Robotic Salvage Pyeloplasty With Buccal Mucosal Onlay Graft: Video Demonstration of Technique and Outcomes.

OBJECTIVE: To present the use of buccal mucosal graft (BMG) in a salvage robotic laparoscopic pyeloplasty as an alternative in the management of a recurrent ureteropelvic junction (UPJ) obstruction. METHODS: We present 2 patients with a recurrent UPJ obstruction who had previously undergone 2 prior open or robotic pyleoplasties, followed by endoscopic management. Preoperative imaging was obtained before surgical repair. The UPJ was incised and the incision extended to reveal margins of a healthy normal-caliber ureteral tissue. Single BMGs were harvested from the inner cheek of each patient. The grafts were of sufficient caliber and size to cover the entire defect as an onlay graft, and to maintain a tension-free and watertight anastomosis. RESULTS: The operative time was between 188 and 284 minutes. The estimated blood loss was 25-50 mL. The hospital stay was 2 days for each patient. Foley catheters were removed before discharge and the Jackson-Pratt drains were removed in the immediate postoperative period. The ureteral stents were removed at 6 and 9 weeks, with retrograde pyelograms confirming patency at the UPJ. Lasix renograms were obtained after 4 months and either demonstrated a resolution or were equivocal for obstruction, with a preservation of renal function. Both patients have been without complication since the stent removal. CONCLUSION: Robotic pyeloplasty with BMG is an alternative in the management of recurrent UPJ obstructions. Short-term follow-up has demonstrated that it is an effective and attractive approach compared with more extensive and invasive surgeries such as a renal autotransplant and an ileal ureter.

Digital Identity in Academic Urology: Assessment of Female Pelvic Medicine and Reconstructive Surgery, and Opportunity for Improvement.

INTRODUCTION: We describe the digital identity of academic urologists in FPMRS (Female Pelvic Medicine and Reconstructive Surgery) by assessing their visible online information. METHODS: A Google™ search of SUFU (Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction) board members, past presidents and fellowship directors was completed. Hits on the first page of results were categorized as institutional page, group/society page, ratings site, interview/multimedia, journal article or book, social media, professional profile or another person. Sites were subclassified as physician controllable content or not controllable. Descriptive statistics, comparisons among SUFU roles and site type associations were calculated. RESULTS: First page results contained a median (Q1-Q3) of 11 (10-11) hits with 2 (2-3) institutional pages and 1 (1-2) group/society. Ratings sites were frequent returns, with 4 hits (3-5) in 98% of searches (60). Only 1 (1-1) social media, 1 (1-2) professional profile and 1 (1-2) interview/multimedia hits occurred. Overall 6 (5-7) sites were physician controllable content with all but 1 physician having at least 1 such result. Institutional (correlation coefficient -0.38, p = 0.001) or group/society (-0.34, p = 0.023) pages were associated with fewer ratings sites. Group/society pages were 3.41 times more prevalent (mean 11.7% vs 3.44%, p = 0.009) among SUFU board members, while past presidents had 3.03 (6.8% vs 2.3%, p = 0.046) times more journal articles or books and fellowship directors had 1.43 (25.6% vs 18.6%, p = 0.021) times more institutional pages. CONCLUSIONS: For active SUFU members ratings sites comprise a substantial portion of their search results. More online engagement or social media use could increase the visibility of physician controllable content in their digital identities.

Gpr124 is essential for blood-brain barrier integrity in central nervous system disease.

Although blood-brain barrier (BBB) compromise is central to the etiology of diverse central nervous system (CNS) disorders, endothelial receptor proteins that control BBB function are poorly defined. The endothelial G-protein-coupled receptor (GPCR) Gpr124 has been reported to be required for normal forebrain angiogenesis and BBB function in mouse embryos, but the role of this receptor in adult animals is unknown. Here Gpr124 conditional knockout (CKO) in the endothelia of adult mice did not affect homeostatic BBB integrity, but resulted in BBB disruption and microvascular hemorrhage in mouse models of both ischemic stroke and glioblastoma, accompanied by reduced cerebrovascular canonical Wnt-ß-catenin signaling. Constitutive activation of Wnt-ß-catenin signaling fully corrected the BBB disruption and hemorrhage defects of Gpr124-CKO mice, with rescue of the endothelial gene tight junction, pericyte coverage and extracellular-matrix deficits. We thus identify Gpr124 as an endothelial GPCR specifically required for endothelial Wnt signaling and BBB integrity under pathological conditions in adult mice. This finding implicates Gpr124 as a potential therapeutic target for human CNS disorders characterized by BBB disruption.