Trauma/ Reconstruo

Highlights
Steven B Brandes, M.D.
Division of Urologic Surgery

Andr Guilherme Cavalcanti.

Prof. Adjunto Urologia
UNIRIO

Trauma e Reconstruo

28 - Uretroplastia
5 - Trauma
5 - Reconstruo genital
4 - Reconstruo ureteral
4 - Esclerose de colo vesical
4 - Medicina regenerativa
3- AUS
3 - Neuro-urologia
1 - Modelos animais

A: 85
Working Toward a Research Definition of
Success after Anterior Urethroplasty
N= 164; 62 Anast, 102 substituio.
FU 15 meses; Sucesso 96% - Anast, 80% - Sub

A: 85
Working Toward a Research Definition of
Success after Anterior Urethroplasty

Take Home Message

Qual a definio de sucesso aps a
uretroplastia?
Ausncia de novos procedimentos hiper
estima.
Cistoscopia maior acurcia.
AUA SS < 8, Q max > 15 = bom

A5: Prospective evaluation of a new visual prostate symptom

score, the international prostate symptom score and
uroflowmetry before and after treatment in men with urethral
stricture disease.

VPSS <8 ou IPSS<10, Q max > 15

livre de estenose em 100%-95%

A6: Multi-institutional one-year bulbar urethroplasty outcomes

using a standardized prospective cystoscopic follow-up
protocol.

Protocolo com cistoscopia- 3 e 12 meses

Cistoscopia- maior acurcia
25% das recorrncia so assintomticas
Ausncia de novos procedimentos hiper
estima.

Seguimento dos pacientes aps

uretroplastia ??
Cistoscopia e uretrografia mais invasivos
/maior acurcia.
Aferies mais frouxas hiper-estimam
resultados.
Necessidade de uma padronizao para a
comparao de diferentes tcnicas.
Fluxo/Sintomas Cistoscopia ou
Uretrografia

A: 86
Buccal mucosal urethroplasty after failed prior
open repair: a single institution experience
N= 114; 32 uretroplastia ( Diversidade de
procedimentos: anastomose, retalhos, enxertos,
hipospdias).
FU 27 meses. Tamanho 3.1 cm
Sucesso 62%
Take Home:
- Taxa de sucesso inferior cirurgia primria.
- Resultados muito prximos aps a
anastomose.
Cavalcanti AC, AUA 2012

A:89
International Multi-institutional Experience with the
Vessel Sparing Technique to Reconstruct the
Anterior Urethra Mid Term Results

N= 79
Anastomose com preservao da artria
bulbar Jordan, 2007.
Tamanho 2.3 cm; Sucesso 95%
TAKE HOME
Dificuldade tcnica
Bons resultados = tcnica clssica.
Pouco clara sobre resultados de ED/ sensao.

Jordan GH, BJU Int, 2007

Futuros estudos bem construdos so

necessrios para definir as reais
desvantagens
da
uretroplastia
anastomtica clssica quanto funo
sexual.

A91: Pseudospongioplasty using tunica

dartos flaps for support of ventral buccal
mucosa grafts in distal urethra: promising
initial results
Take Home
Enxertos de
mucosa oral
posicionados
ventralmente e
recobertos por
retalhos de dartos.

Uretra Bulbar

Uretra Peniana

Apesar da popularizao dos enxertos em

uretra peniana, ainda temos uma srie de
dvidas
como
a
DE/Curvaturas.
O
posicionamento ventral pode reduzir a
morbidade.

A 93: Artificial Urinary Sphincter Placement in

Compromised Urethras -Comparison of
Virgin, Radiated and Reoperative Fields
N= 93; FU 34 meses.
Take Home = fatores de risco
(comprometimento uretral)
Eroso
Estenose
Uretroplastia
RT ( incerto)

Proteo e Reforo Uretral

Preservao
Bulbar

Esclerose de Colo Vesical

A 95: Deep transurethral incision alone for refractory
bladder neck contracture with or without stress
urinary incontinence: is injection therapy necessary?

O AUS pode ser implantado aps 3 meses .

Taxas de patncia aps a inciso
semelhantes ao uso de injees (90%).
A96:Treatment of bladder neck contracture with
multiple immunologic modulators.

Uso de moduladores biolgicos ( mitomicina

C, tracolimus) aps a inciso do colo vesical
pode ser til.

A380: Stricture length and etiology are

preoperative independent predictors of stricture
recurrence after urethroplasty: a multivariate
analysis of 604 urethroplasties

TAKE HOME
A maioria das falhas ocorre nos primeiros
6 meses.
Fatores de risco
> 5 cm
LS
Etiologia inflamatria e iatrognica.

A7: Anastomotic reconstruction of

radiotherapy induced posterior
urethral stenosis
N= 78; 2.4 cm, FU 2.7 anos
Sucesso- > 16 fr lumen
Take Home
72% sucesso (pior do que a anastomose
standard)
Sem efeito sobre a DE.
Altas taxas de IU 51%
17% -AUS

RENAL AUTOTRANSPLANTATION AN EXCELLENT CHOICE FOR

EXCELLENT RESULTS
Richard Johnston a, Natalya Lopushnyan b, Thomas Hefty a, Paul Kozlowski a
a

Virginia Mason Medical Center

b University of Washington Medical Center, Seattle WA

Background
Extensive ureteral defects, renal artery aneurisms and recurrent
stone disease associated with pain may present management
problems not solved with minimally invasive options

Goal
To evaluate our experience with renal autotransplantation and to
assess the safety and outcomes of this option

Methods
Retrospective review of patients who underwent renal
autotransplantation at Virginia Mason Medical Center 2006-2012
Demographic and clinical characteristics were
assessed and reported

Results
Characteristic

Result [mean (range)]

N patients

21

Age (yr)

49 (25-74)

Solitary kidney

3 (14%)

Cr Preoperative/Postoperative (mg/dL)

1.20 mg/dL / 0.96 mg/dL

Peak Cr (mg/dL) mean

1.70 mg/dL

Length of stay (days)

5.8 (4-11)

Length of follow up (mo) median

24 (3-54)

Complications (%)

2 (9.5%)

Complications
Thrombosis of the renal artery immediate take back
Postoperative sepsis and respiratory failure ICU admission

Conclusions
Renal autotransplantation is technically
challenging, but viable management option for
a selected group of patients.

Testosterone recovery in poly-trauma and scrotal injury in patients from

Operation Enduring Freedom and Operation Iraqi Freedom
Molly Williams, MD1, Inger Rosner, MD1,2, Yongmei Chen, PhD2, Jennifer Cullen, PhD2, James Jezior, MD1, Robert Dean, MD1
1

Walter Reed National Military Medical Center, Urology Service, Bethesda, MD ; 2Center for Prostate Disease Research,
Department of Surgery, Uniformed Services University of the Health Sciences, Rockville, MD

Introduction:
Over 50,000 soldiers injured in OEF and OIF
10% genitourinary, majority involving the external genitalia
Burn literature supports the use of exogenous androgens to
attenuate protein loss and wasting ultimately leading to quicker
recovery
Animal models and trauma literature demonstrate that a low
testosterone state in the immediate post injury period is protective
Objective:
Evaluate testosterone recovery in scrotal trauma
Methods:
84 patients retrospectively identified
All had minimum of 2 testosterone values
All had a testosterone value within 40 days of injury

Testosterone Recovery in poly-trauma and scrotal injury in patients

from Operation Enduring Freedom and Operation Iraqi Freedom
Molly Williams, MD1, Inger Rosner, MD1,2, Yongmei Chen, PhD2, Jennifer Cullen, PhD2, James Jezior, MD1, Robert Dean, MD1
1

Walter Reed National Military Medical Center, Urology Service, Bethesda, MD ; 2Center for Prostate Disease Research,
Department of Surgery, Uniformed Services University of the Health Sciences, Rockville, MD

Results:
The time to testosterone replacement is inversely related to the degree of scrotal injury
(p=0.0005).
The time to recovery did not vary based on the degree of scrotal injury (p=0.3486)
Initial testosterone level was statistically different between the group that recovered and
the group who received testosterone replacement (p=0.0063).
With the exception that the initial testosterone did not vary between the recovery
group and the replacement group in patients with testicular tissue loss (p=0.4218).
Testosterone velocity was predictive of the recovered and the replacement group
(<.0001) even when stratified by degree of scrotal injury.
Kaplan Myer analysis of testosterone velocity by quartile demonstrated that no patients
who received testosterone replacement were in the highest quartile.
Kaplan Myer analysis by degree of scrotal injury demonstrated a trend towards
significant degree of injury taking a longer time to recover (p=0.0708).
Conclusions:
Patients who naturally recovered their testosterone did so within 5 months of injury.
Higher testosterone velocity correlates with endogenous testosterone recovery in polytrauma patients.
Men with higher baseline testosterone levels favored natural testosterone recovery.
Future studies are needed to better define patterns of testosterone recovery.

OBRIGADO