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MP18-20 ENDOSCOPIC RENDEZVOUS PROCEDURE FOR URETERAL IATROGENIC DETACHMENT: REPORT OF A CASE SERIES WITH LONG-TERM OUTCOMES
THE JOURNAL OF UROLOGYâ
e214
Vol. 193, No. 4S, Supplement, Saturday, May 16, 2015
MP18-19
MP18-20
DELAY OF SURGICAL TREATMENT OF PENILE FRACTURE RESULTS IN POOR FUNCTIONAL OUTCOME: RESULTS FROM A LARGE RETROSPECTIVE MULTICENTER EUROPEAN STUDY.
ENDOSCOPIC RENDEZVOUS PROCEDURE FOR URETERAL IATROGENIC DETACHMENT: REPORT OF A CASE SERIES WITH LONG-TERM OUTCOMES
Giorgio Bozzini*, Milan, Italy; Maarten Albersen, Leuven, Belgium; Javier Romero Otero, Juan Ignacio Martinez-Salamanca, Madrid, Spain; Markus Margreiter, Wien, Austria; Christian Gratzke, Munich, Germany; Eduardo Garcia Cruz, Barcelona, Spain; Alex Mueller, Zurich, Switzerland; Ege Can Serefoglu, Istanbul, Turkey; Paolo Verze, Naples, Italy
Antonio Luigi Pastore*, Giovanni Palleschi, Luigi Silvestri, Andrea Ripoli, Domenico Autieri, Yazan Al Salhi, Antonio Carbone, Latina, Italy
INTRODUCTION AND OBJECTIVES: Penile fracture is a rare clinical entity, which represents a urological emergency. It involves traumatic rupture of the tunica albuginea of the corpora cavernosa due to twisting or bending of the penile shaft during erection. To determine the differences in preoperative diagnostic evaluation patterns and outcomes of penile fracture patients in order to investigate the impact of delaying the surgery on functional outcomes. METHODS: A retrospective analysis of the data obtained from 137 patients presenting with penile fracture from 7 different European academic medical centers between 1996 and 2013 was carried out. Age, imaging modalities used, timing of surgical intervention, length of tunica albuginea defect and surgical technique were recorded. Postoperative erectile function outcomes were assessed with IIEF-5 and presence of postoperative penile curvature was noted. The association between timing of surgical intervention and postoperative IIEF-5 results was evaluated with discriminant function analysis. RESULTS: The mean age of the patients was 38.9613.55 (range 18e87). Of the 137 patients, 82 (59.85%) underwent penile Doppler ultrasound and 5 patients (3.64%) were evaluated with MRI. All of the patients were treated surgically and the duration between ER admission and surgical intervention was 13.010.51 (range 1.5240) hours. The mean length of tunica albuginea defect was 15.32 8.30 mm (range 7e50). Postoperative penile curvature was observed in 5/137 (3.64%) patients. Postoperative IIEF-5 scores were 15.097.8 and 16.858.96 at 1st and 3rd postoperative months, respectively. Discriminant function analysis revealed that if the surgical intervention was performed later than 8.23 hours after ER admission, postoperative erectile function was significantly worsened (p¼0.0051 and p¼0.0057 at 1st and 3rd months, respectively). CONCLUSIONS: Our multicentric study shows that delaying the surgical intervention for more than 8.23 hours after presentation to the ER results in significantly impaired erectile function. Therefore, surgical treatment must be planned as soon as possible in order to avoid postoperative erectile dysfunction.
INTRODUCTION AND OBJECTIVES: Injury to the ureter is the most common urologic complication of pelvic surgery, with an incidence that ranges from 1% to 10%. Most cases of ureteral injuries are related to gynecologic procedures. The ureter is particularly vulnerable to detachment or ligation during hysterectomy interventions due to its position from the lateral edge of the cervix. Here, we report a case series of female patients that underwent the ureteral rendezvous procedure for ureteral detachment. METHODS: Between January 2009 and April 2013, 18 ureteral rendezvous procedures were performed for complete detachment. We assessed the operative and clinical outcomes of these patients over a mean follow-up duration of 26.5 months, and describe the three most representative cases. RESULTS: The endoscopic rendezvous technique was performed in all cases to manage ureteral detachment. Computed tomography urography at discharge, and 6 and 12 months after discharge, confirmed the restored ureteral integrity without any leakage in 66% (12/18) cases, indicated ureteral stenosis in 22% (4/18) cases, and indicated ureteral leakage in 12% (2/18) cases. The overall longterm success rate for all 18 patients was 78% (14/18) at a mean followup of 26.5 months. CONCLUSIONS: The endoscopic rendezvous procedure reduces the need for invasive open surgical repair and represents the optimal initial option in patients with iatrogenic ureteral lesions before invasive procedures with higher morbidity are attempted.
Source of Funding: none
Source of Funding: None
e214
Vol. 193, No. 4S, Supplement, Saturday, May 16, 2015
MP18-19
MP18-20
DELAY OF SURGICAL TREATMENT OF PENILE FRACTURE RESULTS IN POOR FUNCTIONAL OUTCOME: RESULTS FROM A LARGE RETROSPECTIVE MULTICENTER EUROPEAN STUDY.
ENDOSCOPIC RENDEZVOUS PROCEDURE FOR URETERAL IATROGENIC DETACHMENT: REPORT OF A CASE SERIES WITH LONG-TERM OUTCOMES
Giorgio Bozzini*, Milan, Italy; Maarten Albersen, Leuven, Belgium; Javier Romero Otero, Juan Ignacio Martinez-Salamanca, Madrid, Spain; Markus Margreiter, Wien, Austria; Christian Gratzke, Munich, Germany; Eduardo Garcia Cruz, Barcelona, Spain; Alex Mueller, Zurich, Switzerland; Ege Can Serefoglu, Istanbul, Turkey; Paolo Verze, Naples, Italy
Antonio Luigi Pastore*, Giovanni Palleschi, Luigi Silvestri, Andrea Ripoli, Domenico Autieri, Yazan Al Salhi, Antonio Carbone, Latina, Italy
INTRODUCTION AND OBJECTIVES: Penile fracture is a rare clinical entity, which represents a urological emergency. It involves traumatic rupture of the tunica albuginea of the corpora cavernosa due to twisting or bending of the penile shaft during erection. To determine the differences in preoperative diagnostic evaluation patterns and outcomes of penile fracture patients in order to investigate the impact of delaying the surgery on functional outcomes. METHODS: A retrospective analysis of the data obtained from 137 patients presenting with penile fracture from 7 different European academic medical centers between 1996 and 2013 was carried out. Age, imaging modalities used, timing of surgical intervention, length of tunica albuginea defect and surgical technique were recorded. Postoperative erectile function outcomes were assessed with IIEF-5 and presence of postoperative penile curvature was noted. The association between timing of surgical intervention and postoperative IIEF-5 results was evaluated with discriminant function analysis. RESULTS: The mean age of the patients was 38.9613.55 (range 18e87). Of the 137 patients, 82 (59.85%) underwent penile Doppler ultrasound and 5 patients (3.64%) were evaluated with MRI. All of the patients were treated surgically and the duration between ER admission and surgical intervention was 13.010.51 (range 1.5240) hours. The mean length of tunica albuginea defect was 15.32 8.30 mm (range 7e50). Postoperative penile curvature was observed in 5/137 (3.64%) patients. Postoperative IIEF-5 scores were 15.097.8 and 16.858.96 at 1st and 3rd postoperative months, respectively. Discriminant function analysis revealed that if the surgical intervention was performed later than 8.23 hours after ER admission, postoperative erectile function was significantly worsened (p¼0.0051 and p¼0.0057 at 1st and 3rd months, respectively). CONCLUSIONS: Our multicentric study shows that delaying the surgical intervention for more than 8.23 hours after presentation to the ER results in significantly impaired erectile function. Therefore, surgical treatment must be planned as soon as possible in order to avoid postoperative erectile dysfunction.
INTRODUCTION AND OBJECTIVES: Injury to the ureter is the most common urologic complication of pelvic surgery, with an incidence that ranges from 1% to 10%. Most cases of ureteral injuries are related to gynecologic procedures. The ureter is particularly vulnerable to detachment or ligation during hysterectomy interventions due to its position from the lateral edge of the cervix. Here, we report a case series of female patients that underwent the ureteral rendezvous procedure for ureteral detachment. METHODS: Between January 2009 and April 2013, 18 ureteral rendezvous procedures were performed for complete detachment. We assessed the operative and clinical outcomes of these patients over a mean follow-up duration of 26.5 months, and describe the three most representative cases. RESULTS: The endoscopic rendezvous technique was performed in all cases to manage ureteral detachment. Computed tomography urography at discharge, and 6 and 12 months after discharge, confirmed the restored ureteral integrity without any leakage in 66% (12/18) cases, indicated ureteral stenosis in 22% (4/18) cases, and indicated ureteral leakage in 12% (2/18) cases. The overall longterm success rate for all 18 patients was 78% (14/18) at a mean followup of 26.5 months. CONCLUSIONS: The endoscopic rendezvous procedure reduces the need for invasive open surgical repair and represents the optimal initial option in patients with iatrogenic ureteral lesions before invasive procedures with higher morbidity are attempted.
Source of Funding: none
Source of Funding: None