International Braz J Urol最新文献

{"title":"Association between rectal diameter and response to treatment with parasacral transcutaneous electrical nerve stimulation and behavioral changes in children and adolescents with bladder and bowel dysfunction.","authors":"Noel Charlles Nunes, Glicia Estevam de Abreu, Eneida Regis Dourado, Maria Luiza Veiga, Ananda Nacif, Maria Thaís de Andrade Calasans, Ana Aparecida Nascimento Martinelli Braga, Ubirajara Barroso","doi":"10.1590/S1677-5538.IBJU.2023.0201","DOIUrl":"10.1590/S1677-5538.IBJU.2023.0201","url":null,"abstract":"<p><strong>Purpose: </strong>Parasacral Transcutaneous Electrical Stimulation (TENS) is one of the treatments for children with Bladder and Bowel Dysfunction (BBD). Some studies showed that children with increased Rectal Diameter (RD) have more Functional Constipation (FC). However, RD prediction in maintenance of BBD after treatment was never evaluated. Our aim is to evaluate the association between RD and response to treatment in children and adolescents with BBD.</p><p><strong>Materials and methods: </strong>This study evaluated patients from 5-17 years old with BBD. Dysfunctional Voiding Scoring System (DVSS), Rome IV criteria, and the Constipation Score were used. RD was measured using abdominal ultrasound before treatment according to the technique established by Klijn et al. and was considered enlarged when >3cm. No laxatives were used during treatment. Descriptive analysis and binary regression were performed and the area under the ROC curve was calculated.</p><p><strong>Results: </strong>Forty children were included (mean age 8.4±2.8 years, 52.5% male). Before treatment, RD was enlarged in 15 children (37.5%) (mean diameter 3.84±0.6cm), with FC persisting post-treatment in 11/15(73.3%). Those patients also required more laxatives following treatment and had more severe FC. Binary regression showed pretreatment RD to be an independent predictor of the persistence of FC post-treatment (OR=9.56; 95%CI:2.05-44.60). In ROC curve analysis, the sensitivity was 100% (95%CI: 0.49-1.0) and specificity 77.14% (95%CI:0.60-0.90) for rectal diameter >3 cm. The likelihood ratio was 4.38 (95%CI:2.40-8.0) for the persistence of BBD following treatment.</p><p><strong>Conclusion: </strong>RD appears to be relevant in the evaluation of children with BBD, not only as a diagnostic tool but also as a predictor of treatment outcome.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10947615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nomogram to predict the risk of adverse outcomes in patients with residual stones following percutaneous nephrolithotomy.","authors":"Feng Xie, Shidong Deng, Kuilin Fei, Hanfeng Xu, Huihui Zhang","doi":"10.1590/S1677-5538.IBJU.2023.0111","DOIUrl":"10.1590/S1677-5538.IBJU.2023.0111","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the risk factors associated with adverse outcomes in patients with residual stones after percutaneous nephrolithotomy (PCNL) and to establish a nomogram to predict the probability of adverse outcomes based on these risk factors.</p><p><strong>Methods: </strong>We conducted a retrospective review of 233 patients who underwent PCNL for upper urinary tract calculi and had postoperative residual stones. The patients were divided into two groups according to whether adverse outcomes occurred, and the risk factors for adverse outcomes were explored by univariate and multivariate analyses. Finally, we created a nomogram for predicting the risk of adverse outcomes in patients with residual stones after PCNL.</p><p><strong>Results: </strong>In this study, adverse outcomes occurred in 125 (53.6%) patients. Multivariate logistic regression analysis indicated that the independent risk factors for adverse outcomes were the diameter of the postoperative residual stones (P < 0.001), a positive urine culture (P = 0.022), and previous stone surgery (P = 0.004). The above independent risk factors were used as variables to construct the nomogram. The nomogram model was internally validated. The calculated concordance index was 0.772. The Hosmer-Lemeshow goodness-of-fit test was performed (P > 0.05). The area under the ROC curve of this model was 0.772.</p><p><strong>Conclusions: </strong>Larger diameter of residual stones, positive urine culture, and previous stone surgery were significant predictors associated with adverse outcomes in patients with residual stones after PCNL. Our nomogram could help to assess the risk of adverse outcomes quickly and effectively in patients with residual stones after PCNL.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10547723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can we recommend varicocele surgery for men with hypogonadism?","authors":"Nilson Filho Marquardt, Carlos Teodósio Da Ros","doi":"10.1590/S1677-5538.IBJU.2023.0190","DOIUrl":"10.1590/S1677-5538.IBJU.2023.0190","url":null,"abstract":"s and titles identified through database searching (N = 595) Abstracts and titles screening (N = 36)s and titles screening (N = 36) Studies included. 15 prospective and retrospective 2 meta-analysis Records excluded. N = 559 Full text screening N = 17 Records excluded Another outcome evaluated N = 19 Figure 1 Flow chart of screened and excluded publications.","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10180159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ChatGPT for medical applications and urological science.","authors":"Leonardo O Reis","doi":"10.1590/S1677-5538.IBJU.2023.0112","DOIUrl":"10.1590/S1677-5538.IBJU.2023.0112","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10175623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative assessment of efficacy and safety of approved oral therapies for overactive bladder: a systematic review and network meta-analysis.","authors":"Wenjuan He, Guangliang Huang, Wenyan Cui, Yunfei Tian, Qian Sun, Xiaojuan Zhao, Yonghong Zhao, Dan Li, Xiuju Liu","doi":"10.1590/S1677-5538.IBJU.2023.0158","DOIUrl":"10.1590/S1677-5538.IBJU.2023.0158","url":null,"abstract":"<p><p>bladder based on a systematic review and network meta-analysis approach.</p><p><strong>Methods: </strong>Pubmed, Embase, Web of Science, and the Cochrane Register of Clinical Trials databases were systematically searched. The search time frame was from database creation to June 2, 2022. Randomized controlled double-blind trials of oral medication for overactive bladder were screened against the protocol's entry criteria. Trials were evaluated for quality using the Cochrane Risk of Bias Assessment Tool, and data were statistically analyzed using Stata 16.0 software.</p><p><strong>Result: </strong>A total of 60 randomized controlled double-blind clinical trials were included involving 50,333 subjects. Solifenacin 10mg was the most effective in mean daily micturitions and incontinence episodes, solifenacin 5/10mg in mean daily urinary urgency episodes and nocturia episodes, fesoterodine 8mg in urgency incontinence episodes/d and oxybutynin 5mg in voided volume/micturition. In terms of safety, solifenacin 5mg, ER-tolterodine 4mg, mirabegron, vibegron and ER-oxybutynin 10mg all showed a better incidence of dry mouth, fesoterodine 4mg, ER-oxybutynin 10mg, tolterodine 2mg, and vibegron in the incidence of constipation. Compared to placebo, imidafenacin 0.1mg showed a significantly increased incidence in hypertension, solifenacin 10mg in urinary tract infection, fesoterodine 4/8mg and darifenacin 15mg in headache.</p><p><strong>Conclusion: </strong>Solifenacin showed better efficacy. For safety, most anticholinergic drugs were more likely to cause dry mouth and constipation, lower doses were better tolerated. The choice of drugs should be tailored to the patient's specific situation to find the best balance between efficacy and safety.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10649337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic ventral onlay ureteroplasty with buccal mucosa graft for complex proximal ureteral stricture.","authors":"B G Guliev, Boris Komyakov, Zhaloliddin Avazkhanov, Maksim Shevnin, Ali Talyshinskii","doi":"10.1590/S1677-5538.IBJU.2023.0170","DOIUrl":"10.1590/S1677-5538.IBJU.2023.0170","url":null,"abstract":"<p><strong>Introduction: </strong>There is lack of papers dedicated to the laparoscopic buccal mucosa graft (BMG) ureteroplasty of the complex upper ureteral stricture. The aim of this study is to evaluate the results of laparoscopic BMG ureteroplasty in patients with complex proximal ureteral stricture.</p><p><strong>Material and methods: </strong>Twenty-four patients underwent laparoscopic ventral onlay BMG ureteroplasty for long or recurrent proximal ureteral stricture not amenable to uretero-ureteral anastomosis over 2019-2022. Patient demographics, operative time, estimated blood loss, length of stay, follow-up, intra- and postoperative complication rate and percentage of stricture-free at last visit were analyzed.</p><p><strong>Results: </strong>The mean stricture length was 3.6 cm. The mean operative time was 208.3 min, while mean blood loss was 75.8 mL. The length of hospital stay was 7.3 days. No intraoperative complications were observed. Postoperatively, seven patients developed complications (29.2%). Five patients experienced a Grade II (according to Clavien nomenclature). Two patients developed a Grade IIIa complication, which included leakage of the anastomosis site. The mean follow-up was on the 22 months with stricture free rate 87.5%.</p><p><strong>Conclusion: </strong>Patients with proximal ureteral strictures could be effectively treated by laparoscopic ventral onlay ureteroplasty with a buccal mucosa graft.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10548203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic partial nephrectomy for large renal Leiomyoma: first case report.","authors":"Antonio Franco, Devin Rogers, Savio D Pandolfo, Celeste Manfredi, Francesco Ditonno, Ciro Imbimbo, Marco De Sio, Cosimo De Nunzio, Riccardo Autorino","doi":"10.1590/S1677-5538.IBJU.2023.0205","DOIUrl":"10.1590/S1677-5538.IBJU.2023.0205","url":null,"abstract":"<p><strong>Aim: </strong>Renal leiomyoma is a rare benign mesenchymal tumor arising from the smooth muscle cells of the kidney. Renal capsule is its most common location (1). Large tumor may require surgical excision which can be challenging in case of proximity to major vessels (2). Indications of robotic partial nephrectomy (RPN) have exponentially expanded over the past few years (3). We aim to report a case of large renal leiomyoma successfully managed with RPN.</p><p><strong>Methods: </strong>A 59-year-old female patient with BMI 51 presented with chief complaint of abdominal discomfort. The patient underwent a CT scan that revealed a massive circumscribed exophytic complex solid cystic mass of 4.5 x 7.7 x 6.2 cm, arising from the lower pole of right kidney and abutting the inferior vena cava. RENAL score was 11ah (high complexity). Past surgical history included mid-urethral sling, breast reduction, and hysterectomy with salpingectomy. Preoperative creatinine and eGFR were 0.9 (mg/dL) and 77 (mL/min), respectively. A robotic excision of this mass was successfully performed by using Da Vinci Xi platform. Main steps of the procedure are illustrated in the present video.</p><p><strong>Results: </strong>Dissection and isolation of the tumor were carefully performed after identifying key anatomical structures such as the ureter, the IVC and the renal hilum. Intraoperative ultrasound was used to confirm the margins of the mass. The renal artery was clamped and then the tumor was resected/enucleated. Renal parenchyma was re-approximated with a single layer of interrupted CT-1 Vicryl 0 with sliding clip technique. Warm ischemia time was 19 min. Estimated blood loss (EBL) was 250 ml. Operative time was 165 min. No intraoperative complications occurred. No drain was placed. Patient was discharged on postoperative day 2. Post-operative hypotension was managed with fluid bolus. Postoperative creatinine and eGFR were 1,0 (mg/dL) and 69 (mL/min/1.72m2), respectively. Pathology revealed a leiomyoma of genital stromal origin with hyalinization and calcification.</p><p><strong>Conclusions: </strong>To the best of our knowledge, this is the first description of RPN for the management of a large (about 8 cm) renal leiomyoma. Robotic assisted surgery allows to expand the indications of minimally invasive conservative renal surgery whose feasibility becomes even more clinically significant in case of benign masses which can be managed without sacrificing healthy renal parenchyma.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10177448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of early catheter replacement after HoLEP. Results from a high-volume laser center.","authors":"Fabrizio Di Maida, Anna Cadenar, Antonio Andrea Grosso, Luca Lambertini, Sofia Giudici, Daniele Paganelli, Vincenzo Salamone, Andrea Mari, Matteo Salvi, Andrea Minervini, Agostino Tuccio","doi":"10.1590/S1677-5538.IBJU.2023.0165","DOIUrl":"10.1590/S1677-5538.IBJU.2023.0165","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of the study was to investigate clinical and surgical factors associated with early catheter replacement in patients treated with Holmium Laser Enucleation of the Prostate (HoLEP).</p><p><strong>Materials and methods: </strong>Data of patients treated with HoLEP at our Institution by a single surgeon from March 2017 to January 2021 were collected. Preoperative variables, including non-invasive uroflowmetry and abdominal ultrasonography (US), were recorded. Bladder wall modifications (BWM) at preoperative US were defined as the presence of single or multiple bladder diverticula or bladder wall thickening 5 mm. Clinical symptoms were assessed using validated questionnaires. Only events occurred within the first week after catheter removal were considered.</p><p><strong>Results: </strong>Overall, 305 patients were included, of which 46 (15.1%) experienced early catheter replacement. Maintenance of anticoagulants/antiplatelets (AC/AP) therapy at surgery (p=0.001), indwelling urinary catheter (p=0.02) and the presence of BWM (p=0.001) were more frequently reported in patients needing postoperative re-catheterization. Intraoperative complications (p=0.02) and median lasing time (p=0.02) were significantly higher in this group. At univariate analysis, indwelling urinary catheter (p=0.02), BWM (p=0.01), ongoing AC/AP therapy (p=0.01) and intraoperative complications (p=0.01) were significantly associated with early catheter replacement. At multivariate analysis, indwelling urinary catheter (OR: 1.28; p=0.02), BWM (OR: 2.87; p=0.001), and AC/AP therapy (OR: 2.21; p=0.01) were confirmed as independent predictors of catheter replacement.</p><p><strong>Conclusions: </strong>In our experience the presence of indwelling urinary catheter before surgery, BWM and the maintenance of AC/AP therapy were shown to be independent predictors of early catheter replacement after HoLEP.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10178509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer.","authors":"Marcos Tobias-Machado, Antonio A Ornellas, Alexandre K Hidaka, Luis G Medina, Pablo A L Mattos, Ruben S Besio, Diego Abreu, Pedro R Castro, Ricardo H Nishimoto, Juan Astigueta, Aurus Dourado, Roberto D Machado, Wesley J Magnabosco, Victor Corona-Montes, Gustavo M Villoldo, Hamilton C Zampolli, Anis Taha, Pericles R Auad, Eliney F Faria, Paulo B O Arantes, Alessandro Tavares, Francisco S M S Nascimento, Eder S Brazão, Maurício M Rocha, Walter H Costa, Vinicius Panico, Leonardo O Reis, Roberto J Almeida-Carrera, Rafael C Silva, Stênio C Zequi, José R R Calixto, Rene Sotelo","doi":"10.1590/S1677-5538.IBJU.2023.0065","DOIUrl":"10.1590/S1677-5538.IBJU.2023.0065","url":null,"abstract":"ABSTRACT Objective: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Materials and Methods: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. Results: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. Conclusion: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10547728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic assisted radical nephrectomy with Inferior vena cava tumor thrombus.","authors":"Maxwell Sandberg, Wyatt Whitman, Alejandro Rodriguez","doi":"10.1590/S1677-5538.IBJU.2023.0245","DOIUrl":"10.1590/S1677-5538.IBJU.2023.0245","url":null,"abstract":"<p><strong>Purpose: </strong>Surgery for renal cell carcinoma (RCC) with an inferior vena cava (IVC) tumor thrombus can be done via a robotic approach. While this approach is thought to minimize blood loss, it may still result in significant losses (1) and current publications indicate that it can require upwards of 3-day hospital stays (1, 2). However, innovative surgical techniques, such as the split and roll, may curtail this. The purpose of this video is to present the case and surgical technique of robotic assisted radical nephrectomy with IVC thrombectomy.</p><p><strong>Materials and methods: </strong>The patient was a 77-year-old male found to have a right upper pole renal mass on CT urogram. On MRI (Figure 1), a renal mass and level II thrombus was seen. For this case, the Da Vinci Xi Intuitive robotic system was used, with four robotic 8-millimeter (mm) metallic trocars, two 5 mm assistant trocars, and one 12 mm air seal port. The split and roll technique were utilized to access the IVC and lumbar veins. This surgical method uses the adventitia of the IVC as a plane of dissection and safely identifies all branches/tributaries of the IVC to minimize the chance of vascular injury (3).</p><p><strong>Results: </strong>Robotic console time was 150 minutes. The patient had an excellent outcome, with all tumor thrombus removed, less than 50cc of blood loss, and was discharged within 24 hours of the operation. The tumor pathology came back as papillary, high grade, and was stage pT3bN1.</p><p><strong>Conclusions: </strong>The robotic approach with split and roll technique is a great surgical option for urologists to consider in patients with RCC and a level I or II thrombus, which can minimize blood loss and expedite discharge.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10548200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}