The Right Instrument for the Right Purpose: Spreading the Use of Small Caliber Ureteroscope for the Inspection of the Male and Female Urethra

Kulkarni, Sanjay; Bandini, Marco; Patil, Amey; Bhadranavar, Shreyas; Sharma, Vipin; Bafna, Sandeep; Yatam, Shreeranga L.; Barbagli, Guido; Montorsi, Francesco; Joshi, Pankaj

doi:10.48083/nvko4969

Cited by 8 publications

(3 citation statements)

References 13 publications

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“…Patients were defined as eligible for the technique if they had a non-traumatic bulbar stricture. Additionally, the narrowest portion of the stricture (where the calibre was <7 F [1.5 cm]) should have not exceeded 1.5 cm in length [8]. The study was approved by the Institutional Ethics Committee (KESI/22006).…”

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confidence: 99%

Mucosal‐sparing augmented non‐transected anastomotic (MsANTA) urethroplasty: a step forward in ANTA urethroplasty

2022

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The surgical advancement of urethral reconstruction is a rapidly moving field. In the last decade, the technique for bulbar urethroplasty has evolved towards less invasive approaches with minimal transection and more tissue sparing in order to increase the patency rate. In this study, we provide a step forward in the augmented non‐transected anastomotic (ANTA) urethroplasty proposed in 2012, with a true mucosa‐sparing modification of the technique. In detail, the bulbar urethral lumen is approached with either a ventral or dorsal urethrotomy. Differently from previous techniques, the native urethral mucosa is neither transected nor resected but is reconstructed with a direct mucosa‐to‐mucosa anastomosis. This allows a complete sparing of communicant vessels that come from the corpus spongiosum to the urethral mucosa. The technique aims to preserve the native vascularity of the urethral mucosa by enlarging the native urethral plate with a direct anastomosis at the level of the stricture, and without the need for resection. In our hands the technique was easy and reproducible, and it carried promising results in the preliminary cohort where it was applied.

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Mucosal‐sparing augmented non‐transected anastomotic (MsANTA) urethroplasty: a step forward in ANTA urethroplasty

2022

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“…Assessment of stricture length was carried out using retrograde urethrography (RGU) and voiding cystourethrography (VCUG) on the day of surgery. Moreover, urethrocystoscopy with the use of small caliber rigid/flexible endoscopes to evaluate stricture length, caliber, and the appearance of the urethral mucosa and the bladder neck was performed in each patient prior to the surgery [ 9 ]. Abdominal and pelvic computed tomography (CT) and magnetic resonance urethrography (MRU) were completed in selected cases [ 10 ].…”

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Management of Pelvic Fracture Urethral Injury: Is Supracrural Urethral Rerouting (Step 4) Becoming Anecdotical or Does It Remain in Force?

Yepes

Oszczudłowski

Bandini

et al. 2023

JCM

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Webster described a step-based perineal approach for repairing the posterior urethra in patients with pelvic fracture urethral injury (PFUI). The higher the complexity of the step, the higher the morbidity for the patient and the lower the surgical outcomes. We evaluated the outcomes of anastomotic urethroplasty (especially Step 4 or higher) or substitution urethroplasty in patients with PFUI at our center. Between 2013 to 2021, we retrospectively collected data on patients with PFUI. Surgical procedures were categorized according to the Webster classification and rates of each step were reported. The success rate was defined as Qmax above 10 mL/s and no need for further treatment. In this period, 737 male patients with PFUI were surgically treated. Notably, 18.8%, 17.6%, 46%, 1.8%, and 5.6% of included patients received steps 1, 2, 3, and 4 and the abdominoperineal approach, respectively. In 68 (9.2%) patients, the substitution of urethroplasty with a pedicled preputial tube (PPT) was needed. The success rate was 69.2% in Step 4, 74.4% in the abdominoperineal approach, and 86.4% in PPT; however, recurrence-free survival was not significantly different between groups (p = 0.22). Step 4 perineal anastomotic urethroplasty represents a surgical option in the armamentarium of PFUI treatment. Indications should be carefully reviewed to improve patient selection and avoid surgical failure, stopping at the step which first gives a tension-free anastomosis.

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“…All patients underwent preoperative clinical evaluation: with history, physical examination, urine culture, serum creatinine, uroflow (when possible) and ultrasonography of abdomen and assessment of stricture length was done using retrograde urethrography (RUG) and voiding cystourethrography (VCUG) on the day of surgery (under anaesthesia in uncooperative children). We always performed urethroscopy using antegrade cystoscopy using small calibre rigid/flexible endoscopes (4.5-7.5 F) before starting the surgery [10]. We analysed the baseline demographic parameters (age, mechanism of injury, length of defect, site and type of defect, all previous interventions performed), treatment details (surgery performed, surgical approach, ancillary procedures, number of blood transfusions, total hospital stay), and complications [11].…”

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confidence: 99%

Comprehensive analysis of paediatric pelvic fracture urethral injury: a reconstructive centre experience

et al. 2022

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To analyse our experience in pelvic fracture urethral injury (PFUI) in children and adolescents, with various anastomotic urethroplasties (AUs) used to accomplish tension-free anastomosis described and their surgical outcomes evaluated. Patients and methodsFrom 2008 to 2019, 192 cases including both primary and redo PFUI, which comprised 181 boys and 11 girls aged ≤18 years. The results are presented separately according to gender. Moreover, the two populations were divided in two age-related sub-groups for sensitivity analyses: Group 1 (children) aged ≤11 years and Group 2 (adolescent) aged 12-≤18 years. ResultsThe median (interquartile range [IQR]) age at presentation in our series was 14 (9-17) years for boys and 9 (6-10) years for girls. Primary vs redo cases were 85 (47%) vs 96 (53%) in boys and 10/11 vs one of 11 in girls. In the primary male cases (85), the bulbo-membranous junction was the commonest site of injury (63, 74.1%). In boys, transperineal AU (TPAU) was performed in 160 (88.4%) and transpubic urethroplasty (TPU) in 17 (9.4%). In girls, TPU was utilised in nine cases, where two received meatoplasty and vaginal episiotomy. In boys, the overall success rate for TPAU was 81.2% and in primary PFUI cases success for TPAU was 88.3%. Overall success for TPU was 64.7%. In girls, the success rate for TPU was 100%. In boys and girls, the success rates for various AUs utilised between the child and adolescent groups were comparable. The median (IQR) hospital stay was 3 (3-4) days for boys and girls. The median (IQR) followup duration was 25 (16-33) months and 20 (17-27) months for boys and girls, respectively. Secondary procedures were performed in 39 boys and one girl, which comprised laser optical internal urethrotomy in 26 (14.4%) boys and redo surgery in 13 (7.2%) boys and one (9.1%) girl. Of all patients, four of the 11 girls and 74 boys (38.5%) were lost to follow-up. ConclusionsMost paediatric PFUI can be addressed via a transperineal approach with reasonable long-term outcomes. In challenging cases salvage procedures utilising vascular-based flaps as a urethral substitute give satisfactory results. Even young children can be managed with a high success rate in expert hands and these injuries should be addressed by specialist reconstructive urologists.

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The Right Instrument for the Right Purpose: Spreading the Use of Small Caliber Ureteroscope for the Inspection of the Male and Female Urethra

Cited by 8 publications

References 13 publications

Mucosal‐sparing augmented non‐transected anastomotic (MsANTA) urethroplasty: a step forward in ANTA urethroplasty

Mucosal‐sparing augmented non‐transected anastomotic (MsANTA) urethroplasty: a step forward in ANTA urethroplasty

Management of Pelvic Fracture Urethral Injury: Is Supracrural Urethral Rerouting (Step 4) Becoming Anecdotical or Does It Remain in Force?

Comprehensive analysis of paediatric pelvic fracture urethral injury: a reconstructive centre experience

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