You have accessJournal of UrologyReconstruction: Urethral Reconstruction (Including Stricture) II (MP32)1 May 2024MP32-12 POST-OPERATIVE RETROGRADE URETHROGRAM DOES NOT PREDICT SURGICAL REINTERVENTION FOR ANTERIOR URETHROPLASTY Bryson P. Cook, Gina Tundo, and David Abramowitz Bryson P. CookBryson P. Cook , Gina TundoGina Tundo , and David AbramowitzDavid Abramowitz View All Author Informationhttps://doi.org/10.1097/01.JU.0001008816.80828.35.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Open surgical urethroplasty is considered the gold standard for management of urethral strictures. In this study, we review our post operative retrograde urethrograms (RUG's) to evaluate if there is correlation between contrast extravasation and surgical reintervention. METHODS: This is a retrospective review of open anterior urethroplasties on cis-male patients completed by two fellowship trained surgeons at one institution two years out of fellowship between September 2021 and July 2023. We excluded patients with history of congenital hypospadias. RUG's were routinely completed at 3-4 weeks after surgery to evaluate for contrast extravasation at the repair site. A Chi-Squared test of independence was performed to evaluate for an association between surgical reintervention and RUG extravasation. RESULTS: 60 anterior urethroplasties were completed in the study period with a mean follow-up of 10 months (range 2-23 months). Post operative RUG was completed on 53 patients with extravasation of contrast noted on 7 studies. Four patients with mild extravasation underwent catheter removal. Three patients with extravasation were managed with prolonged catheterization. One patient with RUG extravasation had a symptomatic recurrence of their stricture at 3 months postoperatively. Five patients (8%) required reintervention with mean time to reintervention of 4 months. One underwent repeat augmented urethroplasty and the rest with dilation. A positive correlation was identified between RUG extravasation and stricture length. No correlation was identified between surgical reintervention and RUG extravasation. Multiple prior endoscopic treatments, lichen sclerosis, and stricture length were risk factors for surgical reintervention. CONCLUSIONS: RUG extravasation was not correlated with surgical reintervention. Patients with mild extravasation at time of RUG do well clinically with catheter removal. We continue to perform post operative RUGs as degree of extravasation guides catheter duration. Download PPTDownload PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e519 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Bryson P. Cook More articles by this author Gina Tundo More articles by this author David Abramowitz More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION To report outcomes of our Virtue male sling series and evaluate predictors of surgical success and failure. We also retrofit the Male Stress Incontinence Grading Scale (MSIGS) refined nomogram, including the standing cough test (SCT), to assess its application to our cohort.MATERIALS AND METHODS:A retrospective review was completed at a single institution over a 4 year period of all Virtue male slings implanted for stress urinary incontinence (SUI). Patient demographics including pad usage per day (PPD) and MSIGS were obtained on all patients after their bladders were filled cystoscopically. Failure was defined as > 1 PPD and/or conversion to another anti-incontinence procedure. Incidence, management and outcomes of complications were also evaluated.RESULTS:Forty-six men who underwent Virtue male sling at a median follow up of 15.6 months were analyzed with an objective success rate of 78% and a subjective success rate of 85%. Preoperative predictors of surgical success were ability to stop stream on physical exam, lack of total incontinence and no history of posterior urethral stricture. MSIGS alone was not predictive of sling success or failure. Penile numbness occurred in 11% of patients and reoperation with incision of the sutured together transobturator arms improved sensation in all patients.CONCLUSION:Virtue male sling has high objective and subjective success rates with a manageable side effect profile. Evidence of residual sphincteric function appears to be more predictive of sling success rather than MSIGS.

You have accessJournal of UrologyLower Tract Reconstruction (V10)1 Sep 2021V10-03 TRANSURETHRAL INCISION WITH TRANSVERSE MUCOSAL REALIGNMENT FOR REPAIR OF POSTERIOR URETHRAL STRICTURES, TECHNIQUE AND OUTCOMES David Abramowitz, Jonathan Warner, and Felicia Balzano David AbramowitzDavid Abramowitz More articles by this author , Jonathan WarnerJonathan Warner More articles by this author , and Felicia BalzanoFelicia Balzano More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002061.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In an effort to improve outcomes for patients with vesicourethal anastomotic stenosis (VUAS) and bladder neck contractures (BNC), a novel surgical technique is investigated. This study tests the hypothesis that endoscopically employing a laparoscopic suturing device can successfully reapproximate the mucosa in a transverse fashion after a longitudinal incision of a VUAS or BNC in a Heineke-Milkulicz fashion. METHODS: Patients with VUAS and BNC were treated with a novel technique, transurethral incision with transverse mucosal reapproximation (TUI TMR) from July 2019 to December 2020. The cause of stricture, radiation history, and number of prior treatments were reviewed. Foley was left in place for one week post op. Cystoscopy assessed patency 4 months post-op. Failure was defined as recurrence of stricture. Stone formation on the titanium clip was also assessed. Technique: Strictures were dilated over a wire to 20 Fr using S-CurvedTM dilators (Cook). A needle tip electrode (Olympus Surgical) was introduced. Incisions were made at 3 and 9 o’clock. In the earlier cases, the outer sheath of the resectoscope was left in place. A 5mm RD-180® (LSI solutions, Rochester, NY) suture device and a short rigid ureteroscope were simultaneously passed into the sheath. Using a 2-0 PDS suture, the mucosa was grasped at the mid point of the proximal edge and then the midpoint of the distal edge of the incision. The instruments were removed and the titanium TK Ti-Knot suture device® (LSI solutions) reapproximated the mucosa in a Heineke-Mikulicz fashion. In the later cases, a novel digital offset scope with a 6 mm working channel was used (Neoscope, San Jose, CA). RESULTS: 19 patients have undergone TUI TMR. Average age was 74 (56-87). 17 of 19 patients have remained patent at last follow up (89%), the 2 failures were retreated, and successful at last follow up. 10 patients had VUAS after prostatectomy, and 9 had BNC after transurethral resection of the prostate. 6 had a history of radiation. 14 of 19 patients had prior interventions. Average follow up was 7.2 months (4-16). Three patients had clips requiring removal, one in the OR. 8/18 (42%) had incontinence; no cases of de novo incontinence were seen. CONCLUSIONS: Early outcomes of TUI TMR of posterior urethral stenosis and anterior urethral strictures seem promising, even in refractory and radiation cases. Further follow up will be needed. Source of Funding: DJA is supported by an educational fellows grant from Coloplast © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e755-e756 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Abramowitz More articles by this author Jonathan Warner More articles by this author Felicia Balzano More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION AND OBJECTIVES: Occasional spontaneous shrinkage of renal tumors under active surveillance (AS) is a well-documented phenomenon, but the histology of these shrinking tumors is unknown due to lack of widespread biopsy during AS. Here we describe the incidence and features of histologically confirmed renal cell carcinoma (RCC) with spontaneous shrinkage during AS, including novel discovery of common spontaneous regression among non-clear cell subtypes. METHODS: A prospectively maintained kidney tumor AS database at a single National Comprehensive Cancer Network institute was queried to identify all AS patients with clear cell RCC (ccRCC), chromophobe RCC (chRCC) or papillary RCC (pRCC) diagnosed by percutaneous biopsy with >/=6 months follow-up. Shrinking tumors (>30% volume reduction) were confirmed by radiologist re-review. Needle core biopsies of all shrinking tumors and a subset of growing tumors were scored by a genitourinary pathologist for various histologic features including macrophage and lymphocytic infiltration, eosinophilia and necrosis. RESULTS: 74 AS patients with RCC on biopsy were identified (42 ccRCC, 24 pRCC 8 chRCC). Intriguingly, 9/24 (38%) pRCC and 4/8 (50%) chRCC shrunk during AS without treatment, compared to only 1/42 (2%, p=0.03 and 0.03, respectively) ccRCC. The median tumor volume shrinkage (range) was 57% (31-84%) for pRCC, 83% (68-97%) for chRCC, and 31% for ccRCC. Shrinkage temporally followed the tumor biopsy in all but 2 cases. Most shrinking pRCC tumors demonstrated extensive macrophage infiltration compared to only moderate, low or absent levels in all growing pRCC tumors (Figure 1). Shrinking chRCC tumors exhibited diffusely intense eosinophilia in 3 of 4 cases, whereas shrinking ccRCC tumor lacked substantial eosinophilia or macrophage infiltration . CONCLUSIONS: In among the largest series of biopsied RCC tumors on AS to our knowledge, we discovered a novel phenomenon of common spontaneous tumor regression among non-clear cell subtypes. Macrophage infiltration and temporal association of tumor regression with biopsy suggest a possible immune etiology. Spontaneous RCC shrinkage has implications for AS patient selection and warrants additional study to identify clinical, histologic and molecular predictors. Figure. No caption available. Source of Funding: None