Sigmoid Vaginoplasty Using the Modified Single Monti Tube Following Vaginectomy for RhabdomyosarcomaOptions for vaginal reconstruction include buccal mucosal grafts, skin grafts, skin flaps, peritoneal flaps and different bowel segments. Sigmoid vaginoplasty has several advantages including natural lubrication, lower stenosis rates, regular dilation is not usually required and the anatomic proximity that allows the neovagina to reach the perineum.1 Vaginoplasty using non-tailored bowel segments requires a long bowel segment and may cause tension on the vascular pedicle that may result in ischemia and stenosis of the neovagina.
Single Position Laparoscopic Radical Nephrectomy and Tumor Thrombectomy for Left Renal Cell Carcinoma With High-Risk Mayo 0 ThrombusApproximately 4%-10% of locally advanced renal cell carcinomas have venous tumor thrombus.1 It is become a tendency to treat this complex pathology with a minimally invasive approach, without compromising oncological outcomes.2-5 For the left renal cancer with high-risk mayo grade 0 and 1 tumor thrombus, due to the obstruction of the superior mesenteric artery and the influence of the lateral position, laparoscopic surgery cannot take into account the 2 vital surgical steps of "tumor thrombectomy" and "nephrectomy" in a single position at the same time, making it has become a problematic issue in minimally invasive treatment.
Management of Urethral HemangiomaHemangiomas are benign proliferations of blood vessels, and urethral hemangiomas are extremely rare presentations of this condition. As the condition is quite rare, there is very little literature about best management strategies. The best resources for determining management are case reports which focus on treatment via transurethral ablation or endoscopic resection. However, there is no guidance on management of urethral hemangiomas which are refractory to these minimally invasive methods. Herein, we summarize the literature for urethral hemangioma management, present the case of a male presenting with refractory hematuria due to a hemangioma in the penile urethra, and describe the operative technique for the open excision and reconstruction of this hemangioma.
Robotic Puboprostatic Fistula Repair with Holmium Laser Pubic DebridementUrosymphyseal fistula (UF) with osteomyelitis most commonly occurs as a result of prostate cancer and benign prostate hyperplasia therapy. UF presentation typically includes debilitating pelvic pain exacerbated with ambulation. Traditional management required open surgical genitourinary (GU) reconstruction with pubectomy leading to significant morbidity. However, progressive utilization of robotic approaches and advances in holmium laser technology has led to a less invasive alternative. Herein, we present our series of robotic-assisted holmium laser debridement of pubic osteomyelitis in the setting of UF.
Corrigendum to ‘Opioid Free Ureteroscopy: What is the True Failure Rate?’ [Urology Vol. 154 (2021) pp. 89-95]The authors regret that there is a typo in the Results section of the Abstract. “In the total cohort, benzodiazepine users had a lower risk of OF-URS failure on multivariate analysis” should read “benzodiazepine users had a higher risk of OF-URS failure”.
Robotic-Assisted Testicular AutotransplantationSilber and Kelly first described the successful autotransplantation of an intra-abdominal testis in 1976. Subsequent authors incorporated laparoscopy and demonstrated the viability of transplanted testes based on serial postoperative exams. We sought to extend this experience with use of the da Vinci surgical robot, thereby demonstrating a novel robotic technique for the management of cryptorchidism. The procedure was performed for an 18-year-old male with a solitary left intra-abdominal testis.
Ring Flap MetoidioplastyTo describe our technique for performing ring flap metoidioplasty in transgender men.
The Tomato ModelPercutaneous renal access (PCA) is one of the most difficult intervention in endourology. Hands-on training is a useful tool for a good understanding of the puncturing technique, reducing the learning curve, and lowering risks of complications during first procedures. The ideal surgical simulator should efficiently improve trainees’ skills, be easily accessible, low-cost, and realistic. We aim to present novel fluoroscopy-guided PCA simulator named TOMATO model.
Straight-Up Approach to Bedside Ureteral StentsTo demonstrate placement of bedside double-j ureteral stents in an Emergency Department or hospital floor setting.
Robot-assisted Magnetic Resonance Imaging-ultrasound Fusion Transperineal Targeted BiopsyTo demonstrate the key steps to perform robot-assisted magnetic resonance imaging-ultrasound fusion transperineal prostate biopsy.
Vaginal Free Graft Dorsal Onlay UrethroplastyFemale urethral stricture is a rare, but often underrecognized, cause of voiding dysfunction in females.1 Vaginal free graft urethroplasty has been shown to have good efficacy and durability in treating urethral stricture, though accessible descriptions of technique are not widely available.1,2 Accordingly, we set out to describe and demonstrate our technique for vaginal mucosal free graft dorsal onlay urethroplasty.
Dorsal Onlay Buccal Mucosal Graft Urethroplasty in Post Radiation Female Urethral Stricture - A Technical Appraisal With OutcomesFemale urethral stricture following radiation has been reported sparsely in the literature with just a handful of case reports. Radiation to the pelvis affects the genitourinary tracts and afflicts damage by causing periurethral fibrosis, necrosis, and subsequent tissue contraction, posing as a hurdle to the reconstructive surgeon. We studied the technique and outcomes of dorsal onlay buccal mucosal graft (BMG) urethroplasty in patients of radiation-induced female urethral stricture disease (FUSD).
Sexual-Sparing Robot Assisted Radical Cystectomy in Female: A Step-By-Step GuideTo show different approaches for sexual-sparing robot assisted radical cystectomy in women.
Rectourethral Fistula Repair Using Robotic Transanal Minimally Invasive Surgery (TAMIS) ApproachSmall nonirradiated rectourethral fistula (RUF) without tissue necrosis or peri-fistula abscess are often treated via a trans-sphincteric or transperineal approach. Attempts at transanal rectal advancement flap to reduce associated morbidity have been widely abandoned due to poor visualization, inability to close the urethral defect in a watertight fashion, and compromise of rectal flap vascularity. Robotic transanal minimally invasive surgery (R-TAMIS) has emerged as a useful tool to address distal rectal lesions as it provides enhanced visualization and surgical dexterity.
Patient Tolerability With Office Transperineal Biopsy Using a Reusable Needle GuideTransrectal ultrasound-guided (TRUS) prostate biopsy is associated with a 1%-5% risk of severe sepsis, despite the use of prophylactic antibiotics. Recent studies have demonstrated the feasibility of transperineal (TP) prostate biopsy in the outpatient setting under local anesthetic (LA). We demonstrate the safety, efficacy, and tolerability of our technique for performing TP biopsy under LA in the clinic setting using a reusable needle guide.
Salvage Enbloc Thulium Fiber Laser Enucleation of Prostate for Giant Prostatomegaly After Prostatic Urethral LiftTo demonstrate technique of salvage thylium fiber laser enucleation of prostate in men with history of prior prostatic urethral lift (PUL) implant. PUL is an accepted treatment modality for benign prostatic hyperplasia (BPH) and is currently recommended for surgical management of prostates <80 g in size.1 However, in reality some patients with prostate >80 g also receive PUL.2 A substantial number of these patients may requirement re-treatment for recurrent or persistent lower urinary tract symptoms after PUL.