HOW I DO IT

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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

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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How I Do It: The prostatic urethral lift for obstructive median lobes
Ashley S. Matt, Phillips Jason, Eure Gregg Summit Health, Bend, Oregon, USA

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

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

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

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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