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Urethral reconstruction

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https://www.readbyqxmd.com/read/29332261/is-the-laser-mightier-than-the-sword-a-comparative-study-for-the-urethrotomy
#1
Coen Holzhauer, Anita W T M Roelofs, Arjen C Kums, Philip C Weijerman, Michael R van Balken
PURPOSE: The knife is the most common used instrument for endoscopic urethrotomy. Unfortunately, there are high recurrence rates; it is thought that a laser reduces those rates. We compared the two techniques in this retrospective study. MATERIALS AND METHODS: Between 2010 and 2014, 127 patients were operated on with the knife (KG) and for 65 patients, the laser (LG) was used. We scored the complexity of the stricture using the UREThRAL stricture score (USS) and we scored if a treatment was successful...
January 13, 2018: World Journal of Urology
https://www.readbyqxmd.com/read/29310634/artificial-urinary-sphincter-implantation-an-important-component-of-complex-surgery-for-urinary-tract-reconstruction-in-patients-with-refractory-urinary-incontinence
#2
Fan Zhang, Limin Liao
BACKGROUND: We review our outcomes and experience of artificial urinary sphincter implantation for patients with refractory urinary incontinence from different causes. METHODS: Between April 2002 and May 2017, a total of 32 patients (median age, 40.8 years) with urinary incontinence had undergone artificial urinary sphincter placement during urinary tract reconstruction. Eighteen patients (56.3%) were urethral injuries associated urinary incontinence, 9 (28.1%) had neurogenic urinary incontinence and 5 (15...
January 8, 2018: BMC Urology
https://www.readbyqxmd.com/read/29300208/review-of-optimal-techniques-for-robotic-assisted-radical-prostatectomy
#3
Khushabu Kasabwala, Neal A Patel, Jim C Hu
PURPOSE OF REVIEW: Robotic-assisted radical prostatectomy has been rapidly adopted and is now the standard of care in the surgical management of prostate cancer. Since the initial description in 2001, the technique has evolved to optimize oncological functional outcomes. Herein, we review key techniques for the robotic-assisted radical prostatectomy. RECENT FINDINGS: With the current influx of new technology such as focal therapy, stereotactic body radiation therapy and prostate-sparing treatments, there is greater emphasis on maximizing outcomes of robotic-assisted radical prostatectomy...
January 2, 2018: Current Opinion in Urology
https://www.readbyqxmd.com/read/29239812/dosimetric-impact-of-inter-observer-catheter-reconstruction-variability-in-ultrasound-based-high-dose-rate-prostate-brachytherapy
#4
Alexandru Nicolae, Jure Murgic, Ivan Kruljac, Lior Dubnitzky, Laura D'Alimonte, Lin Lu, Aaron Cumal, Niki Law, Gerard Morton, Andrew Loblaw, Hans T Chung, Ananth Ravi
PURPOSE: To investigate the dosimetric impact of interobserver catheter reconstruction variability in transrectal ultrasound-guided prostate high-dose-rate (HDR) brachytherapy. METHODS AND MATERIALS: Twenty consecutive patients with intermediate- or high-risk prostate cancer were treated with a single, 15-Gy HDR brachytherapy boost as part of this study. The treated plan was used as the study reference plan (PR). Three expert treatment planners (observers) manually reconstructed the catheter paths on the static three-dimensional transrectal ultrasound images, and new plans were generated from the updated positions (POBS); subsequently, the dwell time and positions from the POBS plans were superimposed on the PR catheter paths to evaluate the dosimetric effect of the interobserver variations (PEVAL)...
November 24, 2017: Brachytherapy
https://www.readbyqxmd.com/read/29230940/the-effects-of-recreational-ketamine-cystitis-on-urinary-tract-reconstruction-a-surgical-challenge
#5
Néha Sihra, Jeremy Ockrim, Dan Wood
OBJECTIVES: To identify the rate of post-operative complications in patients who require surgical reconstruction for ketamine-induced urinary tract dysfunction and to identify any predictors for poor post-operative outcome with subsequent management strategies. MATERIALS AND METHODS: A retrospective review of data collected between 2007 and 2017 was performed. Evaluation included CT urogram, cystoscopy and biopsy. Indications and outcomes for surgical intervention were assessed...
December 12, 2017: BJU International
https://www.readbyqxmd.com/read/29221931/urethral-rest-with-suprapubic-cystostomy-in-obliterative-or-nearly-obliterative-urethral-strictures-urethrographic-changes-and-implications-for-management
#6
T Moncrief, R A Gor, R A Goldfarb, S Jarosek, S P Elliott
OBJECTIVE: Precise pre-operative urethral stricture characterization is important for surgical planning. A period of urethral rest by suprapubic cystostomy tube may aid in stricture characterization and may affect the surgical approach. We compare the radiographic characterization of anterior urethral strictures by fellowship-trained reconstructive urologists before and after a period of urethral rest. We then determine how this changed the planned operative approach. METHODS: We queried our prospectively maintained urethroplasty database at the University of Minnesota for men with anterior urethral stricture who had retrograde urethrogram (RUG) and voiding cystourethrogram (VCUG) both before and after pre-operative suprapubic cystostomy tube (SPC) placement (n=29)...
December 5, 2017: Journal of Urology
https://www.readbyqxmd.com/read/29201525/complete-penile-skin-necrosis
#7
Abdulkadir Pektaş, Ali Özgür Karakaş, Ali Çift, Mehmet Özgür Yücel
Superficial penile skin infections may be presented in different clinical situations that vary from simple infection to organ loss and serious morbidity and mortality. Antibiotic treatment and, if necessary, urgent debridement is required. A 46-year-old male patient with the complaints of urethral discharge and pain admitted to our outpatient clinic. He declared that there were midpenil tenderness and erythema 14 days ago which occurred after sexual intercourse. Complete penile skin necrosis with purulent discharge was detected in physical examination...
December 2017: Turkish Journal of Urology
https://www.readbyqxmd.com/read/29199971/collagen-scaffolds-tethered-with-bfgf-promote-corpus-spongiosum-regeneration-in-a-beagle-model
#8
He Tang, Weisheng Jia, Xianglin Hou, Yannan Zhao, Yong Huan, Wei Chen, Wei Yu, Ou Zhu Mi Ma, Gang Ye, Bing Chen, Jianwu Dai
Regeneration of the corpus spongiosum helps prevent complications following urethral reconstruction, but currently there is a lack of effective therapeutic methods in clinic. In previous studies, we fabricated a fusion protein CBD-bFGF that specifically binds to and releases from collagen biomaterials. We demonstrated that CBD-bFGF could promote angiogenesis and tissue regeneration in vivo. In this study, we established a beagle model with extensive urethral defects, and reconstructed the defects with collagen biomaterials that were unmodified or modified with CBD-bFGF...
December 4, 2017: Biomedical Materials
https://www.readbyqxmd.com/read/29198998/surgical-approaches-and-long-term-outcomes-in-adults-with-complex-re-operative-hypospadias-repair
#9
Christopher D Morrison, Davide P Cinà, Christopher M Gonzalez, Matthias D Hofer
PURPOSE: Patients with failed hypospadias repair are a challenging population for both pediatric and reconstructive urologists. In this study, we describe our long-term outcomes and factors associated with complications in repeat hypospadias repairs. MATERIAL AND METHODS: A retrospective review of 32 adult patients with a history of hypospadias repair who required subsequent urethroplasty between 2002 and 2012 was performed. Presenting complaint, past medical and surgical history, demographic data, surgical approach, intraoperative findings, and complications were collected and analyzed...
November 30, 2017: Journal of Urology
https://www.readbyqxmd.com/read/29175024/y-type-urethral-duplication-with-rectal-implantation-of-the-urethra-which-is-the-best-approach
#10
Antonio Macedo, Sérgio Leite Ottoni, Marcela Leal da Cruz, Jorge Antonio Pompermaier, Maria Isabel S Silva, Riberto Liguori, Gilmar Garrone
INTRODUCTION: Y-type urethral duplication describes the condition in which a functional urethra is implanted in the rectum, and there is also a dysplastic topic urethra which produces mostly urinary dribbling. These patients are at risk of urinary tract complications and UTI. We aimed to present the surgical steps of a case treated by ASTRA approach in which we separated the urethra from the rectum and created a perineal urethrostomy. MATERIAL AND METHODS: We treated a 5-month-old boy with Y-type (IIA-2) urethral duplication, in whom the orthotopic urethra was patent just in the penile segment...
November 10, 2017: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/29158171/pubo-urethral-stump-angle-measured-on-preoperative-mri-predicts-urethroplasty-type-for-pelvic-fracture-urethral-injury-repair
#11
Akio Horiguchi, Hiromi Edo, Shigeyoshi Soga, Masayuki Shinchi, Ayako Masunaga, Keiichi Ito, Tomohiko Asano, Hiroshi Shinmoto, Ryuichi Azuma
OBJECTIVES: To examine whether the type of delayed urethroplasty required for pelvic fracture urethral injury (PFUI), which is not easily predicted from conventional urethrography findings, can be predicted from preoperative magnetic resonance imaging (MRI) results. PATIENTS AND METHODS: Records of 74 male patients with PFUI who underwent MRI of the pelvis at least 3 months after injury and, subsequently, delayed anastomotic urethroplasty were retrospectively analyzed...
November 17, 2017: Urology
https://www.readbyqxmd.com/read/29135409/double-inlay-plus-ventral-onlay-buccal-mucosa-graft-for-simultaneous-penile-and-bulbar-urethral-stricture
#12
Luciano A Favorito, Paulo P Conte, Ulisses G Sobrinho, Rodrigo G Martins, Tomas Accioly
OBJECTIVES: Buccal mucosa grafts and fascio-cutaneous flaps are frequently used in long anterior urethral strictures (1). The inlay and onlay buccal mucosa grafts are easier to perform, do not need urethral mobilization and generally have good long-term results (2-4). In the present video, we present a case where we used a double buccal mucosa graft technique in a simultaneous penile and bulbar urethral stricture. MATERIALS AND METHODS: A 54 year-old male patient was submitted to appendectomy where a urethral catheter was used for two days in May 2015...
November 17, 2017: International Braz J Urol: Official Journal of the Brazilian Society of Urology
https://www.readbyqxmd.com/read/29132797/cloaca-reconstruction-a-new-algorithm-which-considers-the-role-of-urethral-length-in-determining-surgical-planning
#13
Richard J Wood, Carlos A Reck-Burneo, Daniel Dajusta, Christina Ching, Rama Jayanthi, D Gregory Bates, Molly E Fuchs, Katherine McCracken, Geri Hewitt, Marc A Levitt
BACKGROUND: Cloacal malformations represent a uniquely complex challenge for surgeons. The surgical approach to date has been based on the common channel (CC) length with two patient groups considered: less than or greater than 3cm, which we believe is an oversimplification. We reviewed 19 patients, referred after surgery done elsewhere. Eight had postoperative urinary complications, 3 had constant urinary leakage and had been left after surgery with a urethra <1cm, .5 with an original 3 to 5cm common channel, who had undergone total urogenital mobilization (TUM), experienced peri-operative urethral loss needing a vesicostomy, and later, a Mitrofanoff...
October 12, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29118550/-horrendoplasty-a-case-of-total-perineal-destruction-by-agricultural-implement
#14
Pedro Simoes de Oliveira, Tiago Ribeiro de Oliveira, David Martinho, Francisco Martins
Although posterior urethral injury occurs almost always in association with pelvic fracture, it may result from severe trauma to the perineum with its associated potential lethality and severe morbidity. Early primary endoscopic realignment over a urethral catheter can be attempted, although an immediate suprapubic tube placement remains the standard of care. Definitive treatment consists of elective open posterior anastomotic urethroplasty through a perineal approach. The authors present a 53-year-old man who sustained total, massive perineal destruction resulting from work accident with an agricultural implement...
October 2017: Urology Annals
https://www.readbyqxmd.com/read/29108977/sexual-dysfunction-in-urethral-reconstruction-a-review-of-the-literature
#15
REVIEW
Cooper R Benson, Ly Hoang, Jonathan Clavell-Hernández, Run Wang
INTRODUCTION: Urethral stricture disease accounts for 5,000 hospitalizations and 1.5 million office visits per year. Urethral reconstruction has become more commonplace with the recognition of the poor long-term success of the endoscopic management of stricture disease. Sexual dysfunction related to the surgical management of urethral strictures is an under-recognized sequela. AIM: To characterize and elucidate the various factors that contribute to sexual dysfunction after urethroplasty and hypospadias reconstruction to improve surgical decision making and patient counseling...
November 3, 2017: Sexual Medicine Reviews
https://www.readbyqxmd.com/read/29107132/staged-urethroplasty-for-penile-urethral-strictures-from-lichen-sclerosus-and-failed-hypospadias-repair
#16
Bradley D Figler, Andrew Gomella, Logan Hubbard
OBJECTIVE: To present our technique for staged urethroplasty with buccal mucosa graft. METHODS: The patient presented is a 42 year-old male with a history of congenital hypospadias repaired as a child. He developed a penile urethral stricture at age 30 and was managed with self intermittent dilation. Recently, dilation became more difficult, and he was referred for reconstruction. Work-up revealed a high-grade stricture extending from the meatus to the site of the previous anastomosis at the penoscrotal junction...
October 26, 2017: Urology
https://www.readbyqxmd.com/read/29104795/the-use-of-amplatz-renal-dilators-in-the-minimally-invasive-management-of-complex-urethral-strictures
#17
Michael Nomikos, Sarantis Papanikolaou, George Athanasopoulos, Athanasios Papatsoris
Introduction: To present the outcomes of using Amplatz renal dilators in the management of complex urethral strictures. Material and methods: From September 2011 to August 2015, 34 patients with complex urethral strictures were treated with Amplatz renal dilators assisted with internal urethrotomy. Evaluation included uroflowmetry, IPSS and post-void residual volume measurement. Under spinal anesthesia, sequential dilatations were performed with Amplatz renal dilators measuring from 8 Fr up to 24 Fr...
2017: Central European Journal of Urology
https://www.readbyqxmd.com/read/29064654/an-unusual-presentation-of-urethral-duplication-presenting-with-chronic-bladder-retention-left-scrotal-transposition-and-left-renal-agenesis
#18
Antonio Macedo, Marcela Leal da Cruz, João Luiz Gomes Parizi, Gustavo Marconi Caetano Martins, Riberto Liguori, Sérgio Leite Ottoni, Bruno Leslie, Gilmar Garrone
INTRODUCTION AND OBJECTIVE: Urethral duplication is a rare congenital anomaly, with roughly 200 cases reported in the literature (1). It is more frequent in males, with few cases reported in females. The clinical presentation differs according to the anatomical variant present. The duplication most commonly occurs in the sagittal plane with one urethra located ventrally and the other dorsally (2). Usually the ventral urethra is the more functional of both. Duplications occurring in the coronal plane are quite rare and they are usually associated with bladder duplication (3)...
October 24, 2017: International Braz J Urol: Official Journal of the Brazilian Society of Urology
https://www.readbyqxmd.com/read/29061068/three-layer-two-step-posterior-reconstruction-using-peritoneum-during-robot-assisted-radical-prostatectomy-to-improve-recovery-of-urinary-continence-prospective-comparative-study
#19
Souichiro Ogawa, Seiji Hoshi, Tomoyuki Koguchi, Junya Hata, Yuichi Sato, Hidenori Akaihata, Masao Kataoka, Nobuhiro Haga, Yoshiyuki Kojima
INTRODUCTION: We present our experience with a novel 3-layer 2-step posterior reconstruction (PR) technique using peritoneum during robot-assisted radical prostatectomy (RARP) to improve recovery of postoperative urinary continence. METHODS: Forty-eight patients with localized prostate cancer were enrolled in this study and were divided randomly into 2 groups, which were treated by the standard PR technique (standard PR group; n=24) or the 3-layer PR technique using peritoneum (3-layer PR group; n=24) during RARP...
October 23, 2017: Journal of Endourology
https://www.readbyqxmd.com/read/29031840/urethral-reconstruction-in-aging-male-patients
#20
Boyd R Viers, Travis J Pagliara, Charles A Rew, Lauren Folgosa-Cooley, Christine Y Shiang, Jeremy M Scott, Allen F Morey
OBJECTIVE: To report stricture characteristics, complications, and treatment outcomes among elderly men undergoing urethral reconstruction. MATERIALS AND METHODS: Retrospective review of urethroplasty cases and outcomes by a single surgeon from 2007-2014 was performed. Men were stratified by decade of life at time of surgery (<50, 50-59, 60-69, ≥70 years). Individuals with a history of hypospadias were excluded. RESULTS: Among 514 urethroplasty procedures, 184 (36%) were ≥60 years...
October 11, 2017: Urology
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