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Re: Intermediate Outcomes after Female Urethral Reconstruction: Graft vs Flap
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TRAUMA, AND GENITAL AND URETHRAL RECONSTRUCTION
Editorial Comment: A single center retrospective comparison of urethrography interpretation was undertaken. The 397 studies were done by urologists and then read by radiologists. Both groups tended to underestimate stricture length compared to intraoperative measurements (radiologists more so), and no concomitant pathology was documented in any of the reports. Radiologists missed 13% of the strictures and more often reported the wrong stricture location and length. The take home message is that urethrography is not an exact science. Retrograde urethrograms can be misleading, and a healthy degree of skepticism is required. For this reason we begin all urethroplasty procedures with intraoperative cystoscopy to confirm the location of the obstruction before skin incision, and we then look again before urethral transection. Allen F. Morey, MD
Re: Intermediate Outcomes after Female Urethral Reconstruction: Graft vs Flap C. Kowalik, J. T. Stoffel, L. Zinman, A. J. Vanni and J. C. Buckley Institute of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts, Department of Urology, University of Michigan Health System, Ann Arbor, Michigan, and Department of Urology, University of California San Diego Health System, San Diego, California Urology 2014; 83: 1181e1185.
Abstract available at http://jurology.com/ Editorial Comment: The authors of this 5-year experience describe outcomes of a small series of women undergoing urethral reconstruction for stricture. Actually 10 patients is a relatively large series, considering the rarity of this diagnosis in women. Examination with the patient under anesthesia with bouginage rather than retrograde urethrography is recommended to verify the diagnosis. As in men with urethral strictures, dilations did not hold up as well as reconstruction (with vaginal flaps or buccal mucosa grafts). In fact, the authors suggest that repeated dilations likely worsened stricturesdan observation we have long shared. These data support the need to abandon the practice of repeated urethral dilations and adopt a paradigm for early reconstruction for men and women with urethral strictures. Allen F. Morey, MD
Re: Creation of a Continent Urinary Channel in Adults with Neurogenic Bladder: Long-Term Results with the Monti and Casale (Spiral Monti) Procedures D. Hadley, K. Anderson, C. R. Knopick, K. Shah and B. J. Flynn Divisions of Urology, Loma Linda University School of Medicine, Loma Linda, California, and University of Colorado Denver, Aurora, Colorado Urology 2014; 83: 1176e1180.
Abstract available at http://jurology.com/ Editorial Comment: This is an interesting investigation of 26 adults undergoing an abdominal catheterizable stoma using the Monti technique rather than appendix. The authors note a recurrent problem achieving adequate limb length in obese patients. Through time a spiral technique was adopted preferentially over the double Monti limb to prevent anastomotic complications. Most patients underwent concomitant bladder augmentation and 1 had a devastated outlet. The most common complications included recurrent urinary tract infections, bowel and wound complications,
TRAUMA, AND GENITAL AND URETHRAL RECONSTRUCTION
Editorial Comment: A single center retrospective comparison of urethrography interpretation was undertaken. The 397 studies were done by urologists and then read by radiologists. Both groups tended to underestimate stricture length compared to intraoperative measurements (radiologists more so), and no concomitant pathology was documented in any of the reports. Radiologists missed 13% of the strictures and more often reported the wrong stricture location and length. The take home message is that urethrography is not an exact science. Retrograde urethrograms can be misleading, and a healthy degree of skepticism is required. For this reason we begin all urethroplasty procedures with intraoperative cystoscopy to confirm the location of the obstruction before skin incision, and we then look again before urethral transection. Allen F. Morey, MD
Re: Intermediate Outcomes after Female Urethral Reconstruction: Graft vs Flap C. Kowalik, J. T. Stoffel, L. Zinman, A. J. Vanni and J. C. Buckley Institute of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts, Department of Urology, University of Michigan Health System, Ann Arbor, Michigan, and Department of Urology, University of California San Diego Health System, San Diego, California Urology 2014; 83: 1181e1185.
Abstract available at http://jurology.com/ Editorial Comment: The authors of this 5-year experience describe outcomes of a small series of women undergoing urethral reconstruction for stricture. Actually 10 patients is a relatively large series, considering the rarity of this diagnosis in women. Examination with the patient under anesthesia with bouginage rather than retrograde urethrography is recommended to verify the diagnosis. As in men with urethral strictures, dilations did not hold up as well as reconstruction (with vaginal flaps or buccal mucosa grafts). In fact, the authors suggest that repeated dilations likely worsened stricturesdan observation we have long shared. These data support the need to abandon the practice of repeated urethral dilations and adopt a paradigm for early reconstruction for men and women with urethral strictures. Allen F. Morey, MD
Re: Creation of a Continent Urinary Channel in Adults with Neurogenic Bladder: Long-Term Results with the Monti and Casale (Spiral Monti) Procedures D. Hadley, K. Anderson, C. R. Knopick, K. Shah and B. J. Flynn Divisions of Urology, Loma Linda University School of Medicine, Loma Linda, California, and University of Colorado Denver, Aurora, Colorado Urology 2014; 83: 1176e1180.
Abstract available at http://jurology.com/ Editorial Comment: This is an interesting investigation of 26 adults undergoing an abdominal catheterizable stoma using the Monti technique rather than appendix. The authors note a recurrent problem achieving adequate limb length in obese patients. Through time a spiral technique was adopted preferentially over the double Monti limb to prevent anastomotic complications. Most patients underwent concomitant bladder augmentation and 1 had a devastated outlet. The most common complications included recurrent urinary tract infections, bowel and wound complications,