Page 5 - CUA2018 Abstracts - Reconstruction

Poster session 6: reconstruction/trauma/transplant

procedures (Table 2; available at https://cua.guide/). Overall, UP for HAUS Results: Forty–five RGUs were performed between March 2016 and
was successful in 88.1%, with a mean followup of 19 months, a compli- September 2017. The median fluoroscopy time was 2.35 seconds (range
cation rate of 9.5%, and a 21.4% rate of urethrocutaneous fistula (Table 0.9–6.5). Quality of RGU was not noted to be less than normal apart from
3; available at https://cua.guide/). Group 1 (66.7% of the total) required a grainy picture (Fig. 1; available at https://cua.guide/). Ten RGUs were a
staged UP in 75% of cases; Group 2 (7.1%) and Group 3 (10.7%) typi- repeat for postoperative confirmation of patency. Pathology (e.g., stricture/
cally had single stage UP with oral mucosa in 83.3% and 66.7% of cases, fistula) were identified in 51% (23) of the examinations. There was a 95%
respectively, while Group 4 (15.5%) required penile fasciocutaneous flap (22) positive intraoperative confirmation of the RGU findings. The one
UP in 69.2% of cases. Despite differing by stricture length (p=0.02), local- patient that the RGU missed was likely due to incomplete opacification
ization (p<0.001), and number of previous repairs (p<0.001), groups did of the distal penile urethra and it was noted intraoperatively.
not significantly differ by UP success (p=0.82), complications (p=0.16), or Conclusions: Pulsed T4 fluoroscopy reduces the radiation exposure in
urethrocutaneous fistula (p=0.19) (Fig. 1; available at https://cua.guide/), RGU. Regular fluoroscopy can use 2–3 times the amount of radiation.
whereas individual UP techniques did. PF was not associated with reduction in the diagnostic capacity of the
Conclusions: Based on our series findings, we propose that HAUS can test. Reduction of fluoroscopy can have detrimental cumulative effect as
be classified into one of four categories. While UP for HAUS is highly per the ALARA principle for the patient and medical personnel involved
successful, a classification–based approach can allow to obtain similar in the patient care.
outcomes in terms of recurrence and complications in all groups, regard-
less of the baseline differences. UP–6.5
References:
1. Craig JR, Wallis C, Brant WO, et al. Management of adults with prior Bladder neck contracture continues to be a misused terminology
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failed hypospadias surgery. Transl Androl Urol 2014;3:196–204. 1 Ryan McLarty , Mark Assmus , Keith Rourke
2. Hoy NY, Rourke KF. Better defining the spectrum of adult hypo- Division of Urology, University of Alberta, Edmonton, AB, Canada
spadias: Examining the effect of childhood surgery on adult pre- Introduction: Nomenclature is important, as it promotes adequate com-
sentation. Urology 2017;99:281–6. https://doi.org/10.1016/j.urol- parisons, communication, and scientific progress. In 2014, the Société
ogy.2016.07.057 Internationale d’Urologie/International Consultation on Urethral Strictures
3. Myers JB, McAninch JW, Erickson BA, et al. Treatment of adults (SIU/ICUD) published recommended nomenclature, in particular differ-
with complications from previous hypospadias surgery. J Urol entiating between bladder neck contracture after transurethral surgery
2012;188:459–63. https://doi.org/10.1016/j.juro.2012.04.007 and vesicourethral stenosis after radical prostatectomy (given the lack of
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4. Snodgrass WT, Bush NC. Management of urethral strictures after bladder neck). However, we hypothesize that these terms remain incor-
hypospadias repair. Urol Clin North Am 2017;44:105–11. https:// rectly used. Our objective was to report how prevalent the term bladder
doi.org/10.1016/j.ucl.2016.08.014 neck contracture/stenosis was misused in a survey of the current literature.
5. Tang S–H, Hammer CC, Doumanian L, et al. Adult urethral stricture Methods: A search of the MEDLINE database between January 2015
disease after childhood hypospadias repair. Adv Urol 2008;2008:1– and June 2017 was conducted. Articles were searched for the terms “blad-
4. der neck contracture,” “bladder neck stenosis,” “vesicourethral steno-
sis,” and “vesicourethral anastomotic stricture.” All review and original
research articles with male subjects were included. Articles were excluded
UP–6.4 if the etiology of the term could not be determined.
Pulsed fluoroscopy in retrograde urethrogram Results: A total of 82 articles were identified with 78 meeting inclusion
Walid Shahrour , Owen Prowse , Hazem Elmansy 1 criteria. Thirty–nine academic journals were represented. The term “blad-
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1 Clinical Sciences Division, Department of Surgery, Northern Ontario der neck contracture or stenosis” was present in 65 articles; 18 (30.7%) of
School of Medicine, Thunder Bay, ON, Canada these articles, which represented 14 different journals of varying impact
Introduction: Retrograde urethrogram (RGU) is one of the cornerstones factors, used the term “bladder neck contracture/stenosis” incorrectly.
for the reconstructive urologist. With hundreds of RGUs being performed Vesicourethral stenosis was used in 13 articles with 100% accuracy.
yearly in busy reconstructive centres, the concern for radiation exposure Conclusions: There remains misuse of the term “bladder neck contracture/
to the patient and the medical personnel becomes important. The ALARA stenosis” in the current literature. Efforts should be made to ensure proper
radiation principle (As Low As Reasonably Achievable) is an important nomenclature to promote proper scientific communication, standardiza-
aspect for safety that is now a part of the regulations. We propose the use tion, and further research.
of pulsed fluoroscopy (PF) to decrease the radiation exposure for patient Reference:
and medical personnel. 1. Latini JM, McAninch JW, Brandes SB, et al. SIU/ICUD consultation
Methods: Between March 2016 and September 2017, RGUs were per- on urethral strictures: Epidemiology, etiology, anatomy, and nomen-
formed by a single urologist. The fluoroscopy machine was set for PF at clature of urethral stenoses, strictures, and pelvic fracture urethral
a setting of four pulses per second. The urologist controlled the pedal for disruption injuries. Urology 2014;83:S1–7. https://doi.org/10.1016/j.
fluoroscopy. Patient information, including demographics, preoperative urology.2013.09.009
diagnosis, intraoperative findings, and fluoroscopy time were recorded.

S100 CUAJ • June 2018 • Volume 12(6Suppl2)