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Re: Pediatric Robot-Assisted Redo Pyeloplasty with Buccal Mucosa Graft: A Novel Technique
Laparoscopy/New Technology Re: Advanced Reconstruction of Vesicourethral Support (ARVUS) during Robot-Assisted Radical Prostatectomy: One-Year Functional Outcomes in a Two-Group Randomised Controlled Trial V. Student, Jr., A. Vidlar, M. Grepl, I. Hartmann, E. Buresova and V. Student Department of Urology, University Hospital, and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic Eur Urol 2017; 71: 822e830. doi: 10.1016/j.eururo.2016.05.032
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/27283216 Editorial Comment: The authors randomized 66 patients to undergo posterior reconstruction (Rocco stitch technique) or more complex pelvic floor reconstruction, where the levator ani and posterior bladder neck are incorporated into the Rocco posterior reconstruction. This approach seems to add a muscular component to the posterior bladder support, preventing bladder descensus during stress maneuvers that promote incontinence. This method seems to improve short-term continence recovery. As early as 2 weeks postoperatively significantly more patients undergoing the ARVUS technique were pad-free (62% vs 15%). No retention or perineal pain was observed. Several groups are striving to improve short-term urinary recovery with all techniques focusing on posterior bladder support beyond the Rocco stitch. Jeffrey A. Cadeddu, MD
Suggested Reading Jeong CW, Lee JK, Oh JJ et al: Effects of new 1-step posterior reconstruction method on recovery of continence after robot-assisted laparoscopic prostatectomy: results of a prospective, single-blind, parallel group, randomized, controlled trial. J Urol 2015; 193: 935.
Re: Pediatric Robot-Assisted Redo Pyeloplasty with Buccal Mucosa Graft: A Novel Technique J. J. Ahn, M. E. Shapiro, J. S. Ellison and T. S. Lendvay Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, Washington Urology 2017; 101: 56e59. doi: 10.1016/j.urology.2016.12.036
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/28039051 Editorial Comment: Buccal mucosa is generally the preferred graft for urethral reconstruction and has sporadically been reported in ureteral reconstruction. Recently there has been renewed interest in its application using the robotic system for complex ureteral reconstruction. This article adds to the growing experience with 3 pediatric cases of a robotic buccal mucosa onlay graft for strictures that averaged 4.3 cm in length. The results to date are promising, although long-term durability in adult and pediatric cases remains unknown. I certainly consider and prefer this technique in patients with long proximal or ureteropelvic junction strictures where the alternative would be an ileal ureter. Jeffrey A. Cadeddu, MD
Suggested Reading Braga LH, Lorenzo AJ, Skeldon S et al: Failed pyeloplasty in children: comparative analysis of retrograde endopyelotomy versus redo pyeloplasty. J Urol 2007; 178: 2571.
0022-5347/17/1986-0001/0 THE JOURNAL OF UROLOGY® Ó 2017 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2017.09.005 Vol. 198, 1, December 2017 Printed in U.S.A.
www.jurology.com
j
1
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/27283216 Editorial Comment: The authors randomized 66 patients to undergo posterior reconstruction (Rocco stitch technique) or more complex pelvic floor reconstruction, where the levator ani and posterior bladder neck are incorporated into the Rocco posterior reconstruction. This approach seems to add a muscular component to the posterior bladder support, preventing bladder descensus during stress maneuvers that promote incontinence. This method seems to improve short-term continence recovery. As early as 2 weeks postoperatively significantly more patients undergoing the ARVUS technique were pad-free (62% vs 15%). No retention or perineal pain was observed. Several groups are striving to improve short-term urinary recovery with all techniques focusing on posterior bladder support beyond the Rocco stitch. Jeffrey A. Cadeddu, MD
Suggested Reading Jeong CW, Lee JK, Oh JJ et al: Effects of new 1-step posterior reconstruction method on recovery of continence after robot-assisted laparoscopic prostatectomy: results of a prospective, single-blind, parallel group, randomized, controlled trial. J Urol 2015; 193: 935.
Re: Pediatric Robot-Assisted Redo Pyeloplasty with Buccal Mucosa Graft: A Novel Technique J. J. Ahn, M. E. Shapiro, J. S. Ellison and T. S. Lendvay Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, Washington Urology 2017; 101: 56e59. doi: 10.1016/j.urology.2016.12.036
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/28039051 Editorial Comment: Buccal mucosa is generally the preferred graft for urethral reconstruction and has sporadically been reported in ureteral reconstruction. Recently there has been renewed interest in its application using the robotic system for complex ureteral reconstruction. This article adds to the growing experience with 3 pediatric cases of a robotic buccal mucosa onlay graft for strictures that averaged 4.3 cm in length. The results to date are promising, although long-term durability in adult and pediatric cases remains unknown. I certainly consider and prefer this technique in patients with long proximal or ureteropelvic junction strictures where the alternative would be an ileal ureter. Jeffrey A. Cadeddu, MD
Suggested Reading Braga LH, Lorenzo AJ, Skeldon S et al: Failed pyeloplasty in children: comparative analysis of retrograde endopyelotomy versus redo pyeloplasty. J Urol 2007; 178: 2571.
0022-5347/17/1986-0001/0 THE JOURNAL OF UROLOGY® Ó 2017 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2017.09.005 Vol. 198, 1, December 2017 Printed in U.S.A.
www.jurology.com
j
1