{"title":"Repairing stress urinary incontinence and dehiscence after masculinizing genital gender affirmation surgery: A staged approach","authors":"Joshua Sterling , Jeffery Carbonella , Aleksandra Golos , Dmitriy Nikolavsky","doi":"10.1016/j.urolvj.2024.100292","DOIUrl":"10.1016/j.urolvj.2024.100292","url":null,"abstract":"<div><h3>Background</h3><div>Stress Urinary incontinence (SUI) is an infrequently reported complication following masculinizing genital gender affirming surgery (gGAS). Thus far there are no reports to describe the management of this post-operative complication.</div></div><div><h3>Objective</h3><div>Here, we show de novo SUI following vaginectomy and metoidioplasty can be safely surgically corrected. These were treated with a staged approach. Stage 1 included placement of an autologous fascial retropubic sling, and a first stage urethroplasty with buccal mucosa graft (BMG) and stage 2 involved tubularization of the neourethra.</div></div><div><h3>Methods</h3><div>We present a 22 year old transgender male who developed severe SUI, constant leakage, and ventral dehiscence following vaginectomy and metoidioplasty. He was referred for treatment of SUI and correction of ventral shaft dehiscence. Prior to surgical repair he completed three months of pelvic therapy, which improved his incontinence.</div><div>The procedure was done in dorsal lithotomy position. Perineum (site of prior vaginectomy) and previously created <em>pars fixa</em> were opened ventrally. Using the balloon of the Foley at the bladder neck as a palpable landmark, the native urethra and the bladder neck were dissected to the inferior aspect of the pubic symphysis. A 1.5 × 8 cm segment of rectus fascia was harvested for the autologous sling. Full length 2–0 polypropylene suture was secured to either end of the fascial sling and delivered retropubically to the abdominal incision from the perineal incision using a fine tonsil clamp. The sling was appropriately tensioned and secured. Ventral penile chordee was released sharply and a stage 1 urethroplasty was performed with dorsal BMG inlay. Six months later the patient did not show any signs of recurrence of SUI or retention, and the second stage urethroplasty was completed.</div></div><div><h3>Results</h3><div>At one year follow up he continues to have a normal voiding pattern, low residuals and no longer needs pads. Patient's office uroflow and post void residual results are: flow rate = 27 ml/s, voided volume = 536 mL, residual = 0 mL. He reports marked improvement in his overall symptoms, leakage, urinary frequency, and quality of life.</div></div><div><h3>Conclusion</h3><div>SUI is a real and devastating complication following masculinizing gGAS. Here we show it can safely be treated using an established pelvic floor reconstructive techniques with durable results. More report is required to determine the true incidence of this complication following masculinizing surgery and further studies are needed to assess the efficacy of this approach.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"25 ","pages":"Article 100292"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Total abdominal robotic approach for level 4 inferior vena cava thrombus in renal cell carcinoma","authors":"Kishore Thekke Adiyat , Jeni Mathew , Venkata Bhargava Bopanna , Shilpa Omkarappa , Sangeeth Srinivasan , Biju Chandran","doi":"10.1016/j.urolvj.2024.100297","DOIUrl":"10.1016/j.urolvj.2024.100297","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to elucidate the technique involved in employing a total robotic approach for managing level 4 inferior vena cava (IVC) thrombus.</div></div><div><h3>Patient and surgical procedure</h3><div>A 71-year-old female presented with a 12 × 9 × 8 cm left renal mass with a thrombus extending into the atrium. Utilizing the Da Vinci Si system (Intuitive Surgical, Sunnyvale, CA), the surgical procedure commenced with the patient in a right lateral position, undergoing left radical nephrectomy, stapling of the renal vein, and distal pancreatectomy due to tumour infiltration. Subsequently, with the patient in the left lateral position, delivery of the left renal vein stump, isolation of the right renal artery/vein, and mobilization of the right lobe of the liver were performed. The patient was then placed in the supine position for further dissection of the suprahepatic IVC. To enhance exposure of the suprahepatic IVC, the central tendon of the diaphragm/pericardium was divided. Sequential clamping of the infrarenal IVC, right renal vein/artery, and porta was performed. The thrombus was gently maneuvered from the atrium to the suprahepatic IVC under real time ultrasound guidance and subsequently extracted through cavotomy with excision of the renal vein stump. Closure of the IVC was then performed.</div></div><div><h3>Results</h3><div>The total operative time was 420 min, with console time comprising 290 min. Porta clamp time was 11 min, while the right renal clamp time was 22 min. Blood loss was 375 ml and the patient's hospital stay lasted 8 days. Pathological examination confirmed clear cell renal carcinoma PT4N0M0, Furhman Grade 2.</div></div><div><h3>Conclusion</h3><div>The total robotic approach for managing level 4 IVC thrombus, involving the division of the central tendon of the diaphragm, demonstrates feasibility and represents a promising surgical technique.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100297"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Iulia Andras , Carlo Andrea Bravi , Juan Gomez Rivas , Giuseppe Basile , Fabrizio di Maida , Paolo Dell'Oglio , Emanuel Căta , Erika Palagonia , Angelo Territo , Federico Piramide , Mike Wenzel , Christoph Wurnschimmel , Nikolaos Liakos , Edward Lambert , Danny Darlington , Filippo Turri , Marco Paciotti , Gabriele Sorce , Ruben de Groote , Marcio Covas Moschovas , Alessandro Larcher
{"title":"Robotic-assisted uretero-ileal reimplantation for benign ureteral strictures in patients with prior minimally-invasive radical cystectomy and intracorporeal urinary diversion","authors":"Iulia Andras , Carlo Andrea Bravi , Juan Gomez Rivas , Giuseppe Basile , Fabrizio di Maida , Paolo Dell'Oglio , Emanuel Căta , Erika Palagonia , Angelo Territo , Federico Piramide , Mike Wenzel , Christoph Wurnschimmel , Nikolaos Liakos , Edward Lambert , Danny Darlington , Filippo Turri , Marco Paciotti , Gabriele Sorce , Ruben de Groote , Marcio Covas Moschovas , Alessandro Larcher","doi":"10.1016/j.urolvj.2024.100293","DOIUrl":"10.1016/j.urolvj.2024.100293","url":null,"abstract":"<div><h3>Objective</h3><div>To present the surgical technique and outcomes of robotic ureteral reimplantation in ileal conduit (IC) and neobladder (NB) in patients with prior minimally-invasive radical cystectomy and intracorporeal urinary diversion, who developed benign uretero-ileal anastomotic strictures.</div></div><div><h3>Patients and surgical procedure</h3><div>We report on a multiinstitutional cohort of 10 patients (7 IC, 3 NB) who had 12 uretero-ileal strictures (8 unilateral, 2 bilateral) causing hydronephrosis and renal function deterioration, who underwent robotic uretero-ileal reimplantation in referral centers for robotic surgery between 2016 and 2022. Median age was 67.5 years (Interquartile range [IQR]: 66–69). The stricture was diagnosed at a median of 6 months (IQR 5–10) from the initial surgery. All unilateral strictures were on the left side. Two patients received unsuccessful endoscopic dilatation before the reconstructive surgery. All patients underwent nephrostomy placement prior to the reconstructive procedure. Robotic uretero-ileal reanastomosis started with adhesiolysis, followed by the identification of the ureters and urinary diversion, facilitated by the use of intracavitary saline or ICG. When dissecting the ureters, a „no touch” technique was used, in order to minimize devascularization and ischemia. Localization of the ureteral stricture was critical. The excision of the entire ischemic segment was performed until signs indicative of adequate tissue trophism were found. At the same time, consideration was given to spare sufficient length of the ureteral stumps to allow for a tension-free anastomosis. Direct anastomosis using monofilament resorbable suture, with insertion of mono J or double J stent was performed with both ileal conduit and neobladder. Bricker technique was used in case of unilateral stricture.</div></div><div><h3>Results</h3><div>The median operative time for robotic uretero-ileal reanastomosis was 152 min (IQR 120–180) and the median blood loss was 50 ml (IQR 40–70). No intraoperative complications occurred according to the ICARUS criteria. Median length of hospital stay was 4.5 days (IQR 3–6). Two Clavien-DIndo II (20 %) postoperative complications were registered (urinary tract infection and acute kidney injury). No patients required readmission or reoperation. The mean length of ureteral catheterization for reimplantation in IC was 20.7 days (± 4.29). For patients with NB, the mean ureteral and urethral catheterization times were 54.3 days (± 22.8) and 19.3 days (± 11.08), respectively. The ureteral stents were removed in all patients. At a median of 16 months follow-up (range 6–36 months), 2 patients (one IC and one NB, respectively) had persistent hydronephrosis.</div></div><div><h3>Conclusion</h3><div>In patients requiring surgery for benign ureteral strictures following cystectomy, robotic surgery allows for safe and efficient ureteral reimplantation in urinary diversion.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100293"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kelley Zhao , Matthew Lee , Michael Raver , Michael D Stifelman , Lee C Zhao , Daniel D Eun
{"title":"Techniques for ureteral reimplantation for distal disease","authors":"Kelley Zhao , Matthew Lee , Michael Raver , Michael D Stifelman , Lee C Zhao , Daniel D Eun","doi":"10.1016/j.urolvj.2024.100288","DOIUrl":"10.1016/j.urolvj.2024.100288","url":null,"abstract":"","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100288"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alessandro Marquis, Marco Allasia, Marco Oderda, Alessandro Dematteis, Federico Lavagno, Simone Livoti, Giancarlo Marra, Francesco Soria, Paolo Gontero
{"title":"Robotic radical cystectomy with intracorporeal neobladder and renal graft nephroureterectomy for urothelial carcinoma in a double renal transplant recipient","authors":"Alessandro Marquis, Marco Allasia, Marco Oderda, Alessandro Dematteis, Federico Lavagno, Simone Livoti, Giancarlo Marra, Francesco Soria, Paolo Gontero","doi":"10.1016/j.urolvj.2024.100296","DOIUrl":"10.1016/j.urolvj.2024.100296","url":null,"abstract":"<div><h3>Objective</h3><div>To present the first surgical video of robotic radical cystectomy with intracorporeal neobladder in a renal transplant recipient.</div></div><div><h3>Patient and surgical procedure</h3><div>A 29-year-old solitary kidney male who previously underwent double renal transplants (2016 right and 2020 left iliac fossa) presented to our attention a wide urothelial carcinoma of the distal part of the right graft ureter extending to the bladder. At the transurethral resection, a muscle-invasive high-grade urothelial carcinoma was diagnosed. At the CT scan, the right renal graft appeared functionally excluded while the left one was well-vascularized and functioning, and no lymph node involvement or metastatic disease was reported. The patient was planned for surgery with curative intent. Robotic radical cystectomy, right graft radical nephroureterectomy, prophylactic bilateral native ureterectomy and Florence robotic intracorporeal neobladder (FloRIN) were performed.</div></div><div><h3>Results</h3><div>The procedure was successfully completed. Technical aspects of the surgery are illustrated in the video. No intra- and postoperative complications were recorded. Blood losses were 200 mL. Operative time was 420 min. The mono J placed to protect the left renal graft was removed after two weeks, while the urinary catheter three weeks after a negative cystogram. The final pathology revealed a bladder pT2a G3 high-grade urothelial carcinoma and a pelvis and ureteral pT1 G3 high-grade urothelial carcinoma with carcinoma in situ. At one year after surgery, the patient was continent, potent, with insignificant residual volume and an unchanged renal function, and disease-free.</div></div><div><h3>Conclusions</h3><div>In renal transplant recipients, robotic radical cystectomy with intracorporeal neobladder in renal transplant recipients is a safe and feasible procedure, guaranteeing optimal surgical and functional outcomes and a low complications rate.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100296"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The “Wheelbarrow Technique” for partial nephrectomy of endophytic small renal mass","authors":"Bellamy Brodie, Alvin YM Lee, Henry SS Ho","doi":"10.1016/j.urolvj.2024.100291","DOIUrl":"10.1016/j.urolvj.2024.100291","url":null,"abstract":"<div><h3>Introduction & objectives</h3><div>Nephron sparing surgery is widely used for the dissection of renal tumours. However, the resection of completely endophytic tumours remains a challenge. Localisation of these tumours is often made difficult due to a limited or complete lack of any external visualisation on the parenchymal surface. It is therefore difficult to determine the optimal location and angle at which dissection should start.</div></div><div><h3>Materials & methods</h3><div>We demonstrate our approach for completely endophytic tumours, termed the ‘Wheelbarrow' technique, with the use of a video case series of robot-assisted laparoscopic partial nephrectomy. While classical convention may dictate entering the renal parenchyma at the edge of the renal tumour with the aims of preserving maximal normal parenchyma, we have found this results in poor vision and difficult enucleation owed to the sharp dissection angle at the tumour apex. Our proposed ‘Wheelbarrow Technique' utilises a less acute dissection angle, aiming towards the deepest aspect of the endophytic tumour. Once this apex is reached, the tumour can easily be retracted upwards with the 3rd robotic arm or laparoscopic assistant. This provides superb visualisation of the tumour/capsule border, facilitating enucleation as well as the easier identification of feeding vessels for ligation. We perform reconstruction with a 2-layer closure, performed with the sliding Hem-olock® technique.</div></div><div><h3>Results</h3><div>All patients recovered well post operatively, being discharged on post operative day 3 without complications including transfusion requirement or urine leak. Histology demonstrated clear cell renal cell carcinoma with clear resection margins.</div></div><div><h3>Conclusions</h3><div>Totally endophytic renal tumours are a challenge for partial nephrectomy. Our proposed technique of Wheelbarrow Dissection aims to provide superior vision, increasing the chances of completing a successful partial nephrectomy, and obtaining an R0 resection.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100291"},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Penile skin tube flap salvage urethroplasty for bulbar urethral necrosis following anastomotic urethroplasty for pelvic fracture urethral injury","authors":"Yoshiyuki Furukawa, Akio Horiguchi, Masayuki Shinchi, Kenichiro Ojima, Yusuke Hirano, Kazuki Takekawa, Hideaki Miyoshi, Yuhei Segawa, Keiichi Ito","doi":"10.1016/j.urolvj.2024.100290","DOIUrl":"10.1016/j.urolvj.2024.100290","url":null,"abstract":"<div><h3>Objective</h3><p>Bulbar urethral necrosis is a rare and devastating complication of anastomotic urethroplasty for pelvic fracture urethral injury, which manifests as bulbar urethral loss due to inadequate retrograde blood supply after transection of the bulbar urethra. In this accompanying video, we demonstrate a case of bulbar urethral necrosis successfully salvaged using penile skin tube flap urethroplasty.</p></div><div><h3>Patient and surgical procedure</h3><p>A 67-year-old male underwent anastomotic urethroplasty for a pelvic fracture urethral injury; however, he experienced urinary retention 3 months after urethroplasty. Urethrography revealed a long (40 mm) urethral defect, suggesting bulbar urethral necrosis. Salvage urethroplasty using a penile skin flap was performed 12 months after failure of the initial urethroplasty. A midline perineal incision was made and the necrotic bulbar urethral segment was excised entirely, exposing the healthy distal and proximal urethral ends. A transverse circular penile skin flap 3 cm wide was harvested and transposed to the perineum. Subsequently, a skin flap tube was created using a 5–0 polydioxanone running suture over a 14 Fr Foley catheter and was anastomosed to both urethral ends to fill the bulbar urethral defect.</p></div><div><h3>Results</h3><p>The postoperative course was uneventful. Four weeks after salvage urethroplasty, the urethral catheter was removed and the patient resumed voiding. Postoperative cystourethroscopy revealed no recurrent stenosis and the flap was healthy with a wide urethral lumen. Two years after surgery, the patient continued to have a good voiding status.</p></div><div><h3>Conclusion</h3><p>Penile skin tube flap urethroplasty may be a viable option for the repair of bulbar urethral necrosis.</p></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100290"},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000306/pdfft?md5=55d88b28bd34124b33bdce008dd30f33&pid=1-s2.0-S2590089724000306-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rebeca Gonzalez Jauregui, Rohan G. Bhalla, Nathaniel Coddington, Brian J. Flynn
{"title":"Robotic-assisted laparoscopic ureteroplasty using a non-transecting side-to-side technique for distal ureteral strictures","authors":"Rebeca Gonzalez Jauregui, Rohan G. Bhalla, Nathaniel Coddington, Brian J. Flynn","doi":"10.1016/j.urolvj.2024.100287","DOIUrl":"10.1016/j.urolvj.2024.100287","url":null,"abstract":"<div><h3>Objective</h3><p>To report our initial experience with robotic-assisted laparoscopic (RAL) ureteroplasty using a non-transecting side-to-side anastomosis to manage distal ureteral strictures and demonstrate our surgical technique.</p></div><div><h3>Patients and surgical procedure</h3><p>We retrospectively reviewed patients who underwent RAL ureteroplasty using a non-transecting side-to-side anastomosis between 2020 and 2023. The primary outcome measure was clinical success, defined as freedom from additional surgical intervention for ureteral stricture recurrence at the last follow-up. The secondary outcome measure was radiologic success, defined as lack of evidence of hydronephrosis on post-operative renal ultrasound (RUS). The video highlights the steps to our surgical technique: 1) set up, 2) ureteral identification and dissection, 3) bladder mobilization, 4) ureterotomy and cystotomy, and 5) anastomosis.</p></div><div><h3>Results</h3><p>Nine patients were included in our study, with 78 % female (<em>n</em> = 7) and a median age of 50 years (IQR 45–66). The median stricture length repaired was 4 cm (IQR 2–8). The etiology of stricture disease included iatrogenic, radiation, endometriosis, and idiopathic. The median operative time and estimated blood loss were 228 min (IQR 211–333) and 50 mL (IQR 40–75). There were no intraoperative complications. Post-operatively, one patient had a Clavien-Dindo grade ≥3 complication due to stent displacement on postoperative day one, which was repositioned endoscopically the same day. The median length of stay was 2 days (IQR 2–3), and the median follow-up time was 4 months (IQR 1–13). 100 % (<em>n</em> = 9) of patients met our clinical and radiologic success definition.</p></div><div><h3>Conclusions</h3><p>RAL ureteroplasty via a non-transecting side-to-side anastomosis is a safe and effective treatment option for distal ureteral strictures.</p></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"23 ","pages":"Article 100287"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000276/pdfft?md5=f666ade1ce08e28c7f02e1070b3f0854&pid=1-s2.0-S2590089724000276-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142097523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}