Intestinal segments are commonly used in reconstructive urology to create continent or incontinent urinary channels. Initially, the viability of these segments depends on the integrity of the vascular pedicle. We report three patients with catheterizable, or incontinent channels constructed using the spiral Monti technique or incontinent ileovesicostomy all of whom developed postoperative complications involving the vascular pedicle. Patients with documented vascular pedicle injury to a continent or incontinent ileovesicostomy in New Children's Hospital, Helsinki University Hospital and in Riley Children's Hospital, Indiana School of Medicine were retrospectively identified and reviewed. In all three cases, the vascular pedicle was transected either electively or during emergency surgery for intestinal volvulus or obstruction, 17 months to 5 years after reconstructive surgery. Despite pedicle loss, all patients retained viable functional channels, supported by collateral blood supply. Follow-up ranging from several months to 19 years confirmed sustained channel viability. These cases suggest that, in select situations, collateral vascularization may be sufficient to preserve the function of a continent stoma despite loss of its primary vascular pedicle.

Urology Practice Perspectives: Building Sustainable Reconstructive Urology Capacity in the Philippines: A Collaborative Global Surgery Mentorship Model.

Urethrocutaneous fistula (UCF) is the most frequent complication after urethroplasty for proximal hypospadias, with reported rates up to 30%. Bio-Platelet Rich Fibrin (Bio-PRF), a novel autologous biomaterial enriched with growth factors, is hypothesized to enhance wound healing and reduce fistula formation when applied as an intermediate layer during urethral reconstruction. This prospective study involved patients with proximal hypospadias undergoing urethroplasty at Hasan Sadikin General Hospital, Bandung, from September 2023 to December 2024. Subjects were divided into Bio-PRF group or control group (no Bio-PRF). The primary outcome was the incidence of UCF observed on 1st, 3rd, and 6th months. Baseline characteristics and outcome data were analyzed using the independent T test or Mann-Whitney U test, and chi-square test. A total of 36 patients were enrolled (18 in each group). Baseline characteristics, including age, hypospadias subtype, glans width, urethral plate dimensions, and laboratory parameters (hematologic, coagulation profiles, and albumin) were comparable. UCF incidence was higher in the Bio-PRF group (56.6% at 6th month) compared to controls though not statistically significant (p > 0.05). There was no significant difference in other post-operative complication rate and operative time between both groups. Bio-PRF application did not significantly reduce UCF rates and other complications after proximal hypospadias urethroplasty. Further studies are warranted to clarify the clinical value of Bio-PRF in pediatric reconstructive urology.

Abstract Introduction Penile augmentation procedures, including suspensory ligament release and autologous fat injection, have gained popularity but carry a risk of serious complications, including vascular compromise and tissue necrosis (Alter, 1998; Elist, 1997). Ischemic injury to the glans penis is rare but can result in significant functional and psychological morbidity if not managed effectively (Muench et al., 2021). Various modalities such as hyperbaric oxygen therapy (HBOT) have shown limited success in advanced cases. Porcine urinary bladder extracellular matrix (ECM) (ACell) has demonstrated promise in complex wound healing but is not well described for penile ischemic injury. Objective To describe the use of porcine urinary bladder ECM (ACell) for salvage and reconstruction of glans ischemia following penile augmentation with autologous fat injection. Methods A 33-year-old male underwent suspensory ligament release with autologous fat transfer by a plastic surgeon in Mexico. He developed right glans ischemia, presenting with necrosis involving urethral tissue on POD2 and subsequently developed a large eschar. He underwent three weeks of HBOT until the eschar spontaneous fell off. Serial application every 7-10 days with porcine urinary bladder ECM was initiated. Each treatment involved local penile block anesthesia, gentle wound debridement to healthy tissue, mixing patient’s blood with ACell MicroMatrix powder and applying a 2–3 mm layer to the defect. A Cytal sheet was placed over the powder and secured with interrupted 5-0 chromic sutures. A foley catheter and compression condom dressing maintained local wound stability and hemostasis for 72 hours per application. Post-application wound care included frequent sterile jelly and xeroform dressing to preserve moisture. Results After serial ACell treatments over several weeks, substantial regrowth of glans tissue was achieved, significantly improving penile length symmetry and cosmesis. No adverse reactions to the porcine ECM were observed. Pictures of each session were taken to document his progress. Conclusions This case highlights the potential role of porcine urinary bladder ECM in managing severe penile ischemia and tissue loss following cosmetic penile augmentation. The use of biologic scaffolds like ACell can facilitate tissue regeneration in challenging urogenital wounds where conventional therapies are limited. Further studies are warranted to define its broader application in sexual medicine and reconstructive urology.

BackgroundErectile dysfunction (ED) is a significant complication following penile fracture repair, and early prediction is critical for clinical management.AimTo evaluate the effectiveness of machine learning (ML) algorithms in predicting the development of severe ED after penile fracture repair and to identify complex risk factors beyond the scope of traditional statistical methods.MethodsA retrospective analysis was conducted using data from 547 patients who underwent surgical repair for penile fracture between January 2020 and June 2024 at 23 urology centers affiliated with the Reconstructive Urology and Trauma Study Group of the Urological Surgery Society. Patients were categorized into two groups based on their International Index of Erectile Function-5 scores at six months postoperatively: severe ED (+) (≤7) and ED (−) (>7). Eleven different ML classifiers were evaluated to determine the most predictive models. Four distinct resampling techniques were employed to address class imbalance in the dataset. Feature importance analysis was also performed to identify the most influential variables contributing to ED risk.OutcomesThis study was conducted to enable the early identification of patients at high risk of developing severe ED following penile fracture surgery.ResultsLogistic Regression, Gaussian Naive Bayes, and Linear Support Vector Machine emerged as the best-performing algorithms on the original dataset, with Area Under the Curve (AUC) scores of 0.81, 0.78, and 0.76, respectively. On the Synthetic Minority Over-sampling Technique (SMOTE)-resampled dataset, Quadratic Discriminant Analysis (QDA) achieved an AUC of 0.85, while the Artificial Neural Network (ANN) reached an AUC of 0.84. On the SMOTE-resampled dataset, QDA achieved a ROC-AUC of 0.85 (95% CI: 0.75-0.93), whereas on the SMOTE–Tomek Link–resampled dataset, the ANN attained a ROC-AUC of 0.84 (95% CI: 0.71-0.94). The most critical predictors of severe ED were age, comorbidities, tunical tear length, and time to surgery. Urethral injuries were not significant contributors, as all were minor and managed conservatively without urethroplasty.Clinical ImplicationsIntegration of ML-based prediction models into clinical workflows could support early risk stratification and individualized patient care, ultimately improving postoperative functional outcomes.Strengths and LimitationsThis study benefits from a large, multicenter dataset and a comparative analysis of multiple ML algorithms. However, its retrospective nature and inter-center variability in data reporting may limit generalizability.ConclusionML algorithms are effective and reliable tools for predicting severe ED after penile fracture repair and may enhance personalized postoperative management. Eliminating class imbalance in the data with resampling techniques improves model performance.

Urological Reconstruction During Retroperitoneal and Pelvic Sarcoma Surgery: Experience from a High-Volume Sarcoma Center

Genitourinary Radiation Injury: A Mixed-Methods Study Exploring Patient-Reported Outcomes and Impact on Quality of Life.

BACKGROUND: Strictures of the bulbar urethra, particularly extensive ones with complete lumen obliteration, are a major challenge in reconstructive urology. AIM: The work aimed to compare the efficacy of single-stage and multistage buccal urethroplasty in adults with complete obliteration of the bulbar urethra. METHODS: A systematic review and meta-analysis were performed according to the PRISMA 2020 guidelines, including data from PubMed/MEDLINE, Scopus, Web of Science, and the Russian Science Citation Index (RSCI) up to January 2025. Comparative studies of single-stage and multistage urethroplasties using buccal mucosa grafts were analyzed. Extracted data included relapse-free survival, complication rates, urodynamic parameters, sexual function, and follow-up duration. Study quality was assessed using the Newcastle–Ottawa Scale. Pooled estimates were calculated using fixed- and random-effects models (odds ratio, relative risk, mean difference, 95% confidence interval). Sensitivity and publication bias analyses were performed (funnel plot, Egger’s test). RESULTS: The meta-analysis included five comparative studies (n = 650). The 5-year relapse-free survival after single-stage reconstruction was 85% versus 60% after multistage procedures (odds ratio 2.8; 95% confidence interval 1.67–4.67; p 0.001). The overall complication rate did not differ significantly (odds ratio 0.6; 95% confidence interval 0.1–1.6; I2 = 74%); however, fistulas and deformities were more common after two-stage interventions. The mean maximum urinary flow rate was 5 mL/s higher after single-stage surgery (p 0.05). No new cases of erectile dysfunction were reported. All studies were nonrandomized (2 prospective, 3 retrospective) and had a moderate risk of bias. CONCLUSION: Single-stage buccal urethroplasty demonstrates at least comparable, and overall superior, long-term outcomes with a similar complication profile compared to the classical two-stage approach. Preference for single-stage reconstruction may help avoid prolonged treatment and repeat surgeries when sufficient healthy tissue is available. Multistage techniques remain justified in cases of panurethral stricture, lichen sclerosus, or failed previous reconstructions. Randomized controlled trials are needed to confirm these findings.

Pediatric and adult reconstructive urology remain underrepresented in global surgical efforts, despite their critical role in restoring genitourinary function. This global surgery initiative aimed to address the gap in specialized urologic care in low- to middle-income countries (LMICs) through a longitudinal, mentorship-based approach integrating augmented reality (AR) telementoring. This report describes an approach used to enhance global surgical expertise in LMICs and summarizes data documenting impact. A Global Surgery Partnership Initiative was launched by an academic surgeon from the University of Toronto to address the lack of specialized pediatric and reconstructive urologic training. Through collaboration with local institutions in the Philippines and Vietnam, the program employed a mixed-method approach that delivered longitudinal mentorship, combining virtual case conferences, in-person surgical mentoring, pilot of AR-supported telementoring, and continuous postoperative coaching. Patient outcomes were assessed and mentees self-reported pre- and post-intervention surveys evaluating comfort and technical understanding. Descriptive statistics and paired t-tests were used to analyze outcomes. Thirty-eight pediatric and adult reconstructive urology cases were performed. Over time, operative times and length of stay decreased, with low complication rates (6/38, 12.7%) and Clavien-Dindo ≥3 complications (3/38, 8%). Mentee comfort and understanding significantly improved (mean comfort score: 3.06 to 6.77; technical understanding: 4.77 to 8.43; p<0.001). AR-assisted mentoring, introduced in 2022 and expanded in 2024, showed feasibility, with further enhanced intraoperative feedback and sustainability. This structured, mixed-method model effectively improved surgical competencies and system-level capacity in LMICs. Unlike short-term missions, this initiative emphasized continuity, adaptability, and sustainability. It presents a scalable framework for integrating reconstructive urology into global health programs while leveraging AR to overcome geographic and resource limitations.

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is a cornerstone treatment for resectable peritoneal carcinomatosis. Urologic reconstructive surgery is required in 7-20% of cytoreductive surgeries due to urinary tract involvement or injury, yet current literature on outcomes remains limited. This study presents one of the largest single-institution cohorts examining outcomes of urologic reconstruction in CRS/HIPEC cases, and is the first to investigate the impact of preoperative planning and intraoperative timing of urologic reconstruction on postoperative outcomes. A retrospective analysis of 314 cases was performed from June 2010 to August 2023. Data from cases involving urologic reconstruction were analyzed, including demographics, surgical details, and outcomes. Statistical analyses evaluated associations between surgical variables and short and long-term urologic complications. Urologic reconstruction was performed in 35 cases (11.1%), with the majority occurring after HIPEC administration. Postoperative urologic complications occurred in 57% of cases. 40% of the urologic reconstruction cases resulted in low-grade, short-term urologic complications (AKI, UTI) while 20% were deemed high-grade (sepsis, urine leak). 29% developed long-term sequelae such as ureteral stricture or urinary retention. Longer operative times were significantly associated with long-term complications. No significant differences were found in long-term complication rates based on the timing of urologic repair (pre-HIPEC or post-HIPEC) or whether urologic intervention was planned prior to surgery. Interestingly, there was a significant association between fewer prior abdominal surgeries and higher complication rates. Surgical complexity and prior surgical history are key determinants of postoperative outcomes following urologic reconstruction at the time of cytoreductive surgery. Timing of urologic intervention and specific preoperative variables, such as age and peritoneal cancer index score, did not significantly impact long-term outcomes. Higher complication rates were also seen among patients with fewer prior abdominal surgeries, which may in part be due to selection bias or other unaccounted variables present in the patients with fewer abdominal surgeries. These findings highlight the importance of individualized surgical planning and inform preoperative discussions about the risks and benefits of CRS with HIPEC.

Aims: Prune Belly Syndrome (PBS), also known as Eagle-Barrett syndrome, is a rare congenital disorder defined by a triad of abdominal muscle deficiency, urinary tract anomalies and bilateral cryptorchidism. This review aims to summarize current knowledge on its etiology, clinical presentation and management. Methodology: This review was based on an extensive search of literature related to PBS using PubMed, Google Scholar and other scientific databases. Relevant clinical studies, reviews and case reports were analyzed to summarize current knowledge on diagnosis, management and outcomes of PBS. State of knowledge: PBS affects approximately 1 in 30,000 to 1 in 50,000 live births, with a strong male predominance. Its pathogenesis is thought to be multifactorial, involving mesodermal maldevelopment and possible genetic factors. The clinical spectrum ranges from severe cases with renal dysplasia and pulmonary hypoplasia to a milder, incomplete form. Woodard’s classification is commonly used to guide prognosis and treatment. Besides the classic triad, patients may present with gastrointestinal, musculoskeletal, cardiopulmonary and developmental systems. Early prenatal diagnosis is possible through imaging. Postnatal care includes urologic reconstruction, orchiopexy, abdominoplasty, renal support and in some cases, transplantation. Assisted reproductive techniques have allowed for fertility in select male patients. Conclusion: PBS is a complex and variable condition requiring early diagnosis and individualized, multidisciplinary care. Advances in surgical and medical treatment have improved outcomes, but long-term monitoring and supportive care remain essential for preserving function and quality of life.

BackgroundUrologic surgical training has been dramatically affected by numerous practice changes including a significant increase in robotic surgery, rise of subspecialty fellows, and even the coronavirus disease 2019 (COVID-19) pandemic, among others. How resident training has been affected is not well understood. In this study, we aim to describe the changes in resident-reported case log data for reconstructive urology surgeries, specifically for female reconstructive cases.MethodsData were obtained from the Accreditation Council for Graduate Medical Education (ACGME) reporting system, which compiles resident-submitted case reports of procedures performed and resident role. Submitted surgeries are categorized by type using Current Procedural Terminology (CPT) codes as well as resident-reported role in the procedure—“surgeon”, “assistant”, “teaching assistant”, or “all roles”. Data from graduating urologic residents from 2010 to 2022 were reviewed.ResultsFrom 2010 to 2022, we observed an increase in “all roles” reconstructive urologic cases logged by residents (0.82 cases per year, P=0.06). Reconstructive cases logged as “surgeon” decreased by 0.77 cases per year (P=0.057), while “assistant” cases increased by 1.48 cases per year (P<0.001). For female reconstructive cases, “surgeon” reported cases declined by 1.1 cases annually (P<0.001) while “assistant” role increased by 0.32 (P<0.001).ConclusionsOver the last decade, we observed a decrease in resident-reported role as “surgeon” in female reconstructive cases while the overall volume of reconstructive urologic cases simultaneously increased. Understanding these trends is essential for resident educators, while further research is necessary to identify potential causes

The objective of this study was to summarize and review literature on treatment methods for stenoses of the posterior urethra. Stenosis of the posterior urethra, particularly of a bladder neck stenosis (BNS) or vesicourethral anastomotic stenosis (VUAS), presents significant clinical challenges, in part owing to the heterogeneity of the patient population and additionally secondary to morbidity of historic definitive treatments. Traditionally, this disease process has been preferentially managed with endoscopic interventions in the form of direct vision internal urethrotomy or dilation, with or without injectables, with variable success rates ranging from 40.0% to 72.0%; however, 90.0% of patients require repeat intervention within the first 2 years. Definitive treatments were often more challenging, requiring joint abdominoperineal approaches, and thus less utilized outside of academic centers with reconstructive urologists. Recent advancements in the endoscopic management of posterior urethral stenosis are synthesized in this review, specifically in populations at increased risk, including those with radiation therapy, transurethral prostate resections, or radical prostatectomy. Herein, a literature review of publications from 2014 to 2024 highlights key endoscopic techniques such as drug-coated balloon dilation and transurethral mucosal realignment aimed at treating BNS and VUAS. These novel techniques demonstrate short-term success rates approaching 85.0% to 90.0%, which represents a significant improvement in success compared with traditional endoscopic therapies. Overall, the current review emphasizes the evolution of minimally invasive treatment options for posterior urethral stenosis, focusing specifically on BNS and VUAS, demonstrating the evolution of the scope of minimally invasive techniques and improved patient outcomes.

Background/Objectives: Buccal mucosa graft (BMG) is increasingly utilized in reconstructive urological surgeries due to its versatility, robust integration, histological characteristics and low morbidity at the donor site. Initially employed in urethral surgery, BMG use has expanded to complex ureteral and penile reconstructive procedures. This narrative review examines BMG applications in various urological surgeries, comparing its outcomes to other graft types, with a focus on surgical techniques and patient outcomes. Methods: A narrative review was conducted using PubMed and Scopus to identify relevant studies published over the last three decades on the use of BMG in urological reconstructive surgery. Articles in English addressing BMG harvesting, applications and functional outcomes were analyzed. Results: BMG has demonstrated high success rates in every field of its application, especially in urethral reconstruction with an 83–91% efficacy rate in intermediate follow-up. Studies have also reported positive outcomes in complex ureteral and penile curvature surgeries, with patient satisfaction rates reaching up to 85%. Conclusions: BMG is an adaptable tissue graft for urological reconstructive surgeries, offering favorable outcomes with minimal morbidity. Although the current results are encouraging, larger prospective studies with standardized protocols are necessary to fully validate its long-term efficacy and optimize treatment approaches for complex urological reconstructions.

Association Between Social Determinants of Health and Choice of Urinary Reconstruction in Children.

Early outcomes and risk factors for complications following pediatric neurogenic bladder reconstruction: A secondary analysis of the pediatric NSQIP database (2015-2020).

BackgroundThe treatment of urethral stricture, particularly long-segment urethral stricture, poses a significant challenge in urological reconstruction. High-pressure balloon dilation has gained widespread recognition as an effective and safe therapeutic option. However, studies on its long-term outcomes, especially for long-segment urethral stricture, remain scarce. This study aims to establish the clinical baseline efficacy and safety of urethral balloon dilation at a tertiary care center and to provide context through an exploratory comparison with a contemporaneous cohort treated with direct vision internal urethrotomy (DVIU)/dilation.MethodsThere were 128 patients with urethral strictures who underwent endoluminal treatment at our center between November 2017 and September 2023. Of these 128 patients, 64 underwent balloon dilation and 64 underwent DVIU/dilation. Demographic and stricture characteristics data were collected. The endpoint was defined as the recurrence of strictures requiring intervention. The efficacy and safety of balloon dilation were analyzed, including outcomes by stricture length within the balloon dilation group. Comparative outcomes with the DVIU/dilation group were explored cautiously due to baseline differences.ResultsThe median follow-up duration was 26 months for the balloon dilation group and 43 months for the DVIU/dilation group. Patients in the balloon dilation group generally had more complex strictures. The overall 1-year success rate for balloon dilation was 70.1%. Within the balloon dilation group, the 1-year success rate for long-segment strictures (≥2 cm) was 70.0%, and for short-segment strictures (<2 cm) was 70.6%, indicating comparable performance across these lengths in this cohort. The overall incidence of complications in the balloon dilation group was 20.3%. The DVIU/dilation group had an overall 1-year success rate of 70.2%. An exploratory subgroup analysis comparing patients with long-segment strictures (≥2 cm) in both treatment arms showed a success rate for balloon dilation (70.0%) that was markedly superior to that for DVIU/dilation (36.4%) within this specific subgroup (P=0.03, hazard ratio =2.48).ConclusionsBalloon dilation represents an effective and safe method for the management of both short and long-segment urethral strictures. These findings establish a valuable clinical baseline for conventional balloon dilation.

International Expert Consensus on Development of a State of the Art Male Perineal Anatomy Simulation Model for Urethroplasty and Artificial Urinary Sphincter Insertion.

Reconstructive urology encompasses a diverse array of surgical modalities for the management of urethral strictures in the male population. Despite the extensive documentation of various surgical approaches and their purported benefits in the existing literature, there remains a notable paucity of comprehensive data regarding intraoperative and postoperative complications. These adverse events unequivocally exert a significant impact on patients’ quality of life and overall treatment satisfaction. The present manuscript provides a systematic review of the international literature pertaining to potential complications associated with diverse therapeutic interventions for urethral stricture disease.

The use of ileum for ureteral reconstruction was first described in 1906. Since then, its utilization has evolved considerably. Early in the history of ileal ureters, urologists were limited by a lack of familiarity with bowel harvesting and handling. The popularization of ileal conduits for urinary diversions, however, allowed urologists to familiarize themselves with the use of ileum and paved the way for broader applications. With the emergence of laparoscopy and, later, robotic-assisted surgery, the application of ileal ureteral replacement expanded the capabilities of reconstructive urologists. This article describes the historical development of surgical techniques for ileal ureter replacement and the integration of new technologies aiding in improved outcomes, and anticipates potential future directions. In contemporary practice, robotic-assisted ileal ureteral replacement is used in cases of extensive ureteral obstruction or damage. Advantages of the robotic platform include reduced blood loss, shorter recovery time and hospital length of stay, and superior operative ergonomics. Although robotic ileal ureter replacement is a complex and challenging surgery with notable complications, studies have demonstrated the efficacy and safety of this technique in patients with an otherwise end-stage ureter. In addition, the robotic approach has provided urologists the ability to conduct complex reconstructive surgeries including bilateral ureteral replacement in conjunction with bladder augmentation or a urinary diversion. Long-term studies and continued innovation are necessary to further improve the surgical techniques, outcomes, and scope of ileal ureter reconstruction.