Best of AUA 2014: Trauma/Reconstruction/Diversion


Andrew C. Peterson, MD, presents the take home messages on trauma/reconstruction/diversion from the AUA annual meeting in Orlando, FL.

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• Descriptive studies of urogenital injuries among active service members in Afghanistan and Iraq showed that more than half the injuries were scrotal, scrotal-only injuries were rare, and urethral injuries were uncommon. The implications are that many of these men may have an increased need for management of andrology and infertility issues when they transition to civilian health care.

• One presentation provided evidence of a previously undescribed condition: pubic bone osteomyelitis associated with treatment of prostate cancer by surgery, radiotherapy, or ablative therapy.

• Two groups reported high success rates with surgical treatment of rectourethral fistula, which declined substantially with radiation therapy.

• Several studies found that quality of life after urinary diversion associated with radical cystectomy changes with progression from one stage to another.

• A majority of men who underwent primary endoscopic realignment for pelvic fracture urethral injuries had major unintended adverse consequences, including delay in resolution, failure of initial urethroplasty, overflow incontinence, pelvic abscess, and prolonged use of clean intermittent catheterization.

• A new scoring system for categorizing anterior urethral stricture complexity demonstrated good correlation with surgical complexity. The system is derived from the location, length, and number of strictures.

• A study of cadaveric organ-specific acellular matrix for urethral reconstruction showed a long-term success rate of 68%, with no major complications or rejection episodes. The procedure involved enzymatic conversion of cadaveric urethra into acellular matrix.

• In vitro studies of spider web silk for tissue regeneration demonstrated superior strength and elasticity.UT

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