Urology video journal最新文献

{"title":"Laparoscopic bladder neck reconstruction techniques in recalcitrant sclerosis of the bladder neck after radical prostatectomy","authors":"Jose J. Alvarez Alvarez ,&nbsp;Jose A. Zapata Gonzalez ,&nbsp;Erick A. Ramirez Perez ,&nbsp;Porfirio D. Lopez Alvarado","doi":"10.1016/j.urolvj.2024.100303","DOIUrl":"10.1016/j.urolvj.2024.100303","url":null,"abstract":"<div><div>The term posterior urethral stricture is typically used to describe any pathological stricture whose anatomic origin is from the bladder neck to the distal end of the membranous urethra (1). Now located in this anatomical segment of the urethra, we can clearly define two basic nomenclature terms for a correct communication and evaluation of the text. Vesicourethral anastomosis stenosis (VUAS) is defined by a reduction in caliber at the level of the surgical junction of the bladder neck with the membranous urethra after radical prostatectomy (RP) in any of its surgical modalities. A minimum urethral caliber below which we will consider VUAS has not been defined. Usually, the method for classifying a VUAS is the impossibility of opening it with a 15 or 17 Fr cystoscope. The lack of uniformity in the diagnostic methods is evident in the wide range of reported incidences and the different percentages of success obtained with the proposed treatments (7,11–15). In contrast, the term bladder neck contracture (BNC) specifically refers to stricture of the proximal urethral junction and bladder neck with the prostate in situ; produced for example after a transurethral resection of the prostate (TURP), photo-vaporization of the prostate (PVP), or after radiation therapy for prostate cancer (2).</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100303"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testicular artery identification with indocyanine green angiography in robotic microsurgical varicocelectomy","authors":"Sarah Brink ,&nbsp;David Shin","doi":"10.1016/j.urolvj.2024.100306","DOIUrl":"10.1016/j.urolvj.2024.100306","url":null,"abstract":"","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100306"},"PeriodicalIF":0.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging technique for posterior endoscopic urethroplasty with graft","authors":"Oscar Li,&nbsp;Ridwan Alam,&nbsp;Mark Alshak,&nbsp;Andrew Cohen","doi":"10.1016/j.urolvj.2024.100304","DOIUrl":"10.1016/j.urolvj.2024.100304","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe a novel surgical technique for endoscopic posterior urethroplasty using buccal graft.</div></div><div><h3>Patients and surgical procedure</h3><div>Patient 1 is an 80-year-old male with benign prostatic hyperplasia status post transurethral resection and Greenlight laser vaporization of the prostate complicated by bladder neck contracture who has been suprapubic tube dependent for years. Patient 2 is a 70-year-old male with prostate cancer status post robotic radical prostatectomy with salvage radiation with multiple prior endoscopic treatments for vesicourethral anastomotic scar. Surgical procedure involved cystoscopy to identify the stenotic area. A transurethral resecting loop was then utilized to establish a shallow trough for the graft. A buccal graft was harvested in the typical fashion and Dermabond was applied to the mucosa surface to prevent curling. Next, we placed stitches on the corner of the graft for ease of endoscopic maneuvering. We used a grasper at the tip of a rigid cystoscope to deliver the graft to the shallow trough. An endoscopic “sewing machine” was prepared by pre-loading a Williams botox with barbed suture. With the graft placed over the bed, we used the cystoscope and preloaded barbed suture to quilt the graft to the urethral bed. This was repeated until the graft appeared immobile. A 16-French Foley catheter was left in place for two weeks.</div></div><div><h3>Results</h3><div>There were no complications during both procedures. For patient 1, cystoscopy two weeks post-op demonstrated pink graft in contact with the urethral floor. There was an open channel to the bladder. For patient 2, post-op cystoscopy was delayed to six weeks post-op due to persistent pain. Cystoscopy showed no obstructive areas and a widely patent urethra. Patient 1 was able to continue to void per urethra for 3 months before stricture recurrence occurred. Patient 2 is still voiding per urethra at 12 months post-op and his urethra remains patent at the time of this manuscript submission.</div></div><div><h3>Conclusion</h3><div>Endoscopic posterior urethroplasty using buccal graft is a viable minimally invasive approach but refinements are still needed. We anticipate additional innovations in this space as the field moves to more minimally invasive techniques.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100304"},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Step-by-step: Intra-arterial renal hypothermia during robot-assisted partial nephrectomy","authors":"Joris Vangeneugden ,&nbsp;Pieter De Backer ,&nbsp;Camille Berquin ,&nbsp;Saar Vermijs ,&nbsp;Peter Dekuyper ,&nbsp;Alexandre Mottrie ,&nbsp;Charlotte Debbaut ,&nbsp;Thierry Quackels ,&nbsp;Charles Van Praet ,&nbsp;Karel Decaestecker","doi":"10.1016/j.urolvj.2024.100308","DOIUrl":"10.1016/j.urolvj.2024.100308","url":null,"abstract":"<div><h3>Objective</h3><div>Renal hypothermia, which can be achieved through several techniques, might allow for longer clamping times in complex robot-assisted partial nephrectomy (RAPN). Intra-arterial cooling (IAC) through arteriotomy was previously found safe and feasible. It may offer several advantages such as prolonged clamping times and working in a bloodless field, allowing for more nephron-sparing surgery in challenging lesions. We provide a step-by-step video elaborating on the surgical technique of RAPN with IAC and present the long-term results of our case series.</div></div><div><h3>Patients and surgical procedure</h3><div>Ten patients with complex renal masses (deep endophytic, hilar, multiple ipsilateral and very large lesions), where clamping times over 25 min were expected, were treated with RAPN using IAC between March 2020 and March 2023 in 3 referral centers by 2 surgeons. All surgeries were performed using the Da Vinci Xi robot. Three-dimensional (3D) models were created for pre-operative planning and peri‑operative guidance.</div></div><div><h3>Results</h3><div>Median warm, cold and rewarming ischemia times were 4 (IQR 3-7) min, 60 (IQR 33-75) min and 11 (IQR 7-24) min respectively. One case was converted to radical nephrectomy and one case required postoperative coiling due to pseudo-aneurysm formation (Clavien-Dindo 3b). No other intraoperative or postoperative complications occurred. Median pre- and postoperative (3 month and 6 month) GFR values were 90 (IQR 78-90) ml/min, 87 (IQR 71-90) ml/min and 90 (IQR 67-90) ml/min. At a median follow-up of 24 (IQR 13-44) months, the median GFR was stable at 90 (IQR 82-90) ml/min.</div></div><div><h3>Conclusions</h3><div>We present a step-by-step video description of RAPN using IAC. This technique allows for safe prolonged clamping times in complex renal masses, with maintained kidney function and no long-term complications at a median follow-up of 2 years. This technique could be considered by expert robotic surgeons, expanding indications for robotic nephron-sparing surgery.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100308"},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic repair of a vesicouterine fistula","authors":"Lucas Arrais Chaves Nascimento,&nbsp;Raul Loures,&nbsp;Daniel Charret Diegues,&nbsp;Lorella Miranda Auricchio,&nbsp;Renato Panhoca,&nbsp;Luís Augusto Seabra Rios,&nbsp;Wagner Aparecido França","doi":"10.1016/j.urolvj.2024.100305","DOIUrl":"10.1016/j.urolvj.2024.100305","url":null,"abstract":"","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100305"},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic ileal ureter replacement for panureteral stricture disease: a step-by-step guide","authors":"Emily Ji,&nbsp;Devin Boehm,&nbsp;Jonathan Rosenfeld,&nbsp;Rebecca Arteaga,&nbsp;Jaewoo Kim,&nbsp;Aidan Raikar,&nbsp;Ziho Lee","doi":"10.1016/j.urolvj.2024.100299","DOIUrl":"10.1016/j.urolvj.2024.100299","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Traditionally, open ileal ureter replacement (IUR) was a reconstructive option for patients with long-segment ureteral strictures not amenable to excision and primary anastomosis. The paradigm has shifted to favoring robotic substitution ureteroplasty using buccal mucosa graft and/or appendix to manage most long-segment strictures. However, for panureteral strictures, IUR remains an important tool in the reconstructive urologist's armamentarium. In this article, we describe our step-by-step approach for intracorporeal robotic right and left IUR and highlight key aspects of our surgical technique.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods and Surgical Procedure&lt;/h3&gt;&lt;div&gt;Our technique involves five major steps: proximal ureteral dissection, bowel harvest, bladder dissection, distal anastomosis, and proximal anastomosis. Given the need to optimize access to the upper and lower urinary tracts, we use two separate patient positions and port placement setups. The modified flank position is used to access the upper urinary tracts and the modified supine position is used to access the lower urinary tracts. Rotating the bed allows for toggling between the modified flank and modified supine positions without the need to reposition or re-drape the patient. For right sided cases, we prefer to orient the ileal ureter in an anti-peristaltic fashion to retroperitonealize the ileal ureter and optimize its mesenteric orientation. For left sided cases, the proximal portion or the entirety of the ileal ureter may be tunneled through the sigmoid mesentery. We prefer the latter option in patients with a history of stone disease to facilitate endoscopic access to the kidney. Postoperatively, we obtain a cystogram at two weeks and remove the urethral catheter if the cystogram is negative for urine leak. The stent is typically removed six weeks postoperatively. Our preference is to monitor for stricture recurrence with serial renal scans obtained three months, 12 months, and yearly thereafter. In cases where there is concern for stricture recurrence, the patients are taken to the operating room for an endoscopic evaluation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Between 2/2022–7/2024, 8 patients underwent robotic IUR for panureteral stricture disease. The median age was 63 years (IQR 60–68), body mass index was 25 kg/m&lt;sup&gt;2&lt;/sup&gt; (IQR 22–27), and length of ureteral defect was 17 cm (IQR 15–21). The median operative time was 305 min (IQR 274–356) and estimated blood loss was 100 cc (IQR 100–200). There were no intraoperative complications. One patient (12.5 %) had a major (Clavien &lt;span&gt;&lt;math&gt;&lt;mo&gt;≥&lt;/mo&gt;&lt;/math&gt;&lt;/span&gt; III) 30-day complication. This patient underwent concomitant robotic colorectal surgery for diverticulitis and developed an intra-abdominal abscess at the colonic anastomosis requiring drain placement. Median length of stay was 5 days (IQR 4–6). &lt;span&gt;&lt;span&gt;Table 1&lt;/span&gt;&lt;/span&gt; lists preoperative and postoperative imaging findings for each pati","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100299"},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142560726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anant's novel and simplified technique of vascular anastomosis in robot assisted kidney transplant","authors":"Anant Kumar ,&nbsp;Samit Chaturvedi ,&nbsp;Ruchir Maheshwari ,&nbsp;Himanshu Sharma ,&nbsp;Amit Aggarwal","doi":"10.1016/j.urolvj.2024.100301","DOIUrl":"10.1016/j.urolvj.2024.100301","url":null,"abstract":"","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100301"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of a challenging case of post chemotherapy retroperitoneal mass in testicular tumour by RASE-RPLND: A novel technique","authors":"Ginil Kumar Pooleri,&nbsp;Shashank Agrawal,&nbsp;Vishnu Prasad,&nbsp;Nazareth T Solomon,&nbsp;Nikhil Vasan Arulmany,&nbsp;Arun Menon","doi":"10.1016/j.urolvj.2024.100302","DOIUrl":"10.1016/j.urolvj.2024.100302","url":null,"abstract":"<div><h3>Objective</h3><div>Retroperitoneal lymph node dissection (RPLND) is a recommended surgical treatment for nonseminomatous germ cell testicular cancer (NSGCT), in post-chemotherapy residual retroperitoneal lymphnode masses. In this video, we present our novel surgical approach, termed robot-assisted supine extraperitoneal RPLND (RASE-RPLND), for managing retroperitoneal lymph metastasis in NSGCT.</div></div><div><h3>Patients and surgical procedure</h3><div>A 32-year-old married gentleman who was initially diagnosed to have NSGCT of left testicle and Stage T1N2M0S2, received four cycles of BEP chemotherapy, showed a residual para-aortic lymph node measuring 3.5 × 2.4 cm on follow up and was planned for RPLND. He underwent RASE-RPLND and the retroperitoneum was approached from the right flank and dissection was done across the midline to the opposite side to clear all residual lymph nodular masses. The entire paracaval, interaortocaval, and para-aortic lymph nodes were removed according to the standard bilateral template. Postganglionic sympathetic efferent fibers were preserved. Following sufficient vascular control, a portion of the left renal vein was resected along with the nodal mass, and the vein was subsequently repaired using prolene suture. Patient was discharged after 48 h.</div></div><div><h3>Results</h3><div>We performed 13 cases of RASE-RPLND in post-chemotherapy patients, with a mean age of 27.8 ± 6.64 years and BMI of 22.8 ± 2.26Kg/m². All cases involved NSGCT. The median operative time was 350 min with 180 ml mean blood loss. One patient required preoperative IVC filter placement, and two cases needed conversion due to adhesions and pneumoperitoneum. A renal vein injury was repaired intraoperatively. Postoperatively, lymphocele was the most common complication, managed conservatively.</div></div><div><h3>Conclusion</h3><div>Nerve-sparing RPLND via the RASE approach in a post-chemotherapy setting shows favourable outcomes, including minimal bowel handling, managing intra-operative challenging situations and, early post-operative recovery. Complicated vascular reconstruction is possible with this approach.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100302"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic robotic assisted sigmoid Vaginoplasty","authors":"Binyamin B Neeman ,&nbsp;Jawdat Jaber ,&nbsp;Shlomo Yellinek ,&nbsp;Boris Chertin","doi":"10.1016/j.urolvj.2024.100295","DOIUrl":"10.1016/j.urolvj.2024.100295","url":null,"abstract":"","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100295"},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142532198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A journey into the Uroverse for robotic partial nephrectomy","authors":"Enrico Checcucci ,&nbsp;Gabriele Volpi ,&nbsp;Federico Piramide ,&nbsp;Daniele Amparore ,&nbsp;Alberto Piana ,&nbsp;Sabrina De Cillis ,&nbsp;Paolo Alessio ,&nbsp;Michele Sica ,&nbsp;Valentina Garzena ,&nbsp;Marco Colombo ,&nbsp;Michele Di Dio ,&nbsp;Cristian Fiori ,&nbsp;Francesco Porpiglia","doi":"10.1016/j.urolvj.2024.100298","DOIUrl":"10.1016/j.urolvj.2024.100298","url":null,"abstract":"<div><h3>Objectives</h3><div>The Metaverse is an immersive environment blending virtual and physical realms. Its application in healthcare and surgery is raising ever more interest. A pioneering experience already investigated surgical planning for partial nephrectomy (PN) within the metaverse, using virtual 3D models. Herein we present the first experience of a Uroverse navigation during robot-assisted PN (RAPN), obtained thanks to further refinements in 3D models’ creation and the metaverse experience.</div></div><div><h3>Patients and surgical procedures</h3><div>Specifically for this study, carried out during the 12th Techno Urology Meeting, the metaverse experience was improved in three main aspects and called “Uroverse”. First, 3D models reached an unprecedented fidelity and were called “digital twin”. Secondly, the metaverse experience was even more immersive, with avatars replicating users’ aspect and the environment reproducing a surgical theater. Finally, preoperative navigation was performed using new headsets, optimizing the interaction with the models, and the Uroverse experience was also integrated into the robotic console using the Tile Pro for intraoperative consultation.</div><div>Thanks to this technology, surgeons and moderators were able to virtually meet in the same room, even if physically distant.</div></div><div><h3>Results</h3><div>Seven patients underwent RAPN after surgical planning in the metaverse. The median time for metaverse discussion was 8 min (IQR 8–9). According to digital twin models, the clamping strategy during the intervention was global in 4 patients (57,2 %) and selective in 3 patients (42,8 %). Enucleation and enucleoresection were performed in 3 (42,8 %) and 4 (57,2 %) cases, respectively. Selective management of intraparenchymal structures, as suggested by digital twin, was performed in 4 cases. The median warm ischemia time was 12 min (IQR 10–16,5). No intraoperative complications occurred; 3 postoperative complications were observed. All the patients had negative surgical margins.</div></div><div><h3>Conclusion</h3><div>The Uroverse experience for preoperative surgical planning and intraoperative navigation was effective and widely appreciated by surgeons.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100298"},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142434326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}