Urology video journal最新文献

{"title":"Bladder clot and prostate mass morcellation and enucleation","authors":"Michael Maidaa ,&nbsp;Isis Sweeney ,&nbsp;Louis Moy ,&nbsp;John Michael DiBianco","doi":"10.1016/j.urolvj.2024.100285","DOIUrl":"10.1016/j.urolvj.2024.100285","url":null,"abstract":"<div><h3>Objective</h3><div>Advanced age, anticoagulation, and frailty are common risk factors for gross hematuria with clot obstruction [<span><span>1</span></span>,<span><span>2</span></span>]. Conservative management is preferred, however, patients with refractory bleeding frequently require invasive interventions. We present a case of endoscopic clot evacuation assisted by morcellation after failed conservative management. We aim to demonstrate the safety and efficacy of this technique as an alternative to open cystotomy.</div></div><div><h3>Patients and surgical procedure</h3><div>Our patient is a 90-year-old male with a history of atrial fibrillation (on anticoagulation), metastatic prostate cancer on androgen deprivation therapy, recurrent hematuria, and urinary retention managed with suprapubic tube. He presented to the emergency department with gross hematuria and clot retention (<span><span>Fig. 1</span></span>) Initial management with <strong><em>cessation of anticoagulation</em></strong>, cystoscopy, and clot evacuation failed due to the size and density of blood products. The patient declined open clot evacuation due to concern about morbidity and opted for repeat endoscopic intervention. We used a 550-micron holmium laser fiber to release the prostate and adherent clot. <strong><em>Next, the clot was morcellated with Wolf® Piranha™ system at 2500 RPM</em></strong> (<span><span>Fig. 2</span></span>). <strong><em>Morcellation time was 35 min</em></strong> due to a lack of engagement and suction leading to divots which decreased efficiency. <strong><em>Care must be taken to optimize visualization during clot morcellation as poor visualization is a common cause of bladder injury during morcellation.</em></strong> After evacuation, <strong><em>excellent</em></strong> hemostasis was achieved.</div></div><div><h3>Results</h3><div>Postoperatively, continuous bladder irrigation was weaned on day 1, and catheter was removed on day 2. The patient was discharged without any notable complications. <strong><em>Final pathology of morcellated tissue was 446</em></strong> <strong><em>mL of poorly differentiated prostatic adenocarcinoma admixed with clot.</em></strong></div></div><div><h3>Conclusion</h3><div>Large volume clot removal assisted by morcellation represents a safe endoscopic alternative to open clot evacuation when other techniques fail. Care must be taken to ensure good visibility, distended bladder, and anticipation of differing tissue characteristics while morcellating.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"24 ","pages":"Article 100285"},"PeriodicalIF":0.0,"publicationDate":"2024-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000252/pdfft?md5=ba8b13d799f85fb8e2e4b41540919645&pid=1-s2.0-S2590089724000252-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142310885","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":"Minimally invasive approach as an ancillary intervention post adult primary bladder exstrophy closure: Minimizing the morbidity","authors":"Sidhartha Kalra,&nbsp;Poojan thakor,&nbsp;L.N. Dorairajan,&nbsp;K.S. Sreerag,&nbsp;Vishal Narkhede,&nbsp;Siddhant Bolar","doi":"10.1016/j.urolvj.2024.100284","DOIUrl":"10.1016/j.urolvj.2024.100284","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>The exstrophy-epispadias complex, including classical and cloacal exstrophy, significantly impacts physical, functional, and psychological health. Adults with primary bladder exstrophy repair often face persistent urinary incontinence due to a patulous bladder neck and reduced bladder capacity. Previous surgeries increase the risks of open procedures. Various studies have used open augmentation cystoplasty and robotic approaches in pediatric patients, not as minimally invasive techniques in adult patients with post exstrophy repair issues. We describe Robotic surgical augmentation cystoplasty which offers a minimally invasive alternative with promising outcomes, reducing postoperative complications, and facilitating adjunct procedures for post-bladder exstrophy repair issues.</p></div><div><h3>Patients and surgical procedure</h3><p>This study presents three urological reconstruction cases. The first involves a patient with primary bladder exstrophy and epispadias repair facing urinary incontinence and limited bladder capacity. The second involves a post-bladder exstrophy repair patient with bladder neck reconstruction in childhood. Both above patient underwent Robotic augmentation cystoplasty. The third case discusses a patient with continuous urinary incontinence post-primary exstrophy repair, treated with robotic Kropp's repair and augmentation cystoplasty.</p></div><div><h3>Results</h3><p>All patients maintained normal renal function without complications. Two patients had no postoperative issues and a urine holding capacity of two hours. The Kropp's procedure patient had less capacity and more frequent micturition. All patients were cosmetically satisfied.</p></div><div><h3>Conclusion</h3><p>Robotic augmentation cystoplasty is a minimally invasive solution for small bladder capacity post-bladder exstrophy repair in adults. It improves urine holding capacity and minimizes postoperative complications, enhancing urological reconstruction and quality of life for these patients.</p></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"23 ","pages":"Article 100284"},"PeriodicalIF":0.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000240/pdfft?md5=389328b631ceb64f5328199eb97a3fb8&pid=1-s2.0-S2590089724000240-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141963466","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":"Reverse lymphatic mapping during robotic inguinal lymphadenectomy for the prevention of lymphedema","authors":"Belén Mora-Garijo ,&nbsp;J. Bradley Mason ,&nbsp;Laura Tom ,&nbsp;Neil Mendhiratta ,&nbsp;Lambros Stamatakis ,&nbsp;Mohit Gupta ,&nbsp;Keith Kowalczyk ,&nbsp;Ross Krasnow","doi":"10.1016/j.urolvj.2024.100283","DOIUrl":"10.1016/j.urolvj.2024.100283","url":null,"abstract":"<div><h3>Background</h3><p>Penile squamous cell carcinoma (SCC) is a rare malignancy with a high propensity for regional dissemination. While current guidelines recommend inguinal lymph node dissection (ILND) for patients with high-risk features, the surgery carries a high risk of lymphedema [<span><span>1</span></span>]. Indocyanine Green (ICG)-guided lymphangiography has been used to increase nodal yield and detection rates in lymph node dissections [<span><span>2</span></span>].</p></div><div><h3>Objectives</h3><p>To demonstrate that “reverse” ICG-guided ILND is a safe and novel technique that may reduce rates of postoperative lymphedema in penile cancer patients and may intraoperatively help identify candidates for lymphovascular anastomosis (LVA).</p></div><div><h3>Methods</h3><p>To evaluate the efficacy of “reverse” ICG-guided ILND, 2.5 mg mixed ICG solution was injected superficially into the intradermal layer at the first and fourth interdigital spaces of the foot prior to beginning robotic-assisted bilateral ILND. The lower extremity lymphatic channels are prospectively identified and preserved during dissection with the aid of near infrared fluorescence imaging.</p></div><div><h3>Results</h3><p>A total of 9 groin dissections have been completed using this technique. Reverse lymphatic mapping was successful in 7 out of 9 (77.7 %) groin dissections. With a follow-up range of 0.9–24 months, there have been no instances of post-operative lymphedema in patients who underwent successful mapping.</p></div><div><h3>Conclusion</h3><p>Reverse lymphatic mapping during robot-assisted inguinal lymphadenectomy is a safe and feasible technique. Enhanced intraoperative visualization of lymphatic structures not only may help minimize the risk of postoperative lymphedema, but it may also help identify those patients at high risk of developing lymphedema and allow for prophylactic interventions. Further investigation is necessary to establish the oncologic safety of reverse lymphatic mapping during ILND.</p></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"23 ","pages":"Article 100283"},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000239/pdfft?md5=471bf5e373b1f04c8b0405dd009b7846&pid=1-s2.0-S2590089724000239-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961000","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":"Our experience in developing and implementing the beak technique, a new surgical technique for bipolar enucleation of prostate","authors":"Yusuke Noda ,&nbsp;Taku Naiki ,&nbsp;Yuki Kobayakawa ,&nbsp;Nobuhiko Shimizu ,&nbsp;Maria Aoki ,&nbsp;Masakazu Gonda ,&nbsp;Toshiharu Morikawa ,&nbsp;Takashi Nagai ,&nbsp;Yuya Ota ,&nbsp;Satoshi Nozaki ,&nbsp;Toshiki Etani ,&nbsp;Keitaro Iida ,&nbsp;Hideyuki Kamisawa ,&nbsp;Satoshi Kurokawa ,&nbsp;Noriyasu Kawai ,&nbsp;Takahiro Yasui","doi":"10.1016/j.urolvj.2024.100282","DOIUrl":"10.1016/j.urolvj.2024.100282","url":null,"abstract":"<div><h3>Objective</h3><p>Transurethral bipolar enucleation of the prostate (BipolEP) is a cost-effective surgical procedure for benign prostatic hyperplasia that is highly curable. However, the surgery has a learning curve in the early stages of implementation. We named an enucleation method that utilizes the beak-like shape of the tip of a resectoscope as the “beak technique''. Our aim was to establish this new surgical technique at our hospital and to examine subsequent surgical results, including those performed by surgeons without experience in enucleation.</p></div><div><h3>Patients and surgical procedure</h3><p>The study participants included 102 patients who underwent BipolEP at our hospital over a 14-month period from June 2022 to August 2023. The median age of patients was 75 (55–88) years, and 50 (49 %) cases involved preoperative urinary retention. The surgery was performed by two surgeons with experience in transurethral prostate enucleation (54 cases) and five surgeons with no experience (48 cases). We shared a video explaining the Beek Technique methodology with the novice enucleation doctors in our hospital and performed the procedure.</p></div><div><h3>Results</h3><p>Times for median surgery, enucleation, and morcellation were 79 (37–157), 28 (8–93), and 13 (2–98) min, respectively. The median enucleation weight was 42 (6–151) g, and the median postoperative hospital stay was 4 days. Incidental prostate cancer was found in 12 cases. For those surgeons who had no prior experience with transurethral enucleation, the median surgical time was 88 (64–194) min, and the median enucleation time was 38 (16–193) min.</p></div><div><h3>Conclusions</h3><p>Using the beak technique, we were able to safely introduce BipolEP in a relatively short period of time, even to surgeons with no experience in enucleation surgery. We believe this method should be recommended for beginners in prostate enucleation. In addition, once proficient, a surgeon can aim for an enucleation efficiency of 2 g/min or higher.</p></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"23 ","pages":"Article 100282"},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000227/pdfft?md5=d62145e667f1bc4fa7a45444cc4e8f05&pid=1-s2.0-S2590089724000227-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141637485","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":"Combination of enucleation and partial nephrectomy techniques for robotic complex renal mass management in Smith-Magenis syndrome","authors":"Mikolaj Filon,&nbsp;Alejandro Sanchez,&nbsp;Bogdana Schmidt","doi":"10.1016/j.urolvj.2024.100281","DOIUrl":"10.1016/j.urolvj.2024.100281","url":null,"abstract":"<div><h3>Introduction</h3><p>Smith-Magenis syndrome (SMS) is a rare genetic syndrome characterized by characteristic phenotypic features, developmental delay, cognitive impairment, and behavioral abnormalities. The diagnosis of SMS is established with suggestive clinical findings and either a heterozygous deletion at chromosome 17p11.2 that includes <em>RAI1</em> or a heterozygous intragenic <em>RAI1</em> variant. Individuals with a 17p11.2 deletion that includes <em>FLCN</em> may require management of features of Birt-Hogg-Dubé syndrome (BHD). The risk of cancer appears to be no greater than in the general population for most individuals with SMS. To date, renal tumors have been reported in three adults with heterozygous deletion of 17p11.2.</p></div><div><h3>Patient and Surgical Procedure</h3><p>A 25-year-old male patient has a history of SMS, presented with back pain, and underwent abdominal ultrasound, which noted bilateral renal masses. A subsequent MRI was performed, noting 7 masses in the right kidney and 3 masses in the left kidney. He underwent renal biopsy of 3 masses on the right and 1 on the left, which were interpreted as renal hybrid oncocytic/chromophobe tumors (HOCTs). Germline genetic testing confirmed the patient carries an <em>FLCN</em> mutation. Haploinsufficiency of <em>FLCN</em> causes Birt-Hogg-Dubé (BHD), a syndrome characterized by pulmonary cysts, renal, and skin tumors. Of note, our patient only exhibits renal findings, with no characteristic skin lesions or pulmonary manifestations.</p></div><div><h3>Results</h3><p>The operative time was 3 h with blood loss of less than 600 mLs. There were several off-clamp enucleations, followed by clamping of the renal hilum for 29 min, with resection of joint upper pole cystic masses in a traditional partial nephrectomy fashion, and enucleation of a deep hilar mass. This was followed by renorrhaphy and unclamping of the hilum. Additional small tumors were enucleated off-clamp. The patient was discharged uneventfully on post-operative day-1 (POD-1). The final pathology was notable for 6 hybrid oncocytic tumors, with the largest tumor measuring 6.6 cm (pT1b). There were no reported complications.</p></div><div><h3>Conclusion</h3><p>In this report, we describe purely renal manifestations of a patient with Smith-Magenis syndrome with an <em>FLCN</em> mutation, without other findings of BHD syndrome. Given that these patients experience the same life expectancy as others with cognitive delay, they should be approached with similar care and the objective of nephron-sparing techniques. We demonstrate the feasibility of approaching the patient with a combination of enucleation off-clamp and traditional partial nephrectomy for large complex multiple renal masses. The technique emphasizes maximum preservation of renal parenchyma while minimizing the necessity for future procedures in cases of tumor growth and recurrence.</p></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"23 ","pages":"Article 100281"},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000215/pdfft?md5=0e6d51754c5070d07377e1b5f2eff2b7&pid=1-s2.0-S2590089724000215-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141637486","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":"Robot assisted laparoscopic ventral rectus abdominis muscle flap for interposition during complex vesicovaginal fistual repair","authors":"Elizabeth Ellis,&nbsp;Amanda Rubano,&nbsp;Joseph Panza,&nbsp;Patrick Reavey,&nbsp;Divya Ajay","doi":"10.1016/j.urolvj.2024.100279","DOIUrl":"10.1016/j.urolvj.2024.100279","url":null,"abstract":"<div><h3>Objective</h3><p>This video aims to provide a detailed description of a robot-assisted laparoscopic harvest of a vertical rectus abdominis muscle (VRAM) for interposition in a complex vesicovaginal fistula repair.</p></div><div><h3>Patient</h3><p>The case presented involves a 38-year-old female patient with a body mass index of 54, who was undergoing chemotherapy for stage 3 high-grade endometrial carcinoma. The patient experienced recurrent urinary tract infections and continuous leakage of fluid per vagina one month after undergoing a robot-assisted laparoscopic hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and macrodebulking. Cystoscopy revealed a 3 cm vesicovaginal fistula, which was biopsied and found to exhibit necrosis and dystrophic calcification.</p></div><div><h3>Surgical procedure</h3><p>Considering the size of the fistula, interposition tissue was deemed necessary for the repair. The patient had previously undergone omentectomy, and macrobulking of the peritoneum was performed by the gyn-oncologists. Consequently, the VRAM was identified as the most suitable option. The vesicovaginal fistula repair was conducted using standard pelvic port placement. 3–0 PDS stay sutures were placed between and around the bladder and vaginal closures to secure the VRAM in place. The robot was undocked and re-docked to a retroperitoneal configuration, and with the aid of a 30 up camera, the posterior rectus sheath was opened. The muscle was dissected off the anterior sheath, with any perforating vessels being ligated and the superior epigastric artery being sealed using a vessel sealer. The flap was then rotated into the pelvis and secured over the bladder and vaginal defect closure. The inferior epigastric artery supplies the flap. With the robotic approach the anterior sheath remains intact. The posterior sheath is not closed. This can cause a post-operative budge in the area.</p></div><div><h3>Results</h3><p>The patient was discharged with an 18 Fr foley catheter, and a postoperative cystogram was performed at 3 weeks, revealing no evidence of a leak. The patient has been followed for 15 months without reporting any urological complaints.</p></div><div><h3>Conclusion</h3><p>The VRAM represents a robust and healthy flap that can be safely harvested using robotic techniques. It can be effectively employed in pelvic reconstruction to fill dead space or serve as tissue interposition</p></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"23 ","pages":"Article 100279"},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000197/pdfft?md5=f157041f6886ba6d68c712a32b30dc63&pid=1-s2.0-S2590089724000197-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141705971","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 radical nephrectomy in the setting of a renal artery aneurysm","authors":"Fenizia Maffucci,&nbsp;Laura Bukavina,&nbsp;Alexander Kutikov","doi":"10.1016/j.urolvj.2024.100280","DOIUrl":"https://doi.org/10.1016/j.urolvj.2024.100280","url":null,"abstract":"<div><h3>Objective</h3><p>Renal artery aneurysms (RAA) may pose significant surgical challenges when encountered with coexisting pathology such as renal tumors. Herein, we demonstrate the management of a patient with an enhancing 6.6 cm central right renal mass and an ipsilateral 2.0 cm RAA. We present the technique for robotic transabdominal right radical nephrectomy in the setting of a right RAA.</p></div><div><h3>Surgical Procedure</h3><p>The patient was placed in the left lateral decubitus position. The ascending colon was mobilized medially to expose the right kidney. The interaortocaval inferior vena cava was exposed. Dissection was performed in a plane inferior to the left renal vein, and the aorta was identified. The right renal artery was skeletonized. A nonabsorbable polymer clip was placed across the right renal artery proximal to the right RAA, followed by a metal clip on either side of the polymer clip. The right renal hilum was dissected. A 60 mm vascular stapler was placed across the right renal vein and right renal artery distal to the right RAA. A nonabsorbable polymer clip was placed across the distal ureter which was then transected proximally. The kidney was completely freed from remaining attachments and was placed into a bag for extraction.</p></div><div><h3>Results</h3><p>The patient had an uncomplicated post-operative course. Pathology revealed pT1bN0 chromophobe renal cell carcinoma with negative surgical margins. 2 years postoperatively, imaging continues to show no evidence of local tumor recurrence or metastatic disease. The RAA has diminished in size over time.</p></div><div><h3>Conclusions</h3><p>Achieving proximal control of the renal artery is paramount when performing radical nephrectomy in the setting of RAA. Robotic surgery remains a viable option in the minimally invasive management of renal masses with complex vascular considerations.</p></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"23 ","pages":"Article 100280"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000203/pdfft?md5=dd2c69cb76f7d4c70c35af4ad5e2c048&pid=1-s2.0-S2590089724000203-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141593225","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":"Embracing innovation: Navigating the evolving landscape of robotic partial nephrectomy","authors":"Riccardo Bertolo ,&nbsp;Riccardo Campi","doi":"10.1016/j.urolvj.2024.100277","DOIUrl":"10.1016/j.urolvj.2024.100277","url":null,"abstract":"","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"22 ","pages":"Article 100277"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000173/pdfft?md5=0abeda589e88054d4cb4fca175f3e243&pid=1-s2.0-S2590089724000173-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400201","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 robotic intracorporeal orthotopic neobladder formation","authors":"Matthew Lee,&nbsp;Connor McPartland,&nbsp;Julienne Jeong,&nbsp;Daniel Eun","doi":"10.1016/j.urolvj.2024.100278","DOIUrl":"https://doi.org/10.1016/j.urolvj.2024.100278","url":null,"abstract":"<div><h3>Objective</h3><p>Radical cystectomy with urinary diversion is the standard of care for management of muscle invasive bladder cancer. In appropriately selected patients, orthotopic neobladder formation may offer benefits including preserved body image and continence. We describe our approach to robotic intracorporeal orthotopic neobladder formation.</p></div><div><h3>Patients and surgical procedure</h3><p>We report the case of a 60-year-old male with high grade T2a muscle invasive bladder cancer who underwent robotic radical cystectomy with intracorporeal orthotopic neobladder formation. Robotic ports are placed 6 cm more cephalad than the standard prostatectomy configuration and the left lateral 12 mm robotic fourth arm is placed one handbreadth toward the anterior superior iliac spine for optimal operability of the robotic stapler. Following standard radical cystectomy and bilateral pelvic lymph node dissection, we construct the neobladder by forming a W-shaped configuration of ileum with two troughs anchored to the foley catheter. The anti-mesenteric side of the ileum is detubularized and a posterior ileal plate is formed by suturing the cut edges of the anti-mesenteric borders. A circumferential ileo-urethral anastomosis is completed, and the anterior ileal plate is formed by suturing together the lateral most cut edges of the anti-mesenteric borders. Ureteral stents are placed and the ileal neobladder is removed from continuity using a robotic stapler. Uretero-enteric anastomoses are completed over the ureteral stents and intravenous indocyanine green is visualized under near infrared fluorescence to assess for vascularization of the anastomosis.</p></div><div><h3>Results</h3><p>Total operative time was 500 min with estimated blood loss of 300 mL. There were no intraoperative complications, and the patient was discharged on postoperative day 5 after an uncomplicated hospitalization. The patient's foley and ureteral stents were removed on postoperative day 14. At 12-months follow-up, there were no major (Clavien &gt; 2) postoperative complications.</p></div><div><h3>Conclusions</h3><p>Robotic intracorporeal orthotopic neobladder formation can be an effective technique for urinary diversion in patients with muscle invasive bladder cancer.</p></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"22 ","pages":"Article 100278"},"PeriodicalIF":0.0,"publicationDate":"2024-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000185/pdfft?md5=9e2fec57fc27e37365c2f58af7284f17&pid=1-s2.0-S2590089724000185-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140815231","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":"Orandi flap—A versatile option for anterior urethral stricture disease and experience in a regional Australian centre","authors":"K Ravichandran,&nbsp;W Harrison,&nbsp;D Desai","doi":"10.1016/j.urolvj.2024.100270","DOIUrl":"10.1016/j.urolvj.2024.100270","url":null,"abstract":"<div><h3>Objective</h3><p>In regards to the treatment of anterior urethral stricture disease, a Urologist must possess diverse techniques tailored to address the varied clinical presentations of the entity. The Orandi flap, a longitudinal ventral penile skin flap with a vascular lateral pedicle lends its utilisation in tackling challenging ischemic strictures and re-do urethroplasty <span>[1]</span>. The technique is elucidated in the accompanying video providing a demonstration and discussion of its application. The study also presents the outcomes achieved at a regional centre, demonstrating its efficacy in clinical practice.</p></div><div><h3>Methods and surgical procedure</h3><p>A 77 year old male with a non-obliterative anterior urethral stricture, had failed clean intermittent self cathterisation and urethral dilatation. He has a three piece penile prosthesis inserted for erectile dysfunction therefore precluding a dorsal approach to urethroplasty. Retrograde urethrography revealed a 6 cm stricture extending proximally from the meatus.</p><p>The urethra is opened dorsally through the length of the stricture and the medial edge of the skin flap which has been dissected in sutured onto the left edge of the urethral plate. The skin flap is then rotated over the IDC and sutured onto the right edge of the urethral plate. Glans is re-approximated and the skin is closed overlying. The patient had no post operative complications and experienced improvement in voiding. The patient did not continue clean intermittent self-catheterisation or further urethral dilatation post operatively. A prospective study was conducted to evaluate the effectiveness of the Orandi flap procedure in reestablishing urinary function and its influence on patients' sexual function and quality of life. All surgeries were performed by a single reconstructive fellowship-trained consultant urologist at a regional centre. Pre and post operative assessments included uroflowmetry and modified patient reported outcomes measures survey.</p></div><div><h3>Results</h3><p>The favourable outcomes elicited in the presented patient was reproduced in the other patients treated at our regional centre. Prospective data collected on all patients undergoing Orandi flap (<em>n</em> = 4), demonstrated that no complications were recorded and no further interventions such as urethral dilatation or urethroplasty is required. Analysis of this patient cohort revealed an average improvement in maximum flow rate (Qmax) of 316 % at 3 months post procedure affirming the efficacy and reproducibility of the outcomes. 100 % of all patients were satisfied at 3,6 and 12 months.</p></div><div><h3>Conclusion</h3><p>The Orandi flap stands as a versatile and efficacious option for anterior urethral stricture disease. Its durability enables its application in challenging scenarios such as those of re-do urethroplasty and ischemic stricture. The flap yields favourable outcomes such as those evidenced at our regiona","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"22 ","pages":"Article 100270"},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000100/pdfft?md5=3ca13fa685c7d48a824242fe340e7c33&pid=1-s2.0-S2590089724000100-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140399673","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}