Repair Of Strictures Research Articles

Anastomotic Urethroplasty with Double Layer Continuous Running Suture Re-Anastomosis Versus Interrupted Suture Re-Anastomosis for Infective Bulbar Urethral Strictures: A Prospective Randomised Trial.

Introduction: The objective of this study was to compare a double-layer running suture re-anastomosis urethral stricture repair with early catheter removal to the conventional interrupted suture re-anastomosis after excision of a bulbar urethral stricture. Methods: A consecutive series of patients with bulbar urethral stricture were enrolled in the study. The patients were randomized into two groups according to an odd/even serial number distribution. Patients’ medical records were analyzed for demographics, stricture characteristics, and lower urinary tract obstructive symptoms. The outcomes were based on the presence/absence of obstructive voiding symptoms, and retrograde urethrography (RGU) performed on the first post-operative day in Group 1 and in both groups (Groups 1 and 2) at six weeks after surgery. Flexible urethroscopy was only performed on specific cases where RGU was unclear both pre- and post-operatively or when clinical recurrence was suspected. The minimum follow-up (FU) was 18 months. Success was defined as no need for subsequent dilatation, direct vision internal urethrotomy (DVIU), or urethroplasty. Results: A total of thirty-six patients with a mean age of 45 years (range 20 to 69 years) with bulbar urethral stricture were included in this study. Group 1 and Group 2 included 19 and 17 patients, respectively. Two patients were lost during randomization and subsequently to FU. The average stricture lengths were comparable between the two groups according to the retrograde urethrogram: 1.20 cm (range 0.6 to 2) in Group 1 and 1.27 cm (range 0.5 to 2.4) in Group 2, respectively (p = 0.631). The success rate for Group 1 was 90% after a mean follow-up of thirty-six months (range 20 to 40), which was clinically significant compared to the 71% in Group 2 after a mean FU of thirty-three months (range 19 to 40; p = 0.0218; 95% CI: 0.462–41.5766). Conclusions: Anastomotic urethroplasty (AR) performed with a double layer re-anastomosis had a cure rate comparable to the conventional anastomosis with interrupted sutures after a follow-up of eighteen months and longer. The urethral catheter can be safely removed within twenty-four hours after the excision of stricture and double-layer re-anastomosis.

V04-08 ROBOT-ASSISTED REPAIR OF BENIGN DISTAL URETEROENTERIC STRICTURES FOLLOWING RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 May 2022V04-08 ROBOT-ASSISTED REPAIR OF BENIGN DISTAL URETEROENTERIC STRICTURES FOLLOWING RADICAL CYSTECTOMY Victoria Maxon and Alvin Goh Victoria MaxonVictoria Maxon More articles by this author and Alvin GohAlvin Goh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002560.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This video aims to provide a step-by-step approach for robot-assisted repair of benign distal ureteroenteric strictures (UES) following radical cystectomy (RC). METHODS: We demonstrate the feasibility and safety of robotic repair through three clinical scenarios after different forms of diversion and open primary surgery. UES repair is performed in the setting of an open RC and neobladder (NB), an open Indiana pouch and a repeat repair after RC and ileal conduit (IC). The RC/IC and Indiana pouch patients were placed in the modified lateral position with right side up. Port placement was directed at the right lower quadrant. The RC/NB patient was placed in the supine position and port placement was similar to that of RC. The operation consists of extensive lysis of adhesions, mobilization of the diversion and ureter, identification of the UES, excision of ureteral scar tissue and spatulation, assessment of ureteral perfusion using indocyanine green (ICG) fluorescence and the creation of a tension-free and watertight anastomosis. RESULTS: All cases were completed successfully without the need for open conversion. There were no intraoperative complications. Operative times ranged from 174-273 minutes. Estimated blood loss ranged from 10-50ml. Patients were discharged on postoperative day 1. No major complications occurred within 90 days of discharge. Renal function remained stable in all three patients at 6 weeks postoperatively. Patients were followed with functional renal imaging at 3 months postoperatively. CONCLUSIONS: Robot-assisted repair of UES is feasible and safe, even in the setting of extensive prior open abdominal surgery. This is the ideal approach for UES repair because it requires less mobilization of surrounding structures, allows for intraoperative ureteral assessment with ICG fluorescence and can successfully create a tension-free and watertight anastomosis. Our patients recovered quickly and without complications. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e369 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Victoria Maxon More articles by this author Alvin Goh More articles by this author Expand All Advertisement PDF downloadLoading ...

V01-08 ROBOTIC ANASTOMOTIC STRICTURE REVISION OF THE TRANSPLANT KIDNEY: TECHNICAL CONSIDERATIONS AND OUTCOMES

You have accessJournal of UrologyCME1 May 2022V01-08 ROBOTIC ANASTOMOTIC STRICTURE REVISION OF THE TRANSPLANT KIDNEY: TECHNICAL CONSIDERATIONS AND OUTCOMES Felicia Balzano, and Boyd Viers Felicia BalzanoFelicia Balzano More articles by this author , and Boyd ViersBoyd Viers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002520.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney transplantation is a widely performed procedure for patients with end stage renal disease. Urologic complications from the transplant kidney range from 3-30% with the incidence of ureteral stricture ranging from 1.9-3.7%. Of all complications that require surgical intervention, ureteral stricture accounts for 78% of them. We aim to discuss the technical considerations and present our outcomes after robotic anastomotic stricture revision in the transplanted kidney. METHODS: We retrospectively reviewed five patients who underwent open kidney transplantation with donor kidney who subsequently developed ureteral stricture and were treated with robotic repair with a single surgeon. All patients were confirmed to have ureteral stricture with preoperative antegrade nephrostogram. RESULTS: The average age of the patients was 54.4 years. 3 patients required ureteroureterostomy to native ureter, 1 required ureteroneocystostomy, and 1 required boari flap. The mean length of stay was 2 days. Average follow up was 326 days with no leaks identified. There were no wound infections or readmissions within 30 days. We had a 100% success rate in our cohort. CONCLUSIONS: By using an algorithmic approach with standardized evaluation, robotic repair of ureteral stricture in a transplant kidney can be done safely and effectively. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e54 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Felicia Balzano More articles by this author Boyd Viers More articles by this author Expand All Advertisement PDF DownloadLoading ...

Onlay Pedicled Transverse Skin Flap versus One-Stage Inlay Buccal Mucosal Graft in Penile Urethroplasty: A Prospective Matched-Pair Analysis

Introduction: The aim of this study was to compare urethroplasty using onlay pedicled transverse skin flap (PSF) versus one-stage inlay buccal mucosa graft (BMG) in repair of penile urethral strictures. Methods: We conducted a prospective matched-pair analysis of 44 male patients receiving penile urethroplasty between June 2016 and June 2019. There were 22 patients who received PSF and 22 patients who received BMG. Matching was performed according to stricture length. Patients with strictures caused by lichen sclerosus, prior hypospadias repair, or failed prior urethroplasty were excluded. Treatment was considered successful if no recurrence was observed. Successful repair, complication rates, patients’ satisfaction, and quality of life improvement were endpoints of this study. Results: Mean follow-up was 40.3 months. PSF and BMG showed comparable success rates (90.9% vs. 86.4%, p = 0.713). Recurrent stricture occurred in 2 patients (9.1%) who received PSF and in 3 patients (13.6%) who received BMG. Operation time was significantly longer for PSF than for BMG (108.4 min vs. 78.1 min, p = 0.01). Univariable logistic regression analysis revealed no relevant risk factors for stricture recurrence. Conclusion: Early results indicate comparable success rates of PSF and BMG in penile urethroplasty. Further studies with larger sample size and longer follow-up periods are required to evaluate subtle differences between both techniques.

Allium Ureteral Stent as a Treatment for Ureteral Stricture: Results and Concerns

Introduction: Ureteral strictures could be a chronic illness that leads to severe side effects and poor quality of life. A treatment with an Allium ureteral stent (URS), a self-expanding, large-caliber URS, was implemented in our department for ureteral stricture. Our study aim was to report the long-term results, including success rate, complications, and adverse effects. Methods: We retrospectively collected data on all patients who were treated with an Allium URS in our department between January 2017 and January 2021. Demographic, clinical, radiological, and perioperative parameters were retrieved and analyzed. The primary outcome was stricture resolution rates following stent removal. Results: Our cohort included 17 patients, 9 men and 8 women. The etiology of ureteral strictures was urolithiasis in 76.5% and pelvic procedure injury in 17.6%. The overall success rate was 35.29% in an average follow-up of 10.42 ± 2.39 months after stent removal. A higher failure rate was observed in the urolithiasis etiology group (90% vs. 66.7%, p = 0.38). The mean indwelling time of the Allium stent was 14.29 ± 1.29 months. Conclusions: Although an Allium URS could be considered as a feasible and attractive treatment of ureteral strictures, due to its minimal invasiveness, the success rate of this treatment is relatively low. Therefore, this option should be carefully considered and should be discouraged in young and fit patients and reserved for older unfit patients who are unwilling to undergo surgical repair of ureteral strictures.

Multi-institutional review of non-hypospadiac penile urethral stricture management and outcomes.

Penile urethral stricture disease not associated with hypospadias is rare, and there is a wide range of commonly used surgical repair techniques for this disease. We sought to compile a multi-institutional database of patients who had surgical correction of strictures in the penile urethra not limited to the meatus, and who had no history of hypospadias, for analysis using the Trauma and Urologic Reconstructive Network of Surgeons length, urethral segment and etiology classification system. A retrospective database from 13 institutions was compiled of patients who had undergone surgical correction of Trauma and Urologic Reconstructive Network of Surgeons length, urethral segment and etiology urethral stricture segments S2b/S2c and excluding E5, with a minimum follow-up time of 4 months. Failure was defined as cystoscopically confirmed recurrence of a stricture measuring less than 16-Fr. We analyzed 222 patients with a median age of 57 years and a follow-up of 49 months. The overall surgical success rate was 80.2%. On multivariate analysis, the two variables identified that were predictive of surgical success were stricture length ≤2 cm as well as use of a buccal mucosa graft as compared to use of a fasciocutaneous flap, which had success rates of 83% and 52%, respectively (P = 0.0004). No statistically significant differences were found based on incisional approach or surgical technique, nor were outcomes different based on etiology or preoperative patient demographics. Surgical repair of penile urethral strictures of non-hypospadiac origin have a favorable overall success rate, at 80.2%. Regardless of incisional approach or surgical technique, all operations appear to have similar outcomes other than repairs using fasciocutaneous flap, which were statistically less successful than those using buccal mucosa graft.

Robotic-assisted Lingual Mucosal Graft Ureteroplasty for the Repair of Complex Ureteral Strictures: Technique Description and the Medium-term Outcome

BackgroundRobot-assisted autologous graft ureteroplasty provides another treatment option for complex ureteral strictures, circumventing ileal ureter or renal autotransplantation. ObjectiveTo report the medium-term outcome of robotic ureteroplasty with a lingual mucosal graft (RU-LMG) for managing complex ureteral strictures. Design, setting, and participantsBetween June 2019 and September 2020, 12 patients underwent RU-LMG. The perioperative variables were prospectively collected, and the outcomes were assessed. Surgical procedureAfter ureteral stricture dissection, the narrow segment was cut longitudinally, and a lingual mucosal graft (LMG) of the required length was harvested, followed by double-J stent placement and LMG ventral onlay anastomosis. If the diseased ureter required transection, posteriorly augmented ureteral anastomosis could be performed before LMG harvest. Finally, the anastomotic area was wrapped by the omental flap. MeasurementsA descriptive statistical analysis was performed. The criteria for complete success included the absence of both clinical symptoms and obstruction on radiography. Results and limitationsSeven patients (58%) had a history of failed ureteral reconstruction. The mean (range) stricture length was 4.7 (3–6.5) cm, LMG length was 4.4 (3–7) cm, LMG width was 1.5 (1–2) cm, operative duration was 197.1 (130–346) min, estimated blood loss was 49.2 (10–200) ml, and the duration of postoperative hospitalization was 6 (4–14) d. No open conversions and intraoperative complications occurred. The median follow-up time was 15 mo (range: 13–27 mo). The overall success rate was 92% (11/12). ConclusionsThese medium-term follow-up results demonstrate that RU-LMG is a safe and feasible technique for repairing ureteral strictures. Patient summaryOur study proves that robotic ureteroplasty with a lingual mucosal graft is a safe and feasible technique for ureteral reconstruction that can serve as another choice for managing long, complex ureteral strictures.

Robotic Repair of Ureteroenteric Stricture Following Radical Cystectomy: A Multi-Institutional Experience

ObjectiveTo examine the safety, feasibility and durability of robotic reimplantation of ureteroenteric stricture after radical cystectomy. Materials and MethodsA retrospective multi-institutional review was performed for all patients undergoing robotic repair of ureteroenteric stricture from January 2010 to January 2019. Functional outcomes and complications were followed and data were analyzed with SPSS statistical software. ResultsA total of 46 patients and 58 renal units were identified, of which 15 had right sided, 19 left sided and 12 patients had bilateral strictures. Presentation of stricture was asymptomatic in 14 (30.4%) patients. Symptomatic presentations included infection in 22 (47.8%), worsening renal function in 11 (23.9%) and pain in 3 (6.5%) patients. Median time from cystectomy to diagnosis of stricture was 5 months (1-40). Median stricture length was 1.5 cm (range 0.5-10). All strictures were of benign etiology except for 4 (6.9%), which were due to malignancy. Overall, 49 (84.5%) ureters underwent primary re-implantation, while 9 (15.5%) required Boari-like advancement flaps prior to re-implantation. Median operative time was 190 min (range 45-540) with median estimated blood loss of 50 mL (range 25-2000) and median length of stay of 2 days (range 1-33, IQR 2-4). Seven (15.2%) patients experienced complications; 3 (6.5%) were low grade and 4 (8.7%) high grade. With median follow up of 18 months (range 1-51) the stricture recurrence rate was 8.6%. ConclusionRobotic reimplantation of ureteroenteric strictures following radical cystectomy is safe and feasible in experienced centers with high success rates.

Combined grafts and flaps in urethral stricture repair

Although urethral strictures have been known since antiquity, the surgical management of urethral strictures has undergone a great (re)evolution over the last six decades, both in the perception of the disease and in the surgical repair techniques, always presenting itself as a challenge for the surgeon and patient. Reconstruction of urethral stricture disease involving a combination of grafts and flaps consists of a group of complex procedures with specific clinical indications. The knowledge of these procedures by reconstructive urologists is both necessary and relevant. A thorough understanding of the anatomy, including blood supply, is a crucial proviso for the correct evaluation and successful management of urethral stricture disease. We discuss the main techniques and indications in combined graft and flap urethroplasties.

Simplified posterior urethroplasty utilizing laparoscopic instrumentation

BackgroundPosterior urethral stricture disease presents challenges for even the most skilled reconstructive urologists. Regardless of the surgical technique used, these are complex operations that occur in hard-to-access locations. We describe the use of a novel combination of laparoscopic instrumentation to simplify posterior urethral reconstruction.MethodsWe retrospectively identified patients undergoing a posterior urethral stricture repair utilizing a combination of the RD-180® suture device and the Securestrap®. These procedures were performed by a single surgeon at our institution. Patients with greater than or equal to 4 months of follow up were included in the analysis.ResultsFrom October 2016 to October 2020, 20 patients underwent posterior urethral stricture repair using these laparoscopic instruments. Median age was 70 years (28–90 years). Median follow up was 12 months (5–50 months). Mean stricture length was 3 cm (1.5–16 cm). Median operative time was 150 minutes (120–180 minutes). No peripheral neuropathies or positional injuries were noted. With failure defined as inability to pass a 16-Fr scope, success rate was 95% (19/20 patients).ConclusionsThe combination of the RD-180® and the Securestrap® has become essential to our posterior urethral stricture repair armamentarium. Further data and longer follow up is needed to confirm these reliable outcomes.

Race as a Predictor of Recurrence and Complications After Urethroplasty in Men With Urethral Stricture Disease

ObjectiveTo determine the role of race in surgical outcomes of and complications after urethroplasty. MethodsA single institution, retrospective review was conducted from 2011 to 2019 on male patients ≥18 years of age who underwent urethroplasty. Exclusion criteria included previous urethral cancer, lack of follow up, or revision urethroplasty. Failure of urethroplasty was defined as requiring revision surgery or recurrence on imaging or cystoscopy. Risk factors for recurrence were determined using descriptive statistics, Wilcoxon comparisons, and multivariate logistic regression. ResultsThree hundred and seven patients were identified with 234 patients meeting inclusion criteria. 63.2% identified as White/Caucasian (CA), 32.5% Black/African American (AA), and 4.3% other race. Mean age was 49.4 years. Between CA and AA patients, there was no difference in mean age, body mass index, smoking status, prior urethroplasty, or prior dilation/DVIU. CAs were more likely to have a fossa navicularis stricture compared to AAs (P = .0094), but there were no significant differences in bulbar, penile, or posterior stricture rates (all P >.05) or length (P = .32). The overall stricture recurrence rate was 15.8% with a median of 242 days to recurrence and no significant difference by race for either outcome (P = .83, P = .64). The only predictor of stricture recurrence was prior dilation/DVIU (P = .0404, OR 2.3, 95% CI 1.0, 5.6). Overall complication rate was 17.5%, with no difference between CA and AAs rates (P = .83) or complication type (P = .62). ConclusionThere was no significant difference in the rate of surgical failure for urethral stricture repair based on race. The only predictor of surgical failure was having a prior urethral dilation/DVIU.

SC71 - Intraoperative bleeding during bulbar urethral strictures repair: does it matter?

SC71 - Intraoperative bleeding during bulbar urethral strictures repair: does it matter?

Robotic Assisted Repair of Post-Ileal Conduit Parastomal Hernia: Technique and Outcomes

ObjectiveTo describe a novel method of robotic assisted laparoscopic parastomal hernia repair (RAL-PHR), including the evolving use of the Da Vinci Single Port (SP) robotic system. MethodsDemographic, intraoperative, and postoperative variables were collected for patients who underwent RAL-PHR. The technique for RAL-PHR utilizes a 3 cm incision in the contralateral upper quadrant for the robotic trocar and a 12 mm assistant port. The hernia sac is freed from the fascial defect. Dual Surface Mesh is approximated to the fascial edges with a portion excised to tailor the conduit. ResultsFour patients underwent RAL-PHR and three utilized the SP robot. Median age was 74.4 (range: 69.0-76.9) and median BMI 28.6 (26.5-43.2). All patients underwent cystectomy for bladder cancer and median time from index operation to parastomal hernia repair was 47.3 (40.4-11.48) months. Concurrent operations to hernia repair included ureteroenteric stricture repair, panniculectomy, abdominal wall reconstruction, stoma revision, and incisional hernia repair. Median operative time was 3.9 (2.6-8.7) hours including concurrent operations, median EBL was 50 (10-100) cc, mesh used in 3 cases, with no intraoperative complications reported. Median length of stay was 1 day and 1 post-operative complication greater than Clavien 2 reported. At median follow up of 18.3 (3.63-38.3) months, no recurrences were reported and 1 patient had undergone stoma dilation in the OR. ConclusionRAL-PHR using the SP system maximizes advantages of laparoscopic repair while allowing for flexibility to perform concurrent procedures and safer takedown of adhesions through just two incisions. RAL-PHR is a safe and effective alternative to open and laparoscopic parastomal hernia repair with several additional benefits.

PD22-02 SURGICAL OUTCOMES OF URETHRAL REVISION SURGERY AFTER GENDER AFFIRMING, SINGLE STAGE RADIAL FOREARM PHALLOPLASTY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II (PD22)1 Sep 2021PD22-02 SURGICAL OUTCOMES OF URETHRAL REVISION SURGERY AFTER GENDER AFFIRMING, SINGLE STAGE RADIAL FOREARM PHALLOPLASTY Mang Chen, Amanda Chi, Brad Figler, Rachel Moses, Bauback Safa, and Andrew Watt Mang ChenMang Chen More articles by this author , Amanda ChiAmanda Chi More articles by this author , Brad FiglerBrad Figler More articles by this author , Rachel MosesRachel Moses More articles by this author , Bauback SafaBauback Safa More articles by this author , and Andrew WattAndrew Watt More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002011.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral strictures and fistulas are common after gender affirming phalloplasty with urethral lengthening. We report our experience in urethroplasty and fistula repairs after single stage radial forearm (RF) free flap phalloplasty. METHODS: We retrospectively reviewed a high volume, single center database of 128 transmen who underwent index, single stage RF phalloplasty between October 2017 and January 2021. Urethral fistulas and strictures were characterized by repair technique, length, and location, which is further categorized as the pars pendulans (PP) urethra, pars pendulans-pars fixa (PP-PF) urethral anastomosis, and pars fixa (PF) urethra. RESULTS: In total, 25% (32/128) of patients with a median follow up of 21.5 months needed urethral revision surgery for solitary fistula (3/128), stricture (21/128), and combination stricture and fistula (8/128). Solitary fistulas developed at the PP-PF (1), PF (1), and PF-native urethra anastomosis (1). These were repaired in one stage using fistula tract excision, primary urethral closure, and dermal autograft interposition without evidence of recurrence. Remaining fistulas were successfully repaired at time of urethroplasty. Strictures developed in 29 patients and were identified in the distal PP (4), PP-PF (18), and PF (12) urethra, with a mean length of 1.4cm (range 0.5 mm-3 cm); 6 patients had more than 1 stricture. Urethroplasty techniques utilized include staged Johanson (4), Heineke-Mikulicz (HM) (18), excision and primary anastomosis (3), and substitution (10) urethroplasty—with 8 patients needing buccal mucosal graft (BMG), and 2 needing split thickness skin grafts. Of the 29 patients undergoing stricture repair, 8 (28%) developed recurrent strictures requiring additional substitution (3) and HM (4) urethroplasty, and dilation (1). Two of the 8 (25%) required a third urethral intervention. No patients required a perineal urethrostomy, and no fistula recurrences were seen in those that needed simultaneous fistula repair. CONCLUSIONS: In a single center series of gender affirming RF phalloplasty, 25% of patients developed urethral strictures and/or fistulas requiring urethral revision, most frequently at the PP-PF anastomosis. Urethroplasty and fistula repair was successful in 75% of patients. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e380-e380 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mang Chen More articles by this author Amanda Chi More articles by this author Brad Figler More articles by this author Rachel Moses More articles by this author Bauback Safa More articles by this author Andrew Watt More articles by this author Expand All Advertisement Loading ...

V01-11 ROBOT-ASSISTED SURGICAL REPAIR OF URETERO-ILEAL ANASTOMOTIC STRICTURE AFTER CYSTECTOMY AND ILEAL CONDUIT IN NEUROLOGICAL PATIENT

You have accessJournal of UrologyIncontinence & Female Pelvic Medicine/Reconstructive Surgery (V01)1 Sep 2021V01-11 ROBOT-ASSISTED SURGICAL REPAIR OF URETERO-ILEAL ANASTOMOTIC STRICTURE AFTER CYSTECTOMY AND ILEAL CONDUIT IN NEUROLOGICAL PATIENT Gilles Dosin, Juliette Hascoet, Clement Mazouin, Zine-Eddine Khene, Gregory Verhoest, Romain Mathieu, Karim Bensalah, Lucas Freton, Emmanuel Voiry, Claire Richard, Camille Haudebert, Etienne Courboin, Andrea Manunta, and Benoit Peyronnet Gilles DosinGilles Dosin More articles by this author , Juliette HascoetJuliette Hascoet More articles by this author , Clement MazouinClement Mazouin More articles by this author , Zine-Eddine KheneZine-Eddine Khene More articles by this author , Gregory VerhoestGregory Verhoest More articles by this author , Romain MathieuRomain Mathieu More articles by this author , Karim BensalahKarim Bensalah More articles by this author , Lucas FretonLucas Freton More articles by this author , Emmanuel VoiryEmmanuel Voiry More articles by this author , Claire RichardClaire Richard More articles by this author , Camille HaudebertCamille Haudebert More articles by this author , Etienne CourboinEtienne Courboin More articles by this author , Andrea ManuntaAndrea Manunta More articles by this author , and Benoit PeyronnetBenoit Peyronnet More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001970.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cystectomy and ileal conduit (IC) are sometimes indicated for patient with a neurogenic bladder. However stricture of the uretero-enteric anastomosis are a common complication after this procedure. Robot-assisted uretero-enteric stricture repair may decrease the post operative morbidity and possibly increase the chance of success thanks to tools such as indocyanine green (ICG) and near infrared fluorescence (Firefly). The objective of this video is to assess the feasibility of this procedure. METHODS: We present the case of a 47 year-old patient with multiple sclerosis since 1987. She had a IC in 2018 with a Wallace 1 anastomosis for neurogenic detrusor overactivity refractory to conservative treatment with upper urinary tract deterioration and inability to self catheterize due to MS progression (cognitive dysfunction and upper limb impairment). She experienced multiple urosepsis with long hospital stays and eventually she needed bilateral nephrostomy tubes. Antegrade opacification revealed a stricture of the left uretero-enteric anastomosis. RESULTS: The patient is placed in 23° Trendelenburg position. Six ports are placed (4 robotic and 2 for the assistant) and the Da Vinci Xi robot is docked. We begin with adhesiolysis which allows to identify the ileal conduit. We carefully preserve the peri ureteral fat to ensure the best possible ureteral vascularization. We cut the ureters distally. The blood supply to the ureters end is checked using IV indocyanine green (ICG) injection and near infrared fluorescence (Firefly) and the ureters are cut as high as necessary and the ureter spatulation. A new uretero-enteric anastomosis is created according the Wallace 1 technique between the “ureteral plate” and the proximal stump of the ileal conduit. Two ureteral stents are placed for 10 days. CONCLUSIONS: Uretero-enteric anastomotic stricture in neurological patients can be treated using a robotic approach refection by robotic assisted procedure in a fully intracorporeal way is feasible. The magnified 3D vision, the precise dissection using the endowrist and the use of ICG may help preserve adequate blood supply to the ureter and minimize the risk of stricture recurrence The absence of large incision could also favored enhanced post operative recovery and minimize the risk of incisional hernias in this frail patient population. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e65-e65 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gilles Dosin More articles by this author Juliette Hascoet More articles by this author Clement Mazouin More articles by this author Zine-Eddine Khene More articles by this author Gregory Verhoest More articles by this author Romain Mathieu More articles by this author Karim Bensalah More articles by this author Lucas Freton More articles by this author Emmanuel Voiry More articles by this author Claire Richard More articles by this author Camille Haudebert More articles by this author Etienne Courboin More articles by this author Andrea Manunta More articles by this author Benoit Peyronnet More articles by this author Expand All Advertisement Loading ...

Histological Evaluation of Vaginal Cavity Remnants Excised During Neourethral Stricture Repair in Transgender Men

ObjectiveTo determine the prevalence of patients who require vaginal cavity remnant excision and obliteration during neourethral stricture repair and to characterize the histological composition of the excised tissue. MethodsA retrospective review was performed of all transgender men who underwent neourethral stricture repair. Preoperative imaging and operative reports were reviewed to determine the presence of a vaginal cavity remnant that was excised and obliterated during neourethral reconstruction. Pathology slides were reviewed by 2 pathologists to determine if there was presence of stratified squamous epithelium consistent with vaginal tissue within the vaginal cavity remnant. ResultsA total of 47 consecutive transgender men underwent neourethral stricture repair between January 2014 and December 2020. Of these, 18 patients (38%) with a mean age of 37 years (23-59) underwent excision and obliteration of a vaginal cavity remnant. Seventy eight percent (14/18) had a prior phalloplasty and 22% (4/18) had a prior metoidioplasty. Primary vaginectomy type was not associated with whether or not a patient had a vaginal cavity remnant (P = .12). Histological evaluation demonstrated the presence of vaginal epithelium in all vaginal cavity remnant specimens. ConclusionA high percentage of transgender men with neourethral strictures present with vaginal cavity remnants despite prior vaginectomy. Pathological evaluation confirms that all vaginal cavity remnant specimens contain vaginal epithelium that was either incompletely excised or regenerated. While the implications of this residual vaginal epithelium require further investigation, total removal of vaginal tissue primarily or during reconstruction is important given the risk of associated symptoms.

Robotic Repair of Ureteral Strictures: Techniques and Review.

To provide an overview and description of the different surgical techniques for the robotic repair of ureteral strictures. The robotic repair of ureteral stenosis has emerged as a useful option for treating strictures unsuitable for endoscopic resolution with good results, lower morbidity, and faster recovery than open techniques. Depending on the stricture's length and location, the reconstructive options are reimplantation, psoas hitch, Boari flap, ureteroureterostomy, appendiceal onlay flap, buccal mucosa graft (BMG) ureteroplasty, ileal replacement, or renal autotransplantation. The robotic approach offers a magnified vision and the possibility of adding near-infrared fluorescence (NIRF) imaging, indocyanine green (ICG), and FireflyTM to facilitate the technique. Multicenter studies with extended follow-up still have to confirm the good results obtained in published case series. Robotic reconstructive techniques are useful for repairing ureteral strictures, obtaining good functional results with less morbidity and faster recovery than open procedures.

Tubularized urethral reconstruction using everted saphenous vein graft in a beagle model

BackgroundA long segment stricture in the anterior urethra is a challenge in urology. We conducted a study to investigate the efficacy of anterior urethral reconstruction using an everted saphenous vein graft (SVG) in a tubular fashion.MethodsTwelve male beagles were randomly divided into three groups: experimental group (n = 5), control group (n = 5) and normal group (n = 2). A 3 cm defect in the anterior urethra was created. Autologous SVG was harvested. In the experimental group, urethral defect was replaced by an everted SVG in a tubular fashion. In the control group, urethral reconstruction was performed using an uneverted SVG. Beagles in all groups received retrograde urethrography to evaluate urethral patency and were killed for histological examination 6 months after operation.ResultsFour beagles in the experimental group had no voiding difficulty and the other one could not void spontaneously. Retrograde urethrography showed the four beagles in experimental group had wide urethral lumens. Ether urethral stricture or fistula were detected in all animals in the control group. Histological analysis of the four beagles in the experimental group indicated the everted SVG completely integrated into the urethra. The reconstructed urethra contained a wide lumen and was completely covered by urothelium. The periurethral collagen and muscle fibers formed and were highly organized. Everted SVG showed a high ability of neovascularization. In the control group, the reconstructed segment showed a fibrotic urethral lumen where the urothelium was not intact. Only few new capillaries were formed.ConclusionsEverted SVG demonstrates for a promising strategy for potential urethral stricture repair.

A new technique in the treatment of ureteroenteric anastomosis stricture: Repair of ureteroenteric anastomosis stricture with low lombotomy incision (retroperitoneal approach).

Ureteroenteric anastomosis stricture (UEAS) is one of the complications of urinary diversion and may lead to serious consequences. In this study, we evaluated our UEAS revision technique outcomes performed with a low lombotomy incision in the lateral decubitus position. Eleven patients who underwent surgical repair due to isolated right UEAS between January 2010 and June 2019 were included in the study. Anastomosis stricture was confirmed by ultrasonography, computed tomography or magnetic resonance urography techniques. Ultrasonography was used to detect hydronephrosis, which is a finding secondary to stricture. However, opaque urography imaging methods were used to confirm the definitive diagnosis of the stricture. Demographic and clinical data, preoperative and postoperative 3rd month serum creatinine, estimated glomerular filtration rate (eGFR) and dynamic renal scintigraphy data of patients were evaluated. The mean operation time was 49.7±9.3minutes. No perioperative complications were observed. While the overall stricture rate was 11.4%, the isolated right-sided stricture rate was 5.7%. Preoperative and postoperative serum creatinine values were similar. Preoperative eGFR value was 58.8±12.9mL/min/1.73 m2 and postoperative value was 53.5±11.5mL/min/1.73 m2 . T½ level decreased in postoperative period (22.3±8.2min vs 15.1±4.3min). Open revision of the UEAS with retroperitoneal approach provides lower morbidity rates and shorter hospitalisation time compared to other methods. The retroperitoneal approach is the main advantage of this technique and prevents morbidity caused by other techniques performed intraperitoneally and owing to it is an open technique, it can be easily applied in isolated right-sided UEAS.

Buccal Mucosa Graft Harvest in Children and Young Adults: Case Series and Harvest Technique.

Buccal mucosa is a great choice for urethroplasty for urethral stricture repair because of ease of harvesting, pliability of the graft, and minimal donor site morbidity. These procedures are performed at our institution as a combined case with Pediatric Otolaryngology and Urology. Harvesting buccal mucosal grafts in younger patients is more technically challenging due to limited oral cavity access and smaller area available for tissue harvest, but is able to be performed safely and with limited morbidity with the addition of parotid duct cannulation and use of retraction sutures to the graft harvest technique. This retrospective case series reports harvest technique, outcomes, and complications of children and young adult males undergoing buccal or lower lip mucosal graft harvesting to repair congenital urethral strictures. Outcome measures were perioperative bleeding, trismus, pain, numbness, parotid duct injury and lip deformity. Six patients underwent nine harvest procedures. Technique modifications included application of anterior graft margin stay sutures to help stabilize the graft mucosa and cannulation of the parotid duct with lacrimal probes to avoid duct injury and to maximize graft size. Overall, buccal mucosal graft harvesting is a well-tolerated procedure with minimal complications using proper harvest technique.