Prostatic Urethra Research Articles

Preoperative Multiparametric Prostate Magnetic Resonance Imaging Structured Report Informs Risk for Positive Apical Surgical Margins During Radical Prostatectomy.

The prostatic apex is the most frequent location of positive surgical margin (PSM) after surgery. Data regarding the ability of multiparametric magnetic resonance imaging (mpMRI) to prospectively identify men at risk for apical PSMs (aPSMs) using a structured report are lacking. The aims of the study are to determine and to compare the rate of aPSM in men with versus without prospectively flagged at-risk prostate lesions during clinical mpMRI interpretation using whole-mount histopathology as the reference standard. This single-center, retrospective study of prospectively collected data included treatment-naive men with abnormal 3T mpMRI (PI-RADS v2 score ≥3) between January 2016 and December 2018 followed by surgery. During routine clinical interpretation, radiologists flagged prostate lesions abutting the apical most gland and/or encircling the distal most prostatic urethra using standardized language available as a "pick list" option in the structured report. Logistic regression was used to compare the rate of PSM in 2 groups (flagged vs nonflagged men). Propensity score covariate adjustment corrected for potential selection bias according to age, prostate-specific antigen (PSA), PSA density, grade group, and pT stage. The estimate was further adjusted by including surgeon as a covariate. A total of 428 men were included. A statistically significant higher proportion of aPSMs was noted in flagged (56% [51/91]) compared with nonflagged apical lesions (31% [105/337]; adjusted odds ratio, 2.5; 95% confidence interval, 1.6-4.1; P < 0.01). The difference in aPSM between both groups also varied according to the surgeon performing the RP. Prostate-specific antigen, PSA density, lesion size, apical location, Prostate Imaging Reporting & Data System score, grade group, pT stage, and surgeon's experience were associated with higher PSM rate. Biochemical recurrence, defined as PSA greater than 0.2 ng/mL on 2 measurements after RP, was significantly associated with PSM status (propensity score adjusted odds ratio, 3.1; 95% confidence interval, 1.8-5.3; P < 0.0001); however, patients flagged by radiologists did not have a significant difference in biochemical recurrence rates as compared with nonflagged patients ( P = 0.11). Standard language built into structured reports for mpMRI of the prostate helps identify preoperatively patients at risk for aPSM. Multiparametric MRI is able to identify patients at increased risk for aPSM, and this information can be conveyed in a structured report to urologists, facilitating patient counseling and treatment decisions.

Bladder neck-sparing retropubic radical prostatectomy: assessing risk factors for detection of positive surgical margins

Background. Bladder neck preservation during retropubic radical prostatectomy (rRP) promotes a protective effect on urinary continence compared to standard rRP.Aim. To assessment of possible predictors for positive surgical margin (PSM) recognition is an important step.Materials and methods. 136 patients with localized prostate cancer (PCa) were studied in the study. Group 1, 90 patients (retrospective assessment), underwent standard rRP, group 2, 46 patients (prospective assessment), underwent rRP modified by bladder neck preservation with a part of the proximal prostatic urethra. The clinical and pathological stages of PCa were assessed; the groups were compared to the parameter PSM. Statistical analysis was performed using nonparametric statistical methods.Results. Both groups were comparable in age and baseline total prostate specific antigen (PSA) but differed in prostate volume and Gleason score. Also, there were differences in clinical and pathological stages of PCa. PSM-patients had more aggressive PCa according to the International Society of Urological Pathology (ISUP) and TNM classifications and had higher progression risk prognosis stages. In PSM-patients, correlations were determined between prostate volume and baseline Gleason index (r = 0.338; p &gt;0.05); baseline total PSA and Gleason score before (r = 0.529; p &gt;0.05) and after (r = 0.310; p &gt;0.05) rRP, respectively. Nevertheless, the incidence of PSM among all subjects was 6.6 % of cases, while in groups 1 and 2 was 7.8 and 4.3 % of cases, respectively. In this way, surgical techniques that maximize bladder neck preservation with a part of proximal prostatic urethra have no significant effect on PSM. Ranges of total PSA, clinical stage of PCa, Gleason score and progression risk stages (prognostic group for PCa) were determined as predictors of PSM. Their use will make it possible to establish patient selection criteria for bladder neck preservation with proximal prostatic urethra during rRP.Conclusion. The identified predictors will allow determining during clinical staging minimal risks of detecting PSM. The rRP modified by bladder neck preservation with part of the proximal prostatic urethra does not increase the incidence of PSM compared to the standard rRP. The feasibility of this technique should be related to total PSA, clinical stage of PCa, Gleason score, and the progression risk stage.

Mucinous adenocarcinoma of the prostatic urethra after brachytherapy for prostatic adenocarcinoma: a case series

Mucinous adenocarcinoma of the urethra is extremely rare, even more so in a setting of postradiation therapy, with only 3 cases reported up to date including the first case published by our group in 2011. In the present study, we included the long-term follow-up on our previously reported case and report 3 additional cases. This is the first case series to date of this rare disease entity. The aim of this study is to review the clinicopathologic features of mucinous adenocarcinoma of the prostatic urethra in patients after receiving brachytherapy for prostatic adenocarcinoma. We identified 4 patients with a mean age of 72 years, and a mean interval of 14.8 years from brachytherapy for prostate carcinoma (grade group 1). Patients presented with hematuria or urinary retention. A colonoscopy was performed in three-fourth of patients and was within normal limits. Three patients underwent cystoprostatectomy and 1 had a transurethral resection of the prostate. On gross examination, only tumor formed a 3.5cm tan-gray, ulcerated, friable, and necrotic mass and 2 displayed either irregular red granular or thickened areas within the prostatic urethra. Abundant extracellular mucin pools dissecting the prostatic stroma were present in all tumors, with clusters of tumor cells floating in the mucin. The mucin pools were lined by pleomorphic pseudostratified columnar mucinous epithelium. Tumors were diffusely positive for CK20, CDX2 (4/4), and AMACR (2/2); they focally expressed CK7 (2/4), and lacked nuclear β-catenin expression (3/3). PSA, PSAP, NKX3.1, p63, and GATA3 were negative in the tumors tested. Among the 3 patients who underwent radical surgery, 2 had stage 2 tumors (confined to the prostatic urethra and prostate), and 1 had a stage 3 tumor, with seminal vesicle involvement. All 4 patients were alive without disease with a mean follow-up of 4.9 years. In conclusion, brachytherapy-associated mucinous adenocarcinoma of the prostatic urethra displays intestinal-type features as its non-radiation-related counterpart. It appears to lack a villous adenoma component, displays a different immunohistochemical profile with diffuse CK20 and CDX2 positivity, and is associated with lower stage and less aggressive behavior.

Urethral Interfractional Geometric and Dosimetric Variations of Prostate Cancer Patients: A Study Using an Onboard MRI.

PurposeFor a cohort of prostate cancer patients treated on an MR-guided radiotherapy (MRgRT) system, we retrospectively analyzed urethral interfractional geometric and dosimetric variations based on onboard MRIs acquired at different timepoints and evaluated onboard prostatic urethra visualization for urethra-focused online adaptive RT.MethodsTwenty-six prostate cancer patients were prospectively scanned on a 0.35-T MRgRT system using an optimized T2-weighted HASTE sequence at simulation and final fraction. Two radiation oncologists (RO1 and RO2) contoured the urethras on all HASTE images. The simulation and final fraction HASTE images were rigidly registered, and urethral interobserver and interfractional geometric variation was evaluated using the 95th percentile Hausdorff distance (HD95), mean distance to agreement (MDA), center-of-mass shift (COMS), and DICE coefficient. For dosimetric analysis, simulation and final fraction HASTE images were registered to the 3D bSSFP planning MRI and 3D bSSFP final setup MRI, respectively. Both ROs’ urethra contours were transferred from HASTE images for initial treatment plan optimization and final fraction dose estimation separately. Stereotactic body radiotherapy (SBRT) plans, 40 Gy in 5 fractions, were optimized to meet clinical constraints, including urethral V42Gy ≤0.03 cc, on the planning MRI. The initial plan was then forward calculated on the final setup MRI to estimate urethral dose on the final fraction and evaluate urethral dosimetric impact due to anatomy change.ResultsThe average interobserver HD95, MDA, COMS, and DICE were 2.85 ± 1.34 mm, 1.02 ± 0.36 mm, 3.16 ± 1.61 mm, and 0.58 ± 0.15, respectively. The average interfractional HD95, MDA, COMS, and DICE were 3.26 ± 1.54 mm, 1.29 ± 0.54 mm, 3.34 ± 2.01 mm, and 0.49 ± 0.18, respectively. All patient simulation MRgRT plans met all clinical constraints. For RO1 and RO2, 23/26 (88%) and 21/26 (81%) patients’ final fraction estimated urethral dose did not meet the planned constraint. The average urethral V42Gy change was 0.48 ± 0.58 cc.ConclusionUrethral interfractional motion and anatomic change can result in daily treatment violating urethral constraints. Onboard MRI with good visualization of the prostatic urethra can be a valuable tool to help better protect the urethra through patient setup or online adaptive RT.

An Unexpected Complication: Glans Ischemia After Urethractomy

Necrosis of the glans is a rare and unexpected complication of urethractomy. The literature is poorly documented regarding this complication. We report here the case of a 49 year old patient with a history of chronic smoking, followed for bladder tumour initially without muscle infiltration. Lost to follow-up for 3 years, his re-evaluation revealed a muscle-infiltrating bladder tumour with localization in the prostatic urethra without other secondary localizations.

Renal outcome in patients with complex anorectal malformations

Introduction: Anorectal malformations (ARMs) are one of the most frequent congenital malformations in pediatric surgery. Its estimated incidence ranges between 1 in 2000 and 1 in 5000 live newborns approximately. The aim of the work is to present the associated urinary anomalies and functional renal outcomes in patients with worse prognosis anorectal malformations treated in our department Material and methods: A retrospective review of the patients operated at our center with complex anorectal malformations was performed, including urological abnormalities and long-term renal follow-up. Collected data included the type of urinary abnormality, classified as high or low, renal function (glomerular filtration rate and blood creatinine level), the presence of chronic kidney failure (CKD), the need for surgery to correct the urinary abnormality, the need for kidney transplantation and complications and long-term results. Results: A total of 55 patients were included, 32 girls and 23 boys. Mean age at the time of corrective surgery for the anorectal malformation was 9 months (SD 2.18). The mean follow-up of the patients was 13 years (SD 7.01). Sixty-nine per cent of the patients presented some urological anomaly, being more frequent in the cloacal group. Renal structural abnormalities were found in 22 (40%) of 55 patients. They were identified in 11 (47%) cloacal patients, being the most frequent renal dysplasia (n=7; 32%), followed by position abnormalities in 3. Regarding the lower urinary tract anomalies, it was described in 32 (58%) patients. In the cloacal group, the incidence was 65%, being the most frequent vesicoureteral reflux (n = 14, 60%) as well as in the group of patients with a fistula to the prostatic urethra and in the group with exstrophies of the cloaca (n = 3, 42%). Regarding the rest of the lower urinary tract anomalies, the general incidence of anatomic bladder anomalies (bladder diverticulum, patent urachus) was 15%. As a pathology related to the upper urinary tract: primary obstructive megaureter 5%, ureterocele 1% and posterior urethral valves 1%. Conclusions: Patients with complex anorectal malformations have a significant risk for renal impairment. Adequate screening, high level of suspicion, treatment and long term follow up of any associated urinary anomaly in patients with complex anorectal malformations is essential to preserve renal function and prevent CKD. Care by a multidisciplinary team and adequate transition to adulthood is essential to optimize the medical management of patients and long-term outcomes.

Numerical investigation of urethra flow characteristics in benign prostatic hyperplasia

Background and objectiveConventional practice includes a limited depiction of urethral pressure and flows based on fragmented gross clinical observations. However, with technological advancements in simulations, computational fluid dynamics (CFD) can provide an alternative approach to predict the bladder pressure with a concordant quantitative flow field in the urethra. Thus, this study aims to comprehensively analyze the urine flow characteristics in various urethra models using simulations. MethodsThree-dimensional urethra models were constructed for seven specific subjects based on clinical radiographs. Simulations with Reynolds averaged Navier-Stokes model were performed to quantitatively investigate the urine flow under various volume flow rate of voided urine. ResultsUnder benign prostatic hyperplasia, the spindle shape of the prostatic urethra (PRU) generates wake flow. The wake flow was also observed in several regions downstream of the PRU, depending on the urethra shape. This wake flow resulted in total pressure loss and urinary tract dysfunction. When comparing pre- and post-operative urethra models, the bladder pressure decreased by 14.98% in P04 and 4.67% in P06. Thus, we identified variability between surgical results of patients. The bladder pressure according to the volume flow rate of voided urine was investigated using simulations and the theoretical consideration based on hydrodynamics. In theoretical consideration, the bladder pressure was expressed as a second-order polynomial for volume flow rate. These results concur with the simulation results. ConclusionNumerical simulation can describe the urine flow field in the urethra, providing the possibility to predict the bladder pressure without requiring painful, invasive interventions, such as cystoscopy. Furthermore, effective treatments to improve urination function can be formulated to be patient-specific, by detecting causes and problem regions based on quantitative analysis and predicting post-surgical outcomes.

Laparoscopic retropubic extraurethral adenomectomy

Introduction. Existing methods of surgical treatment of benign prostatic hyperplasia are accompanied by the frequent development of postoperative complications, such as urinary incontinence, retrograde ejaculation, and urethral strictures. The method of preserving the prostatic urethra has been developed for a long time. At present, it is possible to use the operation technique and perform laparoscopic urethral-sparing adenomectomy.Objective. To assess the possibility of performing extraurethral adenomectomy with prostatic urethral preservation using the laparoscopic approach, its advantages and disadvantages.Materials and methods. Based on St. Luke’s Simferopol сlinical Multidisciplinary Medical Center, 35 successful laparoscopic operations were performed to remove benign prostate hyperplasia with the prostatic urethra preservation. The features of the operation are laparoscopic access, a transverse section of the capsule, alternate isolation of adenomatous nodes while preserving the prostatic urethra on the catheter without replacing it during the operation, suturing the capsule with a decrease in space from the removed adenomatous nodes. Urethral preservation provided accelerated epithelialization of the defect, in the absence of the formation of a “prevesical” space.Results. After the operation, it is possible to turn off the urinary bladder irrigation system earlier (up to 4 – 6 hours after the operation) and early removal of the catheter after surgery (2 – 3 days). The hospital stay averaged 5.7 days. Urination was restored immediately after catheter removal in 92% of the patients. There were no elements of dysuria, particularly urinary incontinence. Prostate volume measured throughout transrectal ultrasound after operation was 20 – 24 cm³.Conclusion. The technique of retropubic extraurethral adenomectomy with prostatic urethral preservation can be performed in laparoscopic technique. The advantages are early activation of the patient and discharge from the hospital, early removal of the catheter with restoration of independent urination, absence of dysuria, urinary incontinence, and postoperative complications. The results of our study demonstrate the effectiveness of the laparoscopic extraurethral adenomectomy technique, the further development of this technique, and the possibility of its application in practice.

Laparoscopic retropubic extraurethral adenomectomy

Introduction. Existing methods of surgical treatment of benign prostatic hyperplasia are accompanied by the frequent development of postoperative complications, such as urinary incontinence, retrograde ejaculation, and urethral strictures. The method of preserving the prostatic urethra has been developed for a long time. At present, it is possible to use the operation technique and perform laparoscopic urethral-sparing adenomectomy.Objective. To assess the possibility of performing extraurethral adenomectomy with prostatic urethral preservation using the laparoscopic approach, its advantages and disadvantages.Materials and methods. Based on St. Luke’s Simferopol сlinical Multidisciplinary Medical Center, 35 successful laparoscopic operations were performed to remove benign prostate hyperplasia with the prostatic urethra preservation. The features of the operation are laparoscopic access, a transverse section of the capsule, alternate isolation of adenomatous nodes while preserving the prostatic urethra on the catheter without replacing it during the operation, suturing the capsule with a decrease in space from the removed adenomatous nodes. Urethral preservation provided accelerated epithelialization of the defect, in the absence of the formation of a “prevesical” space.Results. After the operation, it is possible to turn off the urinary bladder irrigation system earlier (up to 4 – 6 hours after the operation) and early removal of the catheter after surgery (2 – 3 days). The hospital stay averaged 5.7 days. Urination was restored immediately after catheter removal in 92% of the patients. There were no elements of dysuria, particularly urinary incontinence. Prostate volume measured throughout transrectal ultrasound after operation was 20 – 24 cm³.Conclusion. The technique of retropubic extraurethral adenomectomy with prostatic urethral preservation can be performed in laparoscopic technique. The advantages are early activation of the patient and discharge from the hospital, early removal of the catheter with restoration of independent urination, absence of dysuria, urinary incontinence, and postoperative complications. The results of our study demonstrate the effectiveness of the laparoscopic extraurethral adenomectomy technique, the further development of this technique, and the possibility of its application in practice.

Prostate MRI in Stereotactic Body Radiation Treatment Planning and Delivery for Localized Prostate Cancer.

Prostate MRI is increasingly being used to make diagnoses and guide management for patients receiving definitive radiation treatment for prostate cancer. Radiologists should be familiar with the potential uses of prostate MRI in radiation therapy planning and delivery. Radiation therapy is an established option for the definitive treatment of localized prostate cancer. Stereotactic body radiation therapy (SBRT) is an external-beam radiation therapy method used to deliver a high dose of radiation to an extracranial target in the body, often in five or fewer fractions. SBRT is increasingly being used for prostate cancer treatment and has been recognized by the National Comprehensive Cancer Network as an acceptable definitive treatment regimen for low-, intermediate-, and high-risk prostate cancer. MRI is commonly used to aid in prostate radiation therapy. The authors review the uses of prostate MRI in SBRT treatment planning and delivery. Specific topics discussed include the use of prostate MRI for identification of and dose reduction to the membranous and prostatic urethra, which can decrease the risk of acute and late toxicities. MRI is also useful for identification and appropriate dose coverage of the prostate apex and areas of extraprostatic extension or seminal vesicle invasion. In prospective studies, prostate MRI is being validated for identification of and dose intensification to dominant intraprostatic lesions, which potentially can improve oncologic outcomes. It also can be used to evaluate the placement of fiducial markers and hydrogel spacers for radiation therapy planning and delivery. ©RSNA, 2022.

Urethral Stricture/Stenosis as a Complication of High Intensity Focused Ultrasound of the Prostate (HIFU): What is the Overall Patient Experience?

To analyze the location and management of urethral stricture/stenosis in patients treated with High-intensity focused ultrasound (HIFU) of the prostate as well as to describe patient reported satisfaction in these men. Patients with a history of HIFU requesting consultation for stricture were identified from 2010 to 2020. Demographic and prior treatment data were recorded. Patients who presented for evaluation underwent retrograde cystoscopy, retrograde urethrogram, voiding cystourethrogram, and antegrade cystoscopy through a suprapubic tract. Patients who only had virtual consultation and did not present for in-person evaluation, were followed longitudinally to assess long-term outcomes and quality of life. Over the 10-year study period, 17 patients were identified with a mean age of 65.8 years. Prior to initial consultation, a total of 88% of patients had at least 1 failed surgical intervention at a mean of 45 months post-HIFU. The majority of patients (94%) had strictures that included but were not necessarily limited to the prostatic urethra. Patients underwent various treatments postevaluation, favoring endoscopic therapy (38%), and proximal diversion (20%) at a mean follow-up of 68.2 ± 7.5 months. Only 38% reported satisfaction with urinary symptoms. Urethral narrowing post-HIFU appears to overwhelmingly involve the prostatic urethra. Patients usually have a significant treatment burden over a prolonged period and are often managed with repeated endoscopic treatment, extirpative prostatic surgery, or urinary diversion as they have obstruction that is not amendable to urethral reconstruction. Most patients with HIFU strictures experience a diminished QOL due to persistent urinary symptoms.

The EXPANDER-1 trial: introduction of the novel Urocross™ Expander System for treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH)

PurposeTo demonstrate the safety and feasibility of the Urocross Expander System (formerly branded as XFLO Expander System), an implantable nitinol tissue expander to trea t patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).Materials and methodsMen of 50 years or older were eligible to participate in the international, prospective, three-arm, open-label EXPANDER-1 trial if they had a prostate volume between 30 and 80 cc, prostatic urethra length between 20 and 60/80 mm, international prostate symptom score (IPSS) > 13, peak urinary flow (Qmax) < 12 mL/s, post-void residual (PVR) urine volume < 250 mL and quality of life (QoL) score ≥ 3. Patients had pre-assigned implant indwell times (1, 6, and 12 months for Arm-1, Arm-2 and Arm-3 respectively) with follow-up through 6 months (Arm-1) and 3 years (Arm-2 and Arm-3) post-retrieval.ResultsOutcome from treated subjects with their 6-month post-retrieval will be presented in this manuscript, as data collection from longer-term follow-up is ongoing. As of May 24, 2021, 39 and 22 men (mean age: 65), respectively, had implants successfully deployed and retrieved without any complications. No cases of implant encrustation were observed. Device- and procedure-related adverse events were predominantly mild to moderate in severity. Three SAEs were reported. Only one patient required catheterization post-implant for more than three days. Improvements in clinical parameters such as IPSS, QoL, PVR and Qmax as well as sexual function were observed.ConclusionsPreliminary results demonstrate that the Urocross Expander System is a feasible and safe procedure for treating BPH/LUTS. A strong signal of efficacy justifies further evaluation of this PRostatic Urethral Expansion (PURE) procedure. Negative features of earlier generations of prostatic implants such as biocompatibility, migrations and encrustation have possibly been overcome.

Urethrectomy at the time of radical cystectomy for non-metastatic urothelial carcinoma of the bladder: a collaborative multicenter study

IntroductionThe optimal management of the urethra in patients planned for radical cystectomy (RC) remains unclear. We sought to evaluate the impact of urethrectomy on perioperative and oncological outcomes in patients treated with RC for non-metastatic urothelial carcinoma of the bladder (UCB).Materials and methodsWe assessed the retrospective data from patients treated with RC for UCB of five European University Hospitals. Associations of urethrectomy with progression-free (PFS), cancer-free (CSS), and overall (OS) survivals were assessed in univariable and multivariable Cox regression models. We performed a subgroup analysis in patients at high risk for urethral recurrence (UR) (urethral invasion and/or bladder neck invasion and/or multifocality and/or prostatic urethra involvement).ResultsA total of 887 non-metastatic UCB patients were included. Among them, 146 patients underwent urethrectomy at the time of RC. Urethrectomy was performed more often in patients with urethral invasion, T3/4 tumor stage, CIS, positive frozen section analysis of the urethra, and those who received neoadjuvant chemotherapy, underwent robotic RC, and/or received an ileal conduit urinary diversion (all p < 0.001). Estimated blood loss and the postoperative complication rate were comparable between patients who received an urethrectomy and those who did not. Urethrectomy during RC was not associated with PFS (HR 0.83, p = 0.17), CSS (HR 0.93, p = 0.67), or OS (HR 1.08, p = 0.58). In the subgroup of 276 patients at high risk for UR, urethrectomy at the time of RC decreased the risk of progression (HR 0.58, p = 0.04).ConclusionIn our study, urethrectomy at the time of RC seems to benefit only patients at high risk for UR. Adequate risk assessment of UCB patients’ history may allow for better clinical decision-making and patient counseling.

MP22-09 URETHRAL STRICTURE/STENOSIS AS A COMPLICATION OF HIGH INTENSITY FOCUSED ULTRASOUND OF THE PROSTATE: WHAT IS THE OVERALL PATIENT EXPERIENCE?

You have accessJournal of UrologyCME1 May 2022MP22-09 URETHRAL STRICTURE/STENOSIS AS A COMPLICATION OF HIGH INTENSITY FOCUSED ULTRASOUND OF THE PROSTATE: WHAT IS THE OVERALL PATIENT EXPERIENCE? David Barham, John Barnard, and Joel Gelman David BarhamDavid Barham More articles by this author , John BarnardJohn Barnard More articles by this author , and Joel GelmanJoel Gelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002561.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: High Intensity Focused Ultrasound (HIFU) is an emerging treatment option for localized prostate cancer. Urethral stricture/stenosis develops in about 19% of patients on average, and is generally treated endoscopically. The literature does not describe in any detail the location of obstruction, treatment success rate, or impact on the patient's quality of life(QOL). Our objective was to analyze patients with HIFU stricture/stenosis to characterize location, management, and patient reported satisfaction. METHODS: Patients with a history of HIFU requesting consultation for stricture were identified from 2010-2020. Demographic and prior treatment data were recorded. Patients who presented for evaluation underwent cystoscopy, retrograde urethrogram, and voiding cystourethrogram. Patients, including those who did not present for in-person consultation, were followed longitudinally to assess long-term outcomes and QOL. RESULTS: 29 patients were identified with a mean age of 65.8 years. Prior to initial consultation, a total of 86.2% of patients had at least one failed surgical intervention at a mean of 45.1 months post-HIFU. Seventeen patients underwent urethral evaluation and 94.1% had strictures that included but were not necessarily limited to the prostatic urethra. Additionally, 35.3% had bladder neck stenosis, 23.5% had membranous stenosis, and 17.6% had anterior urethral strictures. 20 patients underwent various treatments post-evaluation, favoring endoscopic therapy (45%) and proximal diversion (20%) at a mean of 67.1 months follow-up (Table 1). Only 33.3% reported satisfaction with urinary symptoms. CONCLUSIONS: Urethral narrowing post-HIFU appears to overwhelmingly involve the prostatic urethra. Patients usually have a significant treatment burden over a prolonged period and are often managed with repeated endoscopic or extirpative prostatic surgery. Some undergo urinary diversion, but most patients with HIFU strictures experience a diminished QOL due to persistent urinary symptoms. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e374 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Barham More articles by this author John Barnard More articles by this author Joel Gelman More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP32-09 PATIENT CONTROLLED URETHRAL HYDRODISTENTION REDUCES PAIN DURING MALE FLEXIBLE CYSTOSCOPY

You have accessJournal of UrologyCME1 May 2022MP32-09 PATIENT CONTROLLED URETHRAL HYDRODISTENTION REDUCES PAIN DURING MALE FLEXIBLE CYSTOSCOPY Daniel Wagner, and William Lin Daniel WagnerDaniel Wagner More articles by this author , and William LinWilliam Lin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002581.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Flexible cystoscopy is typically performed under local anesthesia with intraurethral insertion of aqueous lidocaine gel. Male patients often experience significant discomfort as the cystoscope is negotiated past the membranous and prostatic urethra. The objective of this study is to determine whether patient controlled urethral hydrodistention can reduce patient discomfort during male flexible cystoscopy. METHODS: Flexible cystoscopy was performed using Karl Storz 15 F flexible cystoscope by a single urologist in cystoscopy naive male patients, with or without patient controlled urethral hydrodistention. 10 cc of 2% aqueous lidocaine gel was introduced into the urethra and left in place for 10 minutes prior to initiation of the procedure. Urethral hydrodistention was achieved by having the patients forcibly compress 250 ml flexible polyvinyl chloride container of sterile sale as the flexible cystoscope was negotiated past the urethra. clinical outcomes were assessed using analog pain scale post procedure to assess pain associated with the procedure. RESULTS: A total of 63 cystoscopy naive men underwent flexible cystoscopy. 32 patients were in the urethral hydrodistention group with median age of 47. 31 patients were in the control group with median age of 50. Analog pain score was 1.96 in the urethral hydrodistention group and 5.68 in the control group (p <0.01). CONCLUSIONS: In our study, patient controlled urethral hydrodistention significantly reduces pain associated with flexible cystoscopy in cystoscopy naive male patients. It is reasonable to incorporate this technique as part of the male flexible cystoscopy procedure. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e535 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Wagner More articles by this author William Lin More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP55-15 CAN MRI LOCALIZE THE PROXIMITY OF PROSTATE CANCER TO THE URETHRA IN MEN WHO ARE CANDIDATES FOR FOCAL GLAND ABLATION?

You have accessJournal of UrologyCME1 May 2022MP55-15 CAN MRI LOCALIZE THE PROXIMITY OF PROSTATE CANCER TO THE URETHRA IN MEN WHO ARE CANDIDATES FOR FOCAL GLAND ABLATION? Neal Patel, Alexa Hughes, Wayne Brisbane, Ali Rastegarpour, Sohrab Afshari, Lorna Kwan, Anissa V. Nguyen, Anthony Sisk, Steven Raman, and Robert Reiter Neal PatelNeal Patel More articles by this author , Alexa HughesAlexa Hughes More articles by this author , Wayne BrisbaneWayne Brisbane More articles by this author , Ali RastegarpourAli Rastegarpour More articles by this author , Sohrab AfshariSohrab Afshari More articles by this author , Lorna KwanLorna Kwan More articles by this author , Anissa V. NguyenAnissa V. Nguyen More articles by this author , Anthony SiskAnthony Sisk More articles by this author , Steven RamanSteven Raman More articles by this author , and Robert ReiterRobert Reiter More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002634.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite improvements in the localization of prostate cancer with magnetic resonance imaging, appropriate patient selection for focal ablation of prostate cancer remains a challenge. Given that certain focal therapies minimize side effects by preserving prostate tissue near the urethra, in this study, we aim to determine whether prostate MRI could accurately identify the distance of prostate cancer to the urethra in a cohort of men who were potential candidates for focal gland ablation. METHODS: A retrospective, single-institution analysis of men who underwent an MRI, targeted biopsy, had a subsequent radical prostatectomy and were candidates for focal gland ablation based on pre-treatment risk stratification (intermediate Gleason grade, PSA <20, single MRI visible lesion) was performed. The ability of MRI to identify lesions that were within 5 mm of the prostatic urethra on whole-mount pathology was determined. Multivariable regression was utilized to determine clinical characteristics associated with having prostate cancer within 5 mm of the urethra. RESULTS: A total of 90 patients were identified to be candidates for focal-gland ablation. In 66 men (73.3%), the tumor was within 5 mm of the urethra on whole-mount pathology. MRI correctly identified the cancer location either within or outside a 5 mm radius of the urethra in 68 men (75.5%). The sensitivity of MRI for identifying cancer near the urethra was 78.8% (73.5-84.1%), and specificity was 66.7% (58.1-75.3%). The PPV was 86.7% (79.4-91.6%), and NPV was 53.3% (39.8-66.4%). The overall agreement was moderate (kappa=0.47). In adjusted analysis, no clinical factors (PI-RADS, PSA density, or tumor diameter) were significantly associated with having prostate cancer within close proximity of the urethra. CONCLUSIONS: A significant number of men who are potential candidates for focal ablation may have cancer close to the urethra that could serve as a significant source of infield recurrence after treatment. MRI can be used to identify these tumors and the distance from the tumor to the urethra should be calculated to improve patient selection for focal gland ablation. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e943 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Neal Patel More articles by this author Alexa Hughes More articles by this author Wayne Brisbane More articles by this author Ali Rastegarpour More articles by this author Sohrab Afshari More articles by this author Lorna Kwan More articles by this author Anissa V. Nguyen More articles by this author Anthony Sisk More articles by this author Steven Raman More articles by this author Robert Reiter More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP23-01 URETHRECTOMY AT THE TIME OF RADICAL CYSTECTOMY FOR NON-METASTATIC UROTHELIAL CARCINOMA OF THE BLADDER: A COLLABORATIVE MULTICENTER STUDY

MP23-01 URETHRECTOMY AT THE TIME OF RADICAL CYSTECTOMY FOR NON-METASTATIC UROTHELIAL CARCINOMA OF THE BLADDER: A COLLABORATIVE MULTICENTER STUDY

V10-07 NEAR-INFRARED FLUORESCENCE IMAGING TECHNOLOGY APPLICATIONS IN UROLOGIC SURGERY

You have accessJournal of UrologyCME1 May 2022V10-07 NEAR-INFRARED FLUORESCENCE IMAGING TECHNOLOGY APPLICATIONS IN UROLOGIC SURGERY Riccardo Mastroianni, Gabriele Tuderti, Umberto Anceschi, Alfredo Maria Bove, Aldo Brassetti, Mariaconsiglia Ferriero, Leonardo Misuraca, and Giuseppe Simone Riccardo MastroianniRiccardo Mastroianni More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002623.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical applications of near-infrared fluorescence (NIRF) with Indocyanine green (ICG) technology are rapidly growing. Potential improvements especially for functional outcomes have been described in different urologic procedures. In this video we highlights our experience with multiple clinical applications of NIRF-ICG technology in distinct urologic procedures. METHODS: In this video we collected multiple clinical applications of NIRF technology: ICG-marking of totally endophytic renal tumors selected for partial nephrectomy, assessment of thrombus extent during level III IVC tumor thrombectomy, identification of functioning adenomas during adrenal surgery, assessment of ureteral vascularization during robot assisted radical cystectomy and during ureteral reimplantation, identification of urethra and ejaculatory ducts during Madigan prostatectomy. RESULTS: First, NIRF-ICG technique was demonstrated useful to mark endophytic renal tumors in patients selected for purely off-clamp robotic partial nephrectomy. Lipiodol indocyanine green mixture was selectively delivered in the tertiary ordered arteries feeding the tumor. In this way, the use of NIRF imaging allow to easily recognize endophytic renal tumor. Therefore, parenchyma incision, margins scoring and deep part of enucleation were performed under NIRF imaging. Secondly, intravenous injection of ICG was used during robot-assisted radical nephrectomy with level III IVC tumor thrombectomy in order to better define thrombus boundaries, to control cranial IVC thrombus edge, to expect IVC lumen and to confirm proper restoration of IVC flow. Then, NIRF-ICG technology was used to easily identify hypervascularized adrenal mass during robotic partial adrenalectomy and to evaluate proper perfusion of distal ureters both during RARC and robot-assisted ureteral reimplantation. Finally, NIRF-ICG technology was reported as an essential tool during robot-assisted Madigan prostatectomy when ejaculation preservation is planned. A retrograde injection of ICG throw the urethral catheter placed on navicular fossa allowed to easily recognize proximal prostatic urethra, and therefore to preserve ejaculatory function avoiding unintended violation of the urinary tract. CONCLUSIONS: NIRF-ICG technology sounds a safe and feasible procedure. This technique allows to easy identify key anatomical landmarks, providing information about tissue vasculature and perfusion. NIRF-ICG technique demonstrated to potentially improve functional outcomes of robotic procedures even if larger series with longer follow-up are needed. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e850 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Riccardo Mastroianni More articles by this author Gabriele Tuderti More articles by this author Umberto Anceschi More articles by this author Alfredo Maria Bove More articles by this author Aldo Brassetti More articles by this author Mariaconsiglia Ferriero More articles by this author Leonardo Misuraca More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF DownloadLoading ...

V04-06 TRANSPERINEAL BULBOVESICAL ANASTOMOSIS AND STAGED ARTIFICIAL URINARY SPHINCTER IMPLANTATION FOR EXTENSIVE POSTERIOR URETHRAL STENOSES

You have accessJournal of UrologyCME1 May 2022V04-06 TRANSPERINEAL BULBOVESICAL ANASTOMOSIS AND STAGED ARTIFICIAL URINARY SPHINCTER IMPLANTATION FOR EXTENSIVE POSTERIOR URETHRAL STENOSES Akio Horiguchi, Masayuki Shinchi, Kenichiro Ojima, Yusuke Hirano, Ryuichi Azuma, and Keiichi Ito Akio HoriguchiAkio Horiguchi More articles by this author , Masayuki ShinchiMasayuki Shinchi More articles by this author , Kenichiro OjimaKenichiro Ojima More articles by this author , Yusuke HiranoYusuke Hirano More articles by this author , Ryuichi AzumaRyuichi Azuma More articles by this author , and Keiichi ItoKeiichi Ito More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002560.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Posterior urethral stenosis is a complication occurring secondary to transurethral prostate surgery and prostate cancer treatment, and its management remains a significant reconstructive challenge. We herein report our surgical technique of transperineal bulbovesical anastomosis and staged artificial urinary sphincter implantation for extensive posterior urethral stenoses. METHODS: Two male patients aged 77 and 76 years were referred to us for definitive management for posterior urethral stenosis (brachytherapy for prostate cancer, and repeat transurethral surgery for benign prostatic hyperplasia, respectively). A suprapubic tube was placed in both patients due to urinary retention after exhaustive urethrotomies and dilatations. Both patients had normal bladder capacity and extensive posterior urethral stenoses extending from the bulbomembranous junction to the entire prostatic urethra. After making a midline perineal incision, the bulbar urethra was fully mobilized up to the penoscrotal junction distally and transected at the obstruction site. The corpora cavernosa was separated, and a wedge of the inferior pubic bone was excised to expose the ventral side of the bladder neck in the same manner as the repair of pelvic fracture urethral injury. The scarred prostatic tissue was meticulously excised, and the bladder neck was opened. The bladder mucosa was everted and fixed to the surrounding tissue to create an anastomosis site. Eight interrupted 4-0 PDS sutures were placed to reapproximate the bulbar urethra and bladder neck. After confirming the absence of recurrent stenosis at the anastomosis site at 6 months postoperatively, an artificial urethral sphincter was implanted using a transcorporeal approach. We followed up the patients every 6 months, performed uroflowmetry, flexible cystoscopy, and examined the amount of daily pad use. RESULTS: The operative time and blood loss during bulbovesical anastomosis was 163 minutes and 201 ml in case 1 and 193 minutes and 66 ml in case 2, respectively. No Clavien grade 2 or greater perioperative complications were observed. No recurrent stenosis on cystoscopy was found after 20 and 26 months in cases 1 and 2, respectively. The maximum flow rate and the amount of daily pad use at the last recorded follow up was 32 ml/s and no pad in case 1 and 44 ml/s and one pad in case 2. CONCLUSIONS: A bulbovesical anastomosis combined with staged artificial urethral sphincter placement could effectively manage extensive posterior urethral stenoses. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e368 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akio Horiguchi More articles by this author Masayuki Shinchi More articles by this author Kenichiro Ojima More articles by this author Yusuke Hirano More articles by this author Ryuichi Azuma More articles by this author Keiichi Ito More articles by this author Expand All Advertisement PDF downloadLoading ...

OC-0770 Deep Learning-based segmentation of prostatic urethra on CT scans for treatment planning

OC-0770 Deep Learning-based segmentation of prostatic urethra on CT scans for treatment planning