Dr. Cetin Demirdag, Dept. of Urology at Cerrahpasa Medical Faculty, Istanbul
Leading European experts active reconstruction surgeons of genito-urinary system in urology gathered in Istanbul in 14-15th December 2012 to discuss the latest advances and applications in the field. The 3rd meeting of the EAU Section of Genito-Urinary Reconstructive Surgery (ESGURS) met many of our expectations and more. All the presentations and live surgeries were of excellent quality, which resulted in excellent interaction and discussion between speakers and the audience throughout the meeting.
The meeting was focused on being interactive with delegates and participants. An important part of the programme was the live surgery sessions.
The first lecture was Redo Hypospadias by Prof. Serdar Tekgul from Ankara. He mentioned that the choice of the salvage technique needs to be individualised, depending on the location and size of the urethral meatus, the status of the urethral plate and genital skin, the severity of residual chordea and the amount of scar tissue. General principles of hypospadias repair include minimal use of cautery, avoidance of tension, use of well-vascularized tissue, closure in as many layers as possible, the use of optical magnification and identification, and the relief of any obstruction are followed in redo surgery too.
Prof. A. Esen emphasised the use of grafts in penile corporoplasty in Peyronie’s disease. Autologous materials, extracellular matrix tissues and synthetic equipment could be used as graft materials in these operations. He highlighted that the saphenous vein graft is still the most suitable graft among the autologous grafts with its acceptable long-term outcomes.
Prof. Moncada from Madrid talked about the complications of artificial urinary sphincter implantation. The main complications are urethral atrophy, urethral erosion and infection of the device. The risk of prosthesis failure is about 20%, but after correction of detective element, cure is achieved in almost every case.
Dr. E. Palminteri from Italy tried to answer the question of which is the best technique for bulbar or penile urethral stricture urethraplasty. In penile urethroplasty, the wide use of oral mucosa grafts seems to excel the use of skin flap which easily distort the cosmesis and elasticity of the penis. In bulbar urethroplasty , graft augmentation techniques seem to impact less on sexual outcome than excision anastomotic techniques.
Additionally, the second day of the meeting as perfect as first day with live surgeries, lectures and panels. Prof. Seckin mentioned about how to diagnose and manage mesh complications. Prof. Ergen talked about what can an urologist do for the post-prostatectomy incontinence patient.
There were three excellent live surgery sessions on the first day, and four on the second day. All sessions went well, and the audience got a great impression of them. On the first day, Dr. Rados performed distal redo hypospadias procedure. He made a cordie repair as well. In the same time in another operating room, Dr.Palminteri performed an urethroplasty surgery for a penile stricture patient. He performed it with a dorso-lateral approach and used a buccal mucosa which harvested from inner cheek. The third case was a penile prosthesis implantation case caused by prosthesis erosion performed by Dr. R. Djinovic.
One of the procedures on the second day was a robotic sacrocolpopexy which has done by Dr. A. Mottrie. He did a great job for a non-hysterectomysed mid-aged woman. Dr. Sievert performed a male sling operation for a moderate incontinence patient. In the afternoon, Dr. Moncada performed an artificial urinary sphincter implantation for a patient who had an artificial sphincter erosion after radical prostatectomy. The last case was a laparoscopic bladder diverticulectomy performed by Dr. Pansadoro. He excised a 7 cm diameter bladder diverticulum from the posterior wall of the bladder.
The live surgery and presentations are very important for fellows and residents when they are performed together. We observed that this was planned well at this meeting. Additionally, the popularity of reconstructive urology is constantly increasing and ideas on the use of minimally invasive techniques in reconstructive urology is also on the rise within the field.
Interested in reconstructive surgery? ESGURS has two meetings in 2013:
13-14 September 2013 in London, the United Kingdom.
10-12 October 2013 in Tübingen, Germany