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Nikolavsky D. Imagining the future: the five "Laws" of endourethroplasty. Int Urol Nephrol 2025:10.1007/s11255-025-04582-3. [PMID: 40448878 DOI: 10.1007/s11255-025-04582-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2025] [Accepted: 05/22/2025] [Indexed: 06/02/2025]
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Lee M, Lesgart M, McPartland C, Lee R, Eun DD. Robotic Transvesical Bladder Neck Reconstruction: A Novel Approach to Managing Vesicourethral Anastomotic Stenosis. Eur Urol 2025:S0302-2838(25)00279-9. [PMID: 40393860 DOI: 10.1016/j.eururo.2025.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2025] [Revised: 03/20/2025] [Accepted: 04/29/2025] [Indexed: 05/22/2025]
Abstract
BACKGROUND AND OBJECTIVE Our aim was to investigate outcomes of a novel robotic transvesical approach for bladder neck reconstruction in the surgical management of vesicourethral anastomotic stenosis (VUAS). METHODS We performed a retrospective review of our single-institution database of robotic bladder neck reconstruction procedures to identify all consecutive patients who underwent robotic transvesical bladder neck reconstruction (RTV-BNR) for definitive management of VUAS between 2021 and 2024. The surgical technique involves circumferential excision of fibrotic scar tissue and creation of a mucosa-to-mucosa, watertight, tension-free anastomosis between the bladder neck mucosa and posterior urethra via a posterior transvesical approach. The primary outcome was surgical success, defined as patients who did not require any additional surgical reintervention for recurrent stenosis after the initial procedure. Secondary outcomes included de novo stress urinary incontinence (SUI) and major (Clavien grade >2) postoperative complications. KEY FINDINGS AND LIMITATIONS Eleven patients met the inclusion criteria. Two patients (18%) had a history of salvage radiotherapy before RTV-BNR. All strictures were <2 cm in length. The median operative time was 189 min (interquartile range [IQR] 122-248) and median estimated blood loss was 100 ml (IQR 50-100). None of the patients developed de novo SUI. At median follow-up of 22 mo (IQR 14-30), the surgery was successful in ten patients (91%). Major limitations of the study are its retrospective nature, small sample size, and lack of a direct comparison to outcomes with established techniques for VUAS management. CONCLUSIONS AND CLINICAL IMPLICATIONS RTV-BNR is an innovative technique that may offer a safe and effective approach for VUAS management.
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Affiliation(s)
- Matthew Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
| | - Michael Lesgart
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Connor McPartland
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Randall Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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Basiri A, Rabani S, Omrani M. The efficacy of star-like mapping incision on vesicourethral anastomotic stenosis after radical prostatectomy and cystectomy. World J Urol 2025; 43:217. [PMID: 40195171 DOI: 10.1007/s00345-025-05607-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Accepted: 03/28/2025] [Indexed: 04/09/2025] Open
Abstract
PURPOSE To assess the efficacy of star-like internal urethrotomy on vesicourethral anastomotic stenosis (VUAS) and its impact on voiding and continence outcomes. METHODS This observational study was conducted in two tertiary referral hospitals. 31 patients confirmed with VUAS after radical prostatectomy or cystectomy were included. A novel Star-like Incision Urethrotomy procedure focused on a shallow incision on scar tissue all around the anastomotic site was performed. The primary outcome was the procedure's impact on urinary voiding and continence, assessed using the International Prostate Symptom Score (IPSS) and the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). RESULTS Participants had a mean age of 68.32 years, 27 (87%) with a history of radical prostatectomy and 4 (13%) with a history of radical cystectomy, who presented to our clinic with urinary obstructive symptoms. We performed Star-like incision on the anastomotic site using a ureteral catheter as a guide. During patient follow-up, significant improvements were observed in urinary flow and continence. At one month postoperatively, the mean IPSS score decreased from 26.58 to 13.39, and the ICIQ-SF score initially increased from 4.48 to 6.87 at first and then reduced to about 4. These improvements were sustained throughout the six regular follow-ups, with an IPSS score of 12.8 and an ICIQ-SF score of 3.6. Besides these improvements, 5 (16%) patients required repeated urethrotomy due to recurrence of stenosis. CONCLUSION Endoscopic treatment with Star-like incision for VUAS has promising outcomes compared to other endoscopic treatments.
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Affiliation(s)
- Abbas Basiri
- Urology and Nephrology Research Center (UNRC), Research Institute for Urology and Nephrology (UNRI), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran, Tehran, Iran.
| | - Seyedhossein Rabani
- Urology and Nephrology Research Center (UNRC), Research Institute for Urology and Nephrology (UNRI), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran, Tehran, Iran
| | - Mohammadamin Omrani
- Urology and Nephrology Research Center (UNRC), Research Institute for Urology and Nephrology (UNRI), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran, Tehran, Iran
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Rinderknecht E, Engelmann SU, Saberi V, Haas M, Kälble S, Eckl C, Hartmann V, Goßler C, Pickl C, Denzinger S, Burger M, Bründl J, Mayr R. Robotic reconstruction of complex bladder neck stenosis: Single-centre experience with three techniques. BJUI COMPASS 2025; 6:e501. [PMID: 39991632 PMCID: PMC11845854 DOI: 10.1002/bco2.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 01/04/2025] [Accepted: 01/19/2025] [Indexed: 02/25/2025] Open
Abstract
Objectives To evaluate and compare surgical techniques for robot-assisted reconstruction of recurrent bladder neck stenosis (BNS). BNS following a simple prostatectomy represents a rare but challenging condition in operative urology. Various robotic reconstructive techniques have been described, showing differing success rates. This monocentric case series reports on three distinct robotic surgical approaches for managing recurrent BNS. Patients and methods A retrospective analysis was conducted on patients undergoing robot-assisted surgical repair for recurrent BNS at our institution. Clinical data, including patient history, comorbidities (Charlson Comorbidity Index), surgical treatment, complications (Clavien-Dindo classification) and follow-up outcomes, were analysed. Results A total of 27 patients underwent robotic bladder neck reconstruction for recurrent BNS. Twelve patients were treated with YV plasty, 12 with stricture resection and end-to-end anastomosis and 3 with reconstruction using a buccal mucosa graft (BMG). At a median follow-up of 18 months, therapy failure occurred in 9 patients (33.3%), with failure rates of 25.0% for YV plasty, 33.3% for stricture resection and 66.7% for BMG plasty. Nine patients (33.3%) experienced surgery-related complications, including 7 minor complications (5 in the stricture resection group, 1 in the YV plasty group and 1 in the BMG group) and 2 major complications (1 in the stricture resection group and 1 in the YV plasty group). De novo incontinence occurred in five patients (19.2%), all of whom had undergone stricture resection with end-to-end anastomosis. Conclusions Recurrent BNS poses a significant surgical challenge. Based on our experience, BMG reconstruction demonstrated suboptimal outcomes, while stricture resection was associated with the highest complication rate and the most frequent occurrence of de novo incontinence. YV plasty, with its relatively low morbidity and minimally invasive nature, has become the preferred technique in our institution for managing this condition. Prospective studies with larger cohorts are warranted to confirm these findings and further refine surgical approaches.
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Affiliation(s)
- Emily Rinderknecht
- Department of Urology, St. Josef Medical CenterUniversity of RegensburgRegensburgGermany
| | - Simon Udo Engelmann
- Department of Urology, St. Josef Medical CenterUniversity of RegensburgRegensburgGermany
| | - Veronika Saberi
- Department of Urology, St. Josef Medical CenterUniversity of RegensburgRegensburgGermany
| | - Maximilian Haas
- Department of Urology, St. Josef Medical CenterUniversity of RegensburgRegensburgGermany
| | - Sebastian Kälble
- Department of Urology, St. Josef Medical CenterUniversity of RegensburgRegensburgGermany
| | - Christoph Eckl
- Department of Urology, St. Josef Medical CenterUniversity of RegensburgRegensburgGermany
| | - Valerie Hartmann
- Department of Urology, St. Josef Medical CenterUniversity of RegensburgRegensburgGermany
| | - Christopher Goßler
- Department of Urology, St. Josef Medical CenterUniversity of RegensburgRegensburgGermany
| | - Christoph Pickl
- Department of Urology, St. Josef Medical CenterUniversity of RegensburgRegensburgGermany
| | - Stefan Denzinger
- Department of Urology, St. Josef Medical CenterUniversity of RegensburgRegensburgGermany
| | - Maximilian Burger
- Department of Urology, St. Josef Medical CenterUniversity of RegensburgRegensburgGermany
| | - Johannes Bründl
- Department of Urology, St. Josef Medical CenterUniversity of RegensburgRegensburgGermany
| | - Roman Mayr
- Department of Urology, St. Josef Medical CenterUniversity of RegensburgRegensburgGermany
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Nose B, Peterson AC. Editorial Comment on "Substitution Urethroplasty With Buccal Mucosal Graft in the Management of Stricture of Vesicourethral Anastomosis or Membranous Urethra: Single-institution Long-term Experience With Perineal Approach and Endourethroplasty". Urology 2024; 192:133-134. [PMID: 38942392 DOI: 10.1016/j.urology.2024.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
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Doležel J, Hrabec R, Staník M. Reply to Editorial Comment on "Substitution Urethroplasty With Buccal Mucosal Graft in the Management of Stricture of Vesicourethral Anastomosis or Membranous Urethra: Single-institution Long-term Experience With Perineal Approach and Endourethroplasty". Urology 2024; 192:134-135. [PMID: 39038722 DOI: 10.1016/j.urology.2024.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 07/13/2024] [Indexed: 07/24/2024]
Affiliation(s)
- Jan Doležel
- Department of Urologic Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Roman Hrabec
- Department of Urologic Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Staník
- Department of Urologic Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Martins FE, Lumen N, Holm HV. Management of the Devastated Bladder Outlet after Prostate CANCER Treatment. Curr Urol Rep 2024; 25:149-162. [PMID: 38750347 DOI: 10.1007/s11934-024-01206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE OF REVIEW Devastating complications of the bladder outlet resulting from prostate cancer treatments are relatively uncommon. However, the combination of the high incidence of prostate cancer and patient longevity after treatment have raised awareness of adverse outcomes deteriorating patients' quality of life. This narrative review discusses the diagnostic work-up and management options for bladder outlet obstruction resulting from prostate cancer treatments, including those that require urinary diversion. RECENT FINDINGS The devastated bladder outlet can be a consequence of the treatment of benign conditions, but more frequently from complications of pelvic cancer treatments. Regardless of etiology, the initial treatment ladder involves endoluminal options such as dilation and direct vision internal urethrotomy, with or without intralesional injection of anti-fibrotic agents. If these conservative strategies fail, surgical reconstruction should be considered. Although surgical reconstruction provides the best prospect of durable success, reconstructive procedures are also associated with serious complications. In the worst circumstances, such as prior radiotherapy, failed reconstruction, devastated bladder outlet with end-stage bladders, or patient's severe comorbidities, reconstruction may neither be realistic nor justified. Urinary diversion with or without cystectomy may be the best option for these patients. Thorough patient counseling before treatment selection is of utmost importance. Outcomes and repercussions on quality of life vary extensively with management options. Meticulous preoperative diagnostic evaluation is paramount in selecting the right treatment strategy for each individual patient. The risk of bladder outlet obstruction, and its severest form, devastated bladder outlet, after treatment of prostate cancer is not negligible, especially following radiation. Management includes endoluminal treatment, open or robot-assisted laparoscopic reconstruction, and urinary diversion in the worst circumstances, with varying success rates.
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Affiliation(s)
- Francisco E Martins
- Department of Urology, University of Lisbon, School of Medicine, Centro Hospitalar Universitário, Lisboa Norte (CHULN), Lisbon, Portugal
| | - Nicolaas Lumen
- Department of Urology, Ghent University Hospital, 9000, Ghent, Belgium
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Uguzova S, Beisland C, Honoré A, Juliebø-Jones P. Refractory Bladder Neck Contracture (BNC) After Radical Prostatectomy: Prevalence, Impact and Management Challenges. Res Rep Urol 2023; 15:495-507. [PMID: 37954870 PMCID: PMC10638897 DOI: 10.2147/rru.s350777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023] Open
Abstract
Bladder neck contracture is a recognised complication associated with radical prostatectomy. The management can be challenging, especially when refractory to initial intervention strategies. For the patient, the burden of disease is high and continence status cannot be overlooked. This review serves to provide an overview of the management of this recognised clinical pathology. Consideration needs to be given to minimally invasive approaches such as endoscopic incision, injectables, implantable devices as well as major reconstructive surgery where the condition persists. For the latter, this can involve open and robotic surgery as well as use of grafts and artificial sphincter surgery. These elements underline the need for a tailored and a patient centred approach.
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Affiliation(s)
- Sabine Uguzova
- Department of Urology, Stepping Hill Hospital, Manchester, UK
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Alfred Honoré
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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9
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Elliott S. Editorial Comment. Urology 2023; 181:e201-e202. [PMID: 37679261 DOI: 10.1016/j.urology.2023.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
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Ungerer G, Kemble J, Sischka M, Balzano FL, Warner JN. Endoscopic Urethroplasty Using Buccal Graft for Male Membranous Urethral Stricture. Urology 2023; 181:e200-e203. [PMID: 37532087 DOI: 10.1016/j.urology.2023.05.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE To demonstrate a new minimally invasive endoscopic approach to urethroplasty. METHODS The procedure was performed in a male patient with prior history of prostate cancer managed by radiation who subsequently developed an 8 mm flow-limiting membranous urethral stricture. After stricture dilation a 1 cm wide strip of superficial mucosa was resected from the bladder neck past the area of stricture, creating a bed for the graft to lay. Buccal mucosa graft was harvested in standard fashion. With the graft outside the urethra and using the RD 180 endoscopic suturing device, a suture is placed in the proximal end of the graft, then through the bladder neck, and back through the graft. As the suture is pulled, the pulley phenomenon advances the graft into place on the bladder neck. The graft is then anchored to the posterior urethra with secure straps. A catheter is placed to hold the graft flat during the healing process. RESULTS The procedure lasted 2.5 hours without any complications. Estimated blood loss was 50cc, and the patient was discharged after the procedure. Catheter was removed at 4weeks. Cystoscopy at 10weeks post-op showed good graft viability, with peak flow improving to 20 mL/s compared to 4 mL/s preoperatively. At 6months, he continues to do well without evidence of recurrent urethral stricture. CONCLUSION Endoscopic urethroplasty using buccal graft appears to offer a safe and effective repair option for management of ureteral strictures.
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Kunkel G, Patel H, Kaldany A, Allu S, Elsamra S, Cancian M. Pelvic radiation-induced urinary strictures: etiology and management of a challenging disease. World J Urol 2023; 41:1459-1468. [PMID: 37014391 DOI: 10.1007/s00345-023-04378-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/16/2023] [Indexed: 04/05/2023] Open
Abstract
Radiation is a common treatment modality for pelvic malignancies. While it can be effective at cancer control, downstream effects can manifest months to years after treatment, leaving patients with significant morbidity. Within urology, a particularly difficult post-radiation consequence is urinary tract stricture, either of the urethra, bladder neck, or ureter. In this review, we will discuss the mechanism of radiation damage and treatment options for these potentially devastating urinary sequelae.
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Affiliation(s)
- Gregory Kunkel
- Department of Urology, UMass Chan: University of Massachusetts Medical School, Worcester, MA, USA.
| | - Hiren Patel
- Division of Urology, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Alain Kaldany
- Division of Urology, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sai Allu
- Division of Urology, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Sammy Elsamra
- Division of Urology, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Madeline Cancian
- Division of Urology, Brown University Warren Alpert Medical School, Providence, RI, USA
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Mathieu R, Doizi S, Bensalah K, Lebacle C, Legeais D, Madec FX, Phe V, Pignot G, Irani J. Les complications chirurgicales en urologie adulte : chirurgie de la prostate. Prog Urol 2022; 32:953-965. [DOI: 10.1016/j.purol.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022]
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Surgical Complications in the Management of Benign Prostatic Hyperplasia Treatment. Curr Urol Rep 2022; 23:83-92. [PMID: 35262855 DOI: 10.1007/s11934-022-01091-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW There are a variety of treatment options for men with symptomatic benign prostatic hyperplasia (BPH); transurethral resection of the prostate (TURP) remains the gold standard surgical treatment. The field continues to evolve with the introduction of new energy and laser technologies, increasing adoption of enucleation techniques, in addition to the advent of minimally invasive surgical technologies (MIST) that enable office-based treatments. The choice in surgical management has become very nuanced depending on a variety of patient and anatomic factors. There continues to be high success rates for surgical treatment of BPH; however, the risk profiles vary across the various surgical treatments. We sought to evaluate contemporary series and summarize the experience of complications associated with BPH treatment and management of these complications. RECENT FINDINGS A comprehensive literature review was performed, and identified 79 manuscripts, published between 2005 and 2021 characterizing the diagnosis and management of complications following BPH surgery. Commonly cited issues included bleeding, ureteral orifice injury, bladder neck injury, rectal injury, TURP syndrome, bladder neck contractures, urethral stricture disease, refractory OAB symptoms, and complications unique to new modalities of treatment. The practicing urologist has multiple surgical options to choose from in treating patients with symptomatic BPH. The surgical management of BPH is generally well tolerated with high objective success rates that allow for significant improvement in urinary quality of life. It is critical to understand the potential complications associated with these various treatment options, which will enable trainees and practicing urologists to better counsel patients and manage these potential complications.
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Mian A, Balzano FL, Pachorek M, Sam AP, Ruel N, Warner JN. Complications Based on Prostate Size After Plasmakinetic Enucleation of the Prostate. J Endourol 2022; 36:969-976. [PMID: 35018807 DOI: 10.1089/end.2021.0911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lower urinary tract symptoms among adult men can significantly impact quality of life. We evaluated complications based on prostate size following plasma kinetic enucleation of the prostate. METHODS Patients were grouped into small prostate group (SPG) <75 grams, and large prostate group (LPG) >75 grams based on preoperative imaging. Patient demographics, comorbidities, preoperative international prostate symptoms score (IPSS), bother index (BI), prostate specific antigen (PSA) if indicated, post void residual volume (PVR), indwelling catheter or self-catheterization status, and any prior surgical intervention were evaluated. Postoperatively IPSS, BI, and PVR was assessed at 6 weeks, 4 months, and yearly. Post-operative urge urinary incontinence (UUI), stress urinary incontinence (SUI) and pad use was assessed. RESULTS Between September 2015 and December 2020, 296 bipolar enucleation with minimum 4 month follow-up were evaluated. All postoperative IPSS, BI, PVR and PSA timepoints were significantly decreased compared to pre-operative values (p <0.05). There was no significant difference in the complications between groups. Univariable and multivariable analysis found size <75 grams was predictive of stricture formation and bladder neck contracture. UUI was more common at 6 weeks in the SPG, and SUI was more common at 6 weeks in the LPG, but no difference was noted at the 4 month and 1 year time point. Pad use was equal between the two groups at all time points. CONCLUSIONS PKEP provides an effective treatment option for all prostate sizes, however, prostates <75 grams have a higher rate of BNC and urethral strictures compared to those >75 grams.
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Affiliation(s)
- Abrar Mian
- Midwestern University Chicago College of Osteopathic Medicine, 70050, 555 31st Street, Downers Grove, Downers Grove, Illinois, United States, 60515-1235;
| | | | - Mark Pachorek
- Pasadena City College , Pasadena , California, United States;
| | - Andre-Philippe Sam
- University of California Riverside, 8790, Riverside, California, United States;
| | - Nora Ruel
- City of Hope Medical Center, Biostatistics, 1500 East Duarte Rd, Duarte, California, United States, 91010;
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Robotic Urethral Reconstruction Outcomes in Men with Posterior Urethral Stenosis. Urology 2021; 161:118-124. [PMID: 34968569 DOI: 10.1016/j.urology.2021.11.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate surgical outcomes stratified by posterior urethral obstruction (PUO) etiology in men undergoing definitive robotic posterior urethral reconstruction. METHODS A retrospective, single surgeon, review of men undergoing robotic posterior urethral reconstruction between 2018 and 2020 was performed. Differences in complications, reconstructive success (no further intervention), and urinary continence by PUO etiology were assessed. RESULTS Robotic posterior urethral reconstruction was performed in 21 men. PUO etiology included BPH treatment in 5 (24%), prostatectomy in 10 (48%), radiation in 5 (24%), and trauma in 1 (5%). Median number of prior endoscopic treatments was 3 (BPH), 3 (prostatectomy), and 2 (radiation) with an average time between obstruction and reconstruction of 9, 12, and 15 months (p=0.52). Median length of stay after reconstruction was 2, 1, and 2 days (p=0.45). 30-day complications occurred in 0%, 20%, 40% (p =0.19). Post-reconstruction re-intervention was necessary in 0%, 10%, 80% (p =0.004). Ultimately, anatomic success was achieved in 100%, 90%, 80% (p=0.63), with functional success rates of 100%, 100%, 60% (p=0.035). Median postoperative pad/day usage was 0,0, 10.5 (p<0.001), and ultimately 0%, 30%, 80% (p=0.013) underwent artificial urinary sphincter placement. CONCLUSION Endoscopic treatment of posterior urethral obstruction (PUO) secondary to benign and malignant prostate conditions is associated with a high incidence of treatment failure. Robotic posterior urethral reconstruction is a safe and effective surgical solution for men with PUO in the absence of pelvic radiation. Men with pelvic radiation appear to be at increased risk of complications, PUO recurrence, and clinically significant stress urinary incontinence.
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Hughes M, Blakely S, Nikolavsky D. Advancements in transurethral management of urethral stricture disease. Curr Opin Urol 2021; 31:504-510. [PMID: 34175872 DOI: 10.1097/mou.0000000000000913] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To explore and report the recent evolution of transurethral management of urethral stricture disease. RECENT FINDINGS In recent years, new promising techniques in the transurethral management of urethral stricture disease have emerged including adjuvant therapies to direct vision internal urethrotomy, regenerative therapy with buccal mucosa cells and minimally invasive transurethral urethroplasty procedures that avoid skin incisions. SUMMARY Although further work is needed, the expanding field of transurethral therapies for urethral stricture disease demonstrates early promising results through a variety of modalities.
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Affiliation(s)
- Michael Hughes
- SUNY Upstate Medical University, Department of Urology, Syracuse, New York, USA
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