Forthcoming Issues
Testosterone (Source: Urologic Clinics of North America)
Source: Urologic Clinics of North America - August 1, 2022 Category: Urology & Nephrology Source Type: research
Recent Trends and Advances in Anterior Urethroplasty
While patient preference often helps guide treatment decisions, poor long-term success combined with cumulative risk of repeat endoscopic treatments and the complications innately associated with urethral stricture emphasize that urethroplasty is most often the best choice for successful treatment in the long-term. This has led to the need to better refine urethroplasty techniques and optimize patient outcomes. Urethroplasty has now largely transitioned to a day-surgery procedure in the majority of centers. Some evidence suggests that avoiding urethral transection and/or avoiding overzealous urethral mobilization may lead ...
Source: Urologic Clinics of North America - June 30, 2022 Category: Urology & Nephrology Authors: Elizabeth Naud, Keith Rourke Source Type: research
Pelvic Fracture Urethral Distraction Defect
Posterior pelvic fracture urethral distraction defects (PFUDD) can present formidable challenges in genitourinary reconstruction. Once the acuity of trauma subsides, the patient is often faced with chronic, debilitating genitourinary injuries. Treatment requires an astute diagnostic and technical approach, with definitive repair best accomplished in the hands of experts. A delayed, stepwise approach to repair following the resolution of acute injuries remains a time-tested platform for optimal outcomes. The evaluation, relevant anatomy, and approach to surgical repair are described herein. (Source: Urologic Clinics of North America)
Source: Urologic Clinics of North America - June 30, 2022 Category: Urology & Nephrology Authors: Kevin Krughoff, Joshua Shapiro, Andrew C. Peterson Source Type: research
Complex Penile Surgery
Surgical treatments for Peyronie ’s disease and erectile dysfunction are generally straightforward and associated with excellent outcomes. However, severe (>60 °) and multidirectional curvature, hourglass deformity, severe penile shortening, and ossified plaque may complicate surgery in patients with Peyronie’s disease. Similarly, a history of priapism, prior implant infection, and penile injury can pose challenges to successful implant surgery secondar y to severe corporal fibrosis. Thus, when these pathophysiological processes cause severe fibrosis and loss of function of the tunica albuginea and deep cavernosal spa...
Source: Urologic Clinics of North America - June 30, 2022 Category: Urology & Nephrology Authors: Ziho Lee, Jolie Shen, Hunter Wessells Source Type: research
Neurogenic Bladder:
We present a phenotype-based approach to neurogenic bladder (NGB) by describing prototypical patients with spinal cord injury (SCI), spina bifida (SB), cerebral palsy (CP), and multiple sclerosis (MS). Surgical management is categorized by failure to store and failure to empty, with a focus on catheterizable channels, bladder augmentation, and bladder outlet procedures. Mitigation and management of common complications are reviewed. Specific attention is paid to social support, body habitus, and extremity function, as we believe a holistic approach is necessary for appropriate surgical selection. (Source: Urologic Clinics of North America)
Source: Urologic Clinics of North America - June 30, 2022 Category: Urology & Nephrology Authors: Molly E. DeWitt-Foy, Sean P. Elliott Source Type: research
Patient Selection and Outcomes of Urinary Diversion
Urinary diversion selection depends highly on surgeon experience, patient comorbidities, operative indication, and preoperative risk assessment. Navigating this process in the setting of emerging surgical approaches, new operative technology, and evolving perioperative care plans can be difficult for general and reconstructive urologists alike. In this article, we highlight considerations for urinary diversion selection and review new updates in the literature regarding preoperative patient assessment and nutrition optimization. In addition, we review unique perioperative considerations including role of preoperative bowel...
Source: Urologic Clinics of North America - June 30, 2022 Category: Urology & Nephrology Authors: Kevin J. Hebert, Rano Matta, Jeremy B. Myers Source Type: research
Adult-Acquired Buried Penis Classification and Surgical Management
In this article, the authors discuss the epidemiology, pathophysiology, and initial work-up for men with adult-acquired buried penis syndrome (AABP). Given the significant heterogeneity of AABP, a classification system is proposed which classifies the condition by the status of the abdominal pannus, the escutcheon, the penile skin and the scrotal skin, and their respective fascial attachments. Classification is achieved by a uniform assessment of anatomy using the proposed standardized preoperative photos. Various surgical strategies to repair AABP are proposed which, importantly, should be in line with the patient-centere...
Source: Urologic Clinics of North America - June 29, 2022 Category: Urology & Nephrology Authors: Kevin J. Flynn, Alex J. Vanni, Benjamin N. Breyer, Bradley A. Erickson Source Type: research
Gender Affirmation Surgery, Transfeminine
Feminizing genital surgery for transgender women is a feasible and fulfilling intervention in alleviating gender dysphoria. Several techniques in neovaginal creation can be offered, including vulvoplasty, penile skin inversion vaginoplasty, peritoneal vaginoplasty, and enteric vaginoplasty. Complication rates are low and often managed conservatively. Favorable sexual function outcomes indicate high satisfaction rates. (Source: Urologic Clinics of North America)
Source: Urologic Clinics of North America - June 29, 2022 Category: Urology & Nephrology Authors: Jason Elyaguov, Jessica N. Schardein, Joshua Sterling, Dmitriy Nikolavsky Source Type: research
Common Flaps in Genitourinary Reconstruction
This article discusses the commonly used flaps in genitourinary reconstruction. Penile flaps are the commonest. Overall, the winner is the dartos. All penile flaps are based on the excellent vascularity of dartos. (Source: Urologic Clinics of North America)
Source: Urologic Clinics of North America - June 28, 2022 Category: Urology & Nephrology Authors: Pankaj M. Joshi, Marco Bandini, Sanjay B. Kulkarni Source Type: research
Female Urethral Reconstruction
Urethral reconstruction in women encompasses a variety of different entities including female urethral stricture, female urethral diverticulum, and vesicovaginal fistula. Although very different in their causes, they all have in common a vague and nonspecific onset of symptoms and, usually, a delayed diagnosis. Once identified and evaluated, urologists must review the management options with the patient, which range from minimally invasive procedures to complex reconstructive surgeries. In complicated cases, we recommend referral to an experienced specialized center for definitive management. (Source: Urologic Clinics of North America)
Source: Urologic Clinics of North America - June 27, 2022 Category: Urology & Nephrology Authors: Ignacio Alvarez de Toledo, Jessica DeLong Source Type: research
Male Stress Urinary Incontinence
Male stress urinary incontinence most commonly presents secondary to prostate treatment of prostate cancer or benign prostatic hyperplasia, although it can be seen following trauma or secondary to neurologic dysfunction. Patient selection is supremely important when choosing the appropriate nonoperative or surgical treatment. Although most patients prefer the passive mechanism of adjustable balloon devices or slings, the artificial urinary sphincter provides the most efficacious and durable results with regard to patient satisfaction and continence. Changes in prostate treatment modalities and anti-incontinence device deve...
Source: Urologic Clinics of North America - June 27, 2022 Category: Urology & Nephrology Authors: George E. Koch, Melissa R. Kaufman Source Type: research
Gender Affirmation Surgery, Transmasculine
Transmasculine genital gender affirmation surgery (GAS) is evolving rapidly due to social and surgical advances over recent decades. Important innovations include the use of free or pedicled sensate tissue flaps with integrated urethra coupled with an improved understanding of how best to offer inclusive care. Disappointingly, most publications have thus far failed to address standardization, classification systems, and prospective trials to help guide shared decision making. This narrative review highlights contemporary techniques, controversies, and innovations while addressing gaps in the literature and future direction...
Source: Urologic Clinics of North America - June 27, 2022 Category: Urology & Nephrology Authors: Wai Gin Lee, A. Nim Christopher, David J. Ralph Source Type: research
Management of Necrotizing Soft Tissue Infections (Fournier ’s Gangrene) and Surgical Reconstruction of Debridement Wound Defects
In this article, the authors discuss the epidemiology, pathophysiology, and mechanism of spread of necrotizing soft-tissue infections of the genitalia, including classification schemas. The authors then discuss the acute clinical management of the disease, including suggestions for ways to improve surgical debridements (such that eventual reconstructions are simpler), ways to predict disease severity using laboratory, vital sign, and physical examination findings, and suggestions for initial antimicrobial treatments. Finally, reconstructive techniques and algorithms to ensure that the reconstructive goals of coverage, func...
Source: Urologic Clinics of North America - June 27, 2022 Category: Urology & Nephrology Authors: Bradley A. Erickson, Kevin J. Flynn Source Type: research
Complex Lower Genitourinary Fistula Repair
Rectourethral fistula (RUF) and puboprostatic fistula (PPF) are potentially devastating complications that can develop after various pelvic insults, most notable treatment of prostate cancer. Both entities represent surgical challenges given the complex anatomy, risk of injury to adjacent structures, and poor tissue quality and wound healing. While extirpative surgery may be necessary for some patients, meticulous surgical dissection and interposition of healthy muscle allow for fistula repair in a high proportion of appropriately selected patients, especially in RUF. Herein the authors describe the nature, management, and...
Source: Urologic Clinics of North America - June 27, 2022 Category: Urology & Nephrology Authors: Jack G. Campbell, Alex J. Vanni Source Type: research
Robotic Ureteral Reconstruction
It is generally accepted that robotic ureteral reconstruction provides equivalent results to open and laparoscopic approaches while decreasing pain and length of stay. There is a rapid expansion of robotic ureteral reconstructive techniques, platforms, and adjunctive technologies, enabling more efficient, safer, and novel surgical approaches that could not be done in the past. For instance, indocyanine green use allows rapid, precise location of ureteral stenosis and determination of tissue perfusion. Multi-image display allows the surgeon to integrate the robotic field and ureteroscopic images. Novel robotic surgical tech...
Source: Urologic Clinics of North America - June 27, 2022 Category: Urology & Nephrology Authors: Thomas W. Fuller, Adam M. Daily, Jill C. Buckley Source Type: research
