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Author(s): Bhavatej Enganti (corresponding author) [1]; Prashant Nanavati [1]; Vijay Kumar Sarma Madduri [1]; Amish Wani [1]; Mallikarjuna Chiruvella [1] INTRODUCTION Meatal stenosis and fossa navicularis stricture (FNS) are infrequent [...], Introduction: Meatal stenosis and fossa navicularis strictures (FNSs) are commonly caused by lichen sclerosus and instrumentation. We present the technique and short-term functional outcomes of glans cap-preserving dorsal inlay-free graft augmentation for the reconstruction of meatal stenosis and FNS. Methods: This retrospective study analyzed patients with meatal stenosis and FNS who underwent glans cap-preserving dorsal inlay-free graft augmentation at our institute since 2019. The surgical technique included a ventral subcoronal approach, preservation and mobilization of the glans cap, a ventral midline urethrotomy incision over the stricture, and a dorsal midline meatotomy incision extending to the proximal normal urethral mucosa at the fossa navicularis, followed by dorsal inlay graft augmentation. During the follow-up, patients were periodically assessed for symptom scores, urinary flow rates (UFRs), and patient-reported outcomes. Results: A total of 26 patients with a mean age of 45 ± 15 years were assessed. The predominant cause of stricture was lichen sclerosus (n = 15; 58). The mean stricture length was 3.8 ± 0.5 cm, 73 had a circumcised phallus, and an oral mucosa graft augmentation was performed in 22 (85) patients. Notable postoperative complications included intractable meatal hemorrhage (n = 1) and glans suture granuloma (n = 1), which required intervention. At a mean follow-up of 40 months, there were four failures, of which one patient required redo-urethroplasty. The remaining patients (n = 22; 85) showed improved symptom scores (P < 0.05), UFRs (P < 0.05), and satisfactory patient-reported outcomes. Conclusion: Glans cap-preserving dorsal inlay-free graft augmentation is a safe and feasible technique with satisfactory short-term functional outcomes for the management of meatal stenosis and FNS in carefully selected patients. more...

Context: Minimally invasive management (laparoscopic/robot assisted) is currently the standard of care for managing pelvi ureteric junction obstruction (PUJO). Open techniques of management of PUJO are well described in literature. However, there appears to be relative lack of description of minimally invasive techniques in the literature. Objective: This article is aimed at describing in detail, with images, the various techniques and modifications in laparoscopic or robot-assisted management of PUJO. Evidence Acquisition: A review of literature on PubMed was performed and all articles which detailed any technique of minimally invasive pyeloplasty were included. Evidence Synthesis: The various techniques of minimally invasive pyeloplasty as well as the authors' techniques are compiled and described in detail with intraoperative images. Conclusions: Operative techniques of minimally invasive pyeloplasty are not well described in literature. We have attempted to present a comprehensive resource of different techniques of minimally invasive pyeloplasty and the clinical scenarios in which they may be appropriate. This should prove to be a useful reference to the practicing urologist. Patient Summary: In this paper, we have compiled the various surgical techniques of treating obstruction at the PUJ of the kidney along with intraoperative photograph. more...

Introduction: Bipolar transurethral resection of the prostate (B-TURP) is a commonly performed procedure, although it has not yet surpassed the gold standard monopolar TURP. The incidence and contributing factors to the development of urethral stricture following B-TURP are still a matter of debate and were analyzed in the present study. Methods: This prospective study evaluated patients who underwent B-TURP. Demographic characteristics, clinical data, and data on other specific investigations were analyzed. B-TURP was performed using an Olympus TURis bipolar system. Patients were followed up for 6 months with the International Prostate Symptom Score (IPSS), peak flow rate (Q-max), and residual urine estimation. Urethral stricture was defined as narrowing of the urethral lumen requiring instrumentation to improve the urinary flow rate. Results: A total of 352 patients were enrolled, with a mean age of 67 ± 8.6 years. The mean preoperative IPSS, prostate volume, and Q-max were 21 ± 4, 58.8 ± 31.7 cm3, and 8 ± 3 mL/sec, respectively. The mean meatal caliber was 28 ± 2 Fr. In 209 patients (59.4%), B-TURP was performed using a 24-Fr resectoscope, while in the remaining 143 (40.6%), a 26-Fr resectoscope was used. The mean resection times with the 24-Fr and 26-Fr resectoscopes were 36.5 ± 19.8 min and 63.5 ± 30 min, respectively. Urethral strictures were identified in 15 patients, with an incidence of 4.3%. Mean meatal caliber was significantly related to the risk of stricture formation (P = 0.001). Conclusions: The incidence of urethral stricture after B-TURP was 4.3%. We found that small meatal caliber was associated with an increased risk of urethral stricture following B-TURP. more...

Introduction: Transurethral resection of the prostate has been considered as the gold standard for benign prostatic hyperplasia (BPH). LASER enucleation procedures have emerged as a size-independent gold standard. The flip side of LASER procedures is the initial cost of investment and a long learning curve. Transurethral enucleation with bipolar (TUEB) has emerged as an alternative prostatic enucleation procedure. We present our initial experience in TUEB. Materials and Methods: Fifty patients with BPH and indications for surgery underwent TUEB from December 2014 to October 2015. Patients with prostate size> 40 g were selected. All surgeries were done by a single urologist. Various parameters such as preoperative and postoperative International Prostate Symptom Score (IPSS) scores, Qmax (peak flow) scores, duration of surgery, duration of enucleation, drop in hemoglobin, postoperative pain scores, weight of morcellated tissue, and the incidence of stress urinary incontinence were measured. Results: The mean age was 58 years and mean prostatic size was 84 g. Sixteen patients had refractory urinary retention. The mean IPSS score in remaining patients was 24.5. The mean preoperative maximal flow rate (Qmax) on uroflowmetry was 9.3 mL/s. The mean overall duration of surgery was 83 min. The mean drop in hemoglobin was 0.9 g/dl. The mean postoperative pain scores at 12 and 24 h after surgery were 2.1 and 1.3. The mean weight of morcellated tissue was 48 g. Twenty-six patients had de novo transient stress urinary incontinence after surgery. The mean IPSS score after TUEB was 8.3 showing significant improvement in all aspects of IPSS. The mean post-TUEB Qmax on uroflowmetry was 25 mL/s. Conclusions: TUEB is an effective surgical management of BPH. TUEB allows enucleation of large adenomas in a single sitting, mimicking conventional open enucleation of the prostate while having all the advantages of a minimally invasive surgery. more...

Introduction: Laparoscopic or robotic-assisted laparoscopic radical prostatectomy (RALP) is a frequently used approach for localized carcinoma prostate. For intermediate and high-risk cancers, extended pelvic lymph node dissection (e-PLND), is often performed. Conventional e-PLND involves piecemeal retrieval of lymphatic tissue. We describe a novel technique of laparoscopic e-PLND, which involves en-masse removal of pelvic lymph nodes from each side, based on an overlying peritoneal scaffold. Materials and Methods: Fifteen cases of intermediate and high-risk carcinoma prostate underwent laparoscopic radical prostatectomy (LRP) with peritoneal scaffold based e-PLND within a period of 1 year. We describe the surgical techqniue and outcomes in terms of operative time and lymph nodes retrieved. Results: The mean operating times for "peritoneal scaffold" lymphatic dissection was 48 min (38-64). The total number of lymph nodes retrieved was 18 (14-22). There were no cases with postoperative lymph collection or hematoma. Conclusion: The "peritoneal scaffold" technique of e-PLND is a novel technique, which involves having a peritoneal scaffold to bind and hold all the lymphatic tissues together in its anatomical orientation during dissection. This enables complete retrieval of specimen during LRP and RALP. more...

Background: Ureteric reimplantation is the treatment of choice for pelvic lipomatosis with ureteric obstruction. Pelvic adherent fat poses a technical challenge during this surgery. Description of Technique: We describe the robotic approach to facilitate the precise dissection of the ureter and bladder in adherent fat. After creating pneumoperitoneum and port placement, the ureter is exposed at the iliac crossing and dissected distally. Perivesical fat at the intended site of ureteric reimplantation is excised and cystotomy is done. Ureterovesical anastomosis is performed over a stent. Patients and Methods: Two patients with pelvic lipomatosis causing ureteric obstruction and renal function impairment underwent robotic ureteric reimplantation at our institute. Technical aspects and outcomes are discussed here. Results: Blood loss was minimal. No intra-operative or post-operative complication was noted. Renal function improved for both patients. Conclusion: Robotic approach helps to overcome the technical difficulties posed by adherent fat during ureteric reimplantation in pelvic lipomatosis. [ABSTRACT FROM AUTHOR] more...

Objective: To present our initial experience with double-face augmentation urethroplasty for near-obliterative bulbar urethral strictures and analyze the short-term outcomes. Material and methods: We retrospectively evaluated a prospectively maintained database of patients with near-obliterative bulbar urethral strictures (>2 cm), who underwent double-face augmentation urethroplasty. The patients' demographic characteristics, clinical data, and data regarding the investigations conducted were analyzed. Near-obliterative urethral stricture was defined as lumen <6 Fr. Double-face urethroplasty was performed using a ventral approach, during which dorsal inlay and ventral onlay buccal mucosal graft (BMG) augmentation were performed. A successful outcome was defined as normal voiding without the need for any instrumentation to improve the urinary flflow rate. Results: A total of 37 patients with a mean age of 50±11.7 years, who underwent this procedure were included in the study. The mean stricture length was 5.2±0.95 cm. The mean length of the dorsal inlay BMG augmentation was 3.1±0.5 cm and that of the ventral onlay BMG augmentation was 6.3±1.2 cm. Post-void dribbling (18.9%) was the most commonly reported complication. The maximum rates and symptom scores significantly improved in both groups compared with the preoperative parameters (p<0.001). The incidence of both erectile dysfunction and ejaculatory failure was reported in 6 (16.2%) patients; respectively. The overall success rate was 86.5% at a median follow-up period of 36 months (IQR: 26.5-43).Conclusion: Double-face augmentation urethroplasty is a safe and feasible option for near-obliterative bulbar urethral strictures, and our study showed satisfactory short-term outcomes for the same. [ABSTRACT FROM AUTHOR] more...