{"title":"Transurethral resection of an uncommon Brunn's cyst: A resolution for lower urinary tract symptoms","authors":"Dongsu Kim , Yong Mee Cho , Sang Hoon Song","doi":"10.1016/j.urolvj.2024.100273","DOIUrl":"10.1016/j.urolvj.2024.100273","url":null,"abstract":"<div><h3>Objective</h3><p>To present the first surgical video of a patient with Brunn's cyst accompanied by lower urinary tract symptoms (LUTS) who underwent transurethral deroofing and resection.</p></div><div><h3>Patients and Surgical procedure</h3><p>A 44-year-old male patient with LUTS of frequency and urgency was evaluated with cystoscopy and ultrasonography, which revealed a cystic lesion located at the bladder neck. The LUTS were evaluated using the self-administered international prostate symptom score questionnaire and uroflowmetry. We successfully excised Bruun's cyst located in the bladder neck using a cystoscopic approach, allowing us to visualize the internal structure of the cyst.</p></div><div><h3>Results</h3><p>Following the surgical removal of the Bruun's cyst, there was a significant decrease in the International Prostate Symptom Score, dropping from an initial value of 11 to a subsequent score of 5. Hematoxylin/eosin staining and GATA-binding protein 3 immunostaining were employed, confirming the presence of urothelial mucosa within the cystic specimen.</p></div><div><h3>Conclusion</h3><p>Transurethral deroofing and cyst resection constitute an effective treatment approach for Brunn's cyst accompanied by LUTS.</p></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"22 ","pages":"Article 100273"},"PeriodicalIF":0.0,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000136/pdfft?md5=518d5a50acd7b28e5cc168986ac7d967&pid=1-s2.0-S2590089724000136-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140272386","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 deferred cytoreductive nephrectomy in metastatic renal cell carcinoma following immune checkpoint inhibitors plus tyrosine-kinase inhibitor","authors":"Rocco Simone Flammia , Flavia Proietti , Veronica Palombi , Leslie Claire Licari , Eugenio Bologna , Aldo Brassetti , Giuseppe Simone , Costantino Leonardo","doi":"10.1016/j.urolvj.2024.100272","DOIUrl":"10.1016/j.urolvj.2024.100272","url":null,"abstract":"<div><h3>Objective</h3><p>This video aims to demonstrate the safety and feasibility of performing deferred cytoreductive nephrectomy (dCN) using robotic assistance in patient treated with immunotherapy for metastatic renal cell carcinoma (mRCC).</p></div><div><h3>Patients and surgical procedure</h3><p>A 62-year-old woman, affected by right metastatic renal cell carcinoma, showed partial response after 4 cycles of Pembrolizumab and Axitinib. Multidisciplinary team consultation decided for cytoreductive right radical nephrectomy with adrenalectomy. After anatomical landmarks identification, inferior vena cava (IVC) was progressively exposed, until identifying the renal hilum. During surgery, small bleeding occurred, and Weck-clips were placed to control the arterial flow. Nephrectomy proceeded without complications. Right adrenal gland, suspected of metastasis, was removed.</p></div><div><h3>Results</h3><p>No intra- and post-operative high-grade Clavien-Dindo complications occurred, and the patient was discharged in post-operative day 3. Final pathology revealed clear cell renal cell carcinoma with sarcomatoid features, Furhman grade 4, with metastatic lesion in the omolateral adrenal gland (pT3a pM1)</p></div><div><h3>Conclusion</h3><p>Robot-assisted dCN is feasible and safe after immune checkpoint inhibitor-based combination therapy in patients affected by mRCC.</p></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"22 ","pages":"Article 100272"},"PeriodicalIF":0.0,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000124/pdfft?md5=cb9a2851457db587e9a7c376af7fb8ab&pid=1-s2.0-S2590089724000124-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140277788","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}
Davide Ciavarella , Rossella Cicchetti , Angelo Orsini , Martina Basconi , Francesco Berardinelli , Michele Marchioni , Luigi Schips
{"title":"Selective clamping robotic renal enucleoresection: A step-by-step procedure","authors":"Davide Ciavarella , Rossella Cicchetti , Angelo Orsini , Martina Basconi , Francesco Berardinelli , Michele Marchioni , Luigi Schips","doi":"10.1016/j.urolvj.2024.100271","DOIUrl":"https://doi.org/10.1016/j.urolvj.2024.100271","url":null,"abstract":"<div><h3>Objective</h3><p>we aim to illustrate step by step the technique of enucleoresection of renal mass during robot-assisted partial nephrectomy (RAPN).</p></div><div><h3>Patient and surgical procedure</h3><p>72-year-old man affected by asymptomatic and incidental small renal mass in the middle third of the left kidney. The diameter of the renal mass was 3 cm on preoperative imaging, with a PADUA score of 7. We performed left transperitoneal RAPN with selective clamping. After the enucleoresection, medullary and cortical sutures were performed. A hemostatic agent was applied at the end of the procedure.</p></div><div><h3>Results</h3><p>Intraoperative blood loss was 50 ml, with an ischemia time of 15 min. Postoperative hemoglobin was 14.8 g/dL and the creatinine was 0.69 mg/dL. On the third post-operative day, the drain was removed and the patient was discharged on the same day. No postoperative complications or recurrences were found during the 6-month follow-up.</p></div><div><h3>Conclusion</h3><p>partial nephrectomy maximizes the amount of healthy renal parenchyma spared. Evidence supports the adoption of this technique whenever feasible.</p></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"22 ","pages":"Article 100271"},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000112/pdfft?md5=3c8b4f5e4a7bf543e8f26ad388a52416&pid=1-s2.0-S2590089724000112-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140180048","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}
Riccardo Bertolo , Juan Garisto , Marco Carilli , Michele Di Dio , Matteo Vittori
{"title":"Robot-assisted partial nephrectomy with Sutureless technique by application of the Veriset™ patch","authors":"Riccardo Bertolo , Juan Garisto , Marco Carilli , Michele Di Dio , Matteo Vittori","doi":"10.1016/j.urolvj.2024.100275","DOIUrl":"https://doi.org/10.1016/j.urolvj.2024.100275","url":null,"abstract":"<div><p>This was the case of a 60-year-old woman diagnosed with a 6-cm cT1b renal mass (RENAL score 8). The patient was counseled for transperitoneal RPN. Anatomical tumor resection was conducted off-clamp. After the renal mass was excised, some venous bleeding foci were evident from the resection bed. By monopolar coagulation, these were managed, reducing active bleeding. Given the wide and flat surface area of the resection bed, a Veriset™ (Medtronic, Minneapolis, MN, USA) patch was introduced. We secured it to the resection bed using irrigation. Within less than a minute, hemostasis was achieved. We opted to avoid renorrhaphy.</p></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"21 ","pages":"Article 100275"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259008972400015X/pdfft?md5=4304ff110f6753e0b31f808c5c7736a5&pid=1-s2.0-S259008972400015X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140122080","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}
William Harrison, Kapilan Ravichandran, Devang Desai
{"title":"Bulbourethral dorsal onlay buccal mucosal graft urethroplasty","authors":"William Harrison, Kapilan Ravichandran, Devang Desai","doi":"10.1016/j.urolvj.2024.100266","DOIUrl":"https://doi.org/10.1016/j.urolvj.2024.100266","url":null,"abstract":"<div><h3>Objective</h3><p>Urethral strictures are a challenging problem that can have a significant impact on a patient's urinary function, sexual health, and quality of life. Buccal mucosal graft urethroplasty is the gold standard for long-segment or complex urethral strictures. This video submission aims to provide a visual manuscript on performing dorsal onlay buccal mucosal graft urethroplasty with the skilled hands of a fellowship-trained reconstructive urologist. In addition, there is an inclusion of a case series to demonstrate its effectiveness and outcomes.</p></div><div><h3>Methods and Surgical Procedure</h3><p>A 67-year-old male with a non-obliterative fibrous stricture at the bulbourethra underwent a dorsal onlay buccal mucosal graft urethroplasty to improve his obstructive lower urinary tract symptoms and maintain erectile function. The study aimed to determine the success rate of the surgery in restoring urinary function, as well as assessing its effects on quality of life, sexual function, and patient satisfaction. Prospective data was collected on all patients undergoing the surgery, including pre- and post-operative uroflowmetry, IPSS, IIEF-5 questionnaires, and a modified PROM satisfaction survey. Complications were also recorded. The study was conducted by a reconstructive fellowship-trained consultant urologist specializing in urethroplasty at a regional center.</p></div><div><h3>Results</h3><p>32 patients underwent dorsal onlay urethroplasty between 2017 and 2022. The preoperative flow rates had an average Qmax of 8.65 mL/s and Qmean of 5.57 mL/s. The follow up was up to 36 months. Qmax average at 12 months follow up was 22 mL/s. IPSS improved and IIEF-5 scores were preserved. There were minimal complications, with one patient experiencing incontinence and one having overactive bladder symptoms. Patient satisfaction scores showed an increase over time, with 87 % of patients satisfied at 3 months, 94 % at 6 months, and retained at 94 % at 12 months.</p></div><div><h3>Conclusions</h3><p>The success rate was 87.9 %, with 4 cases of recurrence, which increased to 97 % after redo urethroplasty. Objective measurements of urinary flow and quality of life consistently showed improvement over time, with preservation of erectile function. Limitations include the small sample size and incomplete follow-up due to the regional nature of the centre. A video submission demonstrating the procedure may aid trainees and fellows interested in urethroplasty training.</p></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"21 ","pages":"Article 100266"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000069/pdfft?md5=839957a2e83bc61c4364e0cfd8c15485&pid=1-s2.0-S2590089724000069-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140041708","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}
Desiree E. Sanchez, Veronica I Rodriguez, Luis G Medina, Jullet Han
{"title":"Single port robot-assisted laparoscopic pyeloplasty","authors":"Desiree E. Sanchez, Veronica I Rodriguez, Luis G Medina, Jullet Han","doi":"10.1016/j.urolvj.2024.100264","DOIUrl":"https://doi.org/10.1016/j.urolvj.2024.100264","url":null,"abstract":"<div><h3>Objective</h3><p>To demonstrate our step-by-step approach to performing a single-port (SP) robotic-assisted laparoscopic dismembered pyeloplasty.</p></div><div><h3>Patient and Surgical Procedure</h3><p>We present a 52-year-old female with symptomatic hydronephrosis secondary to ureteropelvic junction obstruction (UPJO). A computerized tomography (CT) scan confirmed severe right-sided hydronephrosis. The patient was taken to the operating room for a robotic SP dismembered pyeloplasty. With the patient in left lateral decubitus position, a 3 cm transverse incision was made at the right midclavicular line, two fingerbreadths cephalad to the umbilicus. The da Vinci SP access port was placed and the robot docked. The camera, and two fenestrated bipolar graspers were inserted at the six o'clock, nine o'clock and twelve o'clock positions, respectively. Small and large intestines were reflected until the ureteropelvic junction (UPJ) was exposed and a crossing vessel was observed. The ureter was transected and transposed along with the renal pelvis over the crossing vessel. The posterior anastomosis was performed and a double-J ureteral stent was placed. Finally, the anterior anastomosis was completed in an interrupted fashion.</p></div><div><h3>Results</h3><p>Patient was discharged the same day. No complications were observed during a 3 week follow-up.</p></div><div><h3>Conclusion</h3><p>The SP is a feasible alternative to the multiport (MP) to perform pyeloplasty successfully. This approach allowed for direct access to the surgical field without the need for redocking or extra assistant ports outside of our single incision.</p></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"21 ","pages":"Article 100264"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000045/pdfft?md5=d4f948dfc933cd247f6ea4dc68634a70&pid=1-s2.0-S2590089724000045-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140103346","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 post-chemotherapy retroperitoneal lymph node dissection","authors":"Simone Vernez, Jonathan Yamzon, Ali Zhumkhawala","doi":"10.1016/j.urolvj.2024.100268","DOIUrl":"10.1016/j.urolvj.2024.100268","url":null,"abstract":"<div><h3>Background</h3><p>Post- chemotherapy retroperitoneal lymph node dissection is a technically complex surgery due to significant fibrosis causing dense adherence of nodal tissue and any residual masses to the major vessels. While open- retroperitoneal lymph node dissection (O-RPLND) remains the standard of care in stage I non-seminomatous germ cell tumor and patients with post-chemotherapy masses greater than 1 cm, minimally invasive approaches such as laparoscopic and robotic have become more wide-spread in high volume centers over the past decade. Early research confirms the safety and early oncologic efficacy of post-chemotherapy robotic retroperitoneal lymph node dissection (R-RLPND), demonstrating comparable nodal yield, shorter operative times, lower estimated blood loss, shorter length of stay, and fewer overall post- operative complications.</p></div><div><h3>Methods and results</h3><p>At City of Hope, we are performing both primary and post-chemotherapy XI R- RPNLD on select patients. For post-chemotherapy RPLNDs, a bilateral retroperitoneal lymph node dissection is performed according to standard templates. Patient preparation, positioning, and port position is demonstrated. The steps of the operation, including gonadal vein dissection, bowel mobilization and suspension with Keith needles, paracaval, inter-aortic, and para-aortic dissections are showed. Post-operative care is discussed.</p></div><div><h3>Conclusion</h3><p>Post-Chemotherapy R-RPLND is feasible and safe. Patients are commonly able to discharge either same day or on post-operative day one.</p></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"22 ","pages":"Article 100268"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590089724000082/pdfft?md5=3c46bd60d80057a1ace44a5e5e5a1a60&pid=1-s2.0-S2590089724000082-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140086676","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":"What is medical 3D printing and how does enhance simulation in urology?","authors":"Ahmed Ghazi","doi":"10.1016/j.urolvj.2024.100261","DOIUrl":"10.1016/j.urolvj.2024.100261","url":null,"abstract":"","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"21 ","pages":"Article 100261"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259008972400001X/pdfft?md5=962b91a90b9d012172a20f21e8781f53&pid=1-s2.0-S259008972400001X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139539087","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}