HOW I DO IT

• Urethral bulking with native tissue during artificial urinary sphincter surgery          

  Rabinowitz J. Matthew, Liu L. James, Levy A. Jason, DuComb William, Burnett L. Arthur The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA  

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  The artificial urinary sphincter (AUS) is the “gold standard” surgical treatment for severe stress urinary incontinence.  However, a subset of patients with frail urethras may require technical adjuncts to ensure optimal cuff function.  Our objective is to provide a detailed tutorial of our institution’s method for performing urethral bulking with native tissue in patients with frail urethras during AUS surgery. We have found that urethral bulking with native tissue provides a cost-efficient and durable technique for improved AUS cuff coaptation.  Our experience demonstrates adequate short and intermediate term efficacy with limited complications.  These techniques equip surgeons with an alternative surgical approach for appropriate patients receiving AUS surgery who have been previously exposed to pelvic radiation and/or significant surgical morbidity resulting in frail urethral tissue.

  Keywords: prostate cancer, artificial urinary sphincter, urinary stress incontinence, urethral disease,

  Apr 2023 (Vol. 30, Issue 2 , Page 11516)
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• Next-generation DNA sequencing for infected genitourinary implants: How I do it

  Chung H. Paul, Leong Joon Yau, Teplitsky Seth, Shenot J. Patrick, Das K. Akhil, Gomella G. Leonard, MD Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia Pennsylvania, USA

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  Infection of artificial urinary sphincters or inflatable penile prostheses is one of the most devastating complications after prosthetic surgery and can have a significant impact on a quality of life. Patients undergoing revision surgery with or without device replacement may have increased risk for infection when compared to initial primary surgery. As such, surgeons may utilize traditional culture results to direct antimicrobial therapy for these patients. Unfortunately, culture results can be inconclusive in up to one-third of the time even in the setting of active device infection. Next-generation sequencing (NGS) of DNA is an emerging technology capable of sequencing entire bacterial genomes and has the potential to identify microbial composition in explanted devices. Herein, we describe our institutional experience on NGS utilization in patients with genitourinary prostheses. We also highlight our methods and techniques to inform readers on the potential practices that can enhance the utility and diagnostic yield of this new and upcoming technology.

  Keywords: urethral stricture, inflatable penile prosthesis, IPP, artificial urinary sphincter, AUS, NGS, infection,

  Oct 2020 (Vol. 27, Issue 5 , Page 10418)
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