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HOW I DO IT
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M inverted V glansplasty: an update on technique and outcomes 30 years later
Burns Amy, Harrington Stephen, Boltz Suzanne, Decter M. Ross Department of Urology, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
Distal hypospadias is a common congenital urology anomaly for which numerous corrective procedures have been described. Over the last 40 years, the gold-standard operative technique for distal hypospadias has switched from the meatal advancement and glanuloplasty (MAGPI) procedure to the tubularized incised plate (TIP) urethroplasty. A modification to the MAGPI procedure, first described 30 years ago, is the M inverted V (MIV) glansplasty, which improved upon the MAGPI procedure to reduce instances of meatal retraction. The MIV glansplasty is unique compared to many commonly used procedures as it does not require a formal urethroplasty or incorporation of a dartos flap, and it does not always necessitate as extensive mobilization of the glans wings. We describe our updated technique and outcomes of the MIV glansplasty and delineate situations where the MIV is best employed.
Keywords: urethra, surgery, hypospadias, penis, complication,
Oct 2022 (Vol. 29, Issue 5 , Page 11335)PDF (1.54MB)Free -
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
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)PDF (75.3KB)Free -
How I Do It: The Optilume drug-coated balloon for urethral strictures
Elterman S. Dean, Coutinho Karl, Hagedorn C. Judith, MD Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
Urethral stricture disease can be difficult to treat and stricture recurrence is common. The management of stricture disease has evolved and urethroplasty can achieve a high rate of lasting urethral patency. Nevertheless, endoscopic treatments still seem to have sub-optimal outcomes with high stricture recurrence rates. The Optilume drug-coated balloon represents a step forward in the endoscopic management of urethral strictures. The drug-coated balloon may offer an intermediate step prior to repeated dilations, urethrostomies, or urethroplasty. This treatment modality is a promising alternative to current endoscopic management and an option for patients that are poor surgical candidates or decline urethroplasty.
Keywords: urethral stricture, urethral dilation, drug-coated balloon,
Aug 2020 (Vol. 27, Issue 4 , Page 10322)PDF (473.4KB)Free -
State of the art: Advanced techniques for prostatic urethral lift for the relief of prostate obstruction under local anesthesia
Walsh Patrick Lance, MD Eisenhower Medical Center, Rancho Mirage, California, USA
Benign prostatic hypertrophy (BPH) affects an estimated 60% of men over the age of 50 and 90% of men over the age of 80. The prostatic urethral lift (PUL) is a safe and effective office-based procedure that is used worldwide for the treatment of BPH in men who are dissatisfied with medications due to side effects or lack of efficacy or don?t want to have a transurethral resection of the prostate due to the side effects and invasiveness of the procedure. In 2012 Barkin et al, published the standard technique for the delivery of the Urolift implant. The objective of this article is to describe the current state of the art advanced techniques for the delivery of the UroLift implant.
Keywords: prostatic urethral lift, UroLift, benign prostatic hyperplasia, prostate, LUTS, PUL,
Jun 2017 (Vol. 24, Issue 3 , Page 8859) -
How I do it: Aquablation of the prostate using the AQUABEAM system
MacRae Catriona, Gilling Peter, MD Department of Urology, Tauranga Hospital, Tauranga, New Zealand
Benign prostatic hyperplasia (BPH) represents one of the most common conditions encountered in urological practice. For many years, transurethral resection of the prostate (TURP) has been considered the gold standard for surgical management of symptoms in prostates of 30 cc-80 cc. Although TURP provides excellent functional outcomes, there is significant morbidity associated with the procedure, particularly with regards to bleeding, electrolyte imbalance and sexual dysfunction. Emerging technologies aim to maintain the excellent functional results of TURP whilst decreasing the adverse events experienced by the patient. Aquablation is a novel therapy using a high-velocity waterjet and real-time ultrasound imaging with robotic assistance for targeted removal of prostate tissue. We present our experiences with this new technique, the equipment required and steps involved.
Keywords: benign prostatic hyperplasia, transurethral resection of prostate, ablation techniques, aquablation, bladder outlet obstruction,
Dec 2016 (Vol. 23, Issue 6 , Page 8590)
