HOW I DO IT

• 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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• How I do it: Aquablation in very large prostates (> 150 mL)

  Helfand T. Brian, Kasraeian Ali, Sterious Steve, Glaser P. Alexander, Talaty Pooja, Alcantara Miguel, Alcantara Mola Kaitlyn, Higgins Andrew, Ghiraldi Eric, Elterman S. Dean Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA

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  Aquablation has been well-studied in prostates sizes up to 150 mL. Recently, American Urological Association guidelines distinguish surgical interventions for men with large prostates (80 mL-150 mL) and now very large prostates (> 150 mL). Readers will gain an understanding of how to use Aquablation in the very large prostate size category.

  Keywords: robotics, LUTS, BPH, aquablation, prostate surgery, urology,

  Apr 2022 (Vol. 29, Issue 2 , Page 11111)
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• How I Do It: Cost-effective 3D printed models for renal masses

  Scott Reilly E., Singh Abhay, Quinn Andrea, Boyd Kaitlyn, Lallas D. Costas Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA

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  3D printing has been growing in many surgical fields including Urology. The primary use has been to print kidneys with tumors to better understand anatomy and to assist with surgical planning and education. Previous studies that utilized 3D printing of kidneys for partial nephrectomies have been limited by the cost and complexity of model creation, rendering them highly impractical to be used on a routine basis. Using a simpler and more cost-effective design and materials allow the 3D kidney models to be used in a wider range and number of patients. We describe our streamlined process to create 3D kidney models costing $30 on average and we believe this process can be repeated by others.

  Oct 2021 (Vol. 28, Issue 5 , Page 10874)
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• How I Do It: Technical report on surgically-initiated rectus sheath catheter using catheter-over-needle assembly

  Ip H. Y. Vivian, Khurana Jaasmit, Jacobsen Niels-Erik, Fairey S. Adrian, Sondekoppam V. Rakesh Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada

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  Development of chronic postsurgical pain following major abdominal or pelvic surgeries is increasingly recognized. Multimodal analgesia including regional anesthesia such as rectus sheath block is growing in popularity. While the literature mainly describes ultrasound-guided rectus sheath blocks, there are many advantages to surgically-initiated rectus sheath catheter performed at the end of surgery. In this technical description, we describe the rationale and technique of surgical insertion of rectus sheath catheters following major urologic surgery with midline incision which is routinely performed by urologists at our institution. Furthermore, we would like to highlight the type of catheter used during rectus sheath catheter insertion, namely the catheter-over-needle assembly. It is simple to insert while minimizes complications such as local anesthetic leakage at the insertion site causing dressing disruption and premature catheter dislodgement, as the catheter-over-needle assembly fits snugly with the skin after insertion.

  Oct 2021 (Vol. 28, Issue 5 , Page 10871)
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• Robotic intracorporeal orthotopic neobladder in the supine Trendelenburg position: a stepwise approach

  Bhattu S. Amit, Ritch R. Chad, Jahromi Mona, Banerjee Indraneel, Gonzalgo L. Mark, MD Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA

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  Robotic radical cystectomy with urinary diversion has become increasingly utilized for the surgical management of bladder cancer. Orthotopic neobladder reconstruction is still performed worldwide primarily via an extracorporeal approach because of the difficulty associated with robotic intracorporeal reconstruction. The objective of this article is to demonstrate a stepwise approach for robotic intracorporeal neobladder in a standardized manner that adheres to the principles of open surgery.

  Keywords: robotics, intracorporeal, neobladder, supine, patient positioning, orthotopic, table motion,

  Aug 2021 (Vol. 28, Issue 4 , Page 10794)
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