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V9-10 TRANSURETHRAL RESECTION OF EJACULATORY DUCTS: A STEP-BY-STEP GUIDE
THE JOURNAL OF UROLOGYâ
Vol. 197, No. 4S, Supplement, Monday, May 15, 2017
18 items, each on a 5-point Likert scale. Trainee scores were assessed and compared for improvement over the course of the training course. RESULTS: The most common mistakes made by our trainees revolved around sitting position, hand tremor, instrument handling, needle control, suture placement, and knot tying. The errors were most prevalent early on and there were statistically significant improvements across all domains by the end of the MIM training course (Table). CONCLUSIONS: A MIM training program is an effective tool for teaching MIM skills. By incorporating intense supervision and continuous evaluation into an MIM training program, MIM trainees can avoid the development of bad habits that may be difficult to overcome and potentially have a negative impact on surgical outcomes.
Source of Funding: Supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust.
V9-09 ROBOT-ASSISTED LAPAROSCOPIC MANAGEMENT OF INFLATABLE PENILE PROSTHESIS RESERVOIR MIGRATION INTO BLADDER WITH UTILIZATION OF CRYOPRESERVED AMNIOTIC MEMBRANE AND UMBILICAL TISSUE Mark Ferretti*, New York, NY; Gregory Lovallo, Michael Stifelman, Mutahar Ahmed, Hackensack, NJ INTRODUCTION AND OBJECTIVES: At our institution robot assisted laparoscopy has been adopted for many types of exploratory and reconstructive procedures. We have also utilized cryopreserved amniotic membrane and umbilical cord matrix to facilitate healing in hostile tissue environments. Here we present a 70 year old male with a history of inflatable penile prosthesis placement after radiation and salvage prostatectomy who presented with lower urinary tract symptoms. He was discovered to have reservoir migration into the bladder and was offered a robot assisted laparoscopic exploration with prosthesis reservoir explant and reimplant. METHODS: We performed a robot-assisted laparoscopic exploration and inflatable penile prosthesis reservoir removal and reimplant. We utilized a cryopreserved amniotic membrane and umbilical tissue graft along the suture line to assist in tissue healing. RESULTS: Our patient tolerated procedure well and his lower urinary tract symptoms are improved. He has not experienced infection of his prosthesis and it remains functional. CONCLUSIONS: Robot assisted laparoscopic management of migrated prosthesis reservoirs may be a safe and feasible approach in
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select patients. We will continue to explore the use of cryopreserved amniotic membrane and umbilical cord matrix in patients with tissue environments hostile to normal healing. Source of Funding: None
V9-10 TRANSURETHRAL RESECTION OF EJACULATORY DUCTS: A STEP-BY-STEP GUIDE Luis Savio*, Joseph Palmer, Nachiketh S Prakash, Raul Clavijo, Desmond Adamu, Ranjith Ramasamy, Miami, FL INTRODUCTION AND OBJECTIVES: Ejaculatory duct obstruction (EDO) is a rare but surgically correctable cause of male infertility. Transurethral resection of the ejaculatory ducts (TURED) serves as an important therapeutic management option for partially and/ or completely obstructed ejaculatory ducts (EDs) that may result in significant improvement of semen parameters and pregnancy rate. The aim of this study is to demonstrate the key components for completing a successful TURED. METHODS: We present a case of a 40-year-old man who presented with primary infertility. His past medical history was otherwise not significant. Physical examination revealed non-tender 14cc testes bilaterally with present and non-tender vas deferens and epididymis. Hormone studies were within the normal range. Semen analysis was abnormal (pH 6.4, volume of 0.7cc, concentration 16 million/cc and 7% motility). A trasnrectal ultrasonography revealed dilated seminal vesicles measuring more than 1.5 cm and seminal vesicle aspiration detected no sperm in the aspirate. We began the procedure by placing the patient in the conventional lithotomy position. Transrectal ultrasonography-guided seminal vesicle puncture was performed and methylene blue was injected into both seminal vesicles. Cystoscopy was performed focusing in the area of the verumontanum to assess for methylene blue drainage in order to more precisely proceed with resection of the ejaculatory ducts.Vesiculography was performed by placing a 5 French ureteral into the freshly opened EDs in order to assess for patency and confirm both sides had been opened. Hemostasis was performed carefully in order not to occlude the newly open EDs. RESULTS: Patient was discharged home with foley catheter in place with a voiding trial performed one day later. He returned to clinic at 2 weeks for a post-operative evaluation. Semen analysis revealed improved parameters (pH 7.2, volume of 1cc, concentration 20 million/ cc and 60% motility). CONCLUSIONS: The key portions for performing a successful TURED includes seminal vesicle instillation of methylene blue for easier ED identification. Vesiculography is performed near the end of the procedure to ensure both EDs have been opened as well as to assess for passive drainage of the seminal vesicles through the newly open EDs. Source of Funding: None
V9-11 SUPRAPUBIC FAT PAD EXCISION WITH SIMULTANEOUS PLACEMENT OF INFLATABLE PENILE PROSTHESIS Adam Baumgarten*, Jonathan Beilan, Michael Bickell, Justin Parker, Tampa, FL; Gerard Henry, Shreveport, LA; Rafael Carrion, Tampa, FL INTRODUCTION AND OBJECTIVES: Many men suffering from erectile dysfunction (ED) are overweight with separate generous suprapubic fat pads, which often contribute to a decrease in visible exophytic phallic length. We present a novel surgical concept of suprapubic fat pad excision with concomitant placement of inflatable penile prosthesis (IPP). METHODS: A transverse incision is made starting 2 cm inferior and medial to the ASIS and carried across the infrapubic region in a curvilinear fashion, passing approximately one finger breath above the base of the penis. The incision continues in a symmetric fashion to the contralateral side. Dissection is carried down to the lower abdominal
Vol. 197, No. 4S, Supplement, Monday, May 15, 2017
18 items, each on a 5-point Likert scale. Trainee scores were assessed and compared for improvement over the course of the training course. RESULTS: The most common mistakes made by our trainees revolved around sitting position, hand tremor, instrument handling, needle control, suture placement, and knot tying. The errors were most prevalent early on and there were statistically significant improvements across all domains by the end of the MIM training course (Table). CONCLUSIONS: A MIM training program is an effective tool for teaching MIM skills. By incorporating intense supervision and continuous evaluation into an MIM training program, MIM trainees can avoid the development of bad habits that may be difficult to overcome and potentially have a negative impact on surgical outcomes.
Source of Funding: Supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust.
V9-09 ROBOT-ASSISTED LAPAROSCOPIC MANAGEMENT OF INFLATABLE PENILE PROSTHESIS RESERVOIR MIGRATION INTO BLADDER WITH UTILIZATION OF CRYOPRESERVED AMNIOTIC MEMBRANE AND UMBILICAL TISSUE Mark Ferretti*, New York, NY; Gregory Lovallo, Michael Stifelman, Mutahar Ahmed, Hackensack, NJ INTRODUCTION AND OBJECTIVES: At our institution robot assisted laparoscopy has been adopted for many types of exploratory and reconstructive procedures. We have also utilized cryopreserved amniotic membrane and umbilical cord matrix to facilitate healing in hostile tissue environments. Here we present a 70 year old male with a history of inflatable penile prosthesis placement after radiation and salvage prostatectomy who presented with lower urinary tract symptoms. He was discovered to have reservoir migration into the bladder and was offered a robot assisted laparoscopic exploration with prosthesis reservoir explant and reimplant. METHODS: We performed a robot-assisted laparoscopic exploration and inflatable penile prosthesis reservoir removal and reimplant. We utilized a cryopreserved amniotic membrane and umbilical tissue graft along the suture line to assist in tissue healing. RESULTS: Our patient tolerated procedure well and his lower urinary tract symptoms are improved. He has not experienced infection of his prosthesis and it remains functional. CONCLUSIONS: Robot assisted laparoscopic management of migrated prosthesis reservoirs may be a safe and feasible approach in
e1059
select patients. We will continue to explore the use of cryopreserved amniotic membrane and umbilical cord matrix in patients with tissue environments hostile to normal healing. Source of Funding: None
V9-10 TRANSURETHRAL RESECTION OF EJACULATORY DUCTS: A STEP-BY-STEP GUIDE Luis Savio*, Joseph Palmer, Nachiketh S Prakash, Raul Clavijo, Desmond Adamu, Ranjith Ramasamy, Miami, FL INTRODUCTION AND OBJECTIVES: Ejaculatory duct obstruction (EDO) is a rare but surgically correctable cause of male infertility. Transurethral resection of the ejaculatory ducts (TURED) serves as an important therapeutic management option for partially and/ or completely obstructed ejaculatory ducts (EDs) that may result in significant improvement of semen parameters and pregnancy rate. The aim of this study is to demonstrate the key components for completing a successful TURED. METHODS: We present a case of a 40-year-old man who presented with primary infertility. His past medical history was otherwise not significant. Physical examination revealed non-tender 14cc testes bilaterally with present and non-tender vas deferens and epididymis. Hormone studies were within the normal range. Semen analysis was abnormal (pH 6.4, volume of 0.7cc, concentration 16 million/cc and 7% motility). A trasnrectal ultrasonography revealed dilated seminal vesicles measuring more than 1.5 cm and seminal vesicle aspiration detected no sperm in the aspirate. We began the procedure by placing the patient in the conventional lithotomy position. Transrectal ultrasonography-guided seminal vesicle puncture was performed and methylene blue was injected into both seminal vesicles. Cystoscopy was performed focusing in the area of the verumontanum to assess for methylene blue drainage in order to more precisely proceed with resection of the ejaculatory ducts.Vesiculography was performed by placing a 5 French ureteral into the freshly opened EDs in order to assess for patency and confirm both sides had been opened. Hemostasis was performed carefully in order not to occlude the newly open EDs. RESULTS: Patient was discharged home with foley catheter in place with a voiding trial performed one day later. He returned to clinic at 2 weeks for a post-operative evaluation. Semen analysis revealed improved parameters (pH 7.2, volume of 1cc, concentration 20 million/ cc and 60% motility). CONCLUSIONS: The key portions for performing a successful TURED includes seminal vesicle instillation of methylene blue for easier ED identification. Vesiculography is performed near the end of the procedure to ensure both EDs have been opened as well as to assess for passive drainage of the seminal vesicles through the newly open EDs. Source of Funding: None
V9-11 SUPRAPUBIC FAT PAD EXCISION WITH SIMULTANEOUS PLACEMENT OF INFLATABLE PENILE PROSTHESIS Adam Baumgarten*, Jonathan Beilan, Michael Bickell, Justin Parker, Tampa, FL; Gerard Henry, Shreveport, LA; Rafael Carrion, Tampa, FL INTRODUCTION AND OBJECTIVES: Many men suffering from erectile dysfunction (ED) are overweight with separate generous suprapubic fat pads, which often contribute to a decrease in visible exophytic phallic length. We present a novel surgical concept of suprapubic fat pad excision with concomitant placement of inflatable penile prosthesis (IPP). METHODS: A transverse incision is made starting 2 cm inferior and medial to the ASIS and carried across the infrapubic region in a curvilinear fashion, passing approximately one finger breath above the base of the penis. The incision continues in a symmetric fashion to the contralateral side. Dissection is carried down to the lower abdominal