HOW I DO IT

• How I Do It: The prostatic urethral lift for obstructive median lobes

  Ashley S. Matt, Phillips Jason, Eure Gregg Summit Health, Bend, Oregon, USA

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  Millions of men in North America suffering from lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are managed on medical therapy. Most patients, however, report poor adherence, and yet relatively few pursue more definitive surgical solutions. The Prostatic Urethral Lift (PUL) was designed to address many of the patient-identified barriers to surgery, namely iatrogenic sexual dysfunction, incontinence, lengthy recovery and postoperative catheterization. Randomized studies and large real world multicenter and database studies have demonstrated safety and effectiveness of PUL when addressing lateral lobe disease. In recent years further technique and device development has led to the FDA approval for PUL addressing obstructive median lobes as well. At 12 months, PUL median lobe patients in a controlled trial and a large retrospective study experienced average IPSS improvement of 13.5 and 11.6 points, QoL improvement of 3.0 and 2.1 points, and Qmax improvement of 6.4 and 7.1 mL/sec, respectively. In the controlled setting, both ejaculatory and erectile function were preserved and postoperative catheterization rates, while higher than lateral lobe PUL rates, were similarly short lived with a mean duration of 1.2 days. We describe the current technique for performing PUL to address the obstructive median lobe and detail a new device, which can make it easier to alleviate obstruction due to trilobar anatomy.

  Keywords: prostatic urethral lift, UroLift, benign prostatic hyperplasia, prostate, LUTS, BPH, PUL, middle lobe, median lobe,

  Apr 2023 (Vol. 30, Issue 2 , Page 11509)
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• How I Do It: Transperineal prostate biopsy using local anesthetic in an outpatient setting

  Ordones Vasconcelos Flávio, Vermeulen Lodewikus, Bressington Morgan, Menon Abilash, Burns Timothy, Muller Loretta, Fraundorfer Mark, Gilling J. Peter Urology Department, Tauranga Public Hospital, Tauranga, Bay of Plenty, New Zealand // Division of Urology, São Paulo State University, UNESP, Botucatu, São Paulo, Brazil // Honorary Senior Lecturer, University of Auckland, Auckland, New Zealand

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  Transperineal prostate biopsy (TPPB) is proven to be an effective diagnostic tool for prostate cancer detection. It allows satisfactory sampling of apical and anterior areas which is not well achieved with the transrectal route, without the associated risks of urinary tract infection or sepsis. The main objective of this paper is to describe the technique utilized in our institution to perform transperineal prostate biopsy under local anesthetic in the outpatient clinic setting.

  Keywords: prostate cancer, transperineal, prostate biopsy, local anesthetic,

  Feb 2023 (Vol. 30, Issue 1 , Page 11453)
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• How I Do It: Penthrox in Urology

  Ferreira Roseanne, Zorn C. Kevin, Bhojani Naeem, Chughtai Bilal, Elterman S. Dean Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada

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  Penthrox is a portable handheld inhaler that delivers a low dose of methoxyflurane - an anesthetic with analgesic effects, rapid onset of action, and a favorable side-effect profile. It has been widely used for acute pain management in Australia for the past 40 years. Currently, it is approved for use in over 55 countries, including Canada. Prospective randomized studies highlight Penthrox analgesic effectiveness and safety profile for emergency, prehospital and outpatient settings. In addition, the use of multimodal analgesia, specifically Penthrox, can play an important role in the analgesic management of urological procedures, such as prostatic biopsies and office-based minimally invasive surgical therapies. Herein readers will familiarize themselves with Penthrox, significant studies, and technique used for outpatient urological procedures.

  Keywords: urology, analgesia, Penthrox, methoxyflurane, MIST,

  Feb 2023 (Vol. 30, Issue 1 , Page 11448)
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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

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  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)
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• The pulley stitch: fixation of penile prosthetic exit tubing

  Levy A. Jason, Bhanji Yasin, Burnett L. Arthur Johns Hopkins School of Medicine Brady Urological Institute, Baltimore, Maryland, USA

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  Proximal positioning of the penile prosthesis cylinder is performed during inflatable penile prosthesis surgery. We describe a technique to secure a prosthetic cylinder during inflatable penile prosthesis implantation. Urologists performing prosthetic surgeries employ a variety of surgical techniques to achieve successful outcomes. A surgical technique that secures the prosthetic device may ultimately mitigate cylinder migration and erosion. This is a simple, cost-effective technique that can be readily incorporated into conventional corporotomy closure procedures. It proves to be a feasible technique for both running and interrupted corporotomy closures. The “pulley stitch” offers an adjunctive technique for prosthesis cylinder positioning and may also help prevent migration of prosthetic devices, and it can be incorporated with corporotomy closure.

  Keywords: inflatable penile prosthesis, corporotomy, closure, pulley stitch,

  Jun 2022 (Vol. 29, Issue 3 , Page 11182)
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