Jonathan YuMustafa AhmedBrittney MurrayDivya Ajay...
75-80页
查看更多>>摘要：Posterior urethral stenosis(PUS)is a known complication following prostate cancer treatment as well as other benign endoscopic treatments.Patients with PUS often fail initial endoscopic treatments and have persistent symp-toms negatively affecting quality of life.In the past decade,a variety of dif-ferent surgical techniques and approaches have changed the landscape of PUS management.The goal of this review is to provide details on the his-torical,current,and future direction of the surgical management for PUS.
查看更多>>摘要：Evidence suggests that robot-assisted ureteroplasty is a safe and feasible management option of ureteral strictures.The retroperitoneal approach to ureteral reconstruction using single-port(SP)robot can be beneficial in challenging cases of patients with prior history of abdominopelvic surgery or radiation.Herein,we present a standardized approach to retroperitoneal SP robot-assisted ureteral reconstruction,highlighting the advantages of this technique in selected clinical scenarios.
查看更多>>摘要：Introduction:Urethral erosion is a known complication of artificial urinary sphincter(AUS)surgery.We performed an in-situ urethroplasty(ISU)to reduce the healing time and time to reimplantation of the AUS.We sought to assess urethral integrity one month after ISU and to identify factors associated with delayed healing in our high-volume tertiary referral center experience.Methods:A retrospective review of our AUS database from 2009 to 2023 was conducted to identify all ISU cases.Patients were stratified as healed or non-healed based on the absence of extravasation on voiding cystourethrogram(VCUG)obtained 4 weeks postoperatively.Background characteristics were evaluated including age,body mass index,diabetes,hypogonadism and smoking history.Operative variables included degree of erosion,location of defect,and the number of stitches required for repair.Results:Among 98 patients undergoing an ISU,61 underwent VCUG at one month.Of these,34.4％(21/61)had evidence of delayed healing on VCUG requiring prolonged catheterization.Although a higher average number of repair sutures were used in ISU,this was not significant(p=0.381).The most common complication in both groups was urinary tract infection(UTI).Non-healed patients had a higher rate of UTI,without significant predilection towards fistula,stricture or diverticulum.No other patient or operative characteristic was significantly different between groups.Conclusion:Despite an aggressive approach to management via ISU,many patients still require prolonged catheterization after AUS erosion to ensure complete healing of the defect.
Adrian FernandezBehzad AbbasiArchitha SudhakarChristine Shieh...
101-107,封4页
查看更多>>摘要：Introduction:Though urinary incontinence(UI)after prostate treatment often contributes to emotional distress and significantly impacts quality of life,many patients do not discuss this condition with their physicians.We analyzed the patient perspective by examining online support group posts to gain insight into specific challenges associated with different UI management methods.Methods:We examined discussion board threads from multiple patient-focused forums on experiences of UI due to prostate treatment(threads from January 2016 to January 2022).Principles of grounded theory in thematic analysis were used to analyze the threads.Results:Three hundred and eighteen posts from 84 unique users were analyzed.Among users,47(56％)reported UI following radical prostatectomy(RP),5(6％)secondary to radiation therapy(RT),12(14％)after a combination of RP and RT,and 20(24％)were ambiguous.UI management methods included pads/diapers/liners,condom catheters/external clamps,Kegels/pelvic floor physiotherapy,and surgical treatment(artificial urinary sphincter or sling placement).We identified challenges common to all management methods:"requires trial and error,""physical discomfort,"and"difficult to be in public."Factors influencing management choices included the ability to"feel normal"and the development of a management routine.Conclusion:The current study identifies opportunities for improved expectation-setting and education regarding post-procedural UI and its management.These findings can serve as a guide for providers to counsel patients on the advantages and disadvantages of UI management devices.
查看更多>>摘要：Background:Pelvic lymph node dissection(PLND)in radical cystectomy(RC)is of great significance,but the method and scope of PLND remain controversial.Based on the principle of indirect lymphadenography,we designed a method to localize the whole pelvic lymph nodes by intradermal injection of indocyanine green(ICG)through the lower limbs and perineum,and to evaluate the effectiveness of this method.Methods:In a single center,54 bladder cancer patients who underwent RC and PLND participated in a prospective clinical trial,which began on February 28,2022 and ended on December 30,2022.ICG solution was injected subcutaneously at the medial malleolus of both lower extremities and at both sides of the midline of the perineum.The fluorescent laparoscopy was used to trace,locate,and remove the targeted areas under the image fusion mode.The consistency of lymph node resection was determined by histopathological diagnosis.The impact of ICG guidance on the surgical time of PLND was compared with that of 11 bladder cancer patients who underwent RC and PLND without ICG injection,serving as the control group.Results:Perineal lower limb combined injection can provide comprehensive visualization of pelvic lymph nodes.This technique reduces PLND surgical time and increases the accuracy of PLND.Conclusion:Intracutaneous injection of ICG into the lower limbs and perineum can specifically mark pelvic lymph nodes.Intraoperative fluores-cence imaging can accurately identify,locate,and resect lymph nodes in the pelvic region,reducing PLND surgical time and increasing the accuracy of PLND.
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