Video Archives

Retroperitoneal Fibrosis: Turning Friendly Territory Hostile

Posted by Joshua E. Sterling, MD, MSc | Sep 2024

Joshua E. Sterling, MD, MSc, addresses the complexities and surgical challenges of managing retroperitoneal fibrosis.

In this 9-minute presentation, Dr. Sterling emphasizes the shift in treatment strategy over the years. While early management relied heavily on surgical intervention, the current approach prioritizes high-dose steroids as the cornerstone of treatment. For patients unresponsive to steroids, immunosuppressive agents or monoclonal antibodies are considered. Surgery is now reserved for refractory cases or when systemic therapy is insufficient.
Sterling includes imaging and procedure videos that illustrate the challenges of retroperitoneal fibrosis. He stresses that surgeons must rely on sharp dissection rather than electrocautery to navigate the fibrosis safely. Techniques like intraluminal ICG or cystoscopy are recommended to locate the ureter amidst dense fibrotic tissue.
Dr. Sterling concludes with practical advice on teamwork, backup planning, and the importance of coordinating surgical strategies to maintain team confidence and patient safety.

Tips and Tricks for Robotic Ileal Ureter

Posted by Ziho Lee, MD | Sep 2024

Ziho Lee, MD, provides insights into robotic ileal ureter reconstruction, offering practical strategies for optimizing outcomes.

In this 10-minute presentation, Dr. Lee uses photos and procedure videos to outline an effective surgical strategy, starting with proximal ureter dissection to assess feasibility, followed by bowel harvest, bladder preparation, and distal anastomosis. Proper exposure is stressed as critical to ensure the best outcomes. Port placement strategies are discussed, including single setup configurations and rotating the robotic boom for upper tract access. Various tunneling techniques are detailed, including creating a mesenteric window to reduce strain and ensure smooth passage of the ileal segment.
The presentation concludes by emphasizing the importance of meticulous technique and thorough planning, especially for patients with complex histories, including prior pelvic radiation. While the indications for ileal ureter replacement are decreasing, it remains a vital tool for urologists. With careful patient selection and precise execution, surgical success rates can reach 90%, minimizing the need for future interventions.

Lower Ureteroplasty – Reimplants, Hitch, Boari Flap

Posted by Divya Ajay, MD, MPH | Sep 2024

Divya Ajay, MD, MPH, focuses on strategies and considerations for lower ureteroplasty, emphasizing meticulous surgical technique and patient management.

In this 13-minute presentation, Dr. Ajay addresses various causes of ureteral pathology, including trauma, stones, infections, and malignancy. She stresses that successful outcomes depend on detailed preoperative planning, including a thorough understanding of stricture length after removing stents to avoid incomplete assessment.
Ajay outlines common surgical strategies with videos of procedures, including psoas hitch and Boari flap for distal ureteral reconstruction, and advocates for individualized approaches based on anatomy and patient history. The use of stents is debated, with newer evidence suggesting fewer complications in select cases when stents are avoided, though caution is recommended in complex or radiated patients.

IFRUU Innovations

Posted by Fernando J. Kim, MD, MBA, FACS | Sep 2024

Fernando J. Kim, MD, MBA, FACS, focuses on innovations and emerging technologies in functional urology. In this 14-minute presentation, he highlights recent advancements in areas like 3D printing, robotics, and telemedicine, emphasizing their potential to transform clinical practice.

Penile/Panurethral and Fossa Navicularis Strictures

Posted by Dmitriy Nikolavsky, MD | Sep 2024

Dmitriy Nikolavsky, MD, focuses on penile strictures and discusses their etiology, anatomical considerations, and treatment options. In this 10-minute presentation, Dr. Nikolavsky shares that current surgical techniques have shifted from multi-stage procedures to single-stage approaches using buccal mucosal grafts, which have shown improved success and lower complication rates. Key procedures discussed include the Asopa and Kulkarni techniques.
The discussion highlights evolving strategies for managing urethral strictures, underscoring a trend towards less invasive, more effective interventions prioritizing patient outcomes and satisfaction. The advancements in this field indicate a significant move towards transurethral approaches, with ongoing research aiming to refine and improve surgical techniques.