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1.
World J Urol ; 37(6): 1211-1216, 2019 Jun.
Article in English | MEDLINE | ID: mdl-30229414

ABSTRACT

PURPOSE: We describe our technique for using intraureteral and intraurinary diversion indocyanine green (ICG) during robotic ureteroenteric reimplantation and report our outcomes. METHODS: We retrospectively reviewed eight patients who underwent ten robotic ureteroenteric reimplantations between August 2013 and July 2017. ICG was injected antegrade and/or retrograde into the lumen of the ureter, and retrograde into the lumen of the urinary diversion. All patients consented to off-label use of ICG. Postoperatively, all patients were assessed for: clinical success: the absence of flank pain; and radiological success: the absence of obstruction on renal scan and/or loopogram. RESULTS: Visualization of ICG under near-infrared fluorescence allowed for precise identification of the strictured ureter and urinary diversion, which fluoresced green; and localization the ureteroenteric stricture margins, which poorly fluoresced green. The median operative time was 208 min (IQR 191-299), estimated blood loss was 125 ml (IQR 69-150), and length of stay was 6 days (IQR 1-8). Three of eight (37.5%) patients suffered a minor (Clavien ≤ 2), and 2/8 (25.0%) patients suffered a major (Clavien > 2) post-operative complication. There were no complications related to ICG use. At a median follow-up of 29 months (IQR 21-38), 8/10 (80.0%) ureteroenteric reimplantations were clinically and radiologically successful. CONCLUSIONS: Intraureteral and intraurinary diversion ICG may be utilized as a real-time contrast agent during robotic ureteroenteric reimplantation to assist with identification of the strictured ureter and urinary diversion, and delineation of the ureteroenteric stricture margins. Despite this, RUER remains a technically difficult and morbid procedure.


Subject(s)
Coloring Agents , Ileum/surgery , Indocyanine Green , Postoperative Complications/surgery , Replantation/methods , Robotic Surgical Procedures , Ureter/surgery , Urologic Surgical Procedures/methods , Anastomosis, Surgical , Constriction, Pathologic/surgery , Humans , Retrospective Studies , Urinary Diversion
2.
J Sex Med ; 15(8): 1198-1204, 2018 08.
Article in English | MEDLINE | ID: mdl-29960889

ABSTRACT

AIM: To describe a technique for surgical correction of adult buried penis, including a technique for skin graft harvesting from the escutcheonectomy specimen itself, with an emphasis on remaining open questions in the literature. METHODS: We present our method for surgical correction of adult buried penis with a review of the literature. MAIN OUTCOME MEASURE: Components of successful buried penis repair include return of directed voiding, elimination of local skin inflammation and infection, improvement in hygiene, return of sexual functioning, cosmesis, and patient satisfaction. To date, there are no broadly accepted tools for comprehensive measurement of outcomes after buried penis repair. RESULTS: Adult buried penis repair is generally associated with excellent rates of satisfaction and improvement in functioning. Currently available data are extremely limited; however, they do suggest that, when in doubt, more aggressive debridement of diseased tissue combined with split-thickness skin grafting may provide superior outcomes. Split-thickness skin grafts are associated with excellent rates of successful graft take, even in cases of severe preoperative pathology and patient comorbidity. Although these grafts come at the cost of some increased surgical morbidity, they are associated with low rates of major complications. Morbidity can be further significantly decreased by harvesting the graft from the excised escutcheon itself, a technique that we present here. CONCLUSION: Surgical correction of adult buried penis is safe and effective; however, future work is required to further optimize outcomes and reduce surgical morbidity. Strother MC, Skokan AJ, Sterling ME, et al. Adult Buried Penis Repair with Escutcheonectomy and Split-Thickness Skin Grafting. J Sex Med 2018;15:1198-1204.


Subject(s)
Penis/surgery , Plastic Surgery Procedures/methods , Humans , Male , Patient Satisfaction , Skin Transplantation/methods
3.
Curr Urol Rep ; 19(4): 23, 2018 Mar 01.
Article in English | MEDLINE | ID: mdl-29497854

ABSTRACT

PURPOSE OF REVIEW: We review the buccal mucosa graft (BMG) ureteroplasty literature to evaluate its utility in the management of ureteral strictures, identify indications for which it is particularly useful, and highlight refinements in surgical technique. RECENT FINDINGS: Recent reports have described the efficacy of robotic BMG ureteroplasty and the utilization of near-infrared fluorescence to assist with precise identification of the ureteral stricture margins. BMG ureteroplasty is well-suited for ureteral reconstruction as it allows for minimal disruption of the delicate ureteral blood supply and facilitates a tension-free anastomosis. This technique is particularly useful in patients with long ureteral strictures not amenable to ureteroureterostomy and in patients with a recurrent ureteral stricture after a previously failed ureteral reconstruction.


Subject(s)
Mouth Mucosa/transplantation , Plastic Surgery Procedures/methods , Ureteral Obstruction/surgery , Constriction, Pathologic/diagnostic imaging , Constriction, Pathologic/surgery , Fluorescence , Humans , Optical Imaging , Robotic Surgical Procedures/methods , Ureteral Obstruction/diagnostic imaging
4.
Can J Urol ; 23(5): 8471-8475, 2016 Oct.
Article in English | MEDLINE | ID: mdl-27705733

ABSTRACT

INTRODUCTION: Explantation of the Interstim sacral neuromodulation (SNM) device is occasionally necessary. Removing the tined lead can put strain on the lead, resulting in a possible break and retained fragments. The Food and Drug Administration (FDA) released a notification regarding health consequences related to retained lead fragments. We describe a novel and safe surgical technique for removing the Interstim device and permanent lead. MATERIALS AND METHODS: We searched the Manufacturer and User Facility Device Experience (MAUDE) database for complications related to tined lead removal and searched the database of a single surgeon at our institution. Our standardized technique for tined lead removal is as follows. An incision is made over the previous lead insertion site and the lead is isolated and externalized. The fibrous encapsulation is dissected off the lead to expose the tines and ensure the lead is free from adhesions. The lead is removed by wrapping it around a curved hemostat and turning it under tension. If the lead breaks, the incision is extended and dissection is carried down to the sacral body to remove all fragments. RESULTS: Twenty-eight patients had their tined lead removed between 2009 and 2015 after being in place a median of 2.00 years (IQR 1.32-3.32 years). One lead broke (3.6%) during removal over the 6 years using our standardized approach. CONCLUSION: Permanent tined leads can break on removal and retained fragments can pose significant health consequences. Our technique standardizes the approach for removal and is safe and effective in our series.


Subject(s)
Device Removal , Electric Stimulation Therapy , Foreign Bodies , Intraoperative Complications , Lumbosacral Plexus , Postoperative Complications , Urinary Incontinence/therapy , Adult , Aged , Device Removal/adverse effects , Device Removal/instrumentation , Device Removal/methods , Device Removal/standards , Electric Stimulation Therapy/adverse effects , Electric Stimulation Therapy/instrumentation , Electric Stimulation Therapy/methods , Equipment Design , Female , Foreign Bodies/etiology , Foreign Bodies/surgery , Humans , Intraoperative Complications/etiology , Intraoperative Complications/prevention & control , Male , Middle Aged , Outcome and Process Assessment, Health Care , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Reference Standards , United States , Urinary Incontinence/pathology
5.
Can J Urol ; 23(4): 8368-74, 2016 Aug.
Article in English | MEDLINE | ID: mdl-27544561

ABSTRACT

INTRODUCTION: To determine the contemporary practice patterns of academic emergency department (ED) providers in the United States for an episode of acute renal colic. MATERIALS AND METHODS: A 30-question survey was developed to assess ED providers' clinical decision making for an index patient with acute renal colic. The survey population was all attending and resident physicians affiliated with an American emergency medicine residency program with an institutional profile available on the Society for Academic Emergency Medicine (156 programs; 95% of programs in the United States). The survey was conducted in October 2014. A response rate of 8.1% (289/3563) was achieved, which represented 29% (46/156) of the programs. RESULTS: Only 17% (53/289) of respondents were aware of the American Urological Association (AUA) guidelines on the management and imaging of ureteral calculi. A clinical care pathway was uncommon amongst institutions (6/46; 13%), but desired by providers (193/289; 67%). A low dose non-contrast computed tomography (CT) would be the most preferred initial diagnostic imaging modality (139/289; 48%). Initial imaging choice was not influenced by respondent role, program, census region, practice environment, ED size, ED volume, presence of a clinical care pathway, or knowledge of the AUA guidelines (all p > 0.05). CONCLUSIONS: In this cross-sectional survey of academic emergency medicine providers, we demonstrated a lack of awareness of quality initiatives and uncommon use of clinical care pathways. We observed that diagnostic imaging modalities with reduced radiation were commonly preferred, and that imaging preference was not associated with several demographic or institutional characteristics.


Subject(s)
Emergency Medicine , Patient Care Management , Practice Patterns, Physicians' , Renal Colic , Clinical Decision-Making/methods , Emergency Medicine/methods , Emergency Medicine/standards , Emergency Service, Hospital/statistics & numerical data , Health Care Surveys , Health Services Accessibility/statistics & numerical data , Humans , Patient Care Management/methods , Patient Care Management/standards , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians'/statistics & numerical data , Renal Colic/diagnosis , Renal Colic/etiology , Renal Colic/therapy , United States , Ureteral Calculi/complications
6.
Urol Case Rep ; 6: 33-5, 2016 May.
Article in English | MEDLINE | ID: mdl-27175340

ABSTRACT

Seminal vesicle (SV) adenocarcinoma is a rare and poorly understood malignancy. Symptoms are non-specific and prognosis is extremely poor. Herein we present a case report of a primary SV clear cell adenocarcinoma with bilateral orbital metastases at the time of initial presentation treated with multimodal therapy including radiotherapy and multi-drug chemotherapy.

7.
Urology ; 85(4): 869-75, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25681831

ABSTRACT

OBJECTIVE: To analyze the outcomes of patients with urothelial-type bladder cancer (UBC) who optimally met selection criteria for bladder preservation therapy (BPT) but were treated with radical cystectomy (RC) instead. METHODS: We identified consecutive patients with clinical stage cT2N0M0 UBC who underwent RC with curative intent at our center. Patients without carcinoma in situ, hydronephrosis, multifocality, or mixed histology were classified as BPT eligible. Patients with ≥1 contraindications were considered BPT ineligible. Clinicopathologic characteristics and survival outcomes for BPT-eligible patients were compared with those of the ineligible patients. RESULTS: Of the 275 patients who had cT2N0M0 UBC, 157 (57.1%) were BPT ineligible (carcinoma in situ = 54; hydronephrosis = 77; multifocality = 29; mixed histology = 55; ≥2 contraindications = 51). BPT-eligible and -ineligible patients did not statistically differ with regard to age, sex, race, or neoadjuvant chemotherapy. Of the BPT-eligible patients, 24.1% had occult positive lymph nodes and 36.4% had pT3 or pT4 tumors at RC. On multivariate analysis, mixed histology (odds ratio = 3.18; 95% confidence interval [CI], 1.18-8.56) and progression from noninvasive disease to cT2 (odds ratio = 4.81 [95% CI, 1.67-13.85]) were independently associated with upstaging. Two-year overall survival was higher in BPT-eligible patients (76.7% vs 57.1%; P = .003; hazard ratio = 0.48 [95% CI, 0.3-0.78]). BPT-eligible patients also had better cancer-specific mortality on competing risk analysis (sub-hazard ratio = 0.46 [95% CI = 0.29-0.72]; P = .001). CONCLUSION: Substantial clinicopathologic stage discrepancies occurred even in patients seemingly ideal for BPT, which may provide insight into BPT failures. Furthermore, substantial survival discrepancies existed for BPT-eligible and BPT-ineligible patients, underscoring the heterogeneity of cT2 disease. In the absence of randomized trials, comparisons between RC and BPT must factor in selection bias.


Subject(s)
Carcinoma/surgery , Cystectomy , Organ Sparing Treatments , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/surgery , Aged , Carcinoma/secondary , Carcinoma in Situ/surgery , Contraindications , Cystectomy/adverse effects , Female , Follow-Up Studies , Humans , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , Neoplasm, Residual , Retrospective Studies , Survival Rate , Urothelium
8.
Urology ; 85(3): 664-6, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25582817

ABSTRACT

Extrarenal malignant rhabdoid tumors (MRTs) are rare tumors with a poor prognosis. Five-year overall survival for patients with MRTs is poor at approximately 20%.(1) There are 5 case reports of histologically confirmed primary MRT of the bladder in pediatric patients. Herein, we report a case of an MRT of the bladder in a 14-year-old boy and discuss the preoperative evaluation, treatment options, and possible etiologies of metastasis after radical surgery.


Subject(s)
Rhabdoid Tumor/surgery , Urinary Bladder Neoplasms/surgery , Adolescent , Disease Progression , Humans , Male , Time Factors
9.
Urology ; 79(2): 440-2, 2012 Feb.
Article in English | MEDLINE | ID: mdl-21940042

ABSTRACT

Benign testicular enlargement secondary to diffuse interstitial fibrosis is a rare clinical entity, especially in pediatric patients. To our knowledge, this is the first pediatric case reported of benign testicular enlargement due to interstitial fibrosis in a cryptorchid testis. We report a rare case of an 11-month-old boy with a cryptorchid testis found intraoperatively to have an asymmetrically enlarged testis secondary to diffuse, benign interstitial fibrosis of the testis. Additionally, we discuss previous case reports of testicular enlargement due to interstitial fibrosis, the potential etiology and the management.


Subject(s)
Cryptorchidism/pathology , Testis/pathology , Biopsy , Cryptorchidism/diagnostic imaging , Cryptorchidism/surgery , Diagnosis, Differential , Fibrosis , Frozen Sections , Humans , Infant , Male , Organ Size , Testicular Neoplasms/diagnosis , Testis/diagnostic imaging , Testis/surgery , Ultrasonography
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