International Braz J Urol最新文献

{"title":"The atlas of supine single port extraperitoneal access.","authors":"Luca Lambertini, Matteo Pacini, Luca Morgantini, Jhon Smith, Juan Ramon Torres-Anguiano, Simone Crivellaro","doi":"10.1590/S1677-5538.IBJU.2024.0400","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0400","url":null,"abstract":"<p><strong>Introduction: </strong>The introduction of Single-Port (SP) platform opened the field to new surgical options, allowing to perform major urological robot-assisted procedures extraperitoneally and with a supine patient positioning (1-3). Nevertheless, a comprehensive description of different supine access options is still lacking (4-6). In this light, we provided a step-by-step guide of SP extraperitoneal supine access options also exploring preliminary surgical outcomes.</p><p><strong>Materials and methods: </strong>Transvesical access was performed by a transversal incision 3cm above the pubic bone, after the anterior abdominal sheet incision, the bladder was insufflated with a flexible cystoscope and the detrusor muscle was incised at the level of the bladder dome. Similarly, the extraperitoneal access was carried out with a 4cm incision above the pubic bone, once visualized the preperitoneal space the prevesical fat was gently spread. The Low Anterior Access was performed with a 3cm incision at the McBurney point, the abdominal muscles were then spread. A gentle dissection was used laterally to develop the retroperitoneal space.</p><p><strong>Results: </strong>Overall, sixteen different procedures were performed with supine extraperitoneal access on 623 consecutive patients. No intraoperative conversions occurred. The median access time was 16 (IQR 12-21), 11 (IQR 7-14) and 14 (IQR 10-18) minutes in case of transvesical, extraperitoneal and low anterior access, respectively. Notably, 81.5 % of patients were discharged on the same day with a postoperative opioid free rate of 73%.</p><p><strong>Conclusion: </strong>The Atlas provides a comprehensive step-by-step guide to successfully perform all major urological SP procedures extraperitoneally and with supine patient positioning.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"50 ","pages":"783-784"},"PeriodicalIF":3.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037521","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":"First impressions of Telesurgery robotic-assisted radical prostatectomy using the Edge medical robotic platform.","authors":"Marcio Covas Moschovas, Travis Rogers, Wanhai Xu, Roshane Perera, Xu Zhang, Vipul Patel","doi":"10.1590/S1677-5538.IBJU.2024.0458","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0458","url":null,"abstract":"<p><strong>Purpose: </strong>We reported, as a referral center in prostate cancer, our perspectives and experience performing Telesurgery using robotic surgery and 5G network.</p><p><strong>Material and methods: </strong>We described and illustrated the Telesurgery applications and outcomes to treat a patient with prostate cancer located 1300 kilometers away from the surgeon (Beijing-Harbin) in China. We used the Edge Medical Robot (MP1000) in November 2023 in a 71-year-old patient with Gleason 6 (ISUP 1) in 8 cores from 13, PSA of 14 ng/dL, and clinical stage cT2a. MRI described a PIRADS 5 nodule on the left peripheral zone at the base, and 20gr prostate. We described details about the connection between centers, perioperative outcomes, and our perspectives as a referral center in prostate cancer.</p><p><strong>Results: </strong>We had no delays, or problems with network connection between the centers. The procedure was performed in 60 minutes, with no intra- or postoperative complications. Estimated blood loss was 100 mL. The patient was ambulating soon after anesthesia recovery. Final pathology described a Gleason 6 (ISUP 1) involving the left base and left seminal vesicle, negative surgical margins, and no lymph node involvement (pT3bN0). The patient was continent soon after catheter removal (7 days).</p><p><strong>Conclusion: </strong>As technological progress introduced novel robotic platforms and high-speed networks, the concept of Telesurgery became a tangible reality while 5G technology solved latency and transmission concerns. However, with these advancements, ethical considerations and regulatory frameworks should underline the importance of transparency and patient safety with responsible innovation in the field.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"50 6","pages":"754-763"},"PeriodicalIF":3.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127139","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":"Single Port Robotic Nephrectomy via lower anterior retroperitoneal approach: feasible, safe and effective option in surgically complex patients.","authors":"Angelo Orsini, Francesco Lasorsa, Gabriele Bignante, Jamie Yoon, Kyle Anna Dymanus, Edward E Cherullo, Riccardo Autorino","doi":"10.1590/S1677-5538.IBJU.2024.0420","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0420","url":null,"abstract":"<p><strong>Purpose: </strong>Minimally invasive radical nephrectomy is often preferred for larger renal tumours not suitable for partial nephrectomy (1). When performed with a multiport robot, the procedure is routinely performed with a transperitoneal approach, with recent studies highlighting important factors for surgical outcomes, including predictive factors (2), segmental artery unclamping techniques (3), and comparisons of robotic techniques (4). This video shows that SP Robot-Assisted Radical Nephrectomy (RARN) via a lower anterior approach is valuable in challenging cases.</p><p><strong>Materials and methods: </strong>We performed SP-RARN on two complex patients using a retroperitoneal lower anterior approach. The first patient, a 54-year-old female with a BMI of 36.8 kg/m², had a ventral hernia and bowel obstruction history, with a 9 cm right middle kidney mass. The second patient, a 58-year-old male with a BMI of 31.19 kg/m², had ESRD and was on peritoneal dialysis for 8 years, with a 3.4x3.7 cm mass in the right superior pole, suspected to be RCC. The surgical technique is detailed in the video.</p><p><strong>Results: </strong>Both procedures were successful, with operative times of 173 and 203 minutes and blood loss of 150 mL. No complications occurred. Patients were discharged after 31 and 38 hours, respectively. Histopathology confirmed RCC. At the 3-month follow-up, no complications or readmissions were reported. Second patient continued peritoneal dialysis without issues.</p><p><strong>Conclusion: </strong>Retroperitoneal SP-RARN via the lower anterior approach avoids the peritoneal cavity, making it suitable for certain patients. In these patients, more so than in others, this procedure is feasible, safe, and less morbid than the standard multiport approach.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"50 ","pages":"785-786"},"PeriodicalIF":3.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972215","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":"Retrograde intrarenal surgery with or without ureteral access sheath: a systematic review and meta-analysis of randomized controlled trials.","authors":"Lucas Guimarães Campos Roriz de Amorim, Marcelo Esteves Chaves Campos, Lígia Sant'Ana Dumont, José Augusto Rojas Peñafiel, Eliabe Silva de Abreu, Giovanni Scala Marchini, Manoj Monga, Eduardo Mazzucchi","doi":"10.1590/S1677-5538.IBJU.2024.0452","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0452","url":null,"abstract":"<p><strong>Introduction: </strong>The ureteral access sheath (UAS) is a medical device that enables repeated entrance into the ureter and collecting system during retrograde intrarenal surgery (RIRS). Its impact on stone-free rates, ureteral injuries, operative time, and postoperative complications remains controversial. Therefore, we performed a systematic review and meta-analysis comparing RIRS with versus without UAS for urolithiasis management.</p><p><strong>Purpose: </strong>To compare outcomes from retrograde intrarenal surgery (RIRS) for stone extraction with or without ureteral access sheath (UAS); evaluating stone-free rate (SFR), ureteral injuries, operative time, and postoperative complications.</p><p><strong>Materials and methods: </strong>We systematically searched PubMed, Embase, and Cochrane Library in June 2024 for randomized controlled trials (RCTs) evaluating the efficacy and safety outcomes of UAS use in RIRS for urolithiasis treatment. Articles published between 2014 and 2024 were included. Pooled risk ratios (RRs) and mean differences (MDs) were calculated for binary and continuous outcomes, respectively.</p><p><strong>Results: </strong>Five RCTs comprising 466 procedures were included. Of these, 246 (52.7%) utilized UAS. The follow-up ranged from 1 week to 1 month. UAS reduced the incidence of postoperative fever (RR 0.49; 95% confidence interval [CI] 0.29-0.84; p=0.009), and postoperative infection (RR 0.50; 95% CI 0.30-0.83; p=0.008). There were no significant differences between groups in terms of SFR (RR 1.05; 95% CI 0.99-1.11; p=0.10), ureteral injuries (RR 1.29; 95% CI 0.95-1.75; p=0.11), operative time (MD 3.56 minutes; 95% CI -4.15 to 11.27 minutes; p=0.36), or length of stay (MD 0.32 days; 95% CI -0.42 to 1.07 days; p=0.40).</p><p><strong>Conclusion: </strong>UAS leads to a lower rate of post-operative fever and infection. However, UAS did not significantly reduce or increase the SFR or the rate of ureteral injuries during RIRS for patients with urolithiasis. The use of UAS should be considered to decrease the risk of infectious complications, particularly in those who may be at higher risk for such complications.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"50 ","pages":"670-682"},"PeriodicalIF":3.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037518","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 versus open radical Prostatectomy: comparing automobiles and carriages in 2024.","authors":"Tomás Bernardo Costa Moretti, Leonardo Oliveira Reis","doi":"10.1590/S1677-5538.IBJU.2024.0470","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0470","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"50 6","pages":"772-775"},"PeriodicalIF":3.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127140","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":"Totally Intracorporeal Robot-Assisted Bilateral Ileal Ureter Replacement for the Treat-ment of Ureteral Strictures using Kangduo Surgical Robot 2000 Plus.","authors":"Shubo Fan, Silu Chen, Xinfei Li, Zhihua Li, Kunlin Yang, Han Hao, Liqun Zhou, Xuesong Li","doi":"10.1590/S1677-5538.IBJU.2024.0360","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0360","url":null,"abstract":"<p><strong>Purpose: </strong>Ureteroplasty using buccal or lingual mucosa graft Is feasible for complex proximal ureteral stricture (1, 2). Ileal ureter replacement is considered as the last resort for ureteral reconstruction. Totally intracorporeal robot-assisted ileal ureter replacement can be performed safely and effectively (3). In China, the KangDuo Surgical Robot 2000 Plus (KD-SR-2000 Plus) has been developed featuring two surgeon consoles and five robotic arms. This study aims to share our experience with totally intracorporeal robot-assisted bilateral ileal ureter replacement using KD-SR-2000 Plus.</p><p><strong>Materials and methods: </strong>A 59-year-old female patient underwent a complete intracorporeal robot-assisted bilateral ileal ureter replacement for the treatment of ureteral strictures using KD-SR-2000 Plus. The surgical procedure involved dissecting the proximal ends of the bilateral ureteral strictures, harvesting the ileal ureter, restoring intestinal continuity, and performing an anastomosis between the ileum and the ureteral end as well as the bladder. The data were prospectively collected and analyzed.</p><p><strong>Results: </strong>The surgery was successfully completed with single docking without open conversion. The length of the harvested ileal ureter was 25 cm. The docking time, operation time and console time were 3.4 min., 271 min and 231 min respectively. The estimated blood loss was 50 mL. The postoperative hospitalization was 6 days. No perioperative complications occurred.</p><p><strong>Conclusions: </strong>It is technically feasible to perform totally intracorporeal robot-assisted bilateral ileal ureter replacement for the treatment of ureteral strictures using KD-SR-2000 Plus. A longer follow-up and a larger sample size are required to evaluate its safety and effectiveness.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"50 6","pages":"781-782"},"PeriodicalIF":3.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127141","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":"Role of Gubernaculum testis inervation during the process of testicular migration in human fetuses.","authors":"Luciano A Favorito, Laura M M Favorito, Ana R M Morais, Francisco J B Sampaio","doi":"10.1590/S1677-5538.IBJU.2024.9914","DOIUrl":"10.1590/S1677-5538.IBJU.2024.9914","url":null,"abstract":"<p><strong>Purpose: </strong>The gubernaculum seems to be the most important anatomical structure in the testicular migration process. The objective of this paper is to review current literature regarding the role of gubernaculum testis nerves in testicular migration. We conducted a comprehensive literature review about the gubernaculum testis innervation. A PubMed database search was performed in April 2024, focusing on gubernaculum testis and cryptorchidism and genitofemoral nerve (GFN) and calcitonin gene-related peptide (CGRP) gene. The gubernaculum has its own nerve supply, the GFN, descending on the anteromedial surface of the psoas muscle from L1-L2 segments. The second phase of testicular descent is regulated by androgens and CGRP, released from the sensory nucleus of the GFN. The GFN doesn't directly play a role in testicular migration but there is a theory that shows a regulatory function of this nerve in hormonal action during this process. The gubernaculum testis has important structural alterations during the testicular migration and the genitofemoral nerve and CGRP gene are of great importance in this process. The genitofemoral nerve provides motor innervation to the cremaster muscle and gubernaculum, which helps regulate the position of the testes within the scrotum.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"50 ","pages":"519-529"},"PeriodicalIF":3.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767828","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":"Transperineal versus Transrectal MRI/TRUS fusion-guided prostate biopsy in a large, ethnically diverse, and multiracial cohort.","authors":"Lorenzo Storino Ramacciotti, David Strauss, Francesco Cei, Masatomo Kaneko, Daniel Mokhtar, Jie Cai, Delara Jadvar, Giovanni E Cacciamani, Manju Aron, Pierre B Halteh, Vinay Duddalwar, Inderbir Gill, Andre Luis Abreu","doi":"10.1590/S1677-5538.IBJU.2024.0354","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0354","url":null,"abstract":"<p><strong>Purpose: </strong>To compare transperineal (TP) vs transrectal (TR) magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion-guided prostate biopsy (PBx) in a large, ethnically diverse and multiracial cohort.</p><p><strong>Materials and methods: </strong>Consecutive patients who underwent multiparametric (mp) MRI followed by TP or TR TRUS-fusion guided PBx, were identified from a prospective database (IRB #HS-13-00663). All patients underwent mpMRI followed by 12-14 core systematic PBx. A minimum of two additional target-biopsy cores were taken per PIRADS≥3 lesion. The endpoint was the detection of clinically significant prostate cancer (CSPCa; Grade Group, GG≥2). Statistical significance was defined as p<0.05.</p><p><strong>Results: </strong>A total of 1491 patients met inclusion criteria, with 480 undergoing TP and 1011 TR PBx. Overall, 11% of patients were Asians, 5% African Americans, 14% Hispanic, 14% Others, and 56% White, similar between TP and TR (p=0.4). For PIRADS 3-5, the TP PBx CSPCa detection was significantly higher (61% vs 54%, p=0.03) than TR PBx, but not for PIRADS 1-2 (13% vs 13%, p=1.0). After adjusting for confounders on multivariable analysis, Black race, but not the PBx approach (TP vs TR), was an independent predictor of CSPCa detection. The median maximum cancer core length (11 vs 8mm; p<0.001) and percent (80% vs 60%; p<0.001) were greater for TP PBx even after adjusting for confounders.</p><p><strong>Conclusions: </strong>In a large and diverse cohort, Black race, but not the biopsy approach, was an independent predictor for CSPCa detection. TP and TR PBx yielded similar CSPCa detection rates; however the TP PBx was histologically more informative.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"50 5","pages":"616-628"},"PeriodicalIF":3.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898740","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":"Editorial Comment: Comparative Analysis of Super-Mini Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery for the Management of Renal Calculi ≤2 cm Among Somali Population.","authors":"Luciano A Favorito","doi":"10.1590/S1677-5538.IBJU.2023.0354.1","DOIUrl":"10.1590/S1677-5538.IBJU.2023.0354.1","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"50 5","pages":"655-656"},"PeriodicalIF":3.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898714","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":"Risk of infection during percutaneous nephrolithotomy is the hot topic in this number of the International Brazilian Journal of Urology.","authors":"Luciano A Favorito","doi":"10.1590/S1677-5538.IBJU.2024.05.01","DOIUrl":"10.1590/S1677-5538.IBJU.2024.05.01","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"50 5","pages":"516-518"},"PeriodicalIF":3.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898738","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}