Best of AUA 2013: Trauma/Reconstruction/Diversion

July 1, 2013

Hunter Wessells, MD, presents the take home messages on trauma/reconstruction/diversion from the AUA annual meeting in San Diego.

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Presented by Hunter Wessells, MD

University of Washington, Seattle

 

• A visual symptom score for lower urinary tract symptoms had good correlation with the International Prostate Symptom Score and Qmax, providing a potential option that addresses issues related to literacy and/or language numeracy.

• A comparison of protocols for assessment of urethroplasty outcomes found that cystoscopy detected most recurrences, 25% of which were asymptomatic.

• Vessel-sparing anterior urethroplasty is technically difficult but achieves high stricture-free rates. It is unclear whether the procedure benefits sexual function.

• A plenary video debate covered muscle- and nerve-sparing urethroplasty techniques to reduce morbidity.

• Radiation-induced posterior urethral stenosis is increasing; anastomotic success rate is lower compared with standard procedures, however, and half of patients have persistent incontinence.

• Deep cuts may keep refractory post-prostatectomy bladder neck contracture open. The use of biological modifiers to treat recurrence is intriguing but requires additional study.

• An artificial urinary sphincter (AUS) can be placed safely 3 months after transurethral incision of the bladder neck following prostatectomy.

• AUS failure rates in compromised urethras (those with prior AUS placement, urethroplasty, or radiation) as a whole were approximately 20% higher than in their virgin counterparts.

• A higher complication rate was seen with use of a 3.5-mm cuff versus a transcorporal cuff in treating transurethral stricture.

• Use of external bulking with donor pericardium showed promise for improving the fit of an AUS cuff.

• Presence of >25% devitalized renal fragments proved to be the only predictor of the need for open surgery after initial non-operative management of acute renal injury.

• Success of endoscopic realignment of posterior urethral injury was independent of Young Burgess pelvic fracture severity.

• U.S. military data show immediate post-scrotal injury hypogonadism and slow testosterone recovery in patients without major testis loss.

• Lattisimus dorsi detrusor myoplasty enhances bladder emptying.

• A trial of a tissue-engineered oral mucosal graft in one-stage anterior urethroplasty yielded a 92% success rate after 10 months of follow-up.

• A rat model of urethral injury/repair may provide insight on improving the healing process.

• Urine- and adipose-derived stem cells may be used to recreate the urinary tract without taking a biopsy of the bladder.UT

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