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  • M inverted V glansplasty: an update on technique and outcomes 30 years later

    Burns Amy, Harrington Stephen, Boltz Suzanne, Decter M. Ross Department of Urology, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA

    Distal hypospadias is a common congenital urology anomaly for which numerous corrective procedures have been described. Over the last 40 years, the gold-standard operative technique for distal hypospadias has switched from the meatal advancement and glanuloplasty (MAGPI) procedure to the tubularized incised plate (TIP) urethroplasty. A modification to the MAGPI procedure, first described 30 years ago, is the M inverted V (MIV) glansplasty, which improved upon the MAGPI procedure to reduce instances of meatal retraction. The MIV glansplasty is unique compared to many commonly used procedures as it does not require a formal urethroplasty or incorporation of a dartos flap, and it does not always necessitate as extensive mobilization of the glans wings. We describe our updated technique and outcomes of the MIV glansplasty and delineate situations where the MIV is best employed.

    Keywords: urethra, surgery, hypospadias, penis, complication,

    Oct 2022 (Vol. 29, Issue 5 , Page 11335)
  • The pulley stitch: fixation of penile prosthetic exit tubing

    Levy A. Jason, Bhanji Yasin, Burnett L. Arthur Johns Hopkins School of Medicine Brady Urological Institute, Baltimore, Maryland, USA

    Proximal positioning of the penile prosthesis cylinder is performed during inflatable penile prosthesis surgery. We describe a technique to secure a prosthetic cylinder during inflatable penile prosthesis implantation. Urologists performing prosthetic surgeries employ a variety of surgical techniques to achieve successful outcomes. A surgical technique that secures the prosthetic device may ultimately mitigate cylinder migration and erosion. This is a simple, cost-effective technique that can be readily incorporated into conventional corporotomy closure procedures. It proves to be a feasible technique for both running and interrupted corporotomy closures. The “pulley stitch” offers an adjunctive technique for prosthesis cylinder positioning and may also help prevent migration of prosthetic devices, and it can be incorporated with corporotomy closure.

    Keywords: inflatable penile prosthesis, corporotomy, closure, pulley stitch,

    Jun 2022 (Vol. 29, Issue 3 , Page 11182)
  • How I do it: Aquablation in very large prostates (> 150 mL)

    Helfand T. Brian, Kasraeian Ali, Sterious Steve, Glaser P. Alexander, Talaty Pooja, Alcantara Miguel, Alcantara Mola Kaitlyn, Higgins Andrew, Ghiraldi Eric, Elterman S. Dean Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA

    Aquablation has been well-studied in prostates sizes up to 150 mL. Recently, American Urological Association guidelines distinguish surgical interventions for men with large prostates (80 mL-150 mL) and now very large prostates (> 150 mL). Readers will gain an understanding of how to use Aquablation in the very large prostate size category.

    Keywords: robotics, LUTS, BPH, aquablation, prostate surgery, urology,

    Apr 2022 (Vol. 29, Issue 2 , Page 11111)
  • How I Do It: Cost-effective 3D printed models for renal masses

    Scott Reilly E., Singh Abhay, Quinn Andrea, Boyd Kaitlyn, Lallas D. Costas Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA

    3D printing has been growing in many surgical fields including Urology. The primary use has been to print kidneys with tumors to better understand anatomy and to assist with surgical planning and education. Previous studies that utilized 3D printing of kidneys for partial nephrectomies have been limited by the cost and complexity of model creation, rendering them highly impractical to be used on a routine basis. Using a simpler and more cost-effective design and materials allow the 3D kidney models to be used in a wider range and number of patients. We describe our streamlined process to create 3D kidney models costing $30 on average and we believe this process can be repeated by others.

    Oct 2021 (Vol. 28, Issue 5 , Page 10874)
  • How I Do It: Technical report on surgically-initiated rectus sheath catheter using catheter-over-needle assembly

    Ip H. Y. Vivian, Khurana Jaasmit, Jacobsen Niels-Erik, Fairey S. Adrian, Sondekoppam V. Rakesh Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada

    Development of chronic postsurgical pain following major abdominal or pelvic surgeries is increasingly recognized. Multimodal analgesia including regional anesthesia such as rectus sheath block is growing in popularity. While the literature mainly describes ultrasound-guided rectus sheath blocks, there are many advantages to surgically-initiated rectus sheath catheter performed at the end of surgery. In this technical description, we describe the rationale and technique of surgical insertion of rectus sheath catheters following major urologic surgery with midline incision which is routinely performed by urologists at our institution. Furthermore, we would like to highlight the type of catheter used during rectus sheath catheter insertion, namely the catheter-over-needle assembly. It is simple to insert while minimizes complications such as local anesthetic leakage at the insertion site causing dressing disruption and premature catheter dislodgement, as the catheter-over-needle assembly fits snugly with the skin after insertion.

    Oct 2021 (Vol. 28, Issue 5 , Page 10871)
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