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