Laparoscopic Omentoplasty to Support Anastomotic Urethroplasty in Complex and Redo Pelvic Fracture Urethral Defects

Kulkarni, Sanjay; Barbagli, Guido; Joshi, Pankaj; Hunter, Craig; Shahrour, Walid; Kulkarni, Jyotsna; Sansalone, Salvatore; Lazzeri, Massimo

doi:10.1016/j.urology.2014.12.055

Cited by 9 publications

(9 citation statements)

References 4 publications

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“…We have used gracilis ( n = 3), surrounding perineal fat (akin to Martius pad of fat) ( n = 4) and one limb of bulbospongiosus ( n = 2) muscle as vascular intervening tissue. However, a major advancement has been our technique of laparoscopic omentoplasty wherein omentum was transferred to the perineum avoiding a transpubic approach [23] ( Fig. 7 C and 7 D).…”

Section: Resultsmentioning

confidence: 99%

Management of complex and redo cases of pelvic fracture urethral injuries

Kulkarni

Surana

Desai

et al. 2018

Asian Journal of Urology

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ObjectivesPelvic fracture urethral injuries (PFUI) result from traumatic disruption of the urethra. A significant proportion of cases are complex rendering their management challenging. We described management strategies for eight different complex PFUI scenarios.MethodsOur centre is a tertiary referral centre for complex PFUI cases. We maintain a prospective database (1995–2016), which we retrospectively analysed. All patients with PFUI managed at our institute were included.ResultsOver two decades 1062 cases of PFUI were managed at our institute (521 primary and 541 redo cases). Most redo cases were referred to us from other centres. Redo cases had up to five prior attempts at urethroplasty. We managed complex cases, which included bulbar ischemia, young boys and girls with PFUI, PFUI with double block, concomitant PFUI and iatrogenic anterior urethral strictures. Bulbar ischemia merits substitution urethroplasty, most commonly, using pedicled preputial tube. PFUI in young girls is usually associated with urethrovaginal fistula. Young boys with PFUI commonly have a long gap necessitating trans-abdominal approach. Our success rate with individualised management is 85.60% in primary cases, 79.13% in redo cases and 82.40% in cases of bulbar ischemia.ConclusionThe definition of complex PFUI is ever expanding. The best chance of success is at the first attempt. Anastomotic urethroplasty for PFUI should be performed in experienced hands at high volume centres.

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Section: Resultsmentioning

confidence: 99%

Management of complex and redo cases of pelvic fracture urethral injuries

Kulkarni

Surana

Desai

et al. 2018

Asian Journal of Urology

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“…Twenty-two studies described the use of anastomotic end-to-end urethroplasty in 893 patients (Table 1). AU was used to treat anterior strictures in 32% ( n = 7) [11, 14, 17, 18, 20, 25, 29], posterior strictures in 45% ( n = 10) [13, 15, 19, 23, 26, 28–30, 45, 46] and mixed bulbo-membranous strictures in 14% ( n = 3) [15, 27, 29] of the studies which were reviewed. Five studies ( n = 5) [12, 16, 21, 22, 24] did not provide information on the location of the stricture.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies ( n = 5) [12, 16, 21, 22, 24] did not provide information on the location of the stricture. Additionally, over half ( n = 12) of the studies did not report the mean length of the urethral stricture treated, with only three studies [17, 27, 45] reporting the mean stricture length specifically for the patients who underwent the anastomotic procedure as 2.1 cm for bulbar, 2.8 cm for membranous and 4.2 cm for bulbo-membranous strictures. The mean follow-up ranged from 4 to 70 months in the studies reviewed.…”

Section: Resultsmentioning

confidence: 99%

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Redo-urethroplasty for the management of recurrent urethral strictures in males: a systematic review

et al. 2019

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Purpose Redo-urethroplasty is a challenge for any genitourethral surgeon, with a number of techniques previously described. This systematic review aims to identify the surgical techniques described in the literature and evaluate the evidence for their effectiveness in managing recurrent urethral strictures. Materials and methods A systematic review of the MEDLINE and EMBASE databases from 1945 to July 2018 was performed and the urethroplasty procedures were classified according to the site and surgical technique. Primary outcomes included success rates measured via re-stricture rates and the post-op maximum urinary flow rate. Secondary outcomes included complication rates and patient-reported quality of life. Results A total of 39 identified studies met the inclusion criteria. Twenty-two studies described the use of excision and primary anastomotic urethroplasty with success rates showing wide variability (58–100%). Success rates reported according to the site of the stricture also varied: bulbar (58–100%) and posterior (69–100%) recurrent strictures. One-stage substitution urethroplasty was described in 25 studies with success rates of 18–100%, with the best outcomes reported for bulbar (58–100%) and hypospadias-related (78.6–82%) strictures. Two-stage substitution urethroplasty was described in 12 studies with the success rates of 20–100%, with the best evidence related to hypospadias-related and posterior urethral strictures. The buccal mucosa graft was the graft source with the best evidence for substitution urethroplasty (18–100%). Conclusions Trends of effectiveness were identified for redo-urethroplasty modalities in different locations. However, the current levels of evidence are limited to small observational studies, highlighting the need for further larger prospective data to evaluate different techniques used for recurrent urethral strictures. Electronic supplementary material The online version of this article (10.1007/s00345-019-02709-7) contains supplementary material, which is available to authorized users.

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“…Four studies (4.8%) related to preclinical research (IDEAL phase 0). The 43 remaining original research studies that applied IDEAL were mapped to the corresponding IDEAL stage: IDEAL with nine (20.9%), 27 (62.8%), four (9.3%), 0 (0%), and three (7.0%) publications, respectively .…”

Section: Resultsmentioning

confidence: 99%

Use of the IDEAL framework in the urological literature: where are we in 2018?

2019

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ObjectivesTo assess uptake and application of the IDEAL principles in original surgical procedure-or device-related clinical research studies, as well as its reported relevance as characterized by secondary publications, editorials and reviews. ConclusionsThe IDEAL framework has found widespread adoption in the urology literature as witnessed by a large number of original manuscripts and secondary publications citing IDEAL; however, its application is largely limited to the early stages of surgical innovation, frequently with inappropriate and incomplete implementation. Further efforts are needed to guide investigators in the optimal use of the IDEAL framework as it relates to surgical innovation in urology.Abbreviation: IQR, interquartile range.

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Laparoscopic Omentoplasty to Support Anastomotic Urethroplasty in Complex and Redo Pelvic Fracture Urethral Defects

Cited by 9 publications

References 4 publications

Management of complex and redo cases of pelvic fracture urethral injuries

Management of complex and redo cases of pelvic fracture urethral injuries

Redo-urethroplasty for the management of recurrent urethral strictures in males: a systematic review

Use of the IDEAL framework in the urological literature: where are we in 2018?

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