Intraoperative Urethral Injury Research Articles

IRIS U kit usefulness in transanal total mesorectal excision for lower rectal cancer to avoid urethral injury

Transanal total mesorectal excision (taTME) has improved the laparoscopic dissection for rectal cancer in the narrow pelvis. Although taTME has more clinical benefits than laparoscopic surgery, such as a better view of the distal rectum and direct determination of distal resection margin, an intraoperative urethral injury could occur in excision ta-TME. This study aimed to determine the feasibility and efficacy of the ta-TME with IRIS U kit surgery. This retrospective study enrolled 10 rectal cancer patients who underwent a taTME with an IRIS U kit. The study endpoints were the safety of access (intra- or postoperative morbidity). The detectability of the IRIS U kit catheter was investigated by using a laparoscope-ICG fluorescence camera system. Their mean age was 71.4±6.4 (58–78) years; 80 were men, and 2 were women. The mean operative time was 534.6 ± 94.5 min. The coloanal anastomosis was performed in 80%, and 20% underwent abdominal peritoneal resection. Two patients encountered postoperative complications graded as Clavien–Dindo grade 2. The transanal approach with IRIS U kit assistance is feasible, safe for patients with lower rectal cancer, and may prevent intraoperative urethral injury.

Application of modified urethral separation method in artificial urethral sphincter implantation and its influence on intraoperative urethral pressure profilometry

Objective: To explore the application of modified urethral separation method in artificial urethral sphincter (AUS) implantation in patients with stress urinary incontinence (SUI), and its influence on the results of urethral pressure profilometry. Methods: A prospective collection of clinical data was conducted on 25 patients with stress urinary incontinence who underwent modified urethral separation method in AUS implantation and underwent urethral pressure profilometry in Beijing Hospital, Beijing Jishuitan Hospital Affiliated to Capital Medical University and the Second Hospital Affiliated to Tianjin Medical University from March 2019 to June 2023. The improved urethral separation method was to borrow part of the white membrane tissue of the cavernous body while freeing the dorsal side of the cavernous body of the urethra. The circumference of the urethra, sleeve size, and urethral pressure were recorded, the patient's autonomous urinary control before and after surgery and the changes of the international consultation on incontinence questionnaire-short form (ICI-Q-SF) score, incontinence quality of life questionnaire (I-QoL) score, urinary frequency score, nocturia score were compared. Follow-up was conducted in the clinic or by telephone at 1, 3, 6, and 12 months after activation of the device, and once a year thereafter. Local skin status and urine control were assessed, residual urine volume was measured by ultrasound and subjective score scale was completed. Results: All patients were male, aged 27-85 (65.8±15.7) years old. The circumference of the cuff used in this study was 4.0 cm in 4 patients (16.0%), 4.5 cm in 16 patients (64.0%), 5.0 cm in 4 patients (16.0%), and 5.5 cm in 1 patient (4.0%). Among them, the urethral circumference matched the cuff size in 14 cases (56.0%), the urethral circumference was smaller than the cuff size in 4 cases (16.0%), and the urethral circumference was larger than the cuff size in 7 cases (28.0%). Preoperative urodynamic examination showed that the maximum urethral pressure (MUP) was (78.0±25.9) cmH2O, (1 cmH2O=0.098 kPa) and the maximum urethral closure pressure (MUCP) was (53.4±26.6) cmH2O. The MUP of AUS device in the inactivated state was (88.0±26.5) cmH2O, which was not significantly higher than that before operation (P>0.05). The MUCP was (68.2±24.5) cmH2O, which was significantly higher than that before operation (P<0.05). The MUP and MUCP of the AUS device in the activated state were (146.6±25.2) cmH2O and (123.0±28.3) cmH2O, which were significantly higher than those before surgery and in the inactivated state (both P<0.001). All patients in the group reached the social urinary control standards at the first month of device activation. During a follow-up period of 2-50 months, 22 patients (88.0%) used the initial AUS device and all met social urinary control standards. The AUS device was replaced in 1 case. One patient died of cerebrovascular accident. One patient removed the device due to complications. The number of pads [M (Q1, Q3)] used in 25 patients before and after operation was 4.5 (3.0, 6.5) and 1 (0, 1) respectively, with statistically significant differences (P<0.001). ICI-Q-SF score, I-QoL score, urinary frequency score and nocturia score of 25 patients were significantly improved after surgery (all P<0.05). The incidence of postoperative complications was 20.0% (5/25), including 2 cases of painless hematuria, 1 case of infection, 1 case of urethral erosion, and 1 case of dysuria. Except for one patient who experienced urethral erosion and had his sleeve removed, the remaining four patients regained social urination control with active support treatment, and no symptoms recurred until the last follow-up. Conclusion: The modified urethral separation method has no significant effect on urethral pressure in patients with SUI, and can increase the volume of peri-urethral tissue in the cuff, thereby reducing the risk of intraoperative urethral injury and the incidence of postoperative urethral erosion.

Prospective randomized study correlating intra-operative urethral mucosal injury with early period after transurethral resection of the prostate stricture urethra: A novel concept

ObjectiveTo investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate (TURP) and correlate its incidence with intra-operative urethral mucosal injury during TURP. Also to compare the other established risk factors affecting the development of urethral stricture among patients undergoing monopolar or bipolar TURP over a period of 6 months follow-up as the prospective randomized study. MethodsOne hundred and fifty men older than 50 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo either standard monopolar TURP with glycine as the irrigation fluid or bipolar TURP with normal saline as irrigant. The prostate size, operative time, intra-operative mucosal rupture, catheter time, catheter traction duration, uroflowmetry, and post-operative stricture rate were compared. ResultsA total of 150 patients underwent TURP, including 74 patients undergoing monopolar TURP (one patient was excluded as his post-operative histopathological examination report was of adenocarcinoma prostate) and 75 patients undergoing bipolar-TURP, all of which were performed using a 26 Fr sheath resectoscope. The mean International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 months and 6 months were comparable between the groups. Out of 149 patients, nine patients (6.0%) developed urethral stricture. The severity of the injury (urethral mucosal injury) correlated with the likelihood of developing a subsequent complication (stricture urethra). Patients with stricture had significantly larger prostate volume than patients without stricture (65.0 mL vs. 50.0 mL; p=0.030). Patients with stricture had longer operative time than patients without stricture (55.0 min vs. 40.0 min; p=0.002). In both procedures, formation of post-operative stricture urethra was independently associated with intra-operative mucosal injury. ConclusionIntra-operative recognition of urethral mucosal injury helps in prediction of stricture urethra formation in early post-operative period.

(147) Multicenter Evaluation of Inflatable Penile Prosthesis Placement in Men with a History of Priapism

Abstract Introduction Inflatable penile prosthesis (IPP) can be used in both acute and delayed management of priapism-induced erectile dysfunction. Prolonged priapism may result in corporal fibrosis that makes IPP placement more difficult. The current literature on IPP placement in men with a history of priapism is limited to small series and often single-center experiences. Objective We sought to evaluate a multicenter experience of IPP placement in men with a history of priapism. Methods We performed a multicenter, retrospective cohort study of patients with a history of priapism undergoing IPP placement by 7 highly experienced implant surgeons. Malleable prosthesis placement patients were excluded. Demographic, intraoperative, and postoperative variables were collected. Descriptive statistics were performed using mean and standard deviation for continuous variables, whereas frequencies and percentages were used for categorical variables. We evaluated differences in complication rates in those undergoing early or delayed IPP placement. We defined early placement as ≤4 months from priapism to IPP. Results 31 patients underwent IPP placement at a mean of 97.4 ± 26.7 months following ischemic priapism. The mean duration of priapism was 52.3 ± 21.2 hours. The mean age of the cohort was 52.4 ± 4.2 years with a mean follow-up of 11.6 ± 1.3 mo. Overall, 25 patients (48.3%) had a prior shunt for priapism and 6 (19.4%) had penoscrotal decompression. Four patients (12.9%) underwent early placement and 27 (87.1%) delayed placement. Intraoperative urethral injury occurred in 1 (3.2%) patient. Infection occurred in 1 (3.2%) patient at 4 months postoperatively and was explanted without salvage. Seven (22.5%) implants were revised or removed for infectious or non-infectious complications at a mean 8.8 ± 1.0 months after implantation, of which 5 (71.4%) were cylinder-related (2 displacements of a cylinder through the corporotomy, 1 lateral displacement of the distal cylinders requiring revision, 1 proximal cylinder migration, 1 cylinder leak). No complications occurred in those undergoing early IPP placement. Full-sized cylinders (Boston Scientific CX or Coloplast Titan) were used in all cases that resulted in cylinder extrusion or migration. Narrow cylinders (Coloplast Titan NB or Boston Scientific CXR) were used in only 9 (29.1%) cases. Conclusions IPP placement in men with a history of priapism carries a notable incidence of non-infectious complications, especially in men undergoing delayed placement or when full-sized cylinders are used. Few IPPs in this series were placed early after the priapism episode, as our surgeons are predominantly at tertiary referral centers. Priapism patients should be referred to prosthetic experts early to decrease future morbidity. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Antares Pharma: SpeakBoston Scientific, Clarus Therapeutics, Coloplast, Cynosure, Promescent, Sprout, Viome

Transalbugineal Artificial Urinary Sphincter: A Refined Implantation Technique to Improve Surgical Outcomes.

The artificial urinary sphincter (AUS) implantation is an effective treatment of post-prostatectomy urinary incontinence (PPI). Still, it may result in troublesome complications such as intraoperative urethral lesion and postoperative erosion. Based on the multilayered structure of the tunica albuginea of the corpora cavernosa, we evaluated an alternative transalbugineal surgical technique of AUS cuff placement with the aim to decrease perioperative morbidity while preserving the integrity of the corpora cavernosa. A retrospective study was conducted in a tertiary referral center from September 2012 to October 2021, including 47 consecutive patients undergoing AUS (AMS800®) transalbugineal implantation. At a median (IQR) follow-up of 60 (24-84) months, no intraoperative urethral injury and only one noniatrogenic erosion occurred. The actuarial 12 mo and 5 yr overall erosion-free rates were 95.74% (95% CI: 84.04-98.92) and 91.76% (95% CI: 75.23-97.43), respectively. In preoperatively potent patients, the IIEF-5 score remained unchanged. The social continence (0-1 pads per day) rate was 82.98% (CI 95%: 68.83-91.10) at 12 mos and 76.81% (CI 95%: 60.56-87.04) at 5 yrs follow-up. Our technically refined approach to AUS implantation may help to avoid intraoperative urethral lesions and lower the risk of subsequent erosion without compromising sexual function in potent patients. Prospective and adequately powered studies are necessary to achieve more compelling evidence.

MP62-01 MULTICENTER EVALUATION OF INFLATABLE PENILE PROSTHESIS (IPP) PLACEMENT IN MEN WITH A HISTORY OF PRIAPISM

You have accessJournal of UrologyCME1 Apr 2023MP62-01 MULTICENTER EVALUATION OF INFLATABLE PENILE PROSTHESIS (IPP) PLACEMENT IN MEN WITH A HISTORY OF PRIAPISM David Barham, Muhammed Hammad, Daniel Swerdloff, Kelli Gross, Georgios Hatzichirstodoulou, James Hotaling, Tung-Chin Hsieh, James Jones, Ian Pearce, Hossein Sadeghi-Nejad, Maxime Sempels, C Austin Service, Jay Simhan, Faysal Yafi, and Martin Gross David BarhamDavid Barham More articles by this author , Muhammed HammadMuhammed Hammad More articles by this author , Daniel SwerdloffDaniel Swerdloff More articles by this author , Kelli GrossKelli Gross More articles by this author , Georgios HatzichirstodoulouGeorgios Hatzichirstodoulou More articles by this author , James HotalingJames Hotaling More articles by this author , Tung-Chin HsiehTung-Chin Hsieh More articles by this author , James JonesJames Jones More articles by this author , Ian PearceIan Pearce More articles by this author , Hossein Sadeghi-NejadHossein Sadeghi-Nejad More articles by this author , Maxime SempelsMaxime Sempels More articles by this author , C Austin ServiceC Austin Service More articles by this author , Jay SimhanJay Simhan More articles by this author , Faysal YafiFaysal Yafi More articles by this author , and Martin GrossMartin Gross More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003320.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prolonged priapism can result in corporal fibrosis which may make IPP placement more difficult. The current literature on IPP placement in men with a history of priapism is limited to small and often single-center experiences. We sought to evaluate a multicenter experience of IPP placement in men with a history of priapism. METHODS: We performed a multicenter, retrospective cohort study of patients with a history of priapism undergoing IPP placement by 9 experienced implant surgeons. We excluded patients who underwent IPP in the acute priapism event. Demographic, intraoperative, and postoperative variables were collected. Descriptive statistics were performed using mean and standard deviation for continuous variables, whereas frequencies and percentages were used for categorical variables. We evaluated differences in complication rates in those undergoing early or delayed IPP placement. We defined early placement as ≤4 months from priapism to IPP. RESULTS: 53 patients underwent IPP placement at a median of 29.5 months following ischemic priapism. The mean duration of priapism was 42.6±14.1 hours. The mean age of the cohort was 51.5±1.4 years with a mean follow-up of 16.4±9.5 mo. Overall, 19 patients (36%) had a prior shunt for priapism and 7 (13%) had penoscrotal decompression. Only 5 (9%) patients underwent early placement (≤4 mo) whereas 48 (91%) underwent late placement. No complications occurred in those undergoing early IPP placement. Complications occurred in 19 (39%) of patients undergoing delayed placement. Intraoperative urethral injury and proximal perforation occurred in 1 patient each. Infection occurred in 3 (6%) men. Postoperative complications occurred in 17 (35%). Cylinder related complications accounted for 8 (47%) (3 displacements of a cylinder through the corporotomy, 1 lateral displacement of the distal cylinders requiring revision, 2 proximal cylinder migration, 2 cylinder leaks). Fifteen (22.5%) implants were revised or removed for infectious or non-infectious complications. Full-sized cylinders were used in all cases that resulted in cylinder related complications. CONCLUSIONS: IPP placement in men with a history of priapism carries a notable incidence of complications, especially in men undergoing delayed placement or when full-sized cylinders are used. Few IPPs in this series were placed early after the priapism episode, as our surgeons are predominantly tertiary referral centers. Priapism patients should be referred to prosthetic experts early to decrease future morbidity. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e861 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Barham More articles by this author Muhammed Hammad More articles by this author Daniel Swerdloff More articles by this author Kelli Gross More articles by this author Georgios Hatzichirstodoulou More articles by this author James Hotaling More articles by this author Tung-Chin Hsieh More articles by this author James Jones More articles by this author Ian Pearce More articles by this author Hossein Sadeghi-Nejad More articles by this author Maxime Sempels More articles by this author C Austin Service More articles by this author Jay Simhan More articles by this author Faysal Yafi More articles by this author Martin Gross More articles by this author Expand All Advertisement PDF downloadLoading ...

MP71-04 ADJUSTABLE ARTIFICIAL SPHINCTER VICTO IN THE TREATMENT OF URINARY INCONTINENCE: EARLY RESULTS IN A COHORT OF HIGH-RISK CASES IN A PROSPECTIVE SINGLE CENTER STUDY

You have accessJournal of UrologyCME1 Apr 2023MP71-04 ADJUSTABLE ARTIFICIAL SPHINCTER VICTO IN THE TREATMENT OF URINARY INCONTINENCE: EARLY RESULTS IN A COHORT OF HIGH-RISK CASES IN A PROSPECTIVE SINGLE CENTER STUDY Ghazal Ameli, Peter Weibl, Michael Rutkowski, and Wilhelm Huebner Ghazal AmeliGhazal Ameli More articles by this author , Peter WeiblPeter Weibl More articles by this author , Michael RutkowskiMichael Rutkowski More articles by this author , and Wilhelm HuebnerWilhelm Huebner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Victo is an adjustable artificial urinary sphincter (AUS), consisting of three parts which are preconnected. A pressure regulating balloon, a cuff, and a pump, which includes a self-sealing port for adjustment. The objective of the present study is to test the efficiency and practicality of VICTO in the control of stress urinary incontinence (SUI) and to evaluate the short- and long-term complications. METHODS: A total of 32 patients were included between 1/2020 and 4/2022, the trial is still ongoing and estimated end of the clinical trial is May 2025.41% of the patients in this cohort has undergone prior procedures for SUI: sling n=4, ProACT n=4, AMS 800=1, 3 patients had multiple SUI surgeries. 38% of the patients had undergone secondary irradiation therapy. Additionally, 9 patients had undergone procedures for bladder neck pathologies or urethral strictures.All patients underwent artificial urethral sphincter (AUS) implant “VICTO” according to established technique. The mean age was 71.9 years, 41% of the patients had systemic arterial hypertension and 19% diabetes mellitus.Functional urinary outcomes were assessed according to daily pad use and a standardized questionnaire. Data were collected as part of the follow up care of these patients. RESULTS: The reduction in number of pads compared between baseline and Follow-Up was significant (p<0,001). Cure of urinary incontinence was defined as using either 0 or 1 p/d. All the index patients in this cohort (n=7) were cured. In total 64.5% of the patients reported to be dry and were cured by definition. Additionally, 19.4% patients reported improvement of ≥50 % according the PGI-I (Patients Global Impression of Improvement).Two erosions were reported over the FU-period (mean 4.6 months). One infection occurred after traumatic catheterization without deactivation of the device followed by urethral erosion, infection and explantation of the device. Both patients with erosion had previous pelvic irradiation.One explantation was reported at day 2 after implantation, the presumable cause of explantation was unrecognized intra-operative urethral injury and consequently urethral erosion and was excluded from the study. CONCLUSIONS: In this complex group with mostly high-risk patients, all men with uncomplicated SUI (no previous surgeries and no history of irradiation) were cured after device implantation. The overall treatment success was 84 % according PGI-I and 65% according to pad per day usage. Despite the above average number of patients with risk factors for failure in this cohort, the results of the current trial are consistent with the evidence in literature. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1014 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ghazal Ameli More articles by this author Peter Weibl More articles by this author Michael Rutkowski More articles by this author Wilhelm Huebner More articles by this author Expand All Advertisement PDF downloadLoading ...

A systematic review and meta-analysis on complications of transanal total mesorectal excision.

Transanal total mesorectal excision (TaTME) is a surgical approach for treating mid to low rectal cancer as well as other colorectal diseases. Since the procedure is difficult to master, perioperative complications of TaTME should be examined precisely, especially during the early implementation phase of this procedure. The primary aim of this review was to determine a pooled morbidity and anastomotic leakage (AL) rate after TaTME surgery, and the secondary aim was to show the completeness of reporting of complications among the included studies, as well as the correlation between completeness and reported incidence of complications. A systematic review of literature was conducted using Medline, Embase and Cochrane databases, searching for observational studies reporting on complications after TaTME. Studies published between 1 January 2010 and 15 October 2019 were included. Meta-analysis on the proportion of morbidity, AL and intraoperative complications was performed. Forty-one studies (2446 TaTME cases), consisting of 27 noncomparative studies and 14 comparative studies, were included, after screening 1711 possible studies. The pooled rates of overall morbidity and AL were 30.0% (95% CI 26.4%-34.0%) and 6.8% (95% CI 5.2%-8.9%), respectively. Subgroup analysis showed that the morbidity rate in studies that reported 30-day results (35.5%; 95% CI 31.8%-39.4%) was significantly higher than the rate in studies that did not define the follow-up length for complications (23.4%; 95% CI 17.8%-30.1%; p=0.003). The rates of intraoperative urethral injury, rectal injury, vaginal injury and bladder injury were 0.3% (95% CI 0.1%-1.7%), 0.4% (95% CI 0.1%-2.2%), 0.3% (95% CI 0.1%-0.8%) and 0.3% (95% CI 0.1%-1.7%), respectively. This meta-analysis shows that pooled perioperative complication rates were within acceptable ranges. However, the significant difference in overall morbidity rate between the studies with 30-day results and the studies without a specified follow-up time, indicates a large under-reporting of complications in many studies.

What if artificial urinary sphincter is not possible? Feasibility and effectiveness of ProACT for patients with persistent stress urinary incontinence after radical prostatectomy treated by sling.

Stress urinary incontinence (SUI) is a major component of the post radical prostatectomy (RP) trifecta. Surgical treatments are sub-urethral slings, artificial urinary sphincter (AUS) and adjustable peri-urethral balloons (PUB) ProACT. All options are imperfect at best and persistent SUI is challenging when AUS is not manageable. This study analyzed the cumulate experience of our 2 centers with offering PUB implantation for SUI post RP in patients with insufficient improvement from slings. This retrospective study reviewed all patients implanted with second line ProACT. The primary endpoint was continence, defined as 0 pads per day (PPD). The secondary endpoints were 50% decrease in PPD and increases in the Incontinence Quality of Life score (IQOL). Refilling and complications were reported. Between 2007 and 2016, 26 patients were implanted. Five patients have had adjuvant radiotherapy (18%). The mean follow-up was 36 months (±20; min 14-max 128). All patient presented with persistent SUI, using 2.3 PPD (±1; min 1-max 6), and only one sling was removed due to infection. After ProACT with an average 3 mL refilling (±1.2 min 2-max 6), 18 patients (66.7%) were continent. Eight of the remaining patients (29.6%) were improved; their number of PPD decreased from 2.6 to 1. The average IQOL score of those 8 patients increased by 20 points, from 53.4 up to 74.2 (P = .005). Overall 26 patients (96.3%) were improved. The remaining patient was not implanted because of an intraoperative urethral injury and is considered a failed case (3.7%). He had instead an AUS implantation. Three patients (14.8%) needed PUB replacement. The limited population of patients from both our centers who presented with persistent SUI after RP, despite sling placement, improved with PUB ProACT implantations without significant complications.

Management of Urethral Injury During Penile Prosthesis Surgery

There has been relatively little research into the management of intraoperative urethral injury during insertion of penile prostheses. In this review, we describe how such injuries can occur and the common management strategies. There are no randomized trials or level 1 evidence for managing such intraoperative urethral injury, and most literature are small retrospective series, expert opinions, or systematic reviews that combine small observational studies. Anatomical considerations, corporal fibrosis, and Peyronie’s disease present risk factors for urethral injury. Injuries can be classified by location at the distal urethra (meatus to fossa navicularis), mid-urethra (fossa navicularis through pendulous urethra), or proximal urethra (proximal penile urethra to distal bulbar urethra). There is no true consensus on what actions to take when a urethral injury does occur, and management is changing over time. While the traditional course has been to abort the procedure, some surgeons now choose to repair the defect and proceed with prosthesis implantation. Urethral injury is a rare but serious complication during penile prosthesis insertion. Management is heterogenous and is heavily dependent on the location of the injury and the preference and experience of the surgeon.

Usefulness of an ICG fluorescence catheter system in TaTME for avoiding intraoperative urethral injury.

Sometimes intraoperative urethral injury occurs in Transanal total mesorectal excision (TaTME). The aim of this study is to investigate the usefulness of indocyanine green (ICG) fluorescent catheter system for avoiding intraoperative urethral injury in TaTME in experimental model. A urethral catheter was filled with the mixture of albumin and ICG and raw hams were applied in layers as the surrogate model of rectourethral muscle. The detectability of ICG fluorescence in this catheter was investigated by using laparoscope-type fluorescence camera system. Fluorescence was detected when ICG was mixed with albumin or peripheral blood. ICG fluorescence could be detected within 4 mm depth of layered raw hams as the surrogate model. Quantitative analysis of the picture detected that ICG fluorescence plateaued in lower concentration than that of serum. ICG fluorescent catheter system may be useful for avoiding intraoperative urethral injury in TaTME. J. Med. Invest. 67 : 285-288, August, 2020.

Synchronous Urethral Repair During Prosthetic Surgery: Safety of Planned and Damage Control Approaches Using Suprapubic Tube Urinary Diversion

BackgroundUrethral injury during inflatable penile prosthesis (IPP) or artificial urinary sphincter (AUS) placement is rare, and traditionally most prosthetic surgeons abort prosthetic implantation when urethral repair is necessary. AimTo report our experience with synchronous urethroplasty (SU) as a planned or damage control surgery during urologic prosthetic surgery, to evaluate the safety and outcomes of the procedure. MethodsA retrospective review of our IPP and AUS database was completed to identify patients who underwent an SU between 2007 and 2018. We included patients who underwent an SU during prosthetic surgery in either a planned procedure for known stricture or diverticulum or a “damage control” procedure after intraoperative injury. OutcomePatient characteristics and surgical outcomes were assessed, with success defined as the absence of urethral stricture and revision surgery. ResultsFrom our database of 1,508 prosthetic cases, we identified 7 patients (0.46%) who had an SU in the same setting as complete prosthesis placement (4 AUS and 3 IPP [1 combined IPP/AUS], and 1 sling). Three patients underwent planned repair of a known urethral abnormality (urethral diverticulum, urethrocutaneous fistula, and urethral stricture), and 4 underwent repair of an intraoperative urethral injury. Among the patients who experienced an intraoperative urethral injury, contributing etiologies included previous anti-incontinence surgery with periurethral fibrosis (n = 2), severe corporal fibrosis from priapism, and previous urethral disruption from pelvic fracture. Nearly all of the urethroplasties (6 of 7; 86%) were completed with a primary closure. The average indwelling duration of suprapubic tube (SPT) catheters was 4.1 weeks (range, 7 to 47 days). The average duration of follow-up was 21.5 months, and all patients were continent at follow-up. No device infections or urethral complications were identified. Clinical ImplicationsOur study illustrates the safety of concomitant urethral repair at time of prosthetic placement as an option to avoid the use of 2 anesthetics and prevent further scarring in high-risk patients. Strengths & LimitationsThis is the first study to address definitive urethral reconstruction during anti-incontinence procedures along with planned concomitant urethroplasty during IPP placement. This promising initial experience is relevant for surgeons who may encounter concomitant urethral pathology in the setting of complex reoperative prosthetic cases. The need for SU is rare, and thus our cohort size was limited in this retrospective, single-institution experience. ConclusionSU with prolonged SPT urinary diversion offers a safe damage control approach for men with concomitant urethral pathology during prosthetic surgery without conferring an increased risk of infection or stricture.Yi YA, Fuchs JS, Davenport MT, et al. Synchronous Urethral Repair During Prosthetic Surgery: Safety of Planned and Damage Control Approaches Using Suprapubic Tube Urinary Diversion. J Sex Med 2019;16:1106–1110.

291 Synchronous Urethral Reconstruction During Urologic Prosthetic Surgery

Conventional dogma suggests that management of urethral pathology should not be conducted in the same setting as prosthetic urologic procedures. Recent rare reports of successful urethral repair at the time of device implantation have shown promise. We report our initial favorable experience with synchronous urethroplasty (SU) during urologic implant surgery for patients with urethral injury or other pathology. We retrospectively reviewed patients undergoing inflatable penile prosthesis (IPP) or artificial urinary sphincter (AUS) with SU (2010-2018). Success was defined as absence of complication, urethral stricture and revision surgery. From our database of over 1200 urologic prosthetic patients, we identified seven patients who underwent SU as either (a) “damage control” for intraoperative urethral injury (4/7), or (b) planned repair of urethral abnormality (3/7). Three patients underwent concomitant IPP, four patients had an AUS and one patient had a sling. Urethral injury occurred during urethral dissection (two multiple prior AUS with erosion) or corporal dilation (one recurrent priapism). Planned SU was performed in patients with urethral diverticulum (AUS), urethral stricture (distal bulb repaired with buccal graft and IPP pump revision) and urethroscrotal fistula (pre-existing AUS/IPP with IPP pump revision). Patients were managed postoperatively with suprapubic tube (85.7%, 6/7) or urethral Foley (14.3%, 1/7) for a median of 4 weeks (range 2-6). No patients developed prosthetic infection or urethral stricture during a median follow-up of 38 months (range 4.5-85).

045 Combined Urethral Surgery at Time of Penile Prosthesis Implantation does not Increase Risk of Device Infection

Urethral surgery for stricture disease or urethral trauma sustained at the time of inflatable penile prosthesis (IPP) implantation is thought to significantly increase rates of device infection. The classic teaching requires procedure abortion, urethral repair and a future, delayed IPP implantation. We report our experience with patients who had urethral surgery at the time of IPP implantation in order to further elucidate potential risk factors associated with device complications. Consecutive records of patients who underwent IPP implantation at our institution between May 2007 and March 2017 were queried retrospectively. Medical records of patients with a history of urethral surgery at the time of IPP implantation were evaluated. Patient demographics, pre-operative workup, intra-operative maneuvers and post-operative follow-up data were analyzed with use of standard statistics. Records of thirteen men were identified. Average patient age was 63.9 years (range: 40-81yo), and 11 of men (84.6%) were Caucasian. Two men who sustained intra-operative urethral injuries underwent complex repairs with suprapubic tube (SPT) placement. The remaining eleven men had stricture disease and required either stricture dilation, incision or urethroplasty. IPP revision (explantation/ implantation) was performed in two of the men undergoing urethral dilation for stricture disease. There were no device infections or erosions. (Table 1)

Survey on the Contemporary Management of Intraoperative Urethral Injuries During Penile Prosthesis Implantation

BackgroundIntraoperative urethral injury is an uncommon event during the placement of a penile prosthesis, and alternative management strategies have been proposed with continuation of implantation after urethral injury. AimTo evaluate surgeon practices in the management of intraoperative urethral injury. MethodsAn online survey was sent to the society listservs of the Genitourinary Reconstructive Surgeons (GURS) and the Sexual Medicine Society of North America (SMSNA). Physicians were queried on their fellowship training, experience with penile prosthesis implantation, and management of urethral injuries during prosthesis placement. The response data were analyzed using SAS 9.4 (SAS Institute, Cary, NC, USA). The χ2 test and Fisher exact test were used to determine associations between variables. OutcomesSurvey responses. Results131 survey responses were analyzed. Of the responders, 41.2% were GURS fellowship trained, 19.1% were SMSNA trained, 30.5% were non-fellowship trained, and 9.2% were trained in other fellowships. 25.4% of participants performed more than 50 implantations per year, 37.7% performed 20 to 50 per year, and 36.9% performed fewer than 20 per year. Urethral injury during prosthesis implantation was uncommon, with 26.2% reporting 0 injury, 58.5% reporting 1 to 3 injuries, and 15.4% reporting more than 3 career injuries. Injuries were most commonly encountered during corporal dilation (71.1%) compared with corporal exposure (12.5%) or penile straightening maneuvers (7.0%). There was no statistically significant difference with aborting or continuing implantation among GURS-trained, SMSNA-trained, other fellowship-trained, and non–fellowship-trained surgeons. Of all responders, 55% would abort the procedure after distal urethral injury, whereas 45% would continue the procedure with unilateral or bilateral insertion of cylinders. Patient factors that increased likelihood of terminating the procedure in the case of urethral injury included immunosuppression, spinal cord injury, and clean intermittent catheterization dependence. Clinical ImplicationsA urethral injury during penile prosthesis implantation might not mandate termination of the procedure despite classic teaching. Strengths and LimitationsThe strength of this study is that it provides difficult to obtain epidemiologic data on the frequency and management of this clinically significant injury. Limitations include the inherent biases from a survey-based study including response bias and recall bias. The survey response rate could not be obtained. ConclusionUrethral injury during penile prosthesis implantation is a rare but clinically significant risk of the procedure, with many variations in management of the injury. Termination and delayed implantation might not be necessary after injury, although long-term outcome data are difficult to obtain.Sexton SJ, Granieri MA, Lentz AC. Survey on the Contemporary Management of Intraoperative Urethral Injuries During Penile Prosthesis Implantation. J Sex Med 2018;15:576–581.

The Effect of Oral Phenazopyridine on Perioperative Voiding After Midurethral Slings (EPIPhANy Study).

To determine the effect of preoperative oral phenazopyridine on postoperative voiding dysfunction in women undergoing a retropubic midurethral sling. A single-institution randomized clinical trial was performed from September 2015 to March 2017, comparing 200 mg of oral phenazopyridine versus no phenazopyridine in patients undergoing a retropubic midurethral sling under general anesthesia with no concomitant procedures. A power calculation indicated that we required at least 40 subjects per arm. Preoperative demographics, intraoperative medications, blood loss, and complications were recorded. A standardized voiding trial was performed before discharge. Voiding dysfunction was determined by the proportion of subjects who failed a postoperative voiding trial. Pain scores were obtained before and 2 to 3 hours after the surgical procedure. Patient characteristics and surgical data were compared using χ, Fisher exact test, or Wilcoxon rank sum test. Ninety-two subjects were enrolled in the study. Three patients cancelled their surgery and 1 had an intraoperative urethral injury, leaving 88 patients for the final analysis (44 per arm). Patient demographics showed no differences between groups. Phenazopyridine did not reduce the proportion of patients who failed the voiding trial (27%) compared with subjects who did not receive the medication (21%) (P = 0.453). Postoperative visual analog pain scores were higher in those not receiving phenazopyridine (1.76 vs 1.21, P = 0.046), but after adjusting for the difference in preoperative and postoperative pain scores, the groups showed no difference (P = 0.087). Our prospective trial shows that phenazopyridine has no effect on short-term postoperative voiding dysfunction. This condition appears to be multifactorial, and further research is needed.

201 Survey on the Contemporary Management of Intraoperative Urethral Injuries during Penile Prosthesis Implantation

Intraoperative urethral injury is an uncommon event during the placement of an inflatable penile prosthesis (IPP) with an estimated incidence of up to 3%. The conventional teaching is to perform primary repair, place a transurethral catheter, and abort the procedure. Recently, alternative management strategies have been proposed with continuation of the implant following urethral injury. The objective of this study is to evaluate surgeon practices in the management of intraoperative urethral injury and determine if fellowship training influences management. An online survey was sent to the society listservs of the Genitourinary Reconstructive Surgeons (GURS) and The Sexual Medicine Society of North America (SMSNA). Physicians were queried on their fellowship training, experience with IPP implantation, and management of urethral injuries during IPP placement. The response data was analyzed using SAS 9.4 (SAS Institute Inc., Cary, NC). Chi-squared test and Fisher's exact test were used to determine associations between variables.

The TiLOOP® Male Sling: Did We Forejudge

Introduction: To evaluate the safety and efficacy of the TiLOOP® male sling (pfm medical, Cologne, Germany) used in the treatment for male stress urinary incontinence (SUI). Material and Methods: We retrospectively evaluated a total of 34 patients with a TiLOOP® male sling. Perioperative complication rates were assessed and validated questionnaires were prospectively evaluated to assess quality of life and satisfaction rate. Outcome and complication rates were analysed by using descriptive statistics. Correlation of continence outcome and risk factors was performed with the chi-square test. A p value below 0.05 was considered statistically significant. Results: The majority of patients (70.6%) were diagnosed with mild or moderate male SUI. During surgery, one instance (2.9%) of intraoperative urethral injury was observed. There were no immediate postoperative complications. The mean follow-up time was 44.6 months. An improvement of male SUI was reported by 61.9% of the patients and 38.1% reported no change according the Patient Global Impression of Improvement. The mean perineal pain score was 0.5 according to the international index of pain. Conclusions: The TiLOOP® is a safe treatment option for male SUI in our cohort with a low complication rate. However, the functional outcome of the TiLOOP® was inferior when compared to the outcome of the AdVance® male sling.

MP25-19 SURVEY ON THE CONTEMPORARY MANAGEMENT OF INTRAOPERATIVE URETHRAL INJURIES DURING PENILE PROSTHESIS IMPLANTATION

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy I1 Apr 2017MP25-19 SURVEY ON THE CONTEMPORARY MANAGEMENT OF INTRAOPERATIVE URETHRAL INJURIES DURING PENILE PROSTHESIS IMPLANTATION Stephanie J. Sexton, Michael A. Granieri, and Aaron C. Lentz Stephanie J. SextonStephanie J. Sexton More articles by this author , Michael A. GranieriMichael A. Granieri More articles by this author , and Aaron C. LentzAaron C. Lentz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.769AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intraoperative urethral injury is an uncommon event during the placement of an inflatable penile prosthesis (IPP) with an estimated incidence of up to 3%. The conventional teaching is to perform primary repair, place a transurethral catheter, and abort the procedure. Recently, alternative management strategies have been proposed with continuation of the implant following urethral injury. The objective of this study is to evaluate surgeon management of urethral injury during IPP and determine if fellowship training influences practice. METHODS An online survey was sent to the society listservs of the Genitourinary Reconstructive Surgeons (GURS) and The Sexual Medicine Society of North America (SMSNA). Physicians were queried on their fellowship training, experience with IPP and urethroplasty, IPP surgical approach, and management of urethral injuries during IPP implantation. The response data was analyzed using SAS 9.4 (SAS Institute Inc., Cary, NC). Chi-squared test and Fisher's exact test were used to determine associations between variables. RESULTS There were a total of 131 survey responses. Of the responders, 41.2% were GURS fellowship trained, 19.1% were SMSNA trained, 30.5% were non-fellowship trained, and 9.2% trained in other fellowships. 25.4% of participants perform >50 IPPs per year, while 37.7% perform 20-50 and 36.9% perform fewer than 20 per year. Urethral injury during IPP implantation was uncommon, with 26.2% reporting 0 injuries, 58.5% reporting 1-3 injuries, and 15.4% reporting >3 career injuries. Injuries were most commonly encountered during corporal dilation (71.1%), compared to corporal exposure (12.5%), or penile straightening maneuvers (7.0%). There was no statistically significant difference with aborting or continuing implantation among GURS, SMSNA, and/or non-fellowship trained surgeons. Of all responders, 55% abort the procedure after distal urethral injury, while 45% continue the procedure with unilateral or bilateral insertion of cylinders. For those who chose to abort the procedure, the next implant was attempted in <6 weeks in 9.3%, 6-12 weeks in 45.7%, and >12 weeks in 41.1%. Patient factors that increased likelihood of aborting procedure in the case of urethral injury included immunosuppression, spinal cord injury, and clean intermittent catheterization-dependence. CONCLUSIONS Urethral injury during IPP implantation is a rare but established risk of the procedure. Fellowship training does not appear to have an effect on intraoperative management of this injury. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e318 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Stephanie J. Sexton More articles by this author Michael A. Granieri More articles by this author Aaron C. Lentz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Efficacy and safety of TVT-EXACT procedure for treatment of ISD female stress urinary incontinence

Objective To investigate the efficacy and complication of Tension-free Vaginal Tape (TVT)-Exact for the treatment of type-Ⅲ female stress urinary incontinence (SUI). Methods A total of 20 type-Ⅲ SUI patients enrolled from November 2013 to June 2016 were retrospectively analyzed. The efficacy and complication of the surgery were evaluated. Results The mean operation time was (20.7±1.60)min (range, 19-25 min). The blood loss was 20-50 ml. There were no intraoperative bladder or urethral injury, and no vessel or nerve damage. 2 cases with mixed SUI were relieved by medicine. No case had urethral or vaginal erosion. Therapeutic efficacy: 15 cases were cured (75%), 5 cases were improved (25%), and no case was ineffective. Conclusions TVT-E is a simple, min-invasive, safe and effective surgery for type-Ⅲ SUI. While the long-term efficacy needs great amount of clinical data and long-term follow-up to prove. Key words: Pubic bone/AH/SU; Suburethral slings; Urinary incontinence, stress/SU