5 cm Bartholin duct (BD). The BD may become obstructed from trauma, inflammation, infection, vestibular or vulvar surgery, or idiopathic factors. Despite BD obstruction, the glands may continue to produce mucinous secretion causing cystic dilation of the duct. Thus, a Bartholin duct cyst (BC) is formed and can result in pain during sexual arousal. Treatment strategies include sitz baths, hot compresses, aspiration, Word catheter placement, or BC marsupialization. Objective This chart review was performed to assess the safety and efficacy of a new technique for BD marsupialization in patients with symptomatic BC. Methods This is a chart review of patients with symptomatic BC who underwent BD marsupialization using a new technique. This new strategy involves marsupialization of the anterior wall of the BC, identification of the BD lumen on the posterior wall of the BC under surgical Loupes magnification and advancement of the BD lumen directly to the surface of the introitus at 5:00 and/or 7:00 locations. The BD neo-ostium was secured with interrupted 4.0 chromic sutures. Results 14 patients (mean age 28 ± 9 years) between 2015 - 2022 diagnosed with recurrent BC-induced pain during sexual arousal were treated by marsupialization of the BC and advancement of the BD directly to the mucosal surface of the introitus. Each patient averaged 3 prior BC treatments (range 0- 6). Symptoms included pain with sexual arousal or walking/sitting (100%) and an introitus mass interfering with penetration (50%). The mean BC size on ultrasound was 2.7 ± 1.6 cm x 2.4 ± 1.7 cm. All BD marsupialization surgeries were performed as outpatient procedures. Sexual arousal was encouraged early post-operatively and mucinous secretion documented by vestibular photography post-arousal. With an average follow-up of 14 months, 11/14 (79%) symptomatic BCs have resolved. Conclusions A new surgical strategy is described for patients with symptomatic BCs involving BD anastomosis directly to the introital mucosa at the 5:00 or 7:00 locations, resolution of BD obstruction, and excellent restoration of BG lubrication. Disclosure No

V05-01 EX VIVO PARTIAL NEPHRECTOMY IN A SOLITARY KIDNEY

You have accessJournal of UrologyCME1 Apr 2023V05-01 EX VIVO PARTIAL NEPHRECTOMY IN A SOLITARY KIDNEY Martin Hofmann, Rebecca Campbell, Yi-Chia Lin, Alejandro Pita, Jesse McKenney, Mohamed Eltemamy, and Steven Campbell Martin HofmannMartin Hofmann More articles by this author , Rebecca CampbellRebecca Campbell More articles by this author , Yi-Chia LinYi-Chia Lin More articles by this author , Alejandro PitaAlejandro Pita More articles by this author , Jesse McKenneyJesse McKenney More articles by this author , Mohamed EltemamyMohamed Eltemamy More articles by this author , and Steven CampbellSteven Campbell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003263.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephron-sparing surgery (NSS) is common in the management of small renal masses. In locally advanced tumors, it is typically only considered in cases of a solitary kidney. Robotic and open partial nephrectomy are standard approaches with ex vivo partial nephrectomy rarely reported. This approach was abandoned at Cleveland Clinic in 1986 due to lackluster results. Since then, however, technology has improved with better vessel sealing devices, thrombogenic materials to help pack the defect and reconstruct, and better imaging. METHODS: A 44 year old woman was found to have bilateral renal masses on imaging performed during a hypertension workup. The right renal mass was large with inferior vena cava (IVC) tumor thrombus. The left sided mass was central with renal vein thrombus. After undergoing a right radical nephrectomy and IVC tumor thrombectomy, she was treated with 8 weeks of neoadjuvant axitinib on trial to downstage the remaining left renal mass. After considering all options, an ex vivo partial nephrectomy was performed. First, a laparoscopic nephrectomy was performed in similar fashion as to donor nephrectomy. The kidney was then chilled and perfused with Collins' solution before being defatted and small vascular branches ligated. The central mass was then visualized on ultrasound and a portion of parenchyma overlying it excised to allow for hilar and tumor exposure. The renal vein was opened and tumor resected. After oversewing the parenchyma, closing open vessels, and packing the defect with Surgicel Fibrillar, the outer renorrhaphy was performed with 2-0 Chromic sutures. The autotransplantation was then performed with the kidney placed into the left iliac fossa and vascular anastomoses performed to external iliac vessels and ureteral reimplantation onto the bladder dome. RESULTS: The total time in the operating room was 6 hours with 3 hours spent on the bench preparing the kidney and resecting the mass. The estimated blood loss was 500 cc. Final pathology revealed a 7 cm pT3a grade 3 clear cell renal cell carcinoma with negative margins. She experienced acute kidney injury with peak creatinine of 5.91 on post-operative day 3 which improved to 1.54 by 6 weeks. She suffered a pulmonary embolism at that time but has done well on anticoagulation. At 6 months, her creatinine was 1.32 and surveillance imaging was negative for any recurrent disease. CONCLUSIONS: The management of bilateral locally advanced renal tumors is complex and challenging. In rare circumstances, ex vivo partial nephrectomy can be considered and performed with good result. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e424 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Martin Hofmann More articles by this author Rebecca Campbell More articles by this author Yi-Chia Lin More articles by this author Alejandro Pita More articles by this author Jesse McKenney More articles by this author Mohamed Eltemamy More articles by this author Steven Campbell More articles by this author Expand All Advertisement PDF downloadLoading ...

Exercise induced myelin protein zero improvement in neuropathic pain rats

Purpose Aerobic exercise including swimming plays a suitable role in improving somatosensory injuries. Neuropathic pain is a debilitating condition that occurs following injury or diseases of somatosensory system. In the present study, we tried to investigate the effect of exercise on myelin protein zero of sciatic nerve injured rats. Materials and methods Forty male rats (180–220 g) were divided into five groups (intact, sham, sham + exercise, neuropathy, and neuropathy + exercise). Right Sciatic nerve of anesthetized rats was exposed and loosely ligated (four ligations with 1 mm apart) using catgut chromic sutures to induce neuropathy. After 3 days of recovery, swimming exercise began (20 min/day/5 days a week/4 weeks). Mechanical allodynia and thermal hyperalgesia were detected using Von Frey filaments and plantar test, respectively. Sciatic nerve at the place of injury was dissected out to measure the myelin protein zero by western blot analysis. In the intact and sham groups, sciatic nerve removed at the place similar to injured group. Results We found that neuropathy significantly (p < 0.05) reduced paw withdrawal mechanical and thermal thresholds and swimming exercise significantly (p < 0.05) increased paw withdrawal mechanical and thermal thresholds compared to the neuropathy group. Moreover, we found that MPZ level significantly (p < 0.01) decreased in neuropathy group against that in sham group, and exercise prominently (p < 0.05) reversed MPZ level towards control level. Conclusions Swimming exercise improves myelin protein zero level in neuropathic rats along with attenuating neuropathic pain. This is a promising approach in improving neuropathological disorders including Charcot-Marie-Tooth and Dejerine–Sottas disease.

Introducing a new medical method and innovative suture technique to reduce scars in central lip lift medical surgery

"The central lip lift surgery with a new suture technique called; continuous locking suture in three cases is reported in this article. In this novel method, we used a 5.0 chromic suture by applying a 30-degree angle of the entrance to the skin semi-deeply. We start suturing at the middle of the wound,3-4 mm from the edges of the skin. The needle should be way out at the exact point of entrance, and this process is repeated to reach out to the two sides of the wound. More than 90% of patients (in more than 100 cases) were satisfied with the cosmetic results. Moreover, 90% of cases did not demonstrate any scar after three months without laser or reconstructive ointments. We evaluate many patients who undergo central lip lift surgery with this novel technique, and the scar problem was resolved in more than 90 % of cases with no supportive treatment."

V05-02 SINGLE PORT ROBOT-ASSISTED EXTRAPERITONEAL KIDNEY TRANSPLANTATION: TIPS AND TRICKS

You have accessJournal of UrologyCME1 May 2022V05-02 SINGLE PORT ROBOT-ASSISTED EXTRAPERITONEAL KIDNEY TRANSPLANTATION: TIPS AND TRICKS Aaron Kaviani, Jihad Kaouk, Mahmoud Abou Zeinab, Alp Tuna Beksac, Ethan Ferguson, Yi-Chia Lin, Alvin Wee, and Mohamed Eltemamy Aaron KavianiAaron Kaviani More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Mahmoud Abou ZeinabMahmoud Abou Zeinab More articles by this author , Alp Tuna BeksacAlp Tuna Beksac More articles by this author , Ethan FergusonEthan Ferguson More articles by this author , Yi-Chia LinYi-Chia Lin More articles by this author , Alvin WeeAlvin Wee More articles by this author , and Mohamed EltemamyMohamed Eltemamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002579.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiport transperitoneal robot-assisted kidney transplant is performed in few centers across the globe. We introduced the single-port robot-assisted extraperitoneal kidney transplantation using the da Vinci SP platform (Intuitive Surgical, Sunnyvale, CA USA) in 2019. In this video, we aimed to provide detailed tips and tricks for the surgical steps of this approach. METHODS: Thirteen patients underwent single-port robot-assisted kidney transplantation. The patients are placed in the supine position with the bed slightly flexed, tilted toward the left side, and put in a 15° Trendelenburg position. A 5-cm infraumbilical incision is made. The extraperitoneal space is developed. The robot is docked per the floating docking technique. The external iliac artery and vein are dissected off lymphatics. Benching of the kidney is performed. LigaSure device (Medtronic, Dublin, Ireland) is used to dissect the vessels. The posterior surface of the artery and the vein are marked for better intracorporal orientation. A 14 cm ureteral stent is placed. A 3-0 chromic suture is placed in the lower pole for nephropexy. Kidney is wrapped with a blue glove with cut-off fingers covering the lower pole. A 12 mm port is placed through the same incision and 400 mL of ice is introduced. The kidney is then introduced. The venous and arterial anastomoses are performed using 6-0 GORE-TEX® sutures (Gore Medical, Flagstaff, AZ, USA). An 8-inch suture is used for each anastomosis and it is tied on itself at the distal and proximal corners. Bulldog clamps (Scanlan, Saint Paul, MN, USA) are used for vascular control. Arteriotomy is made using a sleeve-protected scalpel. Aortic punch is introduced directly through the abdominal wall. After completion of the anastomosis, the kidney is repositioned to the space above the psoas muscle. Ureteroneocystostomy is performed using 4-0 Vicryl sutures. The kidney is fixed to the lateral abdominal wall. The robot is undocked and the wound is closed. RESULTS: Surgery was successfully completed in all patients without conversion to open surgery or adding extra ports. There were no intra or postoperative complications greater than Clavien grade 2. There was no delayed graft function. Median (IQR) vein and artery anastomosis times were 26 (24-28) and 37 (33-40) minutes. Patients stayed in the hospital for 2–3 days. Mean (SD) creatinine at 6 and 12 months were 1.31 (0.24) and 1.30 (0.16) mg/dL. CONCLUSIONS: We demonstrated detailed tips and tricks for steps of the single-port robot-assisted extraperitoneal kidney transplantation. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e516 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Kaviani More articles by this author Jihad Kaouk More articles by this author Mahmoud Abou Zeinab More articles by this author Alp Tuna Beksac More articles by this author Ethan Ferguson More articles by this author Yi-Chia Lin More articles by this author Alvin Wee More articles by this author Mohamed Eltemamy More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP11-07 A TECHNIQUE TO PREVENT STOMAL STENOSIS IN RECONSTRUCTIVE UROLOGY

You have accessJournal of UrologyCME1 May 2022MP11-07 A TECHNIQUE TO PREVENT STOMAL STENOSIS IN RECONSTRUCTIVE UROLOGY Stephen Sekoulopoulos, Akshilkumar Patel, Ellius Kwok, Suzanne Boltz, and Ross Decter Stephen SekoulopoulosStephen Sekoulopoulos More articles by this author , Akshilkumar PatelAkshilkumar Patel More articles by this author , Ellius KwokEllius Kwok More articles by this author , Suzanne BoltzSuzanne Boltz More articles by this author , and Ross DecterRoss Decter More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002533.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Antegrade Continent Enema (ACE) and catheterizable bladder channel (Mitrofanoff) procedures are routinely performed in pediatric urology patients with a neurogenic bladder. Stomal stenosis is a common surgical complication of these procedures, occurring in 15-20% of stomas. Our frustration with this complication inspired us to modify our suturing technique to decrease the incidence of stomal stenosis. METHODS: Our historical techniques for stoma creation were initially simply suturing full thickness bowel to full thickness skin using 4-0 chromic suture. Subsequently, we tried suturing full thickness bowel to full thickness skin using 4-0 Vicryl suture with the knots buried. Our current, modified technique for stoma creation reported here consists of full thickness bowel sutured only to the dermal layer of the skin with 5-0 PDS suture knots buried. Demographics and rates of stomal stenosis were compared between patients who underwent the creation of an ACE or Mitrofanoff channel using the historical techniques (prior to April 2018) versus the current technique (from April 2018 to June 2020). Statistics were performed using Fisher’s exact test, with p-values <0.05 considered significant. RESULTS: The historical cohort is comprised of 74 patients (97 stomas) while 18 patients (22 stomas) underwent the current stomal creation technique. There were no significant differences in demographics between the 2 cohorts. The historical cohort included 69 ACE procedures (62 appendix, 5 small bowel, and 2 colon) and 28 Mitrofanoff procedures (3 appendix, 19 small bowel, and 6 colon). Among the current technique patients, there were 17 ACE procedures (15 appendix, 1 small bowel, and 1 colon) and 5 Mitrofanoff procedures (1 appendix, 3 small bowel, and 1 colon). Stenosis occurred in 19 of 97 stomas (19.6%) after undergoing either an ACE or Mitrofanoff procedure using the historical techniques (13 occurring in ACE cases and 6 occurring in Mitrofanoff cases). There were no cases of stomal stenosis in the current technique group (p = 0.022). CONCLUSIONS: Our novel suturing technique for stomal creation significantly reduced the incidence of stomal stenosis. The current, modified technique is straightforward and flexible as it can be applied to any stoma placed in any position. None of the patients in the current technique cohort have manifest any of the early findings we saw in the historical stomas that ultimately stenosed. However, further follow-up will be necessary to assess the long-term reliability of this approach. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e159 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen Sekoulopoulos More articles by this author Akshilkumar Patel More articles by this author Ellius Kwok More articles by this author Suzanne Boltz More articles by this author Ross Decter More articles by this author Expand All Advertisement PDF DownloadLoading ...

V13-06 OPEN RIGHT PARTIAL NEPHRECTOMY WITH INFERIOR VENA CAVA THROMBECTOMY FOR RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 May 2022V13-06 OPEN RIGHT PARTIAL NEPHRECTOMY WITH INFERIOR VENA CAVA THROMBECTOMY FOR RENAL CELL CARCINOMA Ryan Nasseri, Devin Patel, Daniel Holst, Margaret Meagher, and Ithaar Derweesh Ryan NasseriRyan Nasseri More articles by this author , Devin PatelDevin Patel More articles by this author , Daniel HolstDaniel Holst More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002646.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We present a case of a 65 year-old female with cT3b renal cell carcinoma (RCC) and inferior vena cava (IVC) tumor thrombus who underwent open right partial nephrectomy (PN) with IVC thrombectomy at our institution. METHODS: 65 year-old female with CKD stage III [baseline estimated Glomerular Filtration Rate (eGFR) 57 ml/min.1.73m2] and active segmental pulmonary emboli (PE) presented with locally advanced RCC with venous tumor extension to the level of the intrahepatic IVC. Patient was deemed to not be optimal surgical candidate due to symptomatic PE and poor performance status (ECOG 2 status) and also had strong indication for nephron preservation. The patient ultimately underwent systemic therapy with 12 cycles of nivolumab and 6 cycles of ipilimumab with shrinkage of primary tumor and regression of tumor thrombus to the infrahepatic IVC. RESULTS: Open right PN with IVC thrombectomy was undertaken. A reverse-hockey stick incision was made. Large and small intestinal medial reflection was conducted with liver mobilization. Cranial and caudal IVC control was obtained as well as control of the contralateral renal vein. IVC clamping and control of the contralateral renal vein in addition to clamping of the main renal artery was conducted, and the tumor and IVC tumor extension were resected en bloc via a venotomy and longitudinal cavotomy, primary closure of which were performed with 6-0 and 3-0 Prolene. Collecting system entries and segmental vessels were closed with 3-0 Monocryl and 4-0 PDS. The cortical defect was then approximated with 0 Chromic suture and hemostatic agents.Final pathology demonstrated pT3b clear cell RCC/ISUP grade 2 with protrusion into IVC. Negative margins for primary tumor and distal caval margins. Postoperative creatinine was 1.01 ng/dL with eGFR of 55 mL/min/1.73m2. No evidence of disease was noted at 3-month radiologic follow up. CONCLUSIONS: PN with IVC thrombectomy may be safely achieved for select patient with imperative indication for nephron sparing surgery. Further investigation of long-term oncologic outcomes and efficacy are requisite. Source of Funding: Stephen Weissman Kidney Cancer Research Fund © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1032 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Nasseri More articles by this author Devin Patel More articles by this author Daniel Holst More articles by this author Margaret Meagher More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF DownloadLoading ...

Transeptal Approach to the Maxillary Sinus and Pterygopalatine Fossa.

Transeptal Approach to the Maxillary Sinus and Pterygopalatine Fossa.

Comparison of Painful Response to Mechanical Stimulation of the Plantar and Dorsal Surface of Paw Following Chronic Constriction Injury-induced Neuropathic Pain

Mechanical and thermal stimuli were used to evaluate neuropathic pain-like behavior in animal models usually. Mechanical stimulation of paw plantar surface is commonly used to determine mechanical allodynia. In the present study, paw withdrawal response to plantar surface stimulation was compared with paw withdrawal response to dorsal surface stimulation. To this end, a total of 30 female Wistar rats (180-220 g), were assigned randomly to three groups as intact (without any manipulation), sham (incision of skin and muscles without nerve injury), and neuropathy (sciatic nerve lesion) with 10 in each group. To induction of neuropathy (chronic constriction injury), four movable ligations were established around the sciatic nerve using catgut chromic suture with a distance of one millimeter apart and then wound incision was closed. In the sham group, the incision site was closed without nerve ligation. Mechanical allodynia was examined by Von Frey filaments for four weeks. The findings indicated that the paw withdrawal threshold following dorsal surface stimulation was significantly reduced compared to the sham group at day 21 post-surgery. Moreover, paw withdrawal threshold following plantar surface stimulation significantly decreased compared to the sham group at day 21 post-surgery. The present results regarding the sham group showed that the paw withdrawal threshold after mechanical stimulation of the plantar surface was not significantly different from that of the dorsal surface paw. In addition, and there was no significant difference between the paw withdrawal response to plantar surface and dorsal one. In conclusion, paw withdrawal threshold to plantar surface mechanical stimulation was not significantly different from one in dorsal surface following neuropathic pain induced by chronic constriction injury.

Randomized Controlled Trial Comparing Nylon and Chromic Gut Sutures After Minor Hand Surgery

We sought to compare overall satisfaction with treatment and satisfaction with initial wound healing after closure of office hand and upper extremity surgery wounds using polyamide compared to Chromic gut sutures. We compared 62 patients randomized to polyamide suture closure of an office hand and upper extremity incision (mostly carpal tunnel release and trigger finger release) to 50 patients closed with Chromic gut suture. Patients rated overall treatment satisfaction, satisfaction with initial healing, pain intensity, and upper extremity-specific activity tolerance. Accounting for potential confounding in multivariable linear and logistic regression analysis, we found the following: (1) overall satisfaction with care was unrelated to suture type; (2) satisfaction with initial wound healing and appearance was lower among people with no other comorbidities, but unrelated to suture type; (3) there were no factors independently associated with pain intensity; and (4) excisional biopsy was associated with greater activity tolerance. Our findings suggests that Chromic sutures are a viable alternative to polyamide sutures after office hand surgery, provided that the care team anticipates and develops strategies for concerns that may arise if the sutures take an extended period to fall off. Therapeutic II.

COMPARATIVE STUDY OF EPISIOTOMY REPAIR: CHROMIC CATGUT AND VICRYL RAPIDE

Background: Prevalence of the episiotomy varies around the world depending on whether it is used as a routine or a restricted procedure. The rates are still higher in developing countries, like ours, since the use of restricted episiotomy is not being practiced widely in primigravidas.&#x0D; Methods: In our randomized comparative study of 222 women who were admitted to the Department of Obstetrics and Gynaecology, SMS Medical College Jaipur, the enrolled women were divided into 2 groups. In Group-A: Vicrylrapide (polygalactin-910) suture material was used in 111 patients and in Group-B chromic catgut suture material was used in another 111 patients, for repair of episiotomies.&#x0D; Results: In our present study in vicryl rapide group at 24-48 hrs pain was present in 49.55% of patients, redness was found in 8.10% of patients, swelling was found in 3.60% patients and analgesic used by 72.97% of patients. In chromic group at 24-48 hrs pain was present in 69.36% of patients, redness was found in 21.62%, swelling was found in 7.20% and analgesic was used by 89.18% of patients.&#x0D; Conclusion: Our study recommends use of vicryl rapide for episiotomy repair in the care of parturient women.&#x0D; Keywords: Complication, Chromic Catgut, Vicryl Rapide, Episiotomy

COMPARISON TENSILE STRENGTH OF NATURAL AND SYNTHETIC ABSORBABLE SUTURES

Objective: The aim of the investigation is to evaluate and to compare the tensile strength of commercial natural and synthetic absorbable suturematerials currently used in surgery. The natural absorbable sutures of chromic catgut are prepared for this purpose as well as commercial syntheticabsorbable sutures made from polyglycolide.Methods: The analysis has been carried out following the standard test method for tensile strength and Young’s modulus of fiber ASTM C1557-03.Measuring the diameter of each suture has been carried out with an optical microscope to determine the accuracy of manufacturers’ data. Tensiletesting has been performed to evaluate the tensile strength of each type of sutures. The modulus elasticity and strain (ϵ) obtained are also presented.Results: The results show that sutures made from braided synthetic material of polyglycolide (violet coated) present a tensile strength remarkablysuperior (1070.292 MPa) to that of natural absorbable sutures of chromic catgut (392.276 MPa). Using optical macro microscope analysis,monofilament sutures present less surface irregularities than multifilament polyglycolide sutures. Chromic catgut monofilament sutures present lesssurface irregularities than multifilament polyglycolide.Conclusion: Tensile test of absorbable sutures was conducted in this research. Two types of absorbable sutures were investigated and compared. It isfound that sutures made from braided synthetic material of polyglycolide (violet coated) having much better tensile strength comparing with suturesmade from natural material (chromic catgut monofilament).

Buccal Mucosa Grafts for Reconstruction in Patients With Female Genital Mutilation

AIM: Reconstruction after female genital mutilation is a relatively new concept in the United States aimed to improve pain and sexual function and to restore a normal physical appearance. The buccal mucosa has been described as a donor-site option for reconstruction of eyelids, cheeks, larynx, urethra, and more recently the vagina. Here we present the novel use of buccal mucosal grafts in the reconstruction of external female genitalia after female genital mutilation. METHODS: 1. Mouth is irrigated with Peridex solution and throat pack is placed. 2. Rectangular piece of thin buccal mucosa is harvested using a #15 blade with care to avoid important structures such as buccal fat pads, buccinator muscle, and Stensen’s duct. Incisions are closed in a single running layer with 4-0 chromic suture. 3. Anterior abdomen fat harvesting is performed using standard Coleman technique. Fat is processed via Telfa rolling on back table. 4. Clitoral scar is incised or excised with careful attention to avoid injury to deeper nerves. 5. A flap harvested from the superior aspect of clitoral skin is rotated inferiorly to cover the superior aspect of the clitoral hood. The remainder of the hood is resurfaced using shaped portions of the buccal mucosa sutured with 4-0 chromic. 6. Flaps from the labia majora are rotated laterally and imbricated to the periosteum with interrupted 4-0 chromic. Medial flaps designed to become the new labia minora are subsequently covered with buccal mucosal grafts on their lateral aspects. 7. Buccal mucosal grafts were dressed with xeroform and antibiotic bolsters. 8. Fat subsequently grafted into bilateral labia majora inferiorly and superiorly into the vulvar region to encourage regeneration of the surgical site. RESULTS: The authors have observed excellent cosmetic outcomes at 6 months postoperatively with well-incorporated tissue. Patients report significantly improved functional outcomes with postoperative clitoral retraining therapy. CONCLUSIONS: Benefits of using the buccal mucosa as a donor site are similar to those reported previously. Namely, these include an inconspicuous donor site scar, primary closure of the donor site, and a decreased need for local tissue rearrangement and distortion of anatomy due to a distant donor site.1,2 As with any new technique, further investigation is needed to examine the long-term functional and cosmetic outcomes, including patient satisfaction and sexual function. Exposure of this technique to plastic surgeons will enable the therapeutic benefits to this greatly underserved population. REFERENCES: 1. Cohen SD, Armenakas NA, Light DM, et al. Single-surgeon experience of 87 buccal mucosal graft harvests. Plast Reconstr Surg. 2012;130:101–104. 2. Simman R, Jackson IT, Andrus L. Prefabricated buccal mucosa-lined flap in an animal model that could be used for vaginal reconstruction. Plast Reconstr Surg. 2002;109:1044–1049.

39: Ovarian and uterine suspension in laparoscopic surgery

Temporary suspension of the ovaries and uterus during laparoscopic surgery aids the surgeon by optimizing visualization of different areas of the pelvis. Ovarian suspension allows visualization of the retro-ovarian fossa and also optimizes tissue tension for pelvic side wall dissection. Using 0 chromic suture on a CT-1 needle, the surgeon can suspend the ovary from the round ligament, ideally at the level of the external iliac vessels to allow for maximum tissue tension. Use of chromic suture allows for peritoneal healing time and quick ovarian drop after healing takes place. Uterine suspension can be used for visualization of the posterior and anterior cul-de-sac, particularly when use of a uterine manipulator is not possible. Using #1 polydioxanone suture on a CT needle, the surgeon can place a figure-of-eight stitch through the myometrium at the fundus. This stitch can be used to place cranial traction on the uterus to allow exposure of the anterior cul-de-sac. The suture can also be passed through the anterior abdominal wall using a suture passer device at the midline just superior to the pubic symphysis to allow for exposure of the posterior cul-de-sac. Use of a large diameter suture allows for better support of the uterus while minimizing tissue damage. Monofilament suture aids with easy passage of the stitch through the myometrium. Placement of a urinary catheter is essential prior to passage of suture through the anterior abdominal wall to ensure bladder decompression. Use of these techniques for ovarian and uterine suspension provides the surgeon with an additional tool for providing safe and effective surgical care for patients.

Comparison of Artificial Saliva vs Saline Solution on Rate of Suture Degradation in Oropharyngeal Surgery

Absorbable sutures are designed to degrade and lose strength over time. Manufacturers warn that exposure to various body fluids can change the estimated degradation rate of these sutures, but few studies have been conducted to quantify the degree of change associated with saliva. To quantify the association of increased loss of strength of sutures over time after exposure to artificial saliva (hereinafter referred to as "saliva"). This experimental in vitro study was conducted at Bucknell University (Lewisburg, Pennsylvania) from June 19, 2015, to July 4, 2015. No participants were involved. The loss of strength over time of sutures submerged in physiological saline and artificial saliva solutions was compared. Three types of absorbable sutures commonly used in oral surgery were tested: chromic, poliglecaprone 25, and polyglactin 910. Data analysis was conducted from July 15, 2016, to August 16, 2016. The primary outcome measure was 50% strength reduction. To measure breaking strength, 6 knotted sutures of each type were pulled to failure at regular time intervals after immersion in either saline or synthetic saliva at 37°C. Regression analysis was used to interpret strength degradation profiles and to estimate the time to reach 50% of the original breaking strength. Of the 3 suture types submerged in the 2 solutions, all 3 degraded to 50% strength faster (by 2 to 13 days) in saliva than in saline. The differences in the degradation profiles varied by suture type. Poliglecaprone 25 sutures demonstrated a sudden decrease in failure strength between day 5 and day 8 in both solutions, but the decrease was greater in saliva (-10.2 N; 95% CI, -15.5 to -4.9 N) than in saline (-6.1 N; 95% CI, -11.2 to -0.9 N). The polyglactin 910 and chromic sutures share a similar degradation profile when implanted in tissue, but saliva was associated with more degradation of chromic sutures. Differences in degradation rate were seen in polyglactin 910 sutures after day 6 (saline: -0.9 N/d; 95% CI, -1.0 to -0.7 vs saliva: -1.2 N/d; 95% CI, -1.4 to -1.1). After day 2, chromic sutures had a degradation rate of -0.3 N/d (95% CI, -0.5 to -0.2) in saline and -0.5 N/d (95% CI, -0.6 to -0.3) in saliva. Knowing the association of saliva with suture degradation rates of various suture types may enable oropharyngeal surgeons to select sutures that retain their strength and degrade at an appropriate rate to allow for the effective healing of the wound.

A comparative study of open and closed hemorrhoidectomy

Background: Hemorrhoidectomy is the treatment of choice for patients with third-degree or fourth-degree haemorrhoids. This prospective randomized clinical study compared the outcome of surgical haemorrhoidectomy by open and closed techniques in terms of postoperative pain, wound healing, and morbidity.Methods: All consecutive patients with Grade III internal haemorrhoids or Grade IV haemorrhoids were randomly allocated to one of two groups. The entire wound was left open in the open group and completely closed using 2-0 chromic sutures in the closed group. Postoperative pain was assessed by a linear analog scale. Additional consumption of analgesics on the day of surgery and at defecation during the first week was recorded. Patients were followed up 1, 2, and 3 weeks after the procedure.Results: There were 30 patients in each group. No statistically significant differences were found between the two methods regarding complications, pain, or postoperative stay. There were four reoperations for bleeding, all after Milligan-Morgan operations. At follow-up after three weeks 78 percent of the Ferguson patients had completely healed wounds, and none had signs of infection. Of the Milligan-Morgan patients, only 26 percent had completely healed wounds, and symptoms of delayed wound healing were significantly more frequent.Conclusions: Both methods are fairly efficient treatment for third and fourth degree hemorrhoids, without serious drawbacks. The closed method has no advantage in postoperative pain reduction but is more advantageous with respect to faster wound healing.