International Functional and Reconstructive Urology Update Archives

FRU Discussion

Posted by Brian J. Flynn, MD | Sep 2024

Brian J. Flynn, MD, and Alan J. Wein, MD, PhD (Hon), FACS, discuss the evolution of functional urology.

In this 16-minute discussion, Dr. Wein emphasizes the holistic approach to functional urology, which encompasses all measures to restore normal bladder function, whether through medication, pelvic floor therapy, or surgery. Of note is his stance against dividing male and female urology, advocating for an integrated approach that addresses dysfunction across genders.

Dr. Wein and Dr. Flynn discuss the overlap between storage and voiding dysfunctions, like stress and urge incontinence, which often coexist. Dr. Wein shares insights on how treating one issue can sometimes alleviate the other, though the relationship remains unclear. He stresses the importance of a unified, simplified approach to diagnosis and treatment.

Other colleagues attending the discussion provided perspective and emphasized collaborative, team-based approaches to functional urology. A urogynecologist highlighted how gynecologists primarily manage female pelvic health and storage issues, while a pediatric urologist underscored the importance of standardized nomenclature and communication across specialties.

Urethral Injuries Related to Pelvic Fractures: Contemporary Approach and Recommendations

Posted by Reynaldo Gomez, MD, FACS | Sep 2024

Reynaldo Gomez, MD, FACS, covers two key aspects of reconstructive surgery for pelvic fracture-related urethral injuries (PF UIs): the timing of reconstruction and refinements in surgical techniques. In this 10-minute presentation, Gomez first addresses the mandatory three-month waiting period before reconstruction, noting that this time frame can be shortened in certain cases. The second part of the talk addresses refinements in the surgical technique, emphasizing the importance of preserving bulb arteries during reconstruction to avoid ischemia.

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.

Robotic GU Fistula Repair

Posted by Divya Ajay, MD, MPH | Sep 2024

Divya Ajay, MD, MPH, covers diagnosing and managing genitourinary (GU) fistulas, emphasizing the complexity and challenges involved. Fistulas can occur throughout the urinary system, affecting the lower and upper tracts. Common causes include gynecological surgeries, cancer treatments, radiation, and infections.

In this 24-minute presentation, Dr. Ajay discusses vesicovaginal, urethral, and colovesical fistulas, with treatment strategies varying based on fistula type and patient condition. Ajay shares several surgical approaches, including robotic, vaginal, and open surgeries, tailored to the fistula’s location and severity. Ultimately, successful outcomes depend on precise diagnosis, appropriate surgical technique, and postoperative management.

Reconstruction of Complex Upper and Mid Ureteral Strictures with Buccal Mucosa Graft Ureteroplasty

Posted by Ziho Lee, MD | Sep 2024

Ziho Lee, MD, focuses on using buccal mucosa grafts in ureteral reconstruction and highlights their value in complex cases. Buccal mucosa grafts offer a practical alternative when standard resection and anastomosis are not feasible.

In this 11-minute presentation, Dr. Lee describes onlay grafts, where the anterior surface of the ureter is slit and patched with the graft, and augmented anastomotic repairs for more severe cases with obliterated segments. He shares a short video of both techniques.
Dr. Lee emphasizes the importance of minimizing tissue manipulation and dissection, particularly in cases with fibrosis. Strategies like measuring defects with precision and securing grafts using Monocryl sutures are discussed for graft placement. He recommends using omental wrapping or attaching grafts to the psoas muscle to ensure stability and promote vascularization, especially in retroperitoneal cases.