Reconstructive Surgery Archives - Grand Rounds in Urology

Genital Reconstruction After Massive Tissue Loss

by Maxx A. Gallegos, MD | Feb 2021

Maxx A. Gallegos, MD, Director of Reconstructive Urology at the University of New Mexico Health Sciences Center in Albuquerque, New Mexico, presents on genital reconstruction after patients have suffered massive tissue destruction. He addresses the epidemiology and etiology of genital tissue destruction, as well as the physiology of healing. Though rare, there are many possible ways a person can experience loss of genital skin, including burns, necrotizing fasciitis, lymphedema, self-mutilation, and sclerotic conditions. The incidence of necrotizing fasciitis is also rising, likely due to increased incidence of diabetes in the United States population. As primary intention healing is not a viable option in these severe cases, Dr. Gallegos recommends secondary intention techniques, such as grafts and fasciocutaneous flaps. Dr. Gallegos then presents several case studies, including four patients with Fournier’s gangrene, a patient with stab wounds, and a patient with lymphedema. He concludes by describing his postoperative process and how frequently patients should return for wound checks.

Dilating Scarred Corporal Bodies for Penile Implant Cylinder Placement

by John J. Mulcahy, MD | Sep 2020

John J. Mulcahy, MD, Clinical Professor of Urology at the University of Alabama and the University of Arizona, discusses how urologic surgeons should place penile implant cylinders into scarred corpora cavernosa. He explains that the approach taken (either penoscrotal or infrapubic) should be the one with the fewest prior procedures, but notes that many urologists tend to favor one approach over the other. Dr. Mulcahy then discusses the surgical process he follows, from obtaining adequate exposure with a broad incision to selecting an appropriate corporotomy site. He also discusses the tools he finds most useful, including the Otis urethrotome for cutting corporal scar tissue.

Following the presentation, E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, conducts a Q&A session with Dr. Mulcahy. They discuss salvage protocols for prosthetic infections, as well as the role of new evaluation tools, such as next-generation sequencing, for identifying microbes and fungi.

Path to the First Penoscrotal Transplant: Pre-Clinical Studies that Led to Penile Allotransplantation

by Trinity J. Bivalacqua, MD, PhD | May 2020

Trinity J. Bivalacqua, MD, PhD, Director of Urologic Oncology at the James Buchanan Brady Urological Institute of Johns Hopkins Medicine, discusses the groundbreaking penoscrotal implant surgery performed by a multidisciplinary team at Johns Hopkins Medicine in 2018. He explains their rationale for performing a procedure that many consider dangerous and unnecessary, saying that patients have a right to be normal and to decide on their own fate, and noting that they discussed the surgery with their patient, a military vet who lost his phallus from a blast injury, for years before operating. Dr. Bivalacqua goes on to summarize the pre-clinical cadaveric and ex vivo studies conducted before the procedure, emphasizing the important developments in increasing transplant tolerance and improvements in vascularizing penile allografts. He concludes by saying that the surgery was successful and thus far the graft has not shown rejection, but he notes that the procedure’s utility in clinical practice remains unknown.

Penile Allotransplantation: An Advance in Genitourinary Reconstruction

by Arthur L. Burnett II, MD, MBA, FACS | Sep 2019

Arthur L. Burnett II, MD, MBA, presents penile allotransplantation as an emerging alternative to autogenous reconstruction. He discusses the benefits for military trauma patients in particular, and the importance of considering potential complications as well as improved quality of life.

Robotic Assisted Laparoscopic Buccal Mucosa Graft Ureteroplasty

by Brian J. Flynn, MD | Jul 2019

Brian J. Flynn, MD, discusses the management of mid/upper ureteral strictures, from evaluation and medical decision making to available treatment options for ureteral reconstruction. He then illustrates surgical techniques and considerations for robotic ureteral reconstruction using buccal mucosa grafts.

Management of High Grade Renal Trauma

by Michael Coburn, MD, FACS | Dec 2018

Michael Coburn, MD, FACS, discusses decision-making for urologists consulted in kidney trauma cases. He defines indications for active observation, nephrectomy, and non-operative interventions, as well as practical techniques for gaining vascular control and reconstruction.

Novel Application of Autologous Fascia for Pelvic Floor Reconstruction in the Mesh Era

by Ja-Hong H. Kim, MD | Nov 2018

Ja-Hong Kim, MD, discusses the increased demand for pelvic floor reconstructive surgery, historical surgical methods, and complications associated with these methods. She then reviews two novel applications of fascia lata graft with video demonstrations of surgical techniques.

Pitfalls and Pearls of Penile Prosthesis Surgery

by Brian S. Christine, MD | Nov 2018

Brian S. Christine, MD, reviews the history of penile implant surgery. He then demonstrates critical steps, correct technique, and precautions to avoid intraoperative complications in scrotal and infrapubic placement of inflatable penile prosthesis (IPP).

Urethral Stricture Management in the 21st Century: Treatments for Even the Worst Urethras

by Maxx A. Gallegos, MD | Nov 2018

Maxx Gallegos, MD, reviews traditional urethral stricture management techniques, specifically direct visualization internal urethrotomy (DVIU) and dilation. He then discusses new and emerging techniques, especially urethroplasty, that may better benefit these patients.

Surgical Management of Refractory Bladder Neck Contracture after BPH Surgery

by Brian J. Flynn, MD | Jun 2018

Brain J. Flynn, MD, identifies the frequency of bladder neck contracture (BNC) following benign prostatic hyperplasia (BPH) surgery, prevention strategies, and endoscopic and surgical management. Furthermore, he explains his BNC management algorithm and the currently available lower urinary tract reconstructive procedure options.

AUA Urethral Stricture Guidelines

by Chris M. Gonzalez, MD, MBA, FACS | Jun 2018

Chris Gonzalez MD, MBA, FACS, who served on the 2016 American Urological Association (AUA) Male Urethral Stricture Panel, summarizes the guidelines his panel drafted and provides commentary. He analyzes the indications for evaluation, diagnosis, treatment, and follow up in bulbar, penile, and prostatic urethral strictures, as well as in pelvic fracture urethral injury (PFUI). Furthermore, he discusses the future research needed to perfect urethral stricture management practices.

Principles of Tissue Transfer in Reconstructive Urology

by Joel Gelman, MD | May 2018

Joel Gelman, MD, discusses the basic plastic surgery principles of tissue transfer in reconstructive urology. Specifically, he describes plastic surgery applications for urethral strictures, pelvic fractures, and hypospadias. Furthermore, he explains how these principles can improve surgery best practices and patient outcomes.

Topic: Reconstructive Surgery

Genital Reconstruction After Massive Tissue Loss

Dilating Scarred Corporal Bodies for Penile Implant Cylinder Placement

Path to the First Penoscrotal Transplant: Pre-Clinical Studies that Led to Penile Allotransplantation

Penile Allotransplantation: An Advance in Genitourinary Reconstruction

Robotic Assisted Laparoscopic Buccal Mucosa Graft Ureteroplasty

Management of High Grade Renal Trauma

Novel Application of Autologous Fascia for Pelvic Floor Reconstruction in the Mesh Era

Pitfalls and Pearls of Penile Prosthesis Surgery

Urethral Stricture Management in the 21st Century: Treatments for Even the Worst Urethras

Surgical Management of Refractory Bladder Neck Contracture after BPH Surgery

AUA Urethral Stricture Guidelines

Principles of Tissue Transfer in Reconstructive Urology

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