CAPE TOWN, SOUTH AFRICA (UroToday.com) - The moderated poster session on Traumatic and Reconstructive Urology was chaired by Reynaldo Gomez from Santiago Chile. It consisted of 25 posters on a variety of topics. Some highlights of the session included:

Poster 2 by Richard Santucci from Detroit was entitled The Burden of Male Urethral Stricture Disease in the USA. The poster involved an epidemiologic and economic review of the diagnosis of urethral stricture disease which had a lifetime incidence of 0.6%. In the year of 2000, the disease was estimated to cost US insurance companies over 200 million dollars and involved 1.5 million office visits to urologists a year. The most common presenting symptom was a UTI in 41%.

Poster 3, also by Rich Santucci, examined which procedure, a buccal mucosa onlay or an anastomotic urethroplasty, is better for short and medium length urethral strictures. The study examined a patient population of 47 patients, 19 of which had buccal onlays and 28 had end-to-end urethroplasties. Mean stricture length was 1.4 cm. While both procedures provided excellent success rates, the incidence of de novo sexual dysfunction was 19% in the anastomotic group. This sexual dysfunction was not seen in the buccal onlay group. Rich's procedure of choice, for all but the shortest strictures, is a buccal onlay- especially in potent men.

Poster 5, from Karl Kreder from Iowa, reviewed outcomes from a series of 31 patients undergoing male pubourethral slings with bone anchors. 94% of the patients underwent radical prostatectomy and 25% had adjuvant XRT. The Invance sling system from AMS was employed. Mean pad usage went from 3.75 pads pre-op to 1.1 pads per day post-op. 38% of patients were completely dry while 75% used one or less pad per day.

Poster 7, from Sean Elliot from San Francisco, reported on a series of patients with severe urethral complications of prostate cancer therapy. In a series of 48 patients, 32 had bladder neck contractures or anastomotic strictures, and 16 had rectourinary fistulas. Stenosis repair was successful in 73% and consisted of anastomotic repairs in 19 patients, flap urethroplasty in 2, perineal urethrostomy in 2 or urethral stents in 9. Fistula repair was successful in 14/15 patients (93%). The complexity of the fistula management was dictated by the size of the fistula and the presence or absence or urethral stenosis and included transanal repair, perineal, and combined abdomino-perineal repairs.

Poster 10, from Chiruvella Mallikarjuna India, examined the use of buccal mucosa onlay grafts from ureteric strictures. In 4 patients with mid or upper 1/3rd ureteric strictures, ventral buccal mucosa onlay grafts, covered by omentum or local retroperitoneal fat, were used to reconstruct the stenotic areas of ureter. Outcomes were excellent.

Poster 21, from Peter Rehder from Austria, described the mechanism and reported short-term outcomes for the new transobturator male sling system for moderate stress incontinence. The Advance sling system by AMS, was employed in 28 men with some residual sphincter function as demonstrated by cystoscopic evaluation. The sling, placed via a skin incision just lateral and inferior to the insertion of the adductor longus tendon and passing around the bulbar urethra just between the corpora cavernosal body and the urethra, elevates the urethral bulb back into the pelvis and shows good short-term success in the correctly chosen patient.

Finally, Poster 23, from Ahmed Al-Kandari from Kuwait, discussed the management of the obstructed Urolume stent. In 13 patients, 12 with occluded stents in the bulbar urethra and one in the posterior urethra, urethral substitution with a longitudinal based tubularized penile skin flap was utilized for definitive repair after complete urethral resection of the occluded urethral segment.

The poster session generated lively discussion and was well attended.

SIU 2006 Cape Town, South Africa, Wednesday, November 15

SIU-2006 Abstracts

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Written by Michael J. Metro, MD, a Contributing Editor with UroToday.

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