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      저자 : Ryan Patrick Terlecki (검색결과 2 건)
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        Ventral inlay buccal mucosal graft urethroplasty: A novel surgical technique for the management of urethral stricture disease

        Robert Caleb Kovell,Ryan Patrick Terlecki 대한비뇨의학회 2015 Investigative and Clinical Urology Vol.56 No.2

        To describe the novel technique of ventral inlay substitution urethroplasty for the management of male anterior urethral stricturedisease. A 58-year-old gentleman with multifocal bulbar stricture disease measuring 7 cm in length was treated using a ventral inlaysubstitution urethroplasty. A dorsal urethrotomy was created, and the ventral urethral plated was incised. The edges of the urethralplate were mobilized without violation of the ventral corpus spongiosum. A buccal mucosa graft was harvested and affixedas a ventral inlay to augment the caliber of the urethra. The dorsal urethrotomy was closed over a foley catheter. No intraoperativeor postoperative complications occurred. Postoperative imaging demonstrated a widely patent urethra. After three years of followup,the patient continues to do well with no voiding complaints and low postvoid residuals. Ventral inlay substitution urethroplastyappears to be a safe and feasible technique for the management of bulbar urethral strictures.

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        Proof of concept: Exposing the myth of urethral atrophy after artificial urinary sphincter via assessment of circumferential recovery after capsulotomy and intraoperative pressure profiling of the pressure regulating balloon

        Amy Marcia Pearlman,Alison Marie Rasper,Ryan Patrick Terlecki 대한비뇨의학회 2018 Investigative and Clinical Urology Vol.59 No.4

        Purpose: Rate of continence after artificial urinary sphincter (AUS) placement appears to decline with time. After appropriate workup to exclude inadvertent device deactivation, development of urge or overflow incontinence, and fluid loss, many assume recurrent stress urinary incontinence (rSUI) to be secondary to nonmechanical failure, asserting urethral atrophy as the etiology. We aimed to characterize the extent of circumferential urethral recovery following capsulotomy and that of pressure regulating balloon (PRB) material fatigue in men undergoing AUS revision for rSUI. Materials and Methods: Retrospective review of a single surgeon database was performed. Cases of AUS removal/replacement for rSUI involving ventral subcuff capsulotomy and intraoperative PRB pressure profile assessments were identified. Results: The described operative approach involving capsulotomy was applied in 7 patients from November 2015 to September 2017. Mean patient age was 75 years. Mean time between AUS placement and revision was 103 months. Urethral circumference increased in all patients after capsulotomy (mean increase 1.1 cm; range 0.5–2.5 cm). Cuff size increased, remained the same, and decreased in 2, 3, and 2 patients, respectively. Six of 7 patients underwent PRB interrogation. Four of these 6 PRBs (66.7%) demonstrated pressures in a category below the reported range of the original manufacturer rating. Conclusions: Despite visual appearance to suggest urethral atrophy, subcuff capsulotomy results in increased urethral circumference in all patients. Furthermore, intraoperative PRB profiling demonstrates material fatigue. Future multicenter efforts are warranted to determine if capsulotomy, with or without PRB replacement, may simplify surgical management of rSUI with reductions in cost and/or morbidity.

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