Presenting Complications to a Reconstructive Urologist After Masculinizing Genital Reconstructive Surgery.

Objective: To evaluate the presenting complications of patients to reconstructive urologists after masculinizing gender affirming genital reconstructive surgery (GRS) performed elsewhere.

Methods: We identified patients who underwent revision surgery by one of the co-authors for sequelae of masculinizing GRS. We reviewed patient demographics, medical history, details of prior GRS, and complications from GRS.

Robotic transanal minimally invasive rectal mucosa harvest.

Introduction: Buccal mucosal grafts (BMG) are traditionally used in urethral reconstruction. There may be insufficient BMG for applications requiring large grafts, such as urethral stricture after gender-affirming phalloplasty. Rectal mucosa in lieu of BMG avoids oral impairment, while potentially affording less postoperative pain and larger graft dimensions.

Multicenter analysis of posterior urethroplasty complexity and outcomes following pelvic fracture urethral injury.

Purpose: To analyze outcomes of posterior urethroplasty following pelvic fracture urethral injuries (PFUI) and to determine risk factors for surgical complexity and success.

Methods: Patients who underwent posterior urethroplasty following PFUI were identified in the Trauma and Urologic Reconstructive Network of Surgeons (TURNS) database. Demographics, injury patterns, management strategies, and prior interventions were evaluated.

Multi-Institutional Outcomes of Minimally Invasive Harvest of Rectal Mucosa Graft for Anterior Urethral Reconstruction.

Purpose: We report multi-institutional outcomes in patients who underwent urethroplasty with a rectal mucosa graft.

Materials And Methods: We used the TURNS (Trauma and Urologic Reconstructive Network of Surgeons) database to identify patients who underwent urethral reconstruction with transanal harvest of a rectal mucosa graft. We reviewed preoperative demographics, stricture etiology, previous management and patient outcomes.

Contemporary analysis of management of isolated pendulous urethral strictures using pedicled skin flap urethroplasty repair.

Objectives: To evaluate contemporary outcomes of urethroplasty employing a pedicled skin flap for isolated pendulous urethral strictures.

Subjects/patients: Inclusion of males > 18 years of age with isolated pendulous urethral strictures treated between 1996 and 2012.

Results: A total of 81 patients with isolated pendulous urethral stricture were identified.

Robotic Davydov Peritoneal Flap Vaginoplasty for Augmentation of Vaginal Depth in Feminizing Vaginoplasty.

Purpose: Penile inversion vaginoplasty is the most common procedure for genital reconstruction in transwomen. While penile inversion vaginoplasty usually provides an excellent aesthetic result, the technique may be complicated by vaginal stenosis and inadequate depth, especially in transwomen with limited penile and scrotal tissue. We describe a technique of using peritoneal flaps to augment the neovaginal apex and canal in penile inversion vaginoplasty for transwomen.

Robotics and urologic reconstructive surgery.

Minimally invasive surgery has made a profound impact on how urologists approach the challenges in reconstruction of the urinary tract. The advent of laparoscopic approaches to reconstructive urology have demonstrated comparable outcomes to open surgery with improved morbidity. The recent adoption of robotic surgery has seen further advancements such as improved visibility and, freedom of movement, and an easier technical learning curve.

A Critical Analysis of Bulbar Urethroplasty Stricture Recurrence: Characteristics and Management.

Purpose: We evaluated the management of recurrent bulbar urethral stricture disease after urethroplasty at our institution.

Materials And Methods: We performed an institution review board approved, retrospective case study of our urethroplasty database to collect stricture related and postoperative information with an emphasis on bulbar urethral stricture disease recurrence after urethroplasty between 1996 and 2012. Repair types included primary anastomotic, augmented anastomotic and onlay repair.

Patency and Incontinence Rates After Robotic Bladder Neck Reconstruction for Vesicourethral Anastomotic Stenosis and Recalcitrant Bladder Neck Contractures: The Trauma and Urologic Reconstructive Network of Surgeons Experience.

Objective: To review a robotic approach to recalcitrant bladder neck obstruction and to assess success and incontinence rates.

Materials And Methods: Patients with a recalcitrant bladder neck contracture or vesicourethral anastomotic stenosis who underwent robotic bladder neck reconstruction (RBNR) were identified. We reviewed patient demographics, medical history, etiology, previous endoscopic management, cystoscopic and symptomatic outcomes, urinary continence, and complications.

Robotic Y-V Plasty for Recalcitrant Bladder Neck Contracture.

Objective: To demonstrate the technique and the outcomes of robot assisted Y-V plasty bladder neck reconstruction (RYVBNR).

Methods: We present our technique for treatment of recalcitrant bladder neck contracture (BNC) in 7 patients who underwent RYVBNR at our institution between March 2016 and September 2017. Indication for the procedure was incomplete emptying, recurrent urinary tract infections, and dysuria.

Reconstructive Management Pearls for the Transgender Patient.

Purpose Of Review: A growing number of transgender patients are seeking gender-affirming genital reconstructive surgery (GRS). These complex procedures have high complication rates. We describe common surgical pitfalls in GRS and approaches for minimizing complications.

Survey on the Contemporary Management of Intraoperative Urethral Injuries During Penile Prosthesis Implantation.

Background: Intraoperative urethral injury is an uncommon event during the placement of a penile prosthesis, and alternative management strategies have been proposed with continuation of implantation after urethral injury.

Aim: To evaluate surgeon practices in the management of intraoperative urethral injury.

Methods: An online survey was sent to the society listservs of the Genitourinary Reconstructive Surgeons (GURS) and the Sexual Medicine Society of North America (SMSNA).

Effect of Lichen Sclerosis on Success of Urethroplasty.

Lichen sclerosis (LS) is a chronic, relapsing disease with a variable presentation. In men, genitourinary LS may affect the penile foreskin, glans, meatus, and urethra. Treatment is multifaceted, ranging from pharmacotherapy to surgery.

A Nationwide Assessment of the Emergency Department Management of Acute Urinary Retention Due to Urethral Stricture.

Objective: To evaluate the nationwide practice patterns of the management of acute urinary retention (AUR) secondary to urethral stricture (US) in an emergency department (ED) setting.

Materials And Methods: We used the 2006-2010 Nationwide Emergency Department Sample to identify men with US who received treatment for AUR. We excluded patients with benign prostatic hyperplasia, vesicourethral anastomotic stenosis, neurogenic bladder, and bladder cancer.

High Flow Priapism in a Pediatric Patient after Circumcision with Dorsal Penile Nerve Block.

We report the first documented case of high flow priapism after circumcision with dorsal penile nerve block. A 7-year-old male who had undergone circumcision three years before presented to our institution with a 3-year history of persistent nonpainful erections. Workup revealed a high flow priapism and, after discussion of the management options, the patient's family elected continued observation.

A Critical Evaluation of the Utility of Imaging After Urethroplasty for Bulbar Urethral Stricture Disease.

Objective: To determine the incidence of extravasation on initial postoperative pericatheter retrograde urethrogram (pcRUG) after bulbar urethroplasty and the relationship to repair type.

Materials And Methods: We performed a retrospective review to collect stricture-related and postoperative information with emphasis on pcRUGs. All men had a pcRUG at the initial follow-up appointment.

Utilization of surgical procedures and racial disparity in the treatment of urinary incontinence after prostatectomy.

Aims: To analyze the rates of incontinence procedures after radical prostatectomy, and define the variables associated with them.

Methods: We conducted an IRB approved retrospective review of patients with prostate cancer who underwent radical prostatectomy at a single institute from January 1998 to December 2012. Logistic regression and time to event analyses were performed to ascertain variables associated with receipt of incontinence procedure after prostatectomy.

Critical Analysis of Patient-reported Complaints and Complications After Urethroplasty for Bulbar Urethral Stricture Disease.

Objective: To evaluate the full spectrum of postoperative complications and patient-reported complaints after urethroplasty for bulbar urethral stricture disease.

Materials And Methods: We performed a retrospective review of our institutional database for all patients who underwent urethroplasty from January 1, 2002 to December 1, 2012. We recorded all postoperative complications and patient-reported complaints and grouped them by the Clavien-Dindo classification of surgical complications and into the following categories: perioperative, infectious, anatomic, sexual dysfunction, and voiding related.

Scrotal and perineal sensory neuropathy after urethroplasty for bulbar urethral stricture disease: an evaluation of the incidence, timing, and resolution.

Objective: To examine the timing, incidence, and resolution of scrotal and perineal sensory neuropathy after urethroplasty for bulbar urethral stricture disease.

Materials And Methods: We performed an institutional review board--approved retrospective review of our urethroplasty database with specific attention paid to patient demographics, stricture location, repair type, and postoperative sensory neuropathy defined as the complaint of hypesthesia, anesthesia, paresthesia, hyperesthesia, and pain in the scrotal and perineal region after surgery. Incidence and reported times to onset and resolution of sensory neuropathy were compared among our cohort.

The management of bulbar urethral stricture disease before referral for definitive repair: have practice patterns changed?

Objective: To describe the management of patients with bulbar urethral stricture disease before referral for definitive urethroplasty and determine if practice patterns have changed with respect to endoscopic interventions.

Materials And Methods: We performed an institutional review board-approved retrospective review and recorded patient demographics, stricture-related information, and all procedures performed for bulbar urethral stricture disease before initial presentation at our institution. Included procedures were: UroLume stent (AMS, Minnetonka, MN), laser urethrotomy, direct visual urethrotomy (DVIU), and dilation of urethral stricture.

The evolution of urethroplasty for bulbar urethral stricture disease: lessons learned from a single center experience.

Purpose: We reviewed the evolution of repairs for bulbar urethral stricture disease and analyzed changes in outcomes.

Materials And Methods: We retrospectively reviewed the records of 429 men who underwent urethroplasty for bulbar urethral stricture disease from January 1996 to September 2011. Patient demographics, stricture related details, and intraoperative and postoperative information were collected.