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Re: Male Sling and Artificial Urethral Sphincter for Male Stress Urinary Incontinence among Certifying American Urologists

Re: Male Sling and Artificial Urethral Sphincter for Male Stress Urinary Incontinence among Certifying American Urologists

Urological Survey Trauma, and Genital and Urethral Reconstruction Re: Male Sling and Artificial Urethral Sphincter for Male Stress Urinary Incontinenc...

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Urological Survey Trauma, and Genital and Urethral Reconstruction Re: Male Sling and Artificial Urethral Sphincter for Male Stress Urinary Incontinence among Certifying American Urologists J. S. Liu, M. D. Hofer, J. Milose, D. T. Oberlin, S. C. Flury, A. F. Morey and C. M. Gonzalez Departments of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, University of Texas Southwestern, Dallas, Texas, and Case Western Reserve University, Cleveland, Ohio Urology 2016; 87: 95e99. doi: 10.1016/j.urology.2015.08.023

Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26344152 Editorial Comment: The role of slings in the armamentarium of male anti-incontinence surgeries is controversial. This review of 10 years of surgical case logs of certifying United States urologists indicates a gradual increase in sling procedures, with a plateau and then a recent decrease. I suspect this observation relates to the marketing of new slings early on, with enthusiasm of surgeons and patients for a less complicated artificial urinary sphincter alternative, followed by their gradual adoption and then the growing realization that they just do not perform well for men with severe leakage. I like slings but believe they must be reserved for a narrow slice of the population with healthy tissue and low volume leakage. Just how that clinical decision should be made remains a sticky subject. Allen F. Morey, MD

Re: Reconstruction of Pelvic Fracture Urethral Injuries with Sparing of the Bulbar Arteries R. G. Gomez, R. A. Campos and L. G. Velarde Urology Service, Hospital del Trabajador and Universidad Andres Bello School of Medicine, Santiago, Chile Urology 2016; 88: 207e212. doi: 10.1016/j.urology.2015.09.032

Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26616094 Editorial Comment: These authors have contributed a valuable report focusing on preservation of the proximal branches of the bulbar arteries in posterior urethroplasty. However, ischemic complications of the bulbar urethra are rare and are much less common than restenosis due to incomplete removal of the fibrous scar. As the authors comment, tying the anastomosis may be more difficult with the bulb still attached, and one must be sure not to perform stricture sparing surgery while attempting to perform vessel sparing surgery. Another application of this concept that seems interesting is posterior urethroplasty for patients with radiation induced bulbomembranous strictures, who not infrequently go on to require placement of an artificial urinary sphincter. We have noted higher cuff erosion rates in these patients, and bulbar arterial preservation as described here would seem prudent. Allen F. Morey, MD

0022-5347/16/1964-1181/0 THE JOURNAL OF UROLOGY® Ó 2016 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION

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RESEARCH, INC.

http://dx.doi.org/10.1016/j.juro.2016.07.054 Vol. 196, 1181-1182, October 2016 Printed in U.S.A.

www.jurology.com

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TRAUMA, AND GENITAL AND URETHRAL RECONSTRUCTION

Re: Assessment of the Male Urethral Reconstruction Learning Curve S. F. Faris, J. B. Myers, B. B. Voelzke, S. P. Elliott, B. N. Breyer, A. J. Vanni, C. A. Tam and B. A. Erickson; Trauma and Urologic Reconstruction Network of Surgeons Departments of Urology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, University of Washington, Seattle, Washington, University of Minnesota, Minneapolis, Minnesota, University of California, San Francisco, California, and Lahey Clinic, Burlington, Massachusetts, and Division of Urology, University of Utah, Salt Lake City, Utah Urology 2016; 89: 137e143. doi: 10.1016/j.urology.2015.11.038

Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26723182 Editorial Comment: This multi-institutional series demonstrates improvement in urethroplasty outcomes through time for recent graduates of reconstruction fellowships. Take home messages include an overall functional success rate of 87.8% and the observations that bulbar urethroplasties did better than penile urethroplasties and anastomotic repairs (greater than 90% success) did better than graft cases. The good news for patients is that the outcomes of these delicate procedures appear to be good, although the data strongly suggest that these individuals be referred to regional centers of excellence with skilled urethral surgeons. Allen F. Morey, MD