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ONE-DAY STAY FOR ROBOTIC PYELOPLASTY
V29
V30
SIMULTANEOUS IMPLANTATION OF THE ARTIFICIAL URINARY
DORSAL GRAFT URETHROPLASTY FOR URETHRAL STRICTURE IN
SPHINCTER AND INFLATABLE PENILE PROSTHESIS
THE FEMALE
Jones L.
Tsivian A., Benjamin S., Sidi A.A.
University of Texas Health Science Centre, Urology, San Antonio, United States
Wolfson Medical Centre, Urologic Surgery, Holon, Israel
INTRODUCTION & OBJECTIVES: Fortunately severe post prostatectomy
INTRODUCTION & OBJECTIVES: Urethral strictures in females are
urinary incontinence and erectile dysfunction is not a common occurrence. However when it does occur it is important to aggressively treat these patients
uncommon with scanty treatment options. Herein, we present a video demonstrating a new method of urethroplasty for repair of female urethral stricture.
and restore them to a proper quality of life. The gold standard treatment for
MATERIAL & METHODS: A 60 years old woman with a ten years history of
moderate to severe urinary incontinence is the artificial urinary sphincter. The
recurrent urinary tract infections, and obstructive voiding symptoms underwent
inflatable penile prosthesis is also chosen when the patient is not responsive to the more conservative treatment for erectile dysfunction. Historically simultaneous implantation of both the artificial urinary sphincter and the inflatable penile prosthesis required two separate incisions. This combined procedure was thought to have increased morbidity. The infection rate was also thought to be increased when implanting both devices. Currently both devices can now be placed through
VCUG which demonstrated a distal urethral stricture with pre stenotic dilation. Repeated urethral dilations were unsatisfactory. Technique: Under general anaesthesia in the Trendelenburg position, ureteral catheter was inserted into the urethra over a guide wire. Through a suprameatal incision, a 3 cm of the dorsal aspect of the distal urethra was dissected from the surrounding tissue, and incised at 12 o’clock. The proximal urethra was calibrated with a 30F bougie a boule. A 1.5 x 3 cm free graft was harvested from the buccal mucosa, defatted, and its mucosal
a single upper transverse scrotal incision. We have extensive experience with this
surface sutured with 3/0 Vicryl to the incised urethra. A 18 urethral catheter and
combined procedure and recent published data does not demonstrate an increased
16F suprapubic catheter were left indwelling, for 2 and 3 weeks respectively.
risk of infection.
RESULTS: Three women underwent urethroplasty by means of a dorsal vaginal
CONCLUSIONS: This video will review the surgical approach for simultaneous
(2) or buccal (1) mucosal graft. During a follow-up period of 1 - 27 months
implantation of both the artificial urinary sphincter and inflatable penile prosthesis.
additional treatments were not required. All 3 patients had normal micturition
A single upper transverse scrotal incision is used for this approach. Realizing that
following catheter removal.
this is a time lapsed video, the typical operative time for the combined approach
CONCLUSIONS: Albeit, limited experience, dorsal graft urethroplasty is
is 70-80 minutes. The combined approach has been successful and should be
effective and should be considered for the treatment of persistent urethral stricture
considered if the patient has both urinary incontinence and erectile dysfunction.
in the female.
V6
ENDOSCOPIC AND ROBOTIC SURGERY Friday, 7 April, 12.15-13.45, eUro Auditorium / Level 1 URETEROSCOPIC LASER APPROACH URETEROPELVIC JUNCTION STENOSIS
V31 IN
RECURRENT
V32 ONE-DAY STAY FOR ROBOTIC PYELOPLASTY
Mirciulescu V., Geavlete P., Nita G., Georgescu D.
Murphy D., Khan S., Challacombe B., Olsgurgh J., Dasgupta P.
Saint John Emergency Clinical Hospital, Bucharest, Urology, Bucharest, Romania
Guy’s Hospital, Urology, London, United Kingdom
INTRODUCTION & OBJECTIVES: Although open pyeloplasty remains the gold standard for treating ureteropelvic junction (UPJ) obstruction, endourological procedures, as minimally invasive techniques, could be very effective, especially in recurrences. Our goal was to establish the value of retrograde endopyelotomy (REP) by laser using in such cases.
INTRODUCTION
MATERIAL & METHODS: Between November 2000 and June 2005 we performed 30 REP in recurrent UPJ obstruction with III-rd and IV-th grade hydronephrosis (failed ureteropyeloplasty - 17 cases and failed endopyelotomy 13 cases). Our series was characterized by: absence of renal calculi, stenosis length under 2.5 cm., absence of massive hydronephrosis. We used rigid and flexible endoscopic equipment (Wolf and Storz), and holmium YAG laser. In 17 cases, an indwelling ureteral catheter was placed for 2 weeks (blocked ureteral passage because of the UPJ scar tissue). The incision was made under video assistance and fluoroscopy, until the perinephric fat was largely and clearly exposed. An indwelling pyelostent 8/12 F was placed for 8 weeks.
suturing, however, is technically challenging and may lead to prolonged operating
RESULTS: All cases were evaluated at 6, 12 and 18 months. Doppler echography and IVP were the main follow-up investigations. We found in 9 cases (30%) normal pyelocaliceal system with large ureteropelvic passage; in 4 cases (13.3%), a reduction of the hydronephrosis degree with normal ureteropelvic junction; in 17 cases (56.6%) no changes of the hydronephrosis degree but with large pyelocaliceal passage in 13/17 cases (76.5%). So, REP success did not correlate with the degree of hydronephrosis. The recurrence rate was 13.3% (4 cases). We described minor complications: in 3 cases we coagulated small vessels and 3 cases had urinary tract infections. The mean follow-up period was 31 months (4 to 52 months). CONCLUSIONS: REP may represent an efficient minimally invasive technique in recurrent UPJ stenosis, with a reduced rate of complications, short period of hospitalization and good anatomical and functional results.
&
OBJECTIVES:
Anderson-Hynes
dismembered
pyeloplasty remains the optimum technique for repair of uretero-pelvic junction (UPJ) obstruction associated with a crossing vessel. Laparoscopic intracorporeal
times. Robotic-assistance may reduce this difficulty. MATERIAL & METHODS: Three patients (2 males, 1 female) have undergone short stay pyeloplasty using the Da Vinci robot. They presented with loin pain and had proven UPJ obstruction on IVU/CT and diuretic renography. Patients were selected for <24 hr pyeloplasty based on performance status and motivation. RESULTS: All procedures were completed without conversion or complications. Robot docking time averaged 6 minutes. Anastomotic time was 57 minutes. Total operative time was 200 minutes. Estimated blood loss averaged 10ml. Methylene blue was used to test the anastomosis. Patients were mobile 5 hours later, discharged home 18.5 hours post-extubation, and returned to normal activity within 10 days. CONCLUSIONS: Robotic pyeloplasty is a safe procedure with low morbidity and very short convalescence. Day-case robotic pyeloplasty may also be feasible. Eur Urol Suppl 2006;5(2):333
V30
SIMULTANEOUS IMPLANTATION OF THE ARTIFICIAL URINARY
DORSAL GRAFT URETHROPLASTY FOR URETHRAL STRICTURE IN
SPHINCTER AND INFLATABLE PENILE PROSTHESIS
THE FEMALE
Jones L.
Tsivian A., Benjamin S., Sidi A.A.
University of Texas Health Science Centre, Urology, San Antonio, United States
Wolfson Medical Centre, Urologic Surgery, Holon, Israel
INTRODUCTION & OBJECTIVES: Fortunately severe post prostatectomy
INTRODUCTION & OBJECTIVES: Urethral strictures in females are
urinary incontinence and erectile dysfunction is not a common occurrence. However when it does occur it is important to aggressively treat these patients
uncommon with scanty treatment options. Herein, we present a video demonstrating a new method of urethroplasty for repair of female urethral stricture.
and restore them to a proper quality of life. The gold standard treatment for
MATERIAL & METHODS: A 60 years old woman with a ten years history of
moderate to severe urinary incontinence is the artificial urinary sphincter. The
recurrent urinary tract infections, and obstructive voiding symptoms underwent
inflatable penile prosthesis is also chosen when the patient is not responsive to the more conservative treatment for erectile dysfunction. Historically simultaneous implantation of both the artificial urinary sphincter and the inflatable penile prosthesis required two separate incisions. This combined procedure was thought to have increased morbidity. The infection rate was also thought to be increased when implanting both devices. Currently both devices can now be placed through
VCUG which demonstrated a distal urethral stricture with pre stenotic dilation. Repeated urethral dilations were unsatisfactory. Technique: Under general anaesthesia in the Trendelenburg position, ureteral catheter was inserted into the urethra over a guide wire. Through a suprameatal incision, a 3 cm of the dorsal aspect of the distal urethra was dissected from the surrounding tissue, and incised at 12 o’clock. The proximal urethra was calibrated with a 30F bougie a boule. A 1.5 x 3 cm free graft was harvested from the buccal mucosa, defatted, and its mucosal
a single upper transverse scrotal incision. We have extensive experience with this
surface sutured with 3/0 Vicryl to the incised urethra. A 18 urethral catheter and
combined procedure and recent published data does not demonstrate an increased
16F suprapubic catheter were left indwelling, for 2 and 3 weeks respectively.
risk of infection.
RESULTS: Three women underwent urethroplasty by means of a dorsal vaginal
CONCLUSIONS: This video will review the surgical approach for simultaneous
(2) or buccal (1) mucosal graft. During a follow-up period of 1 - 27 months
implantation of both the artificial urinary sphincter and inflatable penile prosthesis.
additional treatments were not required. All 3 patients had normal micturition
A single upper transverse scrotal incision is used for this approach. Realizing that
following catheter removal.
this is a time lapsed video, the typical operative time for the combined approach
CONCLUSIONS: Albeit, limited experience, dorsal graft urethroplasty is
is 70-80 minutes. The combined approach has been successful and should be
effective and should be considered for the treatment of persistent urethral stricture
considered if the patient has both urinary incontinence and erectile dysfunction.
in the female.
V6
ENDOSCOPIC AND ROBOTIC SURGERY Friday, 7 April, 12.15-13.45, eUro Auditorium / Level 1 URETEROSCOPIC LASER APPROACH URETEROPELVIC JUNCTION STENOSIS
V31 IN
RECURRENT
V32 ONE-DAY STAY FOR ROBOTIC PYELOPLASTY
Mirciulescu V., Geavlete P., Nita G., Georgescu D.
Murphy D., Khan S., Challacombe B., Olsgurgh J., Dasgupta P.
Saint John Emergency Clinical Hospital, Bucharest, Urology, Bucharest, Romania
Guy’s Hospital, Urology, London, United Kingdom
INTRODUCTION & OBJECTIVES: Although open pyeloplasty remains the gold standard for treating ureteropelvic junction (UPJ) obstruction, endourological procedures, as minimally invasive techniques, could be very effective, especially in recurrences. Our goal was to establish the value of retrograde endopyelotomy (REP) by laser using in such cases.
INTRODUCTION
MATERIAL & METHODS: Between November 2000 and June 2005 we performed 30 REP in recurrent UPJ obstruction with III-rd and IV-th grade hydronephrosis (failed ureteropyeloplasty - 17 cases and failed endopyelotomy 13 cases). Our series was characterized by: absence of renal calculi, stenosis length under 2.5 cm., absence of massive hydronephrosis. We used rigid and flexible endoscopic equipment (Wolf and Storz), and holmium YAG laser. In 17 cases, an indwelling ureteral catheter was placed for 2 weeks (blocked ureteral passage because of the UPJ scar tissue). The incision was made under video assistance and fluoroscopy, until the perinephric fat was largely and clearly exposed. An indwelling pyelostent 8/12 F was placed for 8 weeks.
suturing, however, is technically challenging and may lead to prolonged operating
RESULTS: All cases were evaluated at 6, 12 and 18 months. Doppler echography and IVP were the main follow-up investigations. We found in 9 cases (30%) normal pyelocaliceal system with large ureteropelvic passage; in 4 cases (13.3%), a reduction of the hydronephrosis degree with normal ureteropelvic junction; in 17 cases (56.6%) no changes of the hydronephrosis degree but with large pyelocaliceal passage in 13/17 cases (76.5%). So, REP success did not correlate with the degree of hydronephrosis. The recurrence rate was 13.3% (4 cases). We described minor complications: in 3 cases we coagulated small vessels and 3 cases had urinary tract infections. The mean follow-up period was 31 months (4 to 52 months). CONCLUSIONS: REP may represent an efficient minimally invasive technique in recurrent UPJ stenosis, with a reduced rate of complications, short period of hospitalization and good anatomical and functional results.
&
OBJECTIVES:
Anderson-Hynes
dismembered
pyeloplasty remains the optimum technique for repair of uretero-pelvic junction (UPJ) obstruction associated with a crossing vessel. Laparoscopic intracorporeal
times. Robotic-assistance may reduce this difficulty. MATERIAL & METHODS: Three patients (2 males, 1 female) have undergone short stay pyeloplasty using the Da Vinci robot. They presented with loin pain and had proven UPJ obstruction on IVU/CT and diuretic renography. Patients were selected for <24 hr pyeloplasty based on performance status and motivation. RESULTS: All procedures were completed without conversion or complications. Robot docking time averaged 6 minutes. Anastomotic time was 57 minutes. Total operative time was 200 minutes. Estimated blood loss averaged 10ml. Methylene blue was used to test the anastomosis. Patients were mobile 5 hours later, discharged home 18.5 hours post-extubation, and returned to normal activity within 10 days. CONCLUSIONS: Robotic pyeloplasty is a safe procedure with low morbidity and very short convalescence. Day-case robotic pyeloplasty may also be feasible. Eur Urol Suppl 2006;5(2):333