Trauma/Reconstruction: 92% success rate for robotic ureteroplasty

Laura S. Leddy, MDOther key studies in trauma/reconstruction from AUA 2017 evaluated transcorporal artificial urinary sphincter placement using local tunica albuginea flaps and a model for predicting the risk of urethral stricture recurrence after anterior urethroplasty. The Trauma/Reconstruction take-home messages were presented by Laura S. Leddy, MD, of Memorial Sloan Kettering Cancer Center, New York.

Robotic ureteroplasty using buccal mucosa grafts in patients with proximal or mid-ureteral strictures not amenable to ureteroureterostomy was associated with a 92% success rate after follow-up of 17 months.

Low testosterone was more common in men undergoing anterior urethral stricture repair compared with aged-matched controls.

Nanofibers impregnated with anti-inflammatory peptides improved wound healing in a rat model of substitution urethroplasty.

Careful patient selection based on evaluation of the state of the pubis and pubic symphysis and of bladder function is needed to achieve good outcomes with open repair of bladder neck contracture in men with a history of radiotherapy.

Compared with men who have not had radiotherapy, irradiated patients undergoing repair of urorectal fistulae are more likely to be operated on with an abdomino-perineal technique than with a transperineal approach, but the success rate with abdomino-perineal surgery was good in both groups.

• Transcorporal artificial urinary sphincter (AUS) placement using local tunica albuginea flaps was found to be a safe and viable technique in a high-risk group of 11 patients. It was associated with a 27% explantation rate, but all patients with successful AUS placement were using ≤1 pad/day.

• A model for predicting the risk of urethral stricture recurrence after anterior urethroplasty demonstrated moderate sensitivity and specificity. The researchers hope to improve its performance after the number of cases in their database increases.

• Compared with radial free flaps for neophallus reconstruction, ulnar free flaps were associated with significantly lower fistula rate and a trend for a lower stricture rate. The investigators will be analyzing the morbidity of the donor sites.

• Previous repeated transurethral manipulation increases stricture complexity that may lead to a change in the type of urethroplasty performed compared with the repair planned based on urethrography at initial diagnosis.

• In an analysis of data from two tertiary referral hospitals, the incidence of traumatic urethral catheterization over a 6-month period was 6.7 per 1,000 catheters inserted. These events increased cost and length of hospital stay and often led to Clavien-Dindo grade 2 or greater complications. Based on an experimental model investigating the strain and pressure leading to urethral rupture, the investigators developed an inexpensive safety valve that attaches to the syringe used to inflate the balloon. So far, the valve was used in 100 patients with no urethral injuries.

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