Management of pediatric renal trauma: Results from the American Association for Surgery and Trauma Multi-Institutional Pediatric Acute Renal Trauma Study.

Background: Pediatric renal trauma is rare and lacks sufficient population-specific data to generate evidence-based management guidelines. A nonoperative approach is preferred and has been shown to be safe. However, bleeding risk assessment and management of collecting system injury are not well understood.

Testicular rupture following rubber bullet trauma case report.

Following civil unrest during 2020, physicians began to notice a variety of injuries resulting from crowd control weapons. While prior research emphasized ocular trauma, genitourinary complications of injuries have yet to be investigated. A previously healthy 27-year-old male presented to the emergency department due to sudden onset of severe left testicular pain following rubber bullet trauma.

Favourable multi-institutional experience with penoscrotal decompression for prolonged ischaemic priapism.

Objectives: To report our multi-institutional experience using penoscrotal decompression (PSD) for the surgical treatment of prolonged ischaemic priapism (PIP).

Materials And Methods: We retrospectively reviewed clinical records for patients with PIP treated with PSD between 2017 and 2020. Priapisms were confirmed as ischaemic based on clinical presentations and cavernosal blood gas abnormalities.

Improving Male Sling Selectivity and Outcomes-A Potential Role for Physical Demonstration of Stress Urinary Incontinence Severity?

Introduction: We reviewed our 9-year experience with AdVance™ Male Sling System cases to determine clinical features associated with treatment success and to refine procedure selectivity. We hypothesized that preoperative physical demonstration of stress urinary incontinence by the standing cough test improves patient selection for male sling surgery.

Methods: Retrospective review of primary AdVance sling surgeries between 2008 and 2016 was performed.

Changing Trends in Reconstruction of Complex Anterior Urethral Strictures: From Skin Flap to Perineal Urethrostomy.

Objective: To evaluate procedural trends and outcomes for reconstruction of complex strictures at our tertiary center over the last decade.

Methods: We retrospectively reviewed complex urethral reconstruction comparing 3 techniques: (1) buccal mucosal graft (BMG), (2) penile skin flap, or (3) perineal urethrostomy (PU) at our center (2007-2017) with ≥6 months follow-up. Strictures amenable to anastomotic repair were excluded.

Low Serum Testosterone is Present in Nearly Half of Men Undergoing Artificial Urinary Sphincter Placement.

Objectives: To report the prevalence of low serum testosterone (LST) in men undergoing artificial urinary sphincter (AUS) placement at a single high-volume institution.

Methods: We retrospectively reviewed all men undergoing AUS procedures by a single surgeon from January 2015 to January 2018 to identify men with pretreatment total serum testosterone levels. LST was defined as less than 280 ng/dL.

Alternative Reservoir and Balloon Placement in Complex Patients Undergoing Urologic Prostheses.

Purpose Of Review: To evaluate contemporary rationale and techniques for ectopic reservoir/balloon placement in complex urologic prosthetics patients.

Recent Findings: Recent studies have demonstrated that ectopic reservoir placement is safe and durable when compared to traditional space of Retzius placement. Complex patients exist on a spectrum from those with a previously violated retropubic space, to those with bilaterally obscured external inguinal rings and/or multiple prior prosthetic reservoirs.

Outcomes of revision surgery for difficult to catheterize continent channels in a multi-institutional cohort of adults.

Introduction: The study aimed to describe the strategies of surgical revision for catheterizable channel obstruction and their outcomes, including restenosis and new channel incontinence.

Methods: We retrospectively queried the charts of adults who underwent catheterizable channel revision or replacement from 2000-2014 for stomal stenosis, channel obstruction, or difficulty with catheterization at the Universities of Minnesota, Michigan, and Utah. The primary endpoint was channel patency as measured by freedom from repeat surgical intervention.

Is Removal of the Pressure-regulating Balloon Necessary After Artificial Urinary Sphincter Cuff Erosion?

Objective: To characterize the risk of delayed infectious complications from retained pressure-regulating balloons (PRBs) after artificial urinary sphincter (AUS) cuff erosion.

Methods: From our database of 530 AUS cases between 2007 and 2016, we identified 40 total AUS cuff erosions. Twenty-four (60%) presented without evidence of gross device infection and underwent explant of cuff and pump without removal of the PRB.

Role of Chronic Suprapubic Tube in the Management of Radiation Induced Urethral Strictures.

Introduction: We examined the role of chronic suprapubic tube drainage in patients with radiation induced urethral stricture disease.

Methods: A retrospective review was performed of patients undergoing evaluation and treatment of radiation induced urethral stricture. Differences in patient and stricture characteristics among those treated with chronic suprapubic tube vs urethral reconstruction were evaluated.

Urethral Reconstruction in Aging Male Patients.

Objective: To report stricture characteristics, complications, and treatment outcomes among elderly men undergoing urethral reconstruction.

Materials And Methods: A retrospective review of urethroplasty cases and outcomes by a single surgeon from 2007 to 2014 was performed. Men were stratified by decade of life at time of surgery (<50, 50-59, 60-69, ≥70 years).

"Stiction Syndrome": Non-Operative Management of Patients With Difficult AMS 700 Series Inflation.

Introduction: Static friction (stiction) is a mechanical phenomenon in which a state of increased resistance exists across a control valve mechanism.

Aim: To present a strategy for non-operative management of inflatable penile prosthesis (IPP) cases with pump malfunction from pump valve stiction.

Methods: All patients had American Medical Systems (AMS; Minnetonka, MN, USA) 700 series Momentary Squeeze IPPs with transient pump malfunction owing to pump valve stiction after extended periods of device inactivity.

Delayed Reconstruction of Bulbar Urethral Strictures is Associated with Multiple Interventions, Longer Strictures and More Complex Repairs.

Purpose: Prior to urethral reconstruction many patients with stricture undergo a variable period during which endoscopic treatments are performed for recurrent obstructive symptoms. We evaluated the association among urethroplasty delay, endoscopic treatments and subsequent reconstructive outcomes.

Materials And Methods: We reviewed the records of men who underwent primary bulbar urethroplasty from 2007 to 2014.

Characteristics of Idiopathic Urethral Strictures: A Link to Remote Perineal Trauma?

Objective: To characterize the physical features and reconstructive outcomes of a series of idiopathic urethral strictures (IUS) in an effort to elucidate the nature of this common yet poorly understood entity.

Patients And Methods: We retrospectively reviewed our urethroplasty database to identify men undergoing initial urethral reconstruction from 2007 to 2014 at 1 of 3 hospitals (N = 514). Patients were stratified by stricture etiology, including IUS, acute trauma, iatrogenic, hypospadias, balanitis xerotica obliterans, and radiation.

Oxidized Regenerated Cellulose (Fibrillar) Reduces Risk of Postoperative Corporal Bleeding Following Inflatable Penile Prosthesis Surgery.

Objective: To report our initial experience with oxidized regenerated cellulose (ORC; Surgicel Fibrillar) as a hemostatic adjunct during inflatable penile prosthesis (IPP) surgery.

Materials And Methods: Beginning in April 2016, ORC pledgets were placed within the corporotomy closures of all men undergoing IPP insertion. Perioperative characteristics and outcomes including cumulative postoperative drain output were evaluated among consecutive cases with (April 2016 to October 2016) and without ORC (December 2015 to March 2016) using an identical surgical technique by a single surgeon.

Permanent Bulbar Urethral Ligation: Emerging Treatment Option for Incontinent Men With End-stage Urethra.

Objective: To report our experience with permanent urethral ligation for severe incontinence among men with end-stage urethra.

Materials And Methods: From our institutional artificial urinary sphincter database of 512 patients from 2010 to 2016, 10 men underwent permanent urethral ligation with concurrent suprapubic tube diversion following recurrent artificial urinary sphincter cuff erosion. Clinical characteristics and outcomes were evaluated.

Synchronous Ipsilateral High Submuscular Placement of Prosthetic Balloons and Reservoirs.

Introduction: Synchronous ipsilateral high submuscular placement of artificial urinary sphincter (AUS) pressure-regulating balloons (PRBs) and inflatable penile prosthesis (IPP) reservoirs in a single submuscular tunnel is a novel strategy that could be advantageous for patients who have had major pelvic surgery.

Aim: To report our initial experience with synchronous ipsilateral vs bilateral placement of AUS PRBs and IPP reservoirs in men undergoing implant surgery.

Methods: We retrospectively reviewed all patients undergoing synchronous AUS and IPP placement from 2007 through 2015 by a single surgeon at our tertiary center.

Preoperative Urine Culture Results Correlate Poorly With Bacteriology of Urologic Prosthetic Device Infections.

Introduction: Although preoperative negative urine culture results and treatment of urinary tract infections are generally advised before artificial urinary sphincter (AUS) and penile prosthesis (PP) surgery to prevent device infection, limited evidence exists to support this practice.

Aim: To evaluate the relation between preoperative urine culture results and the bacteriology of prosthetic device infections.

Methods: Men undergoing AUS and/or PP placement at a tertiary referral center from 2007 through 2015 were analyzed.

Clinical Risk Factors Associated With Urethral Atrophy.

Objective: To analyze a series of clinical risk factors associated with pretreatment urethral atrophy.

Methods: We retrospectively reviewed 301 patients who underwent artificial urinary sphincter (AUS) placement between September 2009 and November 2015; of these, 60 (19.9%) transcorporal cuff patients were excluded.

Evaluation of the outcomes after posterior urethroplasty.

Posterior urethral injury is a clinically significant complication of pelvic fractures. The management is complicated by the associated organ injuries, distortion of the pelvic anatomy and the ensuing fibrosis that occurs with urethral injury. We report a review of the outcomes after posterior urethroplasty in the context of pelvic fracture urethral injury.

The role of extensive lymphadenectomy in upper tract malignant disease.

Upper tract malignancies represent an estimated 5 %-10 % of urothelial cancers, with roughly 3,000 new cases per year in the United States. These tumors often present at an advanced stage, with invasion and lymph node metastases. There are no large randomized prospective studies demonstrating the benefit of lymph node dissection in upper tract urothelial cancer, and as such, definitive guidelines on the surgical template and timing are lacking.

Contemporary lymphadenectomy templates: kidney, prostate and bladder cancer.

Purpose Of Review: Lymph node dissection (LDN) at the time of a primary malignant resection varies in therapeutic and staging outcomes between organs of origin. The purpose of our review is to provide new updates and a key summary on the developments in lymphadenectomy templates in kidney, prostate and bladder cancer.

Recent Findings: There are still evolving definitions for LDN templates, means of pathologic diagnosis of lymph nodes, as well as implications on staging/cancer-free survival after LND though trends are still emerging.