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Doležel J, Hrabec R, Uher M, Čapák I, Šebová N, Staník M. 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:S0090-4295(24)00418-7. [PMID: 38830554 DOI: 10.1016/j.urology.2024.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/11/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE To present long-term experience with buccal mucosa posterior urethroplasty (BMPU) for refractory posterior urethral stenosis (PUS) or vesicourethral anastomosis stenosis (VUAS) either by perineal approach (PA) or by endourethroplasty (EUP). MATERIALS AND METHODS A single-center retrospective study of 38 consecutive patients operated on between 1999 and 2022. BMPU consisted of the transfer of onlay or tubular buccal mucosa grafts into dilated and/or incised strictures through an open or endourological approach. If VUAS or PUS recurred with short stenosis within the first 12 months after surgery, it was transected by a cold-knife direct vision internal urethrotomy (DVIU), referred to as an "auxiliary" DVIU. The primary outcome was 3-year stricture recurrence-free survival (SRFS). RESULTS BMPU by perineal approach and EUP were performed in 27 (71%) and 11 (29%) patients, respectively. The 3-year SRFS was 65% for the whole cohort, with rates of 63% for the perineal approach and 73% for endourological approach. With permitted auxiliary DVIU, 3-year SRFS for the whole cohort was 81%. De novo incontinence occurred in 2 out of 18 preoperatively continent patients. Limitations include the retrospective nature of the single-center study and a small, heterogenous cohort of patients. CONCLUSION We present 2 techniques of substitution urethroplasty with BMG in the management of PUS and VUAS with a low rate of recurrence or de novo incontinence. A novel endourological approach (EUP) is a promising minimally invasive alternative to the perineal approach.
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Affiliation(s)
- Jan Doležel
- Department of Urologic Oncology, Masaryk Memorial Cancer Institute, Brno; Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno
| | - Roman Hrabec
- Department of Urologic Oncology, Masaryk Memorial Cancer Institute, Brno; Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno
| | - Michal Uher
- Research Group Bioinformatics, Masaryk Memorial Cancer Institute, Brno
| | - Ivo Čapák
- Department of Urologic Oncology, Masaryk Memorial Cancer Institute, Brno; Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno
| | - Natália Šebová
- Department of Urologic Oncology, Masaryk Memorial Cancer Institute, Brno; Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno
| | - Michal Staník
- Department of Urologic Oncology, Masaryk Memorial Cancer Institute, Brno; Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno.
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Liao C, Lu D, Wang X, Guo P, Xiong W. Combined robot-assisted transabdominal and perineal approach to reconstruct the posterior urethral distracted defect due to pelvic fracture: A case report. Asian J Surg 2023; 46:5509-5511. [PMID: 37596234 DOI: 10.1016/j.asjsur.2023.07.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/24/2023] [Indexed: 08/20/2023] Open
Affiliation(s)
- Chongzhou Liao
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China; Department of Urology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital & Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Dan Lu
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China; Department of Urology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital & Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Xiaoxiao Wang
- Department of Urology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital & Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Pu Guo
- Department of Urology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital & Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Wei Xiong
- Department of Urology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital & Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, 610072, China; School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
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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: 0] [Impact Index Per Article: 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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Zhang TR, Alford A, Wang A, Zhao LC. Robotic-assisted Posterior Urethroplasty: Outcomes From 105 Men in a Single-center Experience. Urology 2023; 181:167-173. [PMID: 37543119 DOI: 10.1016/j.urology.2023.05.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE To determine surgical outcomes in a large of cohort men undergoing robotic-assisted posterior urethroplasty (RPU), which has been described in small series as a viable option. MATERIALS AND METHODS We performed a retrospective review of all 105 men who underwent RPU from October 2014 to August 2022 at a single institution. We evaluated postoperative outcomes, including complications; surgical success defined as no need for reintervention; and incontinence requiring artificial urinary sphincter placement. We performed descriptive statistics and chi-square testing to determine if outcomes were associated with certain posterior urethral disease etiologies. RESULTS Mean follow-up time was 18.7months. Over half of patients (57.1%) received prior pelvic radiation. The most common reconstructive techniques were excision and primary anastomosis (n = 45, 30.0%), resitting of the bladder neck (n = 26, 24.8%), Y-V plasty (n = 21, 20.0%), and buccal mucosal graft urethroplasty (n = 14, 13.3%). Forty-one patients (39.0%) required a combined abdominoperineal approach. Seven patients (6.7%) had ≥CD grade 3 complications within 30days. Thirty patients (28.6%) developed incontinence with subsequent artificial urinary sphincter placement. One-quarter (24.8%) of patients required at least one subsequent surgical reintervention. CONCLUSION In the largest RPU cohort to date, surgical success rates were similar and continence rates were improved compared to open surgery and align with existing robotic series, adding to the growing body of evidence demonstrating advantages of RPU.
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Affiliation(s)
- Tenny R Zhang
- Department of Urology, New York University Langone Medical Center, New York, NY; Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Ashley Alford
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Alex Wang
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Lee C Zhao
- Department of Urology, New York University Langone Medical Center, New York, NY.
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Sterling J, Rahman SN, Varghese A, Angulo JC, Nikolavsky D. Complications after Prostate Cancer Treatment: Pathophysiology and Repair of Post-Radiation Urethral Stricture Disease. J Clin Med 2023; 12:3950. [PMID: 37373644 DOI: 10.3390/jcm12123950] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Radiation therapy (RT) in the management of pelvic cancers remains a clinical challenge to urologists given the sequelae of urethral stricture disease secondary to fibrosis and vascular insults. The objective of this review is to understand the physiology of radiation-induced stricture disease and to educate urologists in clinical practice regarding future prospective options clinicians have to deal with this condition. The management of post-radiation urethral stricture consists of conservative, endoscopic, and primary reconstructive options. Endoscopic approaches remain an option, but with limited long-term success. Despite concerns with graft take, reconstructive options such as urethroplasties in this population with buccal grafts have shown long-term success rates ranging from 70 to 100%. Robotic reconstruction is augmenting previous options with faster recovery times. Radiation-induced stricture disease is challenging with multiple interventions available, but with successful outcomes demonstrated in various cohorts including urethroplasties with buccal grafts and robotic reconstruction.
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Affiliation(s)
- Joshua Sterling
- Yale School of Medicine, 20 York Street, New Haven, CT 06511, USA
| | - Syed N Rahman
- Yale School of Medicine, 20 York Street, New Haven, CT 06511, USA
| | - Ajin Varghese
- New York College of Osteopathic Medicine, 8000 Old Westbury, Glen Head, NY 11545, USA
| | - Javier C Angulo
- Faculty of Biomedical Sciences, Universidad Europea, 28905 Madrid, Spain
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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: 0] [Impact Index Per Article: 0] [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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Tsoi H, Elnasharty SF, Culha MG, De Cillis S, Guillot-Tantay C, Hervé F, Hüesch T, Raison N, Phé V, Osman NI. Current evidence of robotic-assisted surgery use in functional reconstructive and neuro-urology. Ther Adv Urol 2023; 15:17562872231213727. [PMID: 38046941 PMCID: PMC10693211 DOI: 10.1177/17562872231213727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/25/2023] [Indexed: 12/05/2023] Open
Abstract
The use of robot-assisted technology has been widely adopted in urological oncological surgery and its benefits have been well established. In recent years, robotic technology has also been used in several functional reconstructive and neuro-urology (FRNU) procedures. The aim of this review was to evaluate the current evidence in the use of robotic technology in the field of FRNU. We performed a PubMed-based literature search between July and August 2022. The keywords we included were 'robotic assisted', 'ureteric reimplantation', 'cystoplasty', 'ileal conduit', 'neobladder', 'sacrocolpopexy', 'colposuspension', 'artificial urinary sphincter', 'genitourinary fistula' and 'posterior urethral stenoses'. We identified the latest available evidence in the use of robotic technology in specific FRNU procedures such as the reconstruction of the ureters, bladder and urinary sphincter, urinary diversion, and repair of genitourinary prolapse and fistula. We found that there is a lack of prospective studies to assess the robotic-assisted approach in the field of FRNU. Despite this, the advantages that robotic technology can bring to the field of FRNU are evident, including better ergonomics and visual field, less blood loss and shorter hospital stays. There is therefore a need for further prospective studies with larger patient numbers and longer follow-up periods to establish the reproducibility of these results and the long-term efficacy of the procedures, as well as the impact on patient outcomes. Common index procedures and a standardized approach to these procedures should be identified to enhance training.
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Affiliation(s)
- Hermione Tsoi
- Department of Urology, Royal Hallamshire Hospital, Glossop Rd, Broomhall, Sheffield S10 2JF, UK
| | | | - Mehmet Gokhan Culha
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Sabrina De Cillis
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy
| | | | - François Hervé
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Tanja Hüesch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | | | - Véronique Phé
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Tenon Academic Hospital, Sorbonne University, Paris, France
| | - Nadir I. Osman
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
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