Balzano, Felicia

ABSTRACT Introduction and Objectives Female urethral strictures remain a challenging clinical entity with limited data on optimal reconstructive techniques. This study presents 12‐month clinical and patient‐reported outcomes following a novel transurethral approach to dorsal inlay buccal graft urethroplasty. Methods We evaluate the outcomes of consecutive female patients with urethral strictures treated via dorsal inlay buccal graft urethroplasty from October 2021 to November 2024. Preoperative evaluation included cystoscopy, uroflowmetry, and/or voiding cystourethrogram. Follow‐up at 4 and 12 months included cystoscopy, uroflowmetry, and patient‐reported outcomes measured via the Global Response Assessment. Success was defined as absence of recurrence on cystourethroscopy. Results Twenty‐one patients were included in the study, with 95% having undergone prior treatments (90% dilation/DVIU and 9% urethroplasty). Stricture locations varied across the distal (33%), mid (19%), proximal (19%), and multifocal/pan urethral (19%). The median operative duration was 60 min (IQR: 56–86) and all were discharged on the day of surgery. Nineteen patients (90%) underwent a dorsal inlay procedure, while two (10%) required combined dorsal and ventral inlay due to obliterative stricture. No complications were observed. The median follow‐up was 13.2 (IQR: 5.1–23.5) months, during which time 1 patient underwent retreatment for recurrent stricture. Clinical success was 95% at 4 months and 92% at 12 months. Median peak urinary flow rate preoperatively versus 4‐month postoperatively was 7.0 cc/s versus 13.0 cc/s ( p = 0.20) and at 12‐month postoperatively was 13.3 cc/s ( p = 0.50). 90% of patients reported improvement on the Global Response Assessment. There were no cases of de novo stress urinary incontinence. Conclusions This novel transurethral dorsal inlay buccal graft urethroplasty offers a safe and efficient treatment for female urethral strictures with durable clinical and patient‐reported outcomes at 12 months. The technique's minimal urethral mobilization translates into shorter operative times and a low risk of stress incontinence, making it a promising alternative to traditional approaches.

Clinical History: A 60-year-old man with a history of muscle invasive small cell carcinoma of the bladder underwent robot-assisted radical cystectomy with pelvic lymph node dissection and Indiana pouch creation. He underwent aspiration and endoscopic urethral fulguration for a symptomatic lymphocele without improvement. Physical Examination: Clear fluid draining per urethra. CT of abdomen/pelvis showed unchanged loculated fluid collections within the dependent pelvis 2 months after aspiration and urethral fulguration. Diagnosis: Pelvic lymphocele with drainage per urethra. Intervention: Fulguration and closure of the urethral stump using a laparoscopic suture device (RD-180; LSI Solutions, Rochester, NY) and novel endoscopic sheath (JNW Urtract TM ; LSI Solutions). Before surgery, a pigtail drain was placed in the pelvic fluid collection. The proximal stump was fulgurated using the bipolar plasma band through a 27F cystourethroscope (Olympus Surgical Technologies America, Westborough, MA) to facilitate scarring. The stump was closed using the RD-180 under direct observation in a figure of eight manner both proximally at the opening and 1 cm distally. Knots were fashioned using the Ti-Knot fastener (LSI Solutions). Total operative time 37 minutes. Follow-Up/Outcomes: Patient was dismissed same-day following surgery. CT scan 2 months postoperatively demonstrated resolution of pelvic fluid collection, and his drain was removed. He remains asymptomatic without recurrence or urethral drainage 4 months postoperatively. To our knowledge, this is the first described case of endoscopic closure of a urethral stump in the setting of persistent drainage from a pelvic lymphocele. Fulguration with endoscopic closure using a novel device is both a safe and efficacious alternative to performing urethral fulguration alone. No competing financial interests exist. No funding was received for this article. Patient consent statement: Patient consented to the use of nonidentifiable intraoperative photography and video recording for the purpose of medical education and publication in professional journals. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. Music: All music was from Pixabay.com, royalty free. Runtime of video: 4 mins 4 secs

Purpose: Lower urinary tract symptoms among adult men can significantly impact quality of life. We evaluated complications based on prostate size following plasmakinetic enucleation of the prostate. Materials and Methods: Patients were grouped into the small prostate group (SPG, <75 g) and large prostate group (LPG, >75 g) based on preoperative imaging. Patient data on demographics, comorbidities, preoperative international prostate symptom score (IPSS), bother index (BI), prostate-specific antigen (PSA) if indicated, postvoid residual volume (PVR), indwelling catheter or self-catheterization status, and any prior surgical intervention were evaluated. Postoperative IPSS, BI, and PVR values were assessed at 6 weeks, 4 months, and yearly. Postoperative urge urinary incontinence (UUI), stress urinary incontinence (SUI), and pad use were assessed. Results: Between September 2015 and December 2020, 296 patients who underwent bipolar enucleation with minimum follow-up of 4 months were evaluated. Postoperative IPSS, BI, PVR, and PSA values at all time points were significantly decreased compared with preoperative values ( p < 0.05). There was no significant difference in the complications between groups. Univariable and multivariable analysis found that size <75 g was predictive of stricture formation and bladder neck contracture (BNC). UUI was more common at 6 weeks in the SPG, and SUI was more common at 6 weeks in the LPG, but no difference was noted at the 4-month and 1-year time points. Pad use was equal between the two groups at all time points. Conclusions: Plasmakinetic enucleation of the prostate provides an effective treatment option for prostates of all sizes; however, prostates <75 g have a higher rate of BNC and urethral strictures compared with those >75 g.