Urethral Injury Research Articles

Non-Invasive Intra-Abdominal Pressure Measurement by Means of Transient Radar Method: In Vitro Validation of a Novel Radar-Based Sensor.

Intra-abdominal hypertension, defined as an intra-abdominal pressure (IAP) equal to or above 12 mmHg is one of the major risk-factors for increased morbidity (organ failure) and mortality in critically ill patients. Therefore, IAP monitoring is highly recommended in intensive care unit (ICU) patients to predict development of abdominal compartment syndrome and to provide a better care for patients hospitalized in the ICU. The IAP measurement through the bladder is the actual reference standard advocated by the abdominal compartment society; however, this measurement technique is cumbersome, non-continuous, and carries a potential risk for urinary tract infections and urethral injury. Using microwave reflectometry has been proposed as one of the most promising IAP measurement alternatives. In this study, a novel radar-based method known as transient radar method (TRM) has been used to monitor the IAP in an in vitro model with an advanced abdominal wall phantom. In the second part of the study, further regression analyses have been done to calibrate the TRM system and measure the absolute value of IAP. A correlation of –0.97 with a p-value of 0.0001 was found between the IAP and the reflection response of the abdominal wall phantom. Additionally, a quadratic relation with a bias of −0.06 mmHg was found between IAP obtained from the TRM technique and the IAP values recorded by a pressure gauge. This study showed a promising future for further developing the TRM technique to use it in clinical monitoring.

MP04-08 BLUNT TRAUMATIC FEMALE URETHRAL AND BLADDER NECK INJURIES: A 15 YEAR SINGLE-INSTITUTION EXPERIENCE

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP04)1 Sep 2021MP04-08 BLUNT TRAUMATIC FEMALE URETHRAL AND BLADDER NECK INJURIES: A 15 YEAR SINGLE-INSTITUTION EXPERIENCE Catalina K. Hwang, Stanley Moore, Ziho Lee, and Judith C. Hagedorn Catalina K. HwangCatalina K. Hwang More articles by this author , Stanley MooreStanley Moore More articles by this author , Ziho LeeZiho Lee More articles by this author , and Judith C. HagedornJudith C. Hagedorn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001971.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Injury of the female urethra and bladder neck (BN) from blunt trauma is rare. Our understanding of its management and outcomes is based on case reports predominantly in the pediatric population, which describe high complication rates related to delayed management. We present our 15-year experience of this injury in an adult population. METHODS: We retrospectively reviewed records of all female patients admitted to our Level 1 trauma center from 2005 to 2019 with a urethral or BN injury. All inpatient and outpatient records were reviewed. RESULTS: Ten patients were identified with a median age of 36.5 (range 17-48) years. All patients had concomitant pelvic fractures. Six injuries involved the BN, 3 the proximal urethra, and 1 the distal urethra. All injuries were confirmed operatively. Median time to diagnosis was 1 (range 0-4) day after presentation. Gross hematuria was seen in all patients. Of 6 patients with preoperative CT cystogram, 50% had a scan that demonstrated the injury. Of 8 patients with pre-operative pelvic examination, 50% had an identifiable injury on that exam. Cystoscopy in the operating room was performed in 4 patients. Visual inspection of the urethra through cystotomy was performed in 5 patients. There were no delayed or missed diagnoses. Two patients were lost to follow-up. One patient was not eligible for early repair of urethral injury due to clinical instability and underwent urethrovaginal fistula repairs at 3 months, and at 18 months after presentation. Of the 7 remaining patients who underwent early management of their injury within 7 days, 2 (29%) had a major surgical complication (Clavien grade >2) including pyelonephritis and suprapubic wound abscess. One patient had a urethrovaginal fistula that was seen on voiding cystourethrogram with spontaneous resolution of pneumaturia. On median follow-up of 15.2 (range 3-19.5) months, none of these patients who underwent early management reported long-term Urologic concerns related to urethral injury, including stricture and incontinence. CONCLUSIONS: Our experience suggests that intraoperative evaluation is the only reliable diagnostic modality for urethral and BN injury in adult females. Although some patients had early surgical complications, none of those who underwent prompt management within 7 days of injury had long-term complications of their urethral injury. Our excellent outcomes reinforce the importance of an aggressive diagnostic strategy and surgical repair for female urethral and BN injury. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e70-e70 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catalina K. Hwang More articles by this author Stanley Moore More articles by this author Ziho Lee More articles by this author Judith C. Hagedorn More articles by this author Expand All Advertisement PDF downloadLoading ...

MP04-10 OES TUNICAL DEFECT LENGTH AFFECT FUNCTIONAL OUTCOMES IN PENILE FRACTURE SURGERY?

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP04)1 Sep 2021MP04-10 OES TUNICAL DEFECT LENGTH AFFECT FUNCTIONAL OUTCOMES IN PENILE FRACTURE SURGERY? Abdullah Hizir Yavuzsan, Ahmet Tevfik Albayrak, Cumhur Yesildal, Musab Ilgi, Ibrahim Halil Baloglu, Mithat Eksi, Kaya Horasanli, and Sinan Levent Kirecci Abdullah Hizir YavuzsanAbdullah Hizir Yavuzsan More articles by this author , Ahmet Tevfik AlbayrakAhmet Tevfik Albayrak More articles by this author , Cumhur YesildalCumhur Yesildal More articles by this author , Musab IlgiMusab Ilgi More articles by this author , Ibrahim Halil BalogluIbrahim Halil Baloglu More articles by this author , Mithat EksiMithat Eksi More articles by this author , Kaya HorasanliKaya Horasanli More articles by this author , and Sinan Levent KirecciSinan Levent Kirecci More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001971.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile fracture is urological emergency, which needs an urgent surgical intervention. In this study we aimed to report our single center surgical outcomes in patients who underwent penile fracture surgery and to investigate the relationship between these functional outcomes and the tunical defect lenght (TDL). METHODS: This study was approved by the institutional ethics committee (approval no. 1707). Forty-six patients who underwent emergency surgery with a diagnosis of penile fracture in our hospital between July 2010 and December 2018 were included in the study. Patients who were treated conservatively because they did not accept surgery and who did not attend a postoperative one-year follow-up were excluded from the study. The diagnosis was made by history, physical examination and ultrasound (US). Functional outcomes were assessed at third, sixth, and twelfth months postoperatively. International Index of Erectile Function-5 (IIEF-5) score was used to assess the erectile function. Moreover, to evaluate the effect of the TDL on the outcomes, the patients were divided into two groups, length ≤10 mm and length >10 mm. The primary outcome of this study was the investigation of the relationship between the erectile function and theTDL. The secondary outcome was to investigate the detection rate of preoperative US according to the TDL. RESULTS: The median age of the patients was 31 years. The cause of the fracture in 34 patients (74%) was sexual intercourse. The median TDL was 17 mm. Three patients (6.5%) with urethrorrhagia were diagnosed with urethral injury and primarily fixed during surgery. Erectile dysfunction was not observed in any of the patients during the follow-up, while 1 (2.2%) had penile curvature and 16 (34.8%) had penile nodules. IIEF-5 scores at the postoperative 3rd month were statistically lower in patients with a TDL >10 mm (n=34) compared to those with ≤10 mm (n=12) (18.7±2.9 vs. 20.7±2.2, p=0.036). However, this statistical difference disappeared in the 6th and 12th month follow-ups. Furthermore, the rate of penile nodules was found to be statistically higher in the patient group with TDL >10 mm at the end of the one-year follow-up period (44.1% vs. 8.3%, p=0.035). All 3 patients with urethral injury was in the TDL > 10 mm group. However, these 3 patients did not experience voiding deterioration consistent with urethral stricture during the 1-year follow-up.Additionally, it was observed that as the length of the defect increases, the sensitivity to US increases. While 25% of the group with TDL ≤ 10 mm experienced sensitivity, 94.1% in the group with TDL >10 mm, and this difference was statistically significant (p< 0.001). CONCLUSIONS: Presence of >10 mm TDL is associated with lower IIEF-5 scores in the early surgical period and higher rates of penile nodule formation. Also, preoperative US is highly sensitive to TDL >10 mm in penile fractures. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e71-e71 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abdullah Hizir Yavuzsan More articles by this author Ahmet Tevfik Albayrak More articles by this author Cumhur Yesildal More articles by this author Musab Ilgi More articles by this author Ibrahim Halil Baloglu More articles by this author Mithat Eksi More articles by this author Kaya Horasanli More articles by this author Sinan Levent Kirecci More articles by this author Expand All Advertisement Loading ...

MP57-05 DOES ASYMMETRY EQUAL CURVATURE? THE CLINICAL SIGNIFICANCE OF ASYMMETRIC CORPORAL MEASUREMENTS AT TIME OF INFLATABLE PENILE PROSTHESIS SURGERY

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy (MP57)1 Sep 2021MP57-05 DOES ASYMMETRY EQUAL CURVATURE? THE CLINICAL SIGNIFICANCE OF ASYMMETRIC CORPORAL MEASUREMENTS AT TIME OF INFLATABLE PENILE PROSTHESIS SURGERY Raevti Bole, Mohamed Ahmed, Ajay Gopalakrishna, Matthew Ziegelmann, Tobias Kohler, and Sevann Helo Raevti BoleRaevti Bole More articles by this author , Mohamed AhmedMohamed Ahmed More articles by this author , Ajay GopalakrishnaAjay Gopalakrishna More articles by this author , Matthew ZiegelmannMatthew Ziegelmann More articles by this author , Tobias KohlerTobias Kohler More articles by this author , and Sevann HeloSevann Helo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002087.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patient satisfaction after inflatable penile prosthesis (IPP) placement has been linked to multiple factors including preexisting curvature. The clinical significance of asymmetric corporal measurements (ACM) unrelated to proximal perforation, crossover or urethral injury is unclear. We sought to assess the clinical significance of intraoperative ACM in patients undergoing IPP surgery. METHODS: A single institution retrospective review of patients undergoing primary IPP placement between 7/2019-9/2020 was performed. Baseline patient characteristics, intraoperative details, and postoperative course were recorded. Regression analysis was conducted to determine factors associated with ACM. RESULTS: A total of 130 patients underwent primary placement of penile prosthesis during this time. Median age was 67 years (IQR 13). Comorbidities included diabetes mellitus in 22.3%, CAD in 22.3%, history of prostatectomy or cystectomy in 33.8%, history of pelvic radiation in 7.7%, and Peyronie’s disease in 21.5%. The median corporal measurement was 21 (IQR 2) bilaterally and median cylinder size 20 cm (IQR 4) bilaterally with 1cm rear tip extenders. Of the 18.5% (24/130) of patients with ACM, asymmetry was as follows: 20.8% (5/24) had a less than 1 cm, 70.8% (17/24) had 1 cm but less than 2 cm, and 8.3% (2/24) had 2 cm or greater. Of these patients 87.5% (21/24) underwent placement of an asymmetric device, only 5% (1/21) of which had residual curvature less than 30 degrees. Despite ACMs, 12.5% (3/24) of patients had a symmetric device placed, one of which had residual curvature. Only 2 patients underwent additional straightening procedures including plication and incision/grafting. Univariate regression did not reveal an association between ACM and residual curvature, adjunctive measures for correction, or postoperative pain or device issues (p >0.05 for all). CONCLUSIONS: Almost 1 in 5 patients undergoing primary placement of penile prosthesis for ED had ACM. However this did not correspond to residual curvature following placement of prosthesis cylinders or requirement for adjunctive straightening techniques. These findings may provide intraoperative reassurance to urologists when noting asymmetric measurements during corporal dilation in penile prosthesis placement. Source of Funding: No © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e979-e980 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raevti Bole More articles by this author Mohamed Ahmed More articles by this author Ajay Gopalakrishna More articles by this author Matthew Ziegelmann More articles by this author Tobias Kohler More articles by this author Sevann Helo More articles by this author Expand All Advertisement Loading ...

Intraoperative complications during laparoscopic total mesorectal excision

Intraoperative complication during laparoscopic mesorectal excision for rectal cancer is a common complication occurring in 11% to 15% of the cases. They are probably underestimated because not systematically reported. The most frequent intraoperative complications are hemorrhage (3-7%), tumor perforation (1-4%), bowel injury (1-3%), ureter injury (1%), urogenital injury (2%), other organ injury (<1%), and anastomotic complications (1%). The mechanisms, management and prevention of vascular port injury, inferior mesenteric artery bleeding, small bowel and colon perforation, ureteral and urethral injury, pelvic nerve damage, tumor perforation and anastomotic failure are described. This review underlines the necessity to prevent intraoperative complication to avoid operative death and severe side-effects.

MP47-12 IMPACT OF URETHRAL GROWTH FACTORS ON IN VITRO UROTHELIAL GROWTH

You have accessJournal of UrologyPediatric Urology III (MP47)1 Sep 2021MP47-12 IMPACT OF URETHRAL GROWTH FACTORS ON IN VITRO UROTHELIAL GROWTH Christopher Foster, and Courtney K. Rowe Christopher FosterChristopher Foster More articles by this author , and Courtney K. RoweCourtney K. Rowe More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002068.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral injuries and congenital anomalies that require surgery are often associated with poor healing that result in strictures and scarring. Current regenerative medicine techniques focus on scaffolds and growth factors; however, there is very limited preliminary research showing which growth factors are ideal for urothelial healing. The goal of this study was to 1) develop an in vitro model of urethral healing and 2) evaluate differences in healing rates between growth factors that are associated with the urethra to establish a foundation upon which future regenerative medicine can expand. We hypothesize that one of six candidate growth factors which have been found present during urethral healing would provide optimal urethral healing in vitro. METHODS: Human urothelial epithelial cells from a bladder source were purchased. Cells were seeded onto prefabricated wound healing dishes and allowed to reach near confluence. Four hours prior to the start of the assay, cells were starved with growth factor free media. At time 0, the well insert was removed and fresh media with one of six candidate growth factors was added to respective dish. At time 0, 6, 10, 14, 24, and 48 hours microscopic images were taken of the wound gap. Images were analyzed using Image-J and % wound gap coverage was considered healing percent of the wound. Comparative statistics were performed using ANOVA with tukey multiple comparisons test where p<0.0002. RESULTS: Insulin-like growth factor 1 (IGF-1) at concentrations of 10 and 100 ng/ml had a statistically significant increase in percentage healing compared to both the controls (Figure A). IGF-1 at 100 ng/ml was the only growth factor to show 100% healing at 48 hours. Epidermal growth factor (EGF) at concentrations of 1 and 10 ng/ml had a statistically significant increase in healing compared to the growth factor free media control (Figure A). FGF-basic, PDGF-BB, TGF-β1, and VEGF had no significant differences compared to the growth factor free media control. CONCLUSIONS: IGF-1 and EGF both drive healing in this urothelial epithelial growth model with IGF-1 having the greatest effect and providing 100% healing at 48 hours. Future studies should evaluate how these individual growth factors effect urothelial healing in an in vivo model. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e827-e828 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Foster More articles by this author Courtney K. Rowe More articles by this author Expand All Advertisement Loading ...

Abstract 30 - Incidence of iatrogenic urethral catheterisation injuries: A prospective multicentre audit

Abstract 30 - Incidence of iatrogenic urethral catheterisation injuries: A prospective multicentre audit

MP67-19 THE IMPACT OF AN INTERNATIONAL PARTNERSHIP ON THE TREATMENT OF MEN WITH BULBAR URETHRAL STRICTURES AND PELVIC FRACTURE URETHRAL INJURIES (PFUI) IN VIETNAM

You have accessJournal of UrologyGlobal Health/Humanitarian (MP67)1 Sep 2021MP67-19 THE IMPACT OF AN INTERNATIONAL PARTNERSHIP ON THE TREATMENT OF MEN WITH BULBAR URETHRAL STRICTURES AND PELVIC FRACTURE URETHRAL INJURIES (PFUI) IN VIETNAM Hung Do, Justin DeGrado, and Joel Gelman Hung DoHung Do More articles by this author , Justin DeGradoJustin DeGrado More articles by this author , and Joel GelmanJoel Gelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002028.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In Vietnam, there is a high incidence of bulbar urethral straddle and pelvic fracture urethral injuries (PFUI) due to the prevalent use of motor bikes for transportation. Urethral strictures have historically been managed with suprapubic tubes, periodic dilation, or 1 or more attempts at urethroplasty that often fail. A United States - Vietnam outreach relationship was established to improve treatment success and decrease the societal burden of urethral stricture disease. We report the impact of this partnership METHODS: A Faculty Urologist at a major Vietnamese teaching hospital (Binh Dan Hospital in HCMC) with an interest in developing expertise in urethroplasty was identified. The Urologist travelled to the United States to receive observational exposure to urethral imaging and surgery. In addition, yearly 2-week trips were established from 2014-present. The initial focus was patient evaluation, urethral imaging (retrograde urethrogram and voiding cystourethrogram), and decision making. This included the first use of flexible cystoscopes in Vietnam. The subsequent focus was operative, mostly anastomotic urethroplasty, with the mentor-mentee. IVUmed provided 2-3 Resident Scholarships for each outreach trip. Binh Dan hospital was provided urethroplasty specific instruments and their first flexible cystoscope. An imaging and follow-up protocol was established which included 4-month cystoscopy to assess outcomes. A database was created to prospectively evaluate success rate over the 2016-2020 study period. RESULTS: Bulbar anastomotic urethroplasty was performed in 97 men. Of the 40 that returned for 4-month cystoscopy, there were 5 recurrences (success rate=87.5%). Posterior urethroplasty for PFUI was performed in 101 men. Of the 74 that returned for 4-month cystoscopy, with 32/74 of those being revision surgery, there were 4 recurrences (success rate=94.6%) with 3 of the 4 failures in re-do cases. With a mean follow-up (defined as time interval between surgery and most recent visit) of 5.0 months (bulbar) and 9.5 months (PFUI), there were no additional recurrences identified, defined as obstructive symptoms or need for intervention. CONCLUSIONS: In Vietnam, the development of an international partnership at a hospital with the necessary infrastructure has been associated with the establishment of a high success rate for bulbar and posterior urethroplasty. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e517-e517 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hung Do More articles by this author Justin DeGrado More articles by this author Joel Gelman More articles by this author Expand All Advertisement Loading ...

PD31-01 A MULTI-CENTER PROSPECTIVE COHORT STUDY OF ENDOSCOPIC URETHRAL REALIGNMENT VERSUS SUPRAPUBIC CYSTOSTOMY AFTER PELVIC FRACTURE URETHRAL INJURY

INTRODUCTION AND OBJECTIVE:Pelvic fracture urethral injury (PFUI) occurs in up to 10% of pelvic fractures. In management of PFUI, there is mixed evidence supporting endoscopic urethral realignment ...

Female Urethroplasty: Outcomes of Different Techniques in a Single Center.

Introduction: Female urethral strictures and injuries are relatively uncommon compared to males. A wide range of possible causes and treatment modalities have been described. Lately female urethral reconstruction is gaining attention and is fortunately no longer a neglected topic within the reconstructive urology. As such, we aimed to describe our surgical techniques and outcomes for female urethroplasty from a tertiary center. Materials and Methods: Records of female patients who underwent a urethroplasty between July 2018 and May 2021 in our tertiary referral center were reviewed. Patients were subdivided in two groups: patients who suffered from a urethral injury and received an early repair urethroplasty, and patients with a true urethral stricture who received a delayed urethroplasty. Preprocedural, surgical and postoperative data were collected and analyzed with descriptive statistics. Results: A total of five patients in group 1 and nine patients in group 2 were included. Etiology of the urethral injury in group 1 was iatrogenic in 80% and transitional cell carcinoma of the urethra in 20% of cases. A patency rate of 100% at a follow-up of 30 months was achieved with the different techniques. In group 2 etiology was idiopathic (44%), iatrogenic (44%) and due to external trauma in 12% of cases. Urethroplasty technique consisted of primary repair or dorsal onlay of a buccal mucosal graft. Patency rate was 100% at a median follow-up of 13 months. Three patients suffered from postoperative urinary incontinence, one in group 1 and two in group 2. Conclusion: Female urethroplasty is a relatively rare entity within reconstructive urethral surgery. This case series of 14 patients demonstrates that with appropriate surgical techniques, a high patency rate with a low complication rate can be achieved. Further prospective studies with standardized diagnostic workup and follow-up should be performed in order to optimize management strategy.

Controversy and prospect of transanal total mesorectal excision

As a novel surgical technique, taTME has developed rapidly in recent years. TaTME inevitably attracts some skepticism on safety, efficacy, and indication. First, the controversies over taTME are mainly reflected on the safety and effectiveness of taTME. On one hand, the increase of surgical complications, such as urethral injury, CO2 embolism, anastomotic leakage and pelvic infection, has raised concerns about the safety of taTME. Second, the poor quality of taTME specimens, the increased local recurrence rate and the impaired anal function after taTME, also make people question the effectiveness of taTME. Third, there are more or less controversies in the selection of taTME cases, surgical procedures and cost-effectiveness. However, it can not be denied that taTME has a promising future in view of both surgical theory and clinical practice. Furthermore, taTME is a relatively safe and effective supplementary surgical procedure, especially for patients with low rectal cancer. We should attach more importance to structured training for beginners and conduct high-quality clinical studies in the future development of taTME in China, so as to ensure the safe implementation of taTME and obtain high-level evidence-based medicine evidence, and then standardize the clinical practice of taTME.

What is your diagnosis? Peritoneal fluid from a dog.

What is your diagnosis? Peritoneal fluid from a dog.

Diagnosis and Management of Female Paraurethral Cysts: A Tertiary Hospital Experience

Objective: To report a case series of female paraurethral cysts (FPCs) at a tertiary hospital. Materials and Methods: Sixteen proximal- and distal-FPC cases treated between 2010 and 2019 were retrospectively evaluated. Demographics, clinical presentations, diagnostic methods, treatments, and outcomes were analyzed. Results: The mean age and BMI of the 11 proximal-FPC patients were significantly higher than those of the five distal-FPC patients [55.6 versus 39.8 years (p=0.008); 27.6 versus 21.5 kg/m² (p=0.036)], respectively. Comorbidity and parity statuses did not differ. The most common presenting symptoms were palpable mass (31.3%) and lower urinary tract symptoms (LUTS) (31.3%). There were palpable masses in four distal-FPC cases (80%), significantly more than in proximal-FPC at one case (9.1%) (p=0.013). Normal urinalyses were found in all five distal-FPC cases, significantly higher than in proximal-FPC at two cases (18.2%) (p=0.005). Diagnosis was confirmed solely by pelvic examination in three distal-FPC cases (60%) with palpable masses at the distal urethra, but in only one proximal-FPC case (9.1%) (p=0.063), otherwise, translabial ultrasound, CT, MRI, or VCUG was used. Patients were managed by transvaginal excision and urethral injury occurred in six (42.9%). While the groups’ operative times, blood losses, and catheter indwelling times were similar, proximal-FPC hospital stays were longer at three versus two days (p=0.019). Disease recurrence, transient stress urinary incontinence (SUI), and urethral stricture occurred in one, two and one of proximal-FPC cases, respectively. One distal FPC developed overactive bladder. The symptom-free success rate was 64.3%. Two proximal-FPC patients had adenocarcinoma. Conclusion: The FPC patients had various presentations. Diagnosis of FPC could be made clinically by pelvic examination. Further investigative imaging might be performed in the equivocal cases to confirm the diagnosis. Transvaginal removal was the mainstay treatment. Keywords: Case series; Management; Paraurethral cyst; Skene’s gland cyst; Urethral diverticulum

Temporal trends in the incidence of severe pelvic fracture urethral injuries in the United States from 1998 to 2014.

To use a contemporary population-based cohort to investigate temporal trends in the national incidence of pelvic fracture urethral injuries (PFUIs) in the United States. Using the NIS (National Inpatient Sample), we identified patients with a severe PFUI by a combination of an ICD-9 diagnosis code for pelvic fracture (808.xx) and ICD-9 procedure code for suprapubic tube (57.17 or 57.18) from 1998 to 2014. We compared the annual rates of PFUIs and the annual rates of pelvic fractures alone. An estimated total of 6052 ± 347 males with PFUIs were identified. The average age was 38.4 ± 0.5years. 9.1% ± 0.8% of patients died while hospitalized. In the time frame studied, the rate of PFUI significantly decreased during from 532 patients in 1998 to 255 patients in 2014. Sensitivity analysis excluding patients with bladder repairs identifieda similar trend. The annual rate of PFUI per 1000 pelvic fractures has also decreased from 14.6 ± 1.6 in 1998 to 6.5 ± 0.9 in 2014 (p = 0.001). In this population level study, the number of severe PFUIs has decreased in the United States from 1998 to 2014, which coincides with the implementation and enforcement of seat belt and air bag regulations. Given the rarity of these cases, there is a strong need for collaborative efforts in research and teaching at tertiary care centers for reconstructive urology.

Is it the Surgeon? A Re-examination of Mid-urethral Sling Complications

ObjectiveTo identify potential technical factors during initial mid-urethral sling (MUS) placement that contribute to subsequent sling revision procedures. MethodsA retrospective chart review was performed examining synthetic MUS reoperations at a single institution from 2008-2020. The implanting surgeon's operative note, when available, was critically reviewed with respect to trocar placement, sling location, and tensioning technique. The reoperative report was reviewed for aberrant intraoperative findings relating to the index surgery. ResultsA total of 306 women underwent revision of their MUS. Operative reports from the implanting surgeon were available for 276 (90.2%) women. Review of index operative reports revealed 47 unambiguous descriptions of improper technique, including 19 cases of described excessive tensioning and 2 cases of MUS placement despite noted urethral injury during the index case. Indications for reoperation were clinical obstruction (63%), pain (40%), and mesh erosion/exposure (33%). In 186 (67.4%) women, there was an intraoperative finding during the revision that likely contributed to the need for reoperation. Among these 186 women, 110 (59.1%) slings were noted to have been placed too proximally, 78 (41.9%) were over-suspended, and 57 (30.6%) were placed too deep in the periurethral fascia. ConclusionReview of the index operative note and findings at operative re-exploration of MUS surgeries, often reveals evidence that the initial MUS implantation was technically suboptimal. Such findings suggest that intraoperative surgical technique is a critically important factor contributing to postoperative complications in MUS surgery. This underscores the importance of surgical training and adherence to surgical principles during the placement of a synthetic MUS.

Validation of a new rat model of urethral sphincter injury and leak point pressure measurements

Aims In vivo experiments were performed to establish and validate a rat model of urethral sphincter injury and to develop a method for leak point pressure (LPP) measurements performed repeatedly in the same animal. Methods Twenty-four Sprague-Dawley female rats underwent bladder and epidural catheter implantation. Five days later, cystometry was performed using continuous infusion. Anesthesia with isoflurane, ketamine-xylazine (KX) or fentanyl-fluanisone-midazolam (FFM) was used. After three micturition cycles, intrathecal bupivacaine was administered leading to the suppression of reflex bladder contractions. LPP measurements were performed using vertical tilt. After the initial LPP measurement, animals underwent partial resection of the striated urethral sphincter. The effect was evaluated 6 weeks after surgery, by repeating the LPP measurement in the same animal. Results Ten out of 19 animals showed full micturition cycles under isoflurane, and all 9 animals under KX anesthesia. No significant difference in micturition pressures (Mean ± SEM; 30.1 ± 2.3 vs. 26.8 ± 1.6 mmHg) and LPP (31.0 ± 2.4 vs. 28.0 ± 0.9 mmHg) was observed between isoflurane and KX groups, respectively. Reflex micturition was suppressed with FFM. Bupivacaine led to overflow incontinence in all cases. Sphincter injury caused fibrotic changes and a significant increase in LPP (26.4 ± 2.3 before vs. 46.9 ± 4.6 mmHg after injury, p < 0.05). Conclusions KX anesthesia preserves bladder contractions. Intrathecal bupivacaine eliminates reflex micturition, allowing for repeated LPP measurements in the same animal. Resection of striated sphincter resulted in increased LPP 6 weeks post injury. The site of urethral sphincter resection healed with fibrosis.

Delayed Anastomotic Urethroplasty in Children and Adolescence with Pelvic Fracture Urethral Injury (PFUI): Experiences in Two Centers of Reconstructive Urethral Surgery in Indonesia

Introduction: Incidence of pediatric pelvic fracture urethral injury (PFUI) is rare. This study reviews the experience of anastomotic urethroplasty surgery in children and adolescence PFUI in the last 3 years in two center of reconstructive urethral surgery in Indonesia. Method: This study retrospectively reviewed PFUI cases in Hasan Sadikin Hospital and Saiful Anwar Hospital from 2013-2016. The data cases were analysed base on aetiology of the trauma, urethral gap, and previous operations. The operation time and intra operative additional procedure to achieve tension free anastomotic was also noted. Result: A total 31 children and adolescence patients with PFUI were recorded in two institutions. Twenty patients were in Hasan Sadikin Hospital while 11 patients were in Saiful Anwar Hospital. The trauma mechanisms for PFUI were 28 (90.3%) cases due to motorcycle accidents and 3 (9.7%) cases due to high falls accidents. All patients underwent delayed urethral reconstruction in median 6 months (3-72). The median operation time was 150±101 minutes for children and 160±50.5 minutes for adolescence. The average length of the urethral gap in children cases was 2.8±1.2 cm, meanwhile 4±1.9 cm for adolescence cases. In order to achieve the tension free of anastomotic urethroplasty, 5 (16.1%) of PFUI patients underwent crural separation, 16 (51.6%) patients underwent inferior pubectomy and 3 (9.7%) patients for supracrural re-routing. Posterior pubectomy with omental wrap via transpubic approach was performed in one patient. The success rate for children cases was 83.3% and 88% for adolescence cases. Thus, the overall success rate after anastomotic urethroplasty for pediatric PFUI was 83.9%. Conclusions: In short-term follow up, delayed repair urethral reconstructive surgery by transperineal and transpubic anastomotic urethroplasty in children and adolescence with PFUI achieved a significant good result and showed promising outcome.

Catheterisation-related urethral injury in a patient with chronic liver disease: a diagnostic dilemma

Catheterisation-related urethral injury in a patient with chronic liver disease: a diagnostic dilemma

Evaluation of T2-Weighted MRI for Visualization and Sparing of Urethra with MR-Guided Radiation Therapy (MRgRT) On-Board MRI.

Simple SummaryStereotactic body radiation therapy (SBRT) has become a standard of care option for prostate cancer patients, utilizing large fractionated dose to shorten treatment times. However, genitourinary (GU) toxicity associated with urethral injury remains prevalent due to non-trivial urethra delineation and sparing at treatment planning and treatment delivery. The aim of our study was to evaluate two optimized urethral MRI sequences (3D HASTE and 3D TSE) with a 0.35T MR-guided radiotherapy (MRgRT) system for urethral visibility and delineation. Among 11 prostate cancer patients, a radiation oncologist qualitatively scored MRgRT 3D HASTE as having the best urethra visibility, superior to CT, clinical MRgRT 3D bSSFP, MRgRT 3D TSE, and similar to diagnostic 3T (2D/3D) T2-weighetd MRI. Moreover, urethra contours from different imaging and clinical workflows demonstrated significant urethra localization variability. Optimized 3D MRgRT HASTE can provide urethral visualization and delineation within an MRgRT workflow for urethral sparing, avoiding cross-modality/system registration errors.Purpose: To evaluate urethral contours from two optimized urethral MRI sequences with an MR-guided radiotherapy system (MRgRT). Methods: Eleven prostate cancer patients were scanned on a MRgRT system using optimized urethral 3D HASTE and 3D TSE. A resident radiation oncologist contoured the prostatic urethra on the patients’ planning CT, diagnostic 3T T2w MRI, and both urethral MRIs. An attending radiation oncologist reviewed/edited the resident’s contours and additionally contoured the prostatic urethra on the clinical planning MRgRT MRI (bSSFP). For each image, the resident radiation oncologist, attending radiation oncologist, and a senior medical physicist qualitatively scored the prostatic urethra visibility. Using MRgRT 3D HASTE-based contouring workflow as baseline, prostatic urethra contours drawn on CT, diagnostic MRI, clinical bSSFP and 3D TSE were evaluated relative to the contour on 3D HASTE using 95th percentile Hausdorff distance (HD95), mean-distance-to-agreement (MDA), and DICE coefficient. Additionally, prostatic urethra contrast-to-noise-ratios (CNR) were calculated for all images. Results: For two out of three observers, the urethra visibility score for 3D HASTE was significantly higher than CT, and clinical bSSFP, but was not significantly different from diagnostic MRI. The mean HD95/MDA/DICE values were 11.35 ± 3.55 mm/5.77 ± 2.69 mm/0.07 ± 0.08 for CT, 7.62 ± 2.75 mm/3.83 ± 1.47 mm/0.12 ± 0.10 for CT + diagnostic MRI, 5.49 ± 2.32 mm/2.18 ± 1.19 mm/0.35 ± 0.19 for 3D TSE, and 6.34 ± 2.89 mm/2.65 ± 1.31 mm/0.21 ± 0.12 for clinical bSSFP. The CNR for 3D HASTE was significantly higher than CT, diagnostic MRI, and clinical bSSFP, but was not significantly different from 3D TSE. Conclusion: The urethra’s visibility scores showed optimized urethral MRgRT 3D HASTE was superior to the other tested methodologies. The prostatic urethra contours demonstrated significant variability from different imaging and workflows. Urethra contouring uncertainty introduced by cross-modality registration and sub-optimal imaging contrast may lead to significant treatment degradation when urethral sparing is implemented to minimize genitourinary toxicity.

Redo pelvic fracture urethral injury repair: The case for tadalafil.

To define the role of tadalafil in improving outcomes of redo urethroplasty for pelvic fracture urethral injury (PFUI). PFUI is common in developing countries, invariably as a result of road traffic trauma. Repair is complex, and redo cases are even more challenging. This was a longitudinal prospective nonrandomized study between 2017 and 2019. Men undergoing redo-urethroplasty were nonrandomized into two groups. Group 1 received tadalafil 5 mg the next day after surgery and continued for 3 months, and group 2 did not receive tadalafil. Inclusion criteria were patients undergoing redo-urethroplasty willing to trial low-dose tadalafil post-operatively. Exclusion criteria were <18 years, females, primary cases, and complex cases such as recto-urethral fistula. Average follow-up was 19.5 months. Sixty patients were enrolled (29 in group 1 and 31 in group 2). Mean age was 31 years. These patients had 1-3 prior failed urethroplasties. Most required step 3 anastomotic urethroplasty (68.3%). Success was defined as absence of symptoms and no need for surgical intervention. Failure was defined as redo urethroplasty or >1 endoscopic intervention. Primary success was 83.3%. Success with tadalafil was 96.6%, compared to 71.0% in the non-Tadalafil group (P ¼ .0008). Only one patient on tadalafil failed, compared with nine in the non-tadalafil group. Secondary success rate was defined as the need for a single subsequent endoscopic intervention and was 93.3%. In our series, there was improved outcome with using tadalafil in patients having redo urethroplasty for PFUI. Further trials should be done to evaluate the use in all PFUI cases.