ECharles Osterberg。Dr.Osterberg is a board-certified urologist with fellowship training in male genitourinary reconstruction.He moved to Austin(TX,USA)in 2016 to join the University of Texas-Dell Medical School as As...ECharles Osterberg。Dr.Osterberg is a board-certified urologist with fellowship training in male genitourinary reconstruction.He moved to Austin(TX,USA)in 2016 to join the University of Texas-Dell Medical School as Associate Professor of Surgery.Dr.Osterberg specializes in reconstructive urology,genitourinary trauma,prosthetics,and robotic surgery.After serving as the Chief of Urology at Dell-Seton Medical Center-the main teaching hospital for Dell Medical School for 7 years,Dr.Osterberg transitioned his practice to Urology Austin,an affiliate of Urology America.At his new practice,he and his team have performed hundreds of complex urologic reconstructions and urethral stricture surgeries.展开更多
Objective:A major role in the establishment of computer-assisted robotic surgery(CARS)can be traced to the work of Mani Menon at Vattikuti Urology Institute(VUI),and of many surgeons of Asian origin.The success of rob...Objective:A major role in the establishment of computer-assisted robotic surgery(CARS)can be traced to the work of Mani Menon at Vattikuti Urology Institute(VUI),and of many surgeons of Asian origin.The success of robotic surgery in urology has spurred its acceptance in other surgical disciplines,improving patient comfort and disease outcomes and helping the industrial growth.The present paper gives an overview of the progress and development of robotic surgery,especially in the field of Urology;and to underscore some of the seminal work done by the VUI and Asian surgeons in the development of robotic surgery in urology in the US and around the world.Methods:PubMed/Medline and Scopus databases were searched for publications from 2000 through June 2014,using algorithms based on keywords“robotic surgery”,“prostate”,“kidney”,“adrenal”,“bladder”,“reconstruction”,and“kidney transplant”.Inclusion criteria used were published full articles,book chapters,clinical trials,prospective and retrospective series,and systematic reviews/meta-analyses written in English language.Studies from Asian institutions or with the first/senior author of Asian origin were included for discussion,and focused on techniques of robotic surgery,relevant patient outcomes and associated demographic trends.Results:A total of 58 articles selected for final review highlight the important strides made by robots in urology,from robotic radical prostatectomy in 2000 to robotic kidney transplant in 2014.In the hands of an experienced robotic surgeon,it has been demonstrated to improve functional patient outcomes and minimize perioperative complications compared to open surgery,especially in urologic oncology and reconstructive urology.With increasing surgeon proficiency,the benefits of robotic surgery were consistently seen across different surgical disciplines,patient populations,and strata.展开更多
The field of tissue engineering is rapidly progressing. Much work has gone into developing a tissue engineered urethral graft. Current grafts, when long, can create initial donor site morbidity. In this article, we ev...The field of tissue engineering is rapidly progressing. Much work has gone into developing a tissue engineered urethral graft. Current grafts, when long, can create initial donor site morbidity. In this article, we evaluate the progress made in finding a tissue engineered substitute for the human urethra. Researchers have investigated cell-free and cell-seeded grafts. We discuss different approaches to developing these grafts and review their reported successes in human studies. With further work, tissue engineered grafts may facilitate the management of lengthy urethral strictures requiring oral mucosa substitution urethroplasty.展开更多
We report here the history and evolution of the use of oral mucosa in reconstructive urethral surgery since it was first used for urethroplasty in 1894.Since that time,many authors have contributed to develop,improve ...We report here the history and evolution of the use of oral mucosa in reconstructive urethral surgery since it was first used for urethroplasty in 1894.Since that time,many authors have contributed to develop,improve and popularize the use of oral mucosa as a substitute material.Paediatric urologists should be considered pioneers on the use of oral mucosa as they used it to repair primary and failed hypospadias.The use of oral mucosa to repair penile and bulbar urethral strictures was described,for the first time,in 1993.Important evolutions in the technique for harvesting oral mucosa from the cheek were reported in 1996.Today,oral mucosa is considered the gold standard material for any type of anterior urethroplasty in a one-or two-stage repair due to its biological and structural characteristics that make it a highly versatile that is adaptable to any environment required by the reconstructive urethral surgery.As the future approaches,tissue engineering techniques will provide patients with new materials originating from the oral epithelial mucosal cells,which are cultured and expanded into a scaffold.However,the path to reach this ambitious objective is still long and many difficulties must be overcome along the way.展开更多
Vesico-vaginal fistula is a global healthcare problem that has a high prevalence in sub-Saharan Africa,where obstetric complications lead to the development of this condition.Despite this,comparatively few fistula rep...Vesico-vaginal fistula is a global healthcare problem that has a high prevalence in sub-Saharan Africa,where obstetric complications lead to the development of this condition.Despite this,comparatively few fistula repairs are performed in well-resourced countries,where iatrogenic injury is the leading aetiological factor.As a consequence,much of our knowledge results from the experience of relatively few fistula surgeons in areas of high prevalence borne out of large case series or retrospective cohorts rather than high level evidence.At present,debate surrounds the exact timing of repair and the most appropriate surgical approach for this condition.Certain fistulae can be selected for conservative management,while those that do not demonstrate factors associated with spontaneous closure can be selected for surgery.Fistula surgeons should be aware of several potential repair options and the principles of contemporary fistula surgery,as the first attempt at repair is likely to be the best opportunity to achieve a successful outcome.We review the available literature and provide evidence on the optimal timing of repair,the appropriate surgical approach and the use of tissue interpositioning in fistula surgery.展开更多
Objective:Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are increasingly being used to treat peritoneal malignancies.Urological resections and reconstruction(URR)are occasionally perfor...Objective:Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are increasingly being used to treat peritoneal malignancies.Urological resections and reconstruction(URR)are occasionally performed during the surgery.We aim to evaluate the impact of these procedures on peri-operative outcomes of CRS and HIPEC patients.Methods:A retrospective review of a prospectively maintained database of all patients who underwent CRS-HIPEC from April 2001 to February 2016 was performed.Outcomes between patients who had surgery involving,and not involving URR were compared.Primary outcomes were the rate of major complications and the duration of stay in the intensive care unit(ICU)and hospital.Secondary outcomes were that of overall survival(OS)and prognostic factors that would indicate a need for URR.Results:A total of 214 CRS-HIPEC were performed,21 of which involved a URR.Baseline clinical characteristics did not vary between the groups(URR vs.No URR).Urological resections comprised of 52%bladder resections,24%ureteric resections,and 24%involving both bladder and ureteric resections.All bladder defects were closed primarily while ureteric reconstructions consisted of two end-to-end anastomoses,one ureto-uretostomy,five direct implantations into the bladder and three boari flaps.URR were more frequently required in patients with colorectal peritoneal disease(p Z 0.029),but was not associated with previous pelvic surgery(76%vs.54%,p Z 0.065).Patients with URR did not suffer more serious complications(14%vs.24%,p Z 0.42).ICU(2.2 days vs.1.4 days,p Z 0.51)and hospital stays(18 days vs.25 days,p Z 0.094)were not significantly affected.Undergoing a URR did not affect OS(p Z 0.99),but was associated with increased operation time(570 min vs.490 min,p Z 0.046).Conclusion:While concomitant URR were associated with an increase in operation time,there were no significant differences in postoperative complications or OS.Patients with colorectal peritoneal metastases are more likely to require a URR compared to other primary tumours,and needs to be considered during pre-operative planning.展开更多
Although urethral strictures have been known since antiquity,the surgical management of urethral strictures has undergone a great(re)evolution over the last six decades,both in the perception of the disease and in the...Although urethral strictures have been known since antiquity,the surgical management of urethral strictures has undergone a great(re)evolution over the last six decades,both in the perception of the disease and in the surgical repair techniques,always presenting itself as a challenge for the surgeon and patient.Reconstruction of urethral stricture disease involving a combination of grafts and flaps consists of a group of complex procedures with specific clinical indications.The knowledge of these procedures by reconstructive urologists is both necessary and relevant.A thorough understanding of the anatomy,including blood supply,is a crucial proviso for the correct evaluation and successful management of urethral stricture disease.We discuss the main techniques and indications in combined graft and flap urethroplasties.展开更多
Genital flaps can provide versatile options for complex penile,genital,and urethral reconstruction.Pedicled muscle flaps can be used in combination with grafting for urethral reconstruction,and genital skin flaps can ...Genital flaps can provide versatile options for complex penile,genital,and urethral reconstruction.Pedicled muscle flaps can be used in combination with grafting for urethral reconstruction,and genital skin flaps can also be utilized as urethral augmentation or replacement.Penile skin flaps,in particular,offer versatile options for the management of anterior urethral stricture disease.The choice of urethral reconstruction depends on surgeon expertise and patient disease.Given its surgical complexity,flap reconstruction is equally dependent on an appropriate understanding of patient disease and surgeon experience.It is crucial to understand the patients’comorbid diseases(e.g.,smoking status or lichen sclerosis),potential flap tissue quality(i.e.,penile/preputial skin quality),and stricture anatomy(length,caliber,location).Of particular importance is any prior intervention that may alter the normal vascular supply to the proposed flap.The ideal skin flap will be(1)hairless;(2)accustomed to the aqueous environment;(3)adaptable;and(4)cosmetic.This review will cover the operative approaches and peri-operative outcomes of genital flaps to manage urethral reconstruction.Particular attention will be paid to penile skin flap urethroplasty.展开更多
Understanding the methods and rationale for managing erectile function in cis-and trans-male patients after neophallus reconstruction is of clinical value to the practicing urologists who encounter such patients.We de...Understanding the methods and rationale for managing erectile function in cis-and trans-male patients after neophallus reconstruction is of clinical value to the practicing urologists who encounter such patients.We describe a brief overview of the urologist’s role in the management of sexual function.This communication focuses on pre-and post-construction of a neophallus,considerations for surgical techniques that are largely dependent on whether the patient is cis-or transgender,the traditional method of placing of inflatable penile prosthesis in a neophallus,and in conjunction with the management of complications post implantation.This manuscript is both a review of the current literature in the field,as well as an overview of experience gained from managing a cohort of patients over the years.Additionally,we discuss novel advances that aim to decrease the risk of complications,including distal erosion of the cylinders of the penile prostheses and the proximal dislodgement of cylinders in these unique patients.展开更多
文摘ECharles Osterberg。Dr.Osterberg is a board-certified urologist with fellowship training in male genitourinary reconstruction.He moved to Austin(TX,USA)in 2016 to join the University of Texas-Dell Medical School as Associate Professor of Surgery.Dr.Osterberg specializes in reconstructive urology,genitourinary trauma,prosthetics,and robotic surgery.After serving as the Chief of Urology at Dell-Seton Medical Center-the main teaching hospital for Dell Medical School for 7 years,Dr.Osterberg transitioned his practice to Urology Austin,an affiliate of Urology America.At his new practice,he and his team have performed hundreds of complex urologic reconstructions and urethral stricture surgeries.
文摘Objective:A major role in the establishment of computer-assisted robotic surgery(CARS)can be traced to the work of Mani Menon at Vattikuti Urology Institute(VUI),and of many surgeons of Asian origin.The success of robotic surgery in urology has spurred its acceptance in other surgical disciplines,improving patient comfort and disease outcomes and helping the industrial growth.The present paper gives an overview of the progress and development of robotic surgery,especially in the field of Urology;and to underscore some of the seminal work done by the VUI and Asian surgeons in the development of robotic surgery in urology in the US and around the world.Methods:PubMed/Medline and Scopus databases were searched for publications from 2000 through June 2014,using algorithms based on keywords“robotic surgery”,“prostate”,“kidney”,“adrenal”,“bladder”,“reconstruction”,and“kidney transplant”.Inclusion criteria used were published full articles,book chapters,clinical trials,prospective and retrospective series,and systematic reviews/meta-analyses written in English language.Studies from Asian institutions or with the first/senior author of Asian origin were included for discussion,and focused on techniques of robotic surgery,relevant patient outcomes and associated demographic trends.Results:A total of 58 articles selected for final review highlight the important strides made by robots in urology,from robotic radical prostatectomy in 2000 to robotic kidney transplant in 2014.In the hands of an experienced robotic surgeon,it has been demonstrated to improve functional patient outcomes and minimize perioperative complications compared to open surgery,especially in urologic oncology and reconstructive urology.With increasing surgeon proficiency,the benefits of robotic surgery were consistently seen across different surgical disciplines,patient populations,and strata.
文摘The field of tissue engineering is rapidly progressing. Much work has gone into developing a tissue engineered urethral graft. Current grafts, when long, can create initial donor site morbidity. In this article, we evaluate the progress made in finding a tissue engineered substitute for the human urethra. Researchers have investigated cell-free and cell-seeded grafts. We discuss different approaches to developing these grafts and review their reported successes in human studies. With further work, tissue engineered grafts may facilitate the management of lengthy urethral strictures requiring oral mucosa substitution urethroplasty.
文摘We report here the history and evolution of the use of oral mucosa in reconstructive urethral surgery since it was first used for urethroplasty in 1894.Since that time,many authors have contributed to develop,improve and popularize the use of oral mucosa as a substitute material.Paediatric urologists should be considered pioneers on the use of oral mucosa as they used it to repair primary and failed hypospadias.The use of oral mucosa to repair penile and bulbar urethral strictures was described,for the first time,in 1993.Important evolutions in the technique for harvesting oral mucosa from the cheek were reported in 1996.Today,oral mucosa is considered the gold standard material for any type of anterior urethroplasty in a one-or two-stage repair due to its biological and structural characteristics that make it a highly versatile that is adaptable to any environment required by the reconstructive urethral surgery.As the future approaches,tissue engineering techniques will provide patients with new materials originating from the oral epithelial mucosal cells,which are cultured and expanded into a scaffold.However,the path to reach this ambitious objective is still long and many difficulties must be overcome along the way.
文摘Vesico-vaginal fistula is a global healthcare problem that has a high prevalence in sub-Saharan Africa,where obstetric complications lead to the development of this condition.Despite this,comparatively few fistula repairs are performed in well-resourced countries,where iatrogenic injury is the leading aetiological factor.As a consequence,much of our knowledge results from the experience of relatively few fistula surgeons in areas of high prevalence borne out of large case series or retrospective cohorts rather than high level evidence.At present,debate surrounds the exact timing of repair and the most appropriate surgical approach for this condition.Certain fistulae can be selected for conservative management,while those that do not demonstrate factors associated with spontaneous closure can be selected for surgery.Fistula surgeons should be aware of several potential repair options and the principles of contemporary fistula surgery,as the first attempt at repair is likely to be the best opportunity to achieve a successful outcome.We review the available literature and provide evidence on the optimal timing of repair,the appropriate surgical approach and the use of tissue interpositioning in fistula surgery.
文摘Objective:Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are increasingly being used to treat peritoneal malignancies.Urological resections and reconstruction(URR)are occasionally performed during the surgery.We aim to evaluate the impact of these procedures on peri-operative outcomes of CRS and HIPEC patients.Methods:A retrospective review of a prospectively maintained database of all patients who underwent CRS-HIPEC from April 2001 to February 2016 was performed.Outcomes between patients who had surgery involving,and not involving URR were compared.Primary outcomes were the rate of major complications and the duration of stay in the intensive care unit(ICU)and hospital.Secondary outcomes were that of overall survival(OS)and prognostic factors that would indicate a need for URR.Results:A total of 214 CRS-HIPEC were performed,21 of which involved a URR.Baseline clinical characteristics did not vary between the groups(URR vs.No URR).Urological resections comprised of 52%bladder resections,24%ureteric resections,and 24%involving both bladder and ureteric resections.All bladder defects were closed primarily while ureteric reconstructions consisted of two end-to-end anastomoses,one ureto-uretostomy,five direct implantations into the bladder and three boari flaps.URR were more frequently required in patients with colorectal peritoneal disease(p Z 0.029),but was not associated with previous pelvic surgery(76%vs.54%,p Z 0.065).Patients with URR did not suffer more serious complications(14%vs.24%,p Z 0.42).ICU(2.2 days vs.1.4 days,p Z 0.51)and hospital stays(18 days vs.25 days,p Z 0.094)were not significantly affected.Undergoing a URR did not affect OS(p Z 0.99),but was associated with increased operation time(570 min vs.490 min,p Z 0.046).Conclusion:While concomitant URR were associated with an increase in operation time,there were no significant differences in postoperative complications or OS.Patients with colorectal peritoneal metastases are more likely to require a URR compared to other primary tumours,and needs to be considered during pre-operative planning.
文摘Although urethral strictures have been known since antiquity,the surgical management of urethral strictures has undergone a great(re)evolution over the last six decades,both in the perception of the disease and in the surgical repair techniques,always presenting itself as a challenge for the surgeon and patient.Reconstruction of urethral stricture disease involving a combination of grafts and flaps consists of a group of complex procedures with specific clinical indications.The knowledge of these procedures by reconstructive urologists is both necessary and relevant.A thorough understanding of the anatomy,including blood supply,is a crucial proviso for the correct evaluation and successful management of urethral stricture disease.We discuss the main techniques and indications in combined graft and flap urethroplasties.
文摘Genital flaps can provide versatile options for complex penile,genital,and urethral reconstruction.Pedicled muscle flaps can be used in combination with grafting for urethral reconstruction,and genital skin flaps can also be utilized as urethral augmentation or replacement.Penile skin flaps,in particular,offer versatile options for the management of anterior urethral stricture disease.The choice of urethral reconstruction depends on surgeon expertise and patient disease.Given its surgical complexity,flap reconstruction is equally dependent on an appropriate understanding of patient disease and surgeon experience.It is crucial to understand the patients’comorbid diseases(e.g.,smoking status or lichen sclerosis),potential flap tissue quality(i.e.,penile/preputial skin quality),and stricture anatomy(length,caliber,location).Of particular importance is any prior intervention that may alter the normal vascular supply to the proposed flap.The ideal skin flap will be(1)hairless;(2)accustomed to the aqueous environment;(3)adaptable;and(4)cosmetic.This review will cover the operative approaches and peri-operative outcomes of genital flaps to manage urethral reconstruction.Particular attention will be paid to penile skin flap urethroplasty.
文摘Understanding the methods and rationale for managing erectile function in cis-and trans-male patients after neophallus reconstruction is of clinical value to the practicing urologists who encounter such patients.We describe a brief overview of the urologist’s role in the management of sexual function.This communication focuses on pre-and post-construction of a neophallus,considerations for surgical techniques that are largely dependent on whether the patient is cis-or transgender,the traditional method of placing of inflatable penile prosthesis in a neophallus,and in conjunction with the management of complications post implantation.This manuscript is both a review of the current literature in the field,as well as an overview of experience gained from managing a cohort of patients over the years.Additionally,we discuss novel advances that aim to decrease the risk of complications,including distal erosion of the cylinders of the penile prostheses and the proximal dislodgement of cylinders in these unique patients.
