Ilgar Akbarov

How to Perform Image-guided Prostate Biopsy: In-bore and Fusion Approaches

The integration of magnetic resonance imaging into urologic routine may be highly beneficial and change our standards for prostate cancer treatment.

Anterior Urethroplasty Using a New Tissue Engineered Oral Mucosa Graft: Surgical Techniques and Outcomes

Purpose: We investigated whether tissue engineered material may be adopted using standard techniques for anterior urethroplasty. Materials and Methods: We performed a retrospective multicenter study in patients with recurrent strictures, excluding those with failed hypospadias, lichen sclerosus, traumatic and posterior strictures. A 0.5 cm2 oral mucosa biopsy was taken from the patient cheek and sent to the laboratory to manufacture the graft. After 3 weeks the tissue engineered oral mucosal MukoCell® graft was sent to the hospital for urethroplasty. Four techniques were used, including ventral onlay, dorsal onlay, dorsal inlay and a combined technique. Cystourethrography was performed 1 month postoperatively. Patients underwent clinical evaluation, uroflowmetry and post‐void residual urine measurement every 6 months. When the patient showed obstructive symptoms, defined as maximum urine flow less than 12 ml per second, the urethrography was repeated. Patients who underwent further treatment for recurrent stricture were classified as having treatment failure. Results: Of the 38 patients with a median age of 57 years who were included in study the strictures were penile in 3 (7.9%), bulbar in 29 (76.3%) and penobulbar in 6 (15.8%). Median stricture length was 5 cm and median followup was 55 months. Treatment succeeded in 32 of the 38 patients (84.2%) and failed in 15.8%. Success was achieved in 85.7% of ventral onlay, 83.3% of dorsal onlay, 80% of dorsal inlay and 100% of combined technique cases. No local or systemic adverse reactions due to the engineered material were noted. Conclusions: Our findings show that a tissue engineered oral mucosa graft can be implanted using the same techniques suggested for anterior urethroplasty and native oral mucosa, and guaranteeing a similar success rate.

MP68-01 EFFECTS AND OUTCOMES OF URETERAL STENTING PRIOR TO URETEROSCOPY VERSUS PRIMARY URETEROSCOPY IN URINARY STONE TREATMENT

INTRODUCTION AND OBJECTIVES: Over 3 million surgeries have been performed globally using the surgical robot since its inception without level 1 evidence. We present the first phase 3 multicenter prospective randomized trial comparing an open to robotic approach for any organ site. Open radical cystectomy (ORC) and urinary diversion remains the gold standard management for invasive bladder cancer, however it is a complex procedure with significant perioperative morbidity. Robotic assisted RC (RARC) is a minimally invasive alternative to ORC with the promise of reducing perioperative morbidity without compromising oncological principles. The RAZOR trial compares open versus robotic cystectomy using oncologic, perioperative, functional and QOL endpoints. METHODS: Across 15 participating institutions in the United States, patients with biopsy proven bladder cancer; clinical stage T1-T4, N0-N1, M0 or carcinoma in situ (CIS) refractory to intravesical treatments were randomized to ORC or RAsRC in a 1:1 ratio. The trial was designed as a non-inferiority comparison with RARC being considered inferior if the 2-year progression-free survival (PFS) was >15% lower than ORC [Power 1⁄4 80% and 2-sided significance level (alpha) 1⁄4 5%]. Other endpoints included blood transfusion rate, estimated blood loss (EBL), length of stay (LOS), complications (Clavien-Dindo system), lymph node yield and margin status. RESULTS: A total of 350 patients were randomized. After exclusions, 150 in the RARC and 156 in the ORC arms were analyzed. Follow-up data is currently being reviewed and the 2-year PFS comparison is under analysis. Results are presented in Table 1. Estimated blood loss was significantly lower in the robotic arm translating into significantly lower blood transfusion rates. Major complications (Grade III and above) were similar in both groups. The number of lymph nodes removed was comparable and there was no significant difference in overall positive margin status. Positive bladder soft tissue margins were more common in the robotic arm. There was a trend to shorter LOS for RARC. CONCLUSIONS: The 2 year oncologic outcomes will be ready for the AUA meeting. The robotic approach is associated with significantly lower EBL and transfusion rates than ORC with a trend to shorter LOS. There is no difference in the perioperative morbidity between the 2 approaches.

Rekonstruktive Chirurgie der Harnröhre

Urethral strictures are independent of a patients age and can happen in every life period. They are often iatrogenic, resulting from a transurethral surgical procedure or traumatic catheterisation. Endoscopic slotting is the surgery of choice; although this method is frequently associated with recurrence. Retrograde urethrography or cystourethrography continue to play a central role in diagnostic evaluation and treatment. There is no standardised procedure regarding the surgical technique, perioperative management, and postoperative follow-up. Evidence-based recommendations or guidelines do not exist. For a successful surgical treatment of the urethra it is important to have an excellent knowledge of the urethral and urogenital anatomy. The permanent removal of urethral strictures can only be achieved by open reconstructive surgery. Direct end-to-end urethroplasty is used, in general, for short bulbar urethral strictures, while urethroplasty with oral mucosa is used for longer bulbar and penile strictures. Urethral reconstruction using a patient-specific autologous cell transplant with MukoCell® is an alternative to the conventional transplantation with native oral mucosa. Urethral reconstruction should be performed in specialised centres with appropriate expertise.