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In pts with compromised renal fcn, bowel interposition is problematic due to urine reabsorption. Creativity is needed. Here bilat recon with BMG on left, appendix on right for radiation stx youtu.be/7qyLDnlEpuc?si… via YouTube

Ileal ureter remains an useful technique to add additional tissue to the urinary tract. Here is a bilateral ileal ureter for radiation induced stricture youtu.be/XvRbXX3Jun4?si… via YouTube

There are multiple ways to ureteral duplication with obstruction. Here the obstructed moiety is anastomosed to the unobstructed one. Upper to Lower Moiety End-to-Side Ureteroureterostomy youtu.be/ASqH-qhOFW4?si… via YouTube

Revision Pyeloplasty may be challenging due to scar tissue. The white light of the ureteroscope helps. ICG injected via nephrostomy tube. youtu.be/2uL257Wsfh0?si… via YouTube

Another option for UPJ obstruction after pyeloplasty is ureterocalycostomy, especially useful in thinned parenchyma over the lower pole. I use a circumferential suture to evert the lower pole mucosa. youtu.be/W3817qCAQyw?si… via YouTube

Glad to see that videos have been helpful! Innovation is only useful if it leads to wider adoption.

Optilume has changed my stricture practice. I've done the balloon dilation without fluoro using a flexible cystoscope for many years but I'm having fewer recurrences now with DCB. will there be less need for GURS? youtu.be/FrhG0ragaaE?si… via YouTube

Here is a case where Optilume won't work. Missing urethra for ~10cm, failed staged repairs w grafts. Free flap of Ileum used for urethroplasty youtu.be/11iEirkU2n8?si… via YouTube

Radial Forearm Free Flap is another option for single stage replacement of the urethra. Here is a RFFF Urethroplasty for radiation stenosis from bladder neck to bulbar urethra youtu.be/yZyU7JccaOk?si… via YouTube

For women with stress incontinence refractory to other treatment, Artificial Urinary Sphincter is a good option. credit to Benoît Peyronnet. Here is a case using SP Robot. Hydrodissection to make the space. Cottonoid to help pass cuff. youtu.be/Ad7eWu6Y-Zk?si… via YouTube

Since 2017, Dr. Bluebond-Langner & I have performed the peritoneal flap technique for gender affirming vaginoplasty NYU Langone Health, allowing for vaginal depth in every patient and leaving all the external genital tissue for vulvar aesthetics. youtu.be/Kz6hXSQMkCI?si… via YouTube

The reservoir can be the hardest part of infected IPP removal. If I have difficulty finding the reservoir, esp in ectopic location, the laparoscopic technique is useful. #UroSoMe youtu.be/yKNbOxTcQdw?si… via YouTube

Collaborating with microsurgery NYU Plastic Surgery is SO helpful for tough cases. In abdominal testis found on adulthood it can be difficult to mobilize the vessels. Here autotransplant done to inferior epigastric; Credit Dr. Jamie Levine youtu.be/FvD6vvDiTlc?si… via YouTube

We are less than 20 days away from Ziho Lee, MD’s, 3rd annual Advances in Genitourinary Robotic Reconstruction Course! Free course for those interested in complex robotic reconstruction. We are looking forward to sharing data, novel techniques, and tips/tricks with Lee Zhao,

Parastomal hernia can affect pouching of the ileal conduit. SP robot allows for outpatient hernia repair without re-siting the stoma. youtu.be/pZIDCLTfu_s?si… via YouTube

There are several techniques for repairing of VUAS after radical prostatectomy. If the stricture is short, can widen the anastomosis using two bladder flaps. The final anastomosis is in the shape of a T, hence, T-plasty. youtu.be/qpr8RNT5qXM?si… via YouTube

Urology residents/fellows finishing 2026 and looking for a high volume experience in complex reconstruction, please reach out DM/email. Our volume continues to grow and we continue to innovate to develop new procedures to solve intractable problems.

Ureteroenteric strictures are hard to fix because the ureter was mobilized and the problem is usually ischemic. Key principle is to bring diversion/bowel to ureter. An additional limb of small bowel can be brought to the ureter. #UroSoMe youtu.be/iSpsaDxQoqg?si… via YouTube

Over time, pts with neobladder may suffer complications that require conversion to conduit. By opening the neobladder on the antimesenteric side and suturing the remainder into a conduit, can avoid bowel segmentation and anastomosis youtu.be/Lzz-W6q8iic?si… via YouTube

#IFRUU2024 Come for the science and stay for the outdoors! Brian J. Flynn, M.D. Dmitriy Nikolavsky Seth Cohen Lee Zhao Jay Simhan, MD