Annual Meeting Of The American Urological Association - Moderated Poster Session: Trauma And Reconstruction II

Main Category: Urology / Nephrology
Article Date: 02 Jul 2008 - 4:00 PDT

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ORLANDO, FL (UroToday.com) - The second session in trauma and reconstruction took place Saturday, May 17, 2008 and was moderated by Gerald Jordan and Jack McAninch.

It consisted of 20 abstracts on topics ranging from blunt and penetrating urologic trauma, urethral reconstruction, management of pelvic fracture urethral defects, urethroplasty in transplant recipients, management of Urolume failures, and the use of bioengineered materials for urethral reconstruction.

Highlights of the session included:

Abstract 53 by Tunc and Acar from Istanbul, Turkey looked at the impact of prior endourologic manipulation on the success rate of bulbar urethroplasty and the repair of membranous urethral strictures. In a group of 175 patients, the success rate was 96% for those in which open urethroplasty was the first intervention while those who underwent prior attempts at endourologic management had a success rate of only 84%.

Abstract 54 by Barbagli and Lazzeri reported on a series of 62 patients with penile urethral strictures and compared flap urethroplasty to graft reconstruction. Penile skin flaps via the technique of Orandi enjoyed only a 66.7% success rate while free graft urethroplasty with either buccal mucosa or penile skin enjoyed an 81% or 78% success rate respectively.

Abstracts 55 from Nishizawa and Abstract 56 from Seiler from Switzerland examined the treatment of men blunt renal trauma. Abstract 55 proposed using the Japan Association for the Surgery of Trauma (JAST) to classify blunt renal trauma. The JAST changes existing grading criteria in that grade 3 injuries are subclassified into deep lacerations, transections and fragmentations. Grade 4 injuries apply to pedicle injuries. They determined that the severity of urinary extravasation predicted the need for operative intervention. Abstract 56 reiterated the growing trend of non-operative management of blunt renal trauma and showed that early surgery led to unnecessary loss of kidneys- even in grade 4 injuries.

Abstract 60 from Park from Korea examined a series of 19 patients with urethral injuries that underwent endoscopic primary realignment for urethral trauma over a 5 year period. 11 patients had anterior urethral injuries and 8 had posterior injuries. Results showed that despite realignment, 6 of the 8 patients with posterior injuries had post-realignment stricture while 54% of anterior injuries required repeat procedures for recurrent stricture.

Two abstracts, number 58 and 62 examined penetrating bladder injuries from the war in Iraq. Abstract 58 looked at the high incidence of bladder injuries among civilians during the conflict mostly from stabbings and sharp objects. Abstract 62 examined penetrating gunshot trauma among civilians- again occurring at a higher than expected rate.

Abstract 63 from Houser and Jordan examined single stage reconstruction for Urolume failures. A series of 13 patients with recurrent strictures in the bulbar, membranous and penile urethra after Urolume implantation underwent one-stage Urolume extraction followed by urethroplasty with a variety of techniques including primary anastomosis, buccal mucosa urethroplasty and penile skin flaps. The success rate was surprisingly good with 11 of 13 requiring no further intervention after a follow-up period of 31 months.

Abstract 64 from Meeks and Chris Gonzalez showed that urethroplasty outcomes in patients with renal and pancreas transplants were similar to those men without transplants, even in those pancreas transplants drained vesically.

Abstract 67 from Andrich and Mundy reported on erosion rates of replacement and redo artificial urinary sphincter placement compared with primary AUS implantation. The results showed that the erosion rate was higher in redo surgery but not when replacement was done for a failing device- even when implanted in the same site on the urethra.

Abstract 71 from Ribiero-Filho examined the use of cadaveric organ-specific acellular matrix in urethral reconstruction in humans. In a series of 10 male patients with long and complex urethral strictures, the matrix graft, which was harvested from cadaveric urethra and treated with DNAase, was employed as a ventral onlay technique for strictures as long as 18 cm. No immunosuppression was utilized; antibiotics and catheters were employed for one month post-procedure. Results were surprisingly good with only 2 of 10 requiring period dilations.

Lastly, Abstract 72 from Buckley and Santucci examined trends in stricture disease management in the US and found that despite our knowledge of the poor overall efficacy of dilations and incisions, and the complications noted with urethral stent placement these procedures are performed much more commonly that that of the open urethroplasty which enjoys the highest success rates.

Discussion was lively with contributions from Anthony Mundy, Hunter Wessels and Ken Angermeier.

Moderated by: Gerald Jordan, MD, and Jack McAninch, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Michael J. Metro, MD

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