Overcoming Understaging and Undergrading in Upper Tract Urothelial Carcinoma. Comment on Ghoreifi et al. Modern Kidney-Sparing Management of Upper Tract Urothelial Carcinoma. 2023, , 4495.

Kidney-sparing management for upper tract urothelial carcinoma (UTUC) has become more common but is still most limited by inaccurate histopathologic diagnosis [...

Upper Tract Tumor En Bloc Enucleation: A Novel Approach to the Diagnosis and Management of Upper Tract Urothelial Carcinoma.

Objectives: To describe and demonstrate our novel en bloc enucleation technique for the endoscopic diagnosis and treatment of upper tract tumors.

Methods: We detail the instruments required for this procedure, as well as the surgical technique to perform an en bloc enucleation and specimen removal. Endoscopic video of a 2 cm renal pelvis tumor demonstrates all aspects of the technique, and histopathologic slides illustrate the diagnostic information obtained.

Excision and Primary Anastomosis Reconstruction for Traumatic Strictures of the Pendulous Urethra.

Objectives: To present a multi-institutional experience with functional and patient-reported outcomes among men undergoing excision and primary anastomosis (EPA) urethroplasty for pendulous urethral strictures.

Methods: We describe the technique and present our experience with EPA for focal penile strictures. Patients undergoing urethroplasty (2004-2017) at 2 tertiary referral centers were reviewed, of whom 14 (0.

Augmented urethroplasty with pseudospongioplasty in the treatment of penile strictures.

Strictures involving the penile urethra generally require tissue transfer techniques. Ventral graft placement usually is avoided in the penile urethra because of the relative paucity of viable corpus spongiosal tissue necessary for vascularization and support. Instead, grafts are commonly placed dorsally using either an onlay or inlay technique.

Contemporary management of small renal tumors.

The incidence of kidney cancer in the United States is rising because the increased use of cross-sectional imaging is resulting in more tumors being detected and because the population is aging. In addition, a stage migration in kidney cancer has been observed—again because of improved detection—with an increase in stage T1 tumors and a concomitant decrease in the number of stage T2 to T4 tumors. Recent studies have shown that up to 80% of small renal tumors (SRTs) either have an indolent course or are histologically benign.

Iatrogenic nonendoscopic bladder injuries over 24 years: 127 cases at a single institution.

Objective: To analyze the etiology, diagnosis, and long-term outcomes of iatrogenic nonendoscopic bladder injuries over a 24-year period.

Methods: All iatrogenic bladder injuries were entered prospectively into our database from 1990 to 2014. Information gathered included causative procedure, injury characteristics, management, and outcome.

Pseudospongioplasty using periurethral vascularized tissue to support ventral buccal mucosa grafts in the distal urethra.

Purpose: For ventral buccal mucosa graft onlay during bulbar urethroplasty, spongioplasty with advancement and closure of the corpus spongiosum is ordinarily performed to stabilize the graft. In the pendulous and distal bulbar urethra the spongiosum is often too thin to allow complete graft coverage. We describe the results of what to our knowledge is a novel technique for ventral graft coverage using periurethral vascularized tissue.

Single-surgeon experience of 87 buccal mucosal graft harvests.

Unlabelled: Although buccal mucosa has been the preferred graft material for use in the reconstruction of anterior urethral strictures for approximately 20 years, the plastic surgery literature is lacking in studies describing and evaluating this technique. The authors sought to report their experience with the technique of buccal mucosa graft harvest for use in urethral reconstruction. The authors identified 87 consecutive patients who underwent buccal mucosal graft harvesting during a 15-year period from 1995 to 2010.

Perioperative patient radiation exposure in the endoscopic removal of upper urinary tract calculi.

Background And Purpose: The efficacy of computed tomography (CT) in detailing upper urinary tract calculi is well established. There is no established acceptable annual recommended limit for medical exposure, yet the global accepted upper limit for occupational radiation exposure is <50 millisieverts (mSv) in any one year. We sought to appreciate the CT and fluoroscopic radiation exposure to our patients undergoing endoscopic removal of upper tract calculi during the periprocedure period.

A randomized prospective trial of primary versus AlloDerm closure of buccal mucosal graft harvest site for substitution urethroplasty.

Objectives: To present a prospective, randomized trial comparing primary and AlloDerm closure of the oral harvest site. The use of buccal mucosa grafts for substitution urethroplasty is an established and durable technique. The optimal management of the buccal mucosa grafts harvest site for the intraoral defect has yet to be determined.

Xanthogranulomatous orchitis in a patient with a history of instrumentation and bacillus Calmette-Guérin therapy.

Xanthogranulomatous orchitis (XGO) is a rare histological finding that is generally diagnosed at orchiectomy. To date, fewer than 10 reports of XGO exist in the literature. The exact pathogenesis of XGO is unknown and patients may present with a rapid onset of symptoms or a longer, more indolent course.

The poppy seed test for colovesical fistula: big bang, little bucks!

Purpose: Diagnosis of a colovesical fistula is often challenging, and usually involves numerous invasive and expensive tests and procedures. The poppy seed test stands out as an exception to this rule. We evaluated the accuracy and cost-effectiveness of various established diagnostic tests used to evaluate a suspected colovesical fistula.

Scrotal reconstruction using rapid intraoperative tissue expansion: a preliminary report.

Purpose: Extensive scrotal skin loss can pose a difficult management problem. In most cases delayed scrotal approximation is feasible due to the redundancy of scrotal skin. However, large defects usually require reconstruction using flaps or grafts.

Influence of prostate volume and percent free prostate specific antigen on prostate cancer detection in men with a total prostate specific antigen of 2.6 to 10.0 ng/ml.

Purpose: Percent free prostate specific antigen and prostate specific antigen density have been independently shown to increase the specificity of prostate cancer screening in men with prostate specific antigen levels between 4.1 and 10.0 ng/ml.

Simplified reconstruction of posterior urethral disruption defects: limited role of supracrural rerouting.

Purpose: We present our combined experience with a simplified posterior urethroplasty technique to determine the necessity and usefulness of ancillary reconstructive maneuvers.

Materials And Methods: We reviewed the records of 135 men and 7 boys who underwent reconstruction of traumatic posterior urethral defects with greater than 1 year of followup from 5 tertiary teaching hospitals. Prior treatments, surgical approach and ancillary techniques required during reconstruction were compiled.

Preliminary report on use of AlloDerm for closure of intraoral defects after buccal mucosal harvest.

The ideal method for managing the intraoral defect after harvesting buccal mucosa for urethral reconstruction has not been clearly established. We describe a novel technique using AlloDerm to cover the harvest site, providing a simple means for a potentially less painful tension-free closure.

Extracorporeal shock wave lithotripsy success based on body mass index and Hounsfield units.

Objectives: To determine whether body mass index (BMI) and Hounsfield units (HUs) could be used as independent predictors of stone-free status after extracorporeal shock wave lithotripsy (ESWL). No detailed studies have assessed BMI as an independent predictor of ESWL outcome. Some studies have suggested that HUs of urinary calculi on noncontrast computed tomography may predict the stone-free rate after ESWL.

Efficacy of high-energy transurethral microwave thermotherapy in alleviating medically refractory urinary retention due to benign prostatic hyperplasia.

Objectives: To determine the efficacy of high-energy transurethral microwave thermotherapy (HE-TUMT) in treating patients with medically refractory complete urinary retention secondary to benign prostatic hyperplasia (BPH).

Methods: Between April 2000 and July 2003, 39 patients in urinary retention due to BPH were treated with HE-TUMT. A Foley catheter was reinserted after HE-TUMT and removed at 3 weeks for a voiding trial.

Urethroplasty in patients older than 65 years: indications, results, outcomes and suggested treatment modifications.

Purpose: Despite an aging population, the results of urethroplasty in elderly patients have not been extensively reported. We performed a multi-institutional review of urethroplasty results in 70 elderly males to determine outcomes.

Materials And Methods: We reviewed all urethroplasties performed on males older than 64 years with at least 6 months of followup at 4 medical centers.