Page 4 - CUA 2020_Trauma and Reconstruction

2020 CUA ABSTRACTS

Moderated Poster Session 2: Trauma, Reconstruction, Pelvic Pain

MP-2.1 laris strictures using our technique. The primary outcome was urethroplasty
Assessing the management of collecting system injuries in renal success defined as easy passage of a 16 Fr flexible cystoscope with a
trauma grade 4 and 5 in a large, retrospective cohort minimum of 12 months’ followup. Secondary outcomes included 90-day
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Jennifer A. Locke , Roshan Navaratnam , Sarah R. Ferrara , Andrea Phillips , complications, de novo erectile dysfunction, and chordee at six months
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Avery Nathens , Sender Herschorn , Ronald T. Kodama 1 postoperatively. Comparisons were made using Cox regression, t-test, or
1 Urology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada chi-squared as appropriate.
Support: Tory Trauma Program Results: From January 2013 to May 2018, 27 patients underwent fossa
Introduction: Collecting system injuries coincide with 50% of AAST grade navicularis reconstruction with the “sliding-T” technique. Etiologies were
4/5 renal injuries and 29% of these collecting system injuries are stented. lichen sclerosus (70.4%), iatrogenic (18.5%), or idiopathic (11.1%). Mean
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AUA guidelines suggest that, “surgeons perform urinary drainage (via stent stricture length was 3.2±1.2 cm and mean patient age was 47.3 years
or percutaneous nephrostomy tube) in the presence of complications, such (19–71); 92.6% of patients failed prior endoscopic treatment, 7.4% failed
as enlarging urinoma, fever, increasing pain, ileus, fistula, or infection.” prior urethroplasty. At a mean followup of 29.6 (12–60) months, the success
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In this retrospective study, we question if ureteral stenting is necessary in rate was 92.6%. Both recurrences were treated with meatotomy. Ninety-day
the management of collecting system injuries after grade 4/5 renal trauma. complications (Clavien ≥2) occurred in two patients (7.4%) (treated surgi-
Methods: After REB approval, we conducted a chart review of grade 4/5 renal cal site infections). Functionally, one patient experienced de novo erectile
traumas with collecting system injuries at our institution from 1998–2019. dysfunction, one reported mild chordee, and 96.3% of patients reported
Results: We identified 149 patients with grade 4/5 renal traumas; 98 had being satisfied with surgical outcome.
immediate trauma imaging leading to the diagnosis of urinary extravasation Conclusions: Reconstruction of fossa navicularis strictures using buccal
in 46 (47%). Three patients underwent eventual stent insertion and two mucosa with a single-stage “sliding-T” dorsal inlay technique provides sat-
had a late drain placed for a urinoma. Five patients underwent immediate isfying anatomic and functional outcomes with a low rate of complications.
trauma laparotomy (two nephrectomy, three operative repair of the kidney).
The remaining 36 (78%) did not undergo any interventions. Of those who MP-2.3
did not undergo an intervention for a collecting system injury, 31 (86%) Augmented anastomotic urethroplasty in the treatment of long
had repeat imaging (ultrasound [US]: five; computed tomography [CT], bulbar urethral strictures is independently associated with
non-contrast: three; CT with IV contrast: 13; and CT urogram: 10; median stricture recurrence
time four days; range 1–112). Of those reimaged, 20 (65%) demonstrated Elaine Redmond , Dylan Hoare , Nathan Hoy , Keith F. Rourke 1
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no extravasation and 10 (32%) demonstrated continued urinary extravasa- 1 Department of Urology, University of Alberta, Edmonton, AB, Canada
tion. Resolution of extravasation on subsequent imaging was observed in Introduction: Controversy exists regarding the optimal urethroplasty tech-
nine of those, while one was lost to followup. nique for bulbar urethral strictures requiring buccal mucosal graft (BMG).
Conclusions: Our results suggest that collecting system injuries do not Augmented anastomotic urethroplasty (AAU) involves partial stricture exci-
require stent intervention and will resolve with time. This supports the role sion to remove the most fibrotic portion, with subsequent onlay of the
for conservative management of high-grade renal traumas with collecting remaining stricture. However, this technique may risk ischemic recurrence
system injuries and questions the necessity for routine early CT with IV through transection of the urethra. “Pure” dorsal onlay (DO) grafting avoids
contrast reimaging in the stable and asymptomatic patient. transection of the urethra but may suboptimally treat obliterative segments
References at risk of recurrence. The aim of our study was to assess the relative out-
1. Keihani S, Xu Y, Presson AP, et al. Contemporary management of high- comes of AAU vs. DO in the setting of bulbar urethroplasty requiring buccal
grade renal trauma: Results from the American Association for the mucosal graft.
Surgery of Trauma Genitourinary Trauma study. J Trauma Acute Care Methods: A retrospective review was performed on all patients who under-
Surg 2018;4:418-25. https://doi.org/10.1097/TA.0000000000001796 went urethroplasty with BMG for long (2–10 cm) bulbar strictures between
2. Morey AF, Brandes S, Dugi DD 3rd, et al. Urotrauma: AUA guideline. October 2003 and March 2019. In approximately 2011, institutional tech-
J Urol 2014;192:327-35. https://doi.org/10.1016/j.juro.2014.05.004 nique shifted from routinely performing a transecting augmented anasto-
motic urethroplasty with dorsal BMG to a non-transecting DO. Exclusion
MP-2.2 criteria included anastomotic urethroplasty without BMG, ventral onlay,
Single-stage reconstruction of fossa navicularis strictures using a staged, flap, or circumferential reconstructions. Patients were assessed with
“sliding-T” dorsal inlay urethroplasty with buccal mucosal graft routine cystoscopy at six months postoperatively and symptomatically there-
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Jordana Fersovich , Alvaro Saavedra , Keith F. Rourke 1 after. Recurrence was defined as stricture <16 Fr on cystoscopy. Those who
1 Department of Urology, University of Alberta, Edmonton, AB, Canada failed to attend for cystoscopy were excluded from analysis. Secondary out-
Introduction: Fossa navicularis strictures are challenging to treat. Endoscopic comes included 90-day complications. Multivariate Cox regression analysis
treatments typically offer temporary relief and require lifelong instrumenta- was performed to assess the impact of technique and other relevant clinical
tion. Reconstruction requires establishing an unobstructed urethra while factors on stricture recurrence.
preserving cosmesis and sexual function. Various urethroplasty techniques Results: Of the 836 patients who underwent bulbar urethroplasty during the
exist, including single- and multi-staged approaches. We describe a single- study period, 507 met inclusion criteria. Of these, 221 patients received an
stage urethroplasty for fossa navicularis strictures using a “sliding-T” dorsal AAU with dorsal BMG, while 286 underwent DO with BMG. Mean patient
inlay technique with buccal mucosa. age and stricture length was 45.4±14.8 years and 4.4±1.5 cm, respectively.
Methods: A retrospective review of a prospectively maintained reconstruc- Overall success rate was 93.9%, with a mean followup of 78.9 (5–189)
tion database identified patients undergoing urethroplasty of fossa navicu- months. On multivariate Cox regression analysis AAU (hazard ratio [HR]
S86 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)
© 2020 Canadian Urological Association