Dmitriy Nikolavsky Archives

Posterior Stenosis – Post-Radiation or Anti-BPH Procedures

Posted by Dmitriy Nikolavsky, MD | Sep 2024

Dmitriy Nikolavsky, MD, discusses urethral stricture and stenosis management following radiation and anti-BPH procedures, highlighting surgical challenges, outcomes, and the evolution of treatment strategies.

In this 11-minute presentation, Nikolavsky explores the differences in stricture occurrence across treatment types. Surgical approaches are tailored based on oncologic status, patient preference, and local tissue health. Buccal mucosal grafts for dorsal urethroplasty are highlighted as a promising technique. Notably, dorsal-only urethroplasty has demonstrated comparable success to EPA with a lower incidence of postoperative incontinence.

Dr. Nikolavsky emphasizes the difficulties of traditional excision procedures in radiated fields, proposing dorsal-only urethroplasty as a better alternative due to its minimal disruption of adjacent structures. He shares evidence from multi-institutional studies that support its efficacy.

With a call to challenge established dogmas, Nikolavsky underscores the need to refine guidelines and expand the use of innovative approaches like dorsal urethroplasty to improve patient outcomes.

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.

Genital Affirmation: Surgical Anatomy and Complications

Posted by Dmitriy Nikolavsky, MD | Sep 2024

Dmitriy Nikolavsky, MD, draws on his 12-year experience in managing complications from gender-affirming surgeries, starting with an admission of initial unfamiliarity with the procedures. In this 21-minute presentation, Nikolavsky begins by emphasizing the importance of competent, sensitive healthcare, as many transgender patients report mistreatment in medical settings.
Dr. Nikolavsky outlines surgical procedures such as vaginoplasty and phalloplasty. He describes the steps to create a neovagina, including penile inversion techniques, and highlights common complications like strictures, fistulas, and prolapse. For phalloplasty, the steps involve creating urethral extensions and penile structures, with complications such as urethral strictures and fistulas also being common. He shares photos, illustrations, and a short video to illustrate the steps and possible complications in the procedures.
The importance of postoperative care, including dilation protocols for vaginoplasty patients, is highlighted, as failure to adhere can lead to neovaginal obliteration. Dr. Nikolavsky also touches on long-term issues, such as the need for prostate monitoring in trans women due to the retained prostate after surgery, and managing complications that arise from using various tissues, including gastrointestinal segments.