Peyronie’s Disease Surgery: Considerations, Tips, and Pitfalls
William O. Brant, MD, FACS, FECSM, explores surgical approaches for Peyronie’s disease, focusing on penile curvature correction.
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Topic: Reconstructive Surgery
Penile Filling with Hyaluronic Acid – Where are We
Fernando Tardelli, MD, explores penile enlargement, particularly using hyaluronic acid (HA) fillers as a minimally invasive approach.
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IPP and Penile Curvature Decisions: Doing Nothing, Something or Everything
Jay Simhan, MD, FACS, examines the challenges of penile implants in patients with refractory erectile dysfunction and Peyronie’s disease.
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Robotic Urinary Diversion Ilial Conduit
Janet B. Kukreja, MD, MPH, FACS, provides a detailed overview of performing robotic-assisted ileal conduit surgery, focusing on practical techniques and strategies for effective urinary diversion.
In this 12-minute presentation, Dr. Kukreja shares a video of one of her procedures, beginning with port placement and tool selection. Using both handheld and robotic staplers, she demonstrates methods to minimize complications and ensure precision during bowel anastomosis. She discusses techniques to avoid complications, such as meticulous ureter preparation, vascular supply preservation, and strategic suture placement. The demonstration covers methods for managing the ureters, including tunneling under the sigmoid and spatulating to ensure optimal flow and reduce the risk of narrowing.
This comprehensive overview provides practical insights into optimizing robotic urinary diversion procedures, making it a valuable guide for surgeons managing complex cases requiring ileal conduits.
Robotic GU Fistula Repair
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.
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Reconstruction of Complex Upper and Mid Ureteral Strictures with Buccal Mucosa Graft Ureteroplasty
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.
Tips and Tricks for Robotic Ileal Ureter
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
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
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.
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Penile/Panurethral and Fossa Navicularis Strictures
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
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.
UPJO Management: Cut, Construct, or Check
Benjamin K. Canales, MD, MPH, discusses the pathophysiology and clinical presentation of UPJO, emphasizing its impact on renal function and patient quality of life. He outlines the diagnostic approach, including imaging techniques such as ultrasound, CT, and diuretic renography, which are essential for assessing the obstruction and guiding treatment decisions.
The presentation delves into the three primary management strategies for UPJO: surgical intervention, reconstructive techniques, and conservative monitoring. Dr. Canales provides a detailed analysis of each approach and discusses the indications, success rates, and potential complications of open, laparoscopic, and robotic-assisted pyeloplasty, offering insights into selecting the most appropriate surgical technique based on patient-specific factors.
Dr. Canales reviews the evidence supporting reconstructive techniques, including endopyelotomy and balloon dilation, as minimally invasive alternatives, highlighting their benefits and limitations. Conservative management and active surveillance are presented as viable options for patients with mild or asymptomatic UPJO.
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