Videourology (New Rochelle, N.Y.)最新文献

{"title":"Modern Reinterpretation of Scrotal Drop Back Procedure for Bulbar Urethral Loss: Surgical Insights","authors":"Chiranjeet Singh Khurana, Sidhartha Kalra, Lalgudi Narayanan Dorairajan, K.S. Sreerag, Swapnil Singh Kushwaha, Deepanshu Aggarwal, Shiva Gaur","doi":"10.1089/vid.2023.0066","DOIUrl":"https://doi.org/10.1089/vid.2023.0066","url":null,"abstract":"Clinical History, Physical Examination, Diagnosis, Intervention, Follow-Up/Outcomes. We present the case of a 53-year-old gentleman who had a road traffic accident after which he developed painful acute urinary retention along with pelvic fracture. He was found to have a pelvic fracture urethral injury and suprapubic catheter (SPC) was placed. He was evaluated with retrograde urethrogram (RGU) and micturating cystourethrogram (MCU) to know the site and extent of urethral injury/defect. The findings were suggestive of 1.6 cm focal distraction defect at bulbomembranous junction with right pubic bone fracture. He was managed with progressive single-stage anastomotic urethroplasty. Postoperative course was uneventful and he was discharged with both per-urethral catheter (PUC) and SPC in situ. PUC was removed after 1 month after which he voided effectively and satisfactorily. SPC was removed after 1 week of removing PUC. He presented again after 1 month of SPC removal with complaints of poor urinary flow. Urethroscopy was done, which was suggestive of anastomotic site stricture, after which endoscopic dilatation was done up to 22F and PUC was reinserted. PUC was removed after 7 days. Voiding difficulty was persistent even after endoscopic dilatation and he went into acute urinary retention after 2 weeks of endoscopic dilatation, hence SPC was placed again and he was referred to us for further management. After detailed history of antecedent events, he was examined. General physical examination was normal. On per abdomen examination, there was 16F SPC in situ with normal other parameters. On local examination there was a midline perineal scar of previous surgery. Rest of the systemic examinations were normal. We reinvestigated him. RGU and MCU was done and it was found that there was a defect of 7.74 cm from penobulbar junction to membranous urethra probably caused by bulbar ischemia. Managing this ischemic condition necessitates vascularized flaps, either circumferentially substituting the loss or augmenting in cases of stenosis. Options encompass a preputial tube on a vascular pedicle mobilized subcutaneously to the perineum, an innovative technique employing oral mucosal flap urethroplasty, dorsal buccal mucosal graft with a ventral pedicle preputial flap, a pedicled preputial or penile skin flap, and entero-urethroplasty utilizing retubularized sigmoid colon along with its associated mesentery. Post-use of the preputial tube, patients rarely achieve normal voiding streams. The preputial tube serves as a conduit but lacks the viscoelastic properties of a normal urethra. Flap surgeries for bulbar urethral strictures offer potential advantages but have several notable disadvantages. First, these procedures are characterized by their complexity and the need for specialized expertise, limiting the pool of surgeons proficiently performing them. In addition, the intricate nature of flap surgeries often leads to extended operating times, which can increase","PeriodicalId":92974,"journal":{"name":"Videourology (New Rochelle, N.Y.)","volume":"83 1-3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135565873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-Assisted Modified Vescica Ileale Padovana Neobladder: A Novel and Simple Technique for Robotic Intracorporeal Bladder Replacement Reproducing Open Surgical Principles","authors":"Sanjoy Kumar Sureka, Madhur Anand, Utsav Shailesh Shah, Sanchit Rustagi, Ankit Misra, Himanshu Raj, Anupam Shukla, Uday Pratap Singh","doi":"10.1089/vid.2023.0025","DOIUrl":"https://doi.org/10.1089/vid.2023.0025","url":null,"abstract":"Introduction and Objective: Vescica Ileale Padovana (VIP) pouch has gained popularity because of its technical simplicity and good outcomes. We intended to replicate the open technique robotically in case of nonmetastatic muscle-invasive carcinoma bladder as described by Cacciamani et al.1 Methods: A 53-year-old man underwent robotic radical cystoprostatectomy with pelvic lymphadenectomy and intracorporeal VIP orthotopic neobladder. DaVinci SI-system with four arms and seven-port access was used. Cystectomy and pelvic lymphadenectomy were performed. After confirming negative frozen section of the proximal urethral end and distal margin of ureters, ileal loop of 40 cm was isolated. Adequate mobilization of ileum to perform tension-free urethroileal anastomosis was done. Using Endo GIA stapler, ileum was cut. “U”-shaped loop of 30 cm ileum was used. Extension of 10 cm folded ileum was added to proximal ileal loop. Urethroileal anastomosis with 3-0 barbed suture was performed after approximating rectoprostatic fascia. Ileum was opened on antimesenteric border and suturing was done to make VIP reservoir. Both ureters were separately anastomosed directly to lateral horns of the reservoir. Ureters were stented using infant feeding tubes (IFTs). Drain was placed. Results: Operative time was 412 minutes. Console time was 357 minutes. Blood loss was 375 mL. No Intraoperative Adverse Event happened according to the ICARUS Global Surgical Collaboration Criteria.2 Drain was removed on post-operative day (POD) 4. The patient was discharged on POD 8 with per urethral catheter, supra pubic catheter, and both IFTs, which were removed 3 weeks after surgery after a cystogram. Conclusions: Robot-assisted technique for totally intracorporeal bladder replacement with VIP neobladder is feasible and replicates the technical steps of open reconstruction. No competing financial interests exist. Runtime of video: 5 mins 44 secs Authors' Contributions: S.K.S. contributed to conceptualization, methodology, and supervision. M.A. carried out investigation, data curation, and writing original draft. U.S.S. was involved in review and editing, and writing original draft. S.R. took charge of review and editing, and observation. A.M. took charge of data curation and observation. H.R. carried out validation. A.S. carried out data curation. U.P.S. was in charge of review and editing. Acknowledgment: The authors thank the Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, for its support in patient management. Consent for Publication: Written informed consent was obtained from the patient to publish the details without disclosing the identity. Patient Consent Statement: Written informed consent was obtained from the patient for publication of the video without disclosing his identity.","PeriodicalId":92974,"journal":{"name":"Videourology (New Rochelle, N.Y.)","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135963193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification and Repair of Rectal Injury During Da Vinci Prostatectomy with Prior SpaceOAR Placement","authors":"Peter J. Arnold, Courtney Yong, Jason Farrow, Chandru P. Sundaram","doi":"10.1089/vid.2023.0060","DOIUrl":"https://doi.org/10.1089/vid.2023.0060","url":null,"abstract":"Clinical History: The patient is a 72-year-old man who underwent SpaceOAR hydrogel placement in preparation for brachytherapy for Gleason 4+3 prostate cancer at an outside hospital. However, interference from the pubic bone prevented brachytherapy seed placement. He was referred to our center for surgery. Physical Examination: Healthy-appearing man with large midline surgical scar from prior right partial colectomy. Diagnosis: Prostate cancer (Gleason 4+3 = 7). Intervention: An anterior approach radical prostatectomy was performed with the Intuitive Surgical da Vinci XI robot-assisted surgical system 75 days after SpaceOAR placement. No bowel preparation was performed. During the procedure, the posterior dissection planes were found to be significantly distorted because of the SpaceOAR. An injury to the rectum was identified ~1.5 hours into the operation. General surgery was consulted intraoperatively. As there was no gross contamination of the field, the rectal injury was closed primarily in two layers without diversion with an overlying peritoneal flap. A sigmoidoscopy was then performed intraoperatively, which revealed a watertight closure. The rest of the procedure was completed without any further complications. Final pathology analysis showed pT2N0 Gleason 4+3 prostate cancer with negative margins. Follow-Up/Outcomes: The patient experienced an iatrogenic rectal injury during a robot-assisted radical prostatectomy, likely related to the tissue distortion caused by the previously placed SpaceOAR as has been previously reported in the literature.1,2 The injury was repaired intraoperatively, with no further complications. The patient was discharged to home on postoperative day 5, and continues to do well as of his most recent follow-up 2 years postoperatively. The authors have no relevant or material financial interests that relate to the research described in this article and video production. Patient Consent Statement: The authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. Music Copyright: Music featured in the video was obtained from www.royaltyfreemusicweb.com, and thus no copyright infringements have occurred as part of the production of this video. Runtime of video: 4 mins 49 secs","PeriodicalId":92974,"journal":{"name":"Videourology (New Rochelle, N.Y.)","volume":"135 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135849079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Robot-Assisted Reconstruction of the Ureter with Buccal Graft and Omental Wrapping","authors":"Charan Mohan, Justin Han, Arun Rai","doi":"10.1089/vid.2023.0016","DOIUrl":"https://doi.org/10.1089/vid.2023.0016","url":null,"abstract":"Introduction and Objective: The patient is a 52-year-old man presenting to urology with renal failure secondary to bilateral ureteral strictures managed with nephrostomy tubes. He was taken to the operating room for robotic bilateral repair of ureteral strictures. Methods: Simultaneous bilateral nephrostograms and pyelograms demarcate the stricture burden at the start of case. The extent of stricture on the left was demarcated using indocyanine green injected antegrade through the pre-existing nephrostomy. The strictured portion of the left ureter was excised and a uretero-ureterostomy was performed. Next the right-sided repair was performed. Using intraoperative ureteroscopy, the extent of the right proximal stricture was appreciated and a ureterotomy was made along it, ~2 cm in total. Given the length of the stricture, decision was made to perform a buccal graft ureteroplasty. An omental wrap was also used over the repair. Finally, a ureteral reimplantation was performed for management of the right distal ureteral stricture. Once the ureter was transected proximal to the strictured urethra, it was reimplanted into the bladder. Bilateral ureteral stents were left along with bilateral Jackson-Pratt drains. Results: At 2-month follow-up, the patient was noted to have complete patency of the left ureter without hydronephrosis. However, he was noted to have a new stricture on the right requiring replacement of stent on this side. Conclusions: We demonstrated here that robot-assisted upper tract reconstruction is a valuable tool for management of ureteral strictures and that buccal mucosa grafting can also help address long strictures that may otherwise be difficult to repair. There are no commercial associations between the authors listed here and content of this surgical video. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. No competing financial interests exist. Runtime of video: 5 mins","PeriodicalId":92974,"journal":{"name":"Videourology (New Rochelle, N.Y.)","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135849080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salvage Greenlight Laser Prostatectomy Following Previous Failed Urolift","authors":"Jamie V. Krishnan, Sami Hamid, Feras Al Jaafari","doi":"10.1089/vid.2023.0061","DOIUrl":"https://doi.org/10.1089/vid.2023.0061","url":null,"abstract":"","PeriodicalId":92974,"journal":{"name":"Videourology (New Rochelle, N.Y.)","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136129329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Use of Buccal Mucosal Graft for Robotic Ureteral Reconstruction After Appendiceal Interposition","authors":"Emily Chin, Christine M. Van Horn, Igor Sorokin","doi":"10.1089/vid.2023.0034","DOIUrl":"https://doi.org/10.1089/vid.2023.0034","url":null,"abstract":"","PeriodicalId":92974,"journal":{"name":"Videourology (New Rochelle, N.Y.)","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radial Artery Free Flap Urethroplasty","authors":"Helen H. Sun, Crystal An, Kirtishri Mishra, Joseph Khouri, Shubham Gupta","doi":"10.1089/vid.2023.0049","DOIUrl":"https://doi.org/10.1089/vid.2023.0049","url":null,"abstract":"Introduction: Urethroplasty is essential for transmasculine individuals who desire the ability to perform standing micturition. Currently, a variety of techniques are employed, including staged phalloplasty with urethroplasty performed in a subsequent surgery.1 This staged approach allows for gradual tissue healing, which may reduce the risk of complications such as wound breakdown, urethral fistulae, and infections. Some patients may not desire a functional urethra during initial consultation, or develop complications from their initial phalloplasty. Staged urethroplasty may incorporate a radial artery free flap, buccal mucosa graft, and labia minora flap.2–4 In this video, we demonstrate our technique for radial artery free flap urethroplasty (RAU) in an individual with an existing neophallus. Materials and Methods: The following footage is from a transmasculine individual who had undergone abdominal phalloplasty 6 months prior. Outcomes of other patients who underwent RAU between January 2022 and May 2023 were reviewed. Preoperatively, the patient underwent permanent hair removal, and an Allen's test was performed on the donor extremity to ensure perfusion of the one hand after occlusion of the radial artery. The flap is designed to be 4 cm wide to allow for an tubularized urethra adequate for a 16F catheter, and length 3 cm longer than the existing neophallus to allow for a tension-free anastomosis. Two teams may work simultaneously, one harvesting and tubularizing the radial artery free flap, while the other prepares the existing neophallus. An external oblique fasciotomy is made to access the recipient artery, and a groin incision is used to access the recipient veins. The neophallus is detubularized and debulked as necessary to achieve a tension-free closure. Flap transfer is performed with a surgical microscope, anastomosing the radial artery with the deep inferior epigastric artery and cephalic vein with the greater saphenous system. The ilioinguinal nerve is coapted to the lateral antebrachial cutaneous nerve with the aid of an off-the-shelf nerve allograft. A microdoppler is used to assess perfusion prior to neophallus tubularization and wound closure. In the donor arm, the brachioradialis and flexor carpi radialis muscles are advanced over the proximal ends of the donor arteries, and the wound is covered with a split thickness skin graft. A negative pressure wound dressing is then applied. The ventral abdominal wall defect is closed and reinforced with resorbable polydiaxone mesh. Results: The patient had an uneventful recovery and was discharged on postoperative day 5. Flushing of the neourethra with normal saline instilled via a small bore catheter into the meatus may be done to help remove debris starting 1 to 2 weeks postoperatively. Three patients have undergone RAU thus far, with follow-up periods of 11, 7, and 2 months. No reoperations or instances of flap failure have occurred. Two patients subsequently underwent neourethral a","PeriodicalId":92974,"journal":{"name":"Videourology (New Rochelle, N.Y.)","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135654197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-Assisted Simple Prostatectomy with Bladder Neck-Sparing Technique","authors":"Narmina Khanmammadova, Jacob Basilius, Andrei D. Cumpanas, Tuan Thanh Nguyen, Christian Im, Caroline Nguyen, Mohammed Shahait, David I. Lee","doi":"10.1089/vid.2023.0051","DOIUrl":"https://doi.org/10.1089/vid.2023.0051","url":null,"abstract":"Introduction: Benign prostatic hyperplasia (BPH) is the most common benign tumor in men in the United States and one of the most common causes of lower urinary tract symptoms.1 Several modalities are utilized to manage BPH surgically including vaporization, laser enucleation of the prostate (LEP), and open, laparoscopic, and robotic-assisted simple prostatectomy (RASP). RASP is endorsed by American Urological Association (AUA) guidelines for patients with large (>100 mL) and very large prostates (>150 mL) as it has favorable outcomes including low perioperative morbidity rates, blood loss, transfusion rates, and short recovery time.2–4 The learning curve is significantly shorter with RASP compared to LEP.4,5 RASP can also be utilized with same-day discharge pathway reducing the cost of care and healthcare burden. Here we describe our bladder-neck sparing technique for RASP with emphasis on intraoperative technical aspects to hasten the recovery and avoid the use of continuous bladder irrigation. Methods: Data were prospectively recorded from 24 patients who underwent outpatient RASP from September 2021 to March 2023 following the IRB approval. Patient demographics, preoperative, perioperative, and postoperative outcomes were collected. All patients followed an enhanced recovery after surgery protocol. Results: The mean age was 71.5 ± 7.8 years, mean body mass index was 28.8 ± 4.5 kg/m2, median preoperative Prostate Specific Antigen (PSA) was 5.9 (3.1–11) ng/mL, median preoperative AUA score was 20 (13.5–28.25), and 9 patients (37.5%) were in retention, median prostate size was 135 (101.5–158) mL, mean operative time was 138.3 ± 39.8 minutes, mean console time was 78 ± 20.1 minutes, estimated blood loss was 100 (50–100) mL, median weight of the removed specimen was 72.4 (47.1–95.1) mL, median hospital stay was 157 (116.5–180) minutes, median length of catheterization was 7-days. There were no perioperative complications, blood transfusions, conversions to open, or need for continuous bladder irrigation. Twenty-one (87.5%) patients were discharged home on the day of surgery. The median pain score at discharge time reported by 15 patients was 3 (0–5). Only 3 (25%) of 12 patients reporting on pain management needed to use opioids. All patients were able to urinate after the catheter removal. One patient was readmitted for blood clot retention due to strenuous exercise at 3-weeks postoperatively (Clavien Dindo class II). Incidental cancer (Gleason Score 3+3) was found in one patient (4.2%) who is now managed by monitoring the PSA levels every 3 months. The median postoperative 3-month PSA was 0.8 (0.48–1.65) ng/mL. Twenty patients reported their postoperative 3-month urinary continence status, and all of them were continent. The median postoperative 3-month AUA score reported by 15 patients was 5 (3–11). Only one patient needed reintervention postoperatively due to slowing of the urinary stream as he had a urethral mucosal flap from preoperative cathe","PeriodicalId":92974,"journal":{"name":"Videourology (New Rochelle, N.Y.)","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135656770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hood Technique for Single Port Robot-Assisted Radical Prostatectomy","authors":"Narmina Khanmammadova, Tuan Thanh Nguyen, Andrei D. Cumpanas, Kirsten Young, Catherine Fung, Mohammed Shahait, David I. Lee","doi":"10.1089/vid.2023.0045","DOIUrl":"https://doi.org/10.1089/vid.2023.0045","url":null,"abstract":"Introduction: The gold standard for surgical management of localized prostate cancer is robot-assisted radical prostatectomy (RARP) in the United States.1 Different techniques and modifications were implemented in the last two decades to enhance the functional outcomes while not compromising the oncological outcomes.2,3 Recently, the Hood technique which emphasizes the preservation of periurethral anatomical structures in Space of Retzius including endopelvic fascia, puboprostatic ligaments, anterior vessels, detrusor apron as well as some detrusor muscle was described using the multiport robotic platform. Since the approval of the da Vinci Single-Port (SP) platform (Intuitive Surgical, Sunnyvale, CA), multiple benefits were reported such as shorter length of stay with higher rates of discharge on the day of surgery, decrease in operation time, postoperative opioid use, and patient-reported pain scores.4 However, the learning curve of the RARP with SP platform remains substantial.5 Herein, we describe our modified hood technique for SP-RARP, which aims to develop a reproducible procedure with a short learning curve, without compromising oncological outcomes, as well as offering durable improved functional outcomes. Methods: All data were prospectively collected into an IRB-approved registry database. A total of 10 consecutive patients with localized prostate cancer underwent transperitoneal SP-RARP by a single high-volume surgeon (D.I.L.). There were no exclusion criteria defined preoperatively. The postoperative status of sexual function was defined by the percentage of erection fullness as the patient-reported ability to have a full and hard erection, and several patient and tumor characteristics as well as perioperative and postoperative outcomes were abstracted. Continence recovery was defined as the patient reported no pads or only one security pad used. Results: The median age was 62.5 (53.5–72.75) and median BMI was 26.25 (24.68–27.58) kg/m2. The median operative time of 10 SP RARP cases was 144.5 (134.3–177.5) minutes and the median console time (n = 7) was 93 (93–110) minutes. The mean estimated blood loss was 50 (50–100) mL. There were no patients with positive surgical margins. No blood transfusions and conversions to open surgery were needed and no perioperative complications occurred. One patient who developed a urinary tract infection was managed with oral antibiotics and one patient needed replacement of the Foley catheter as he went into urinary retention after the first catheter removal on 7-day postop. All patients were discharged home on the same day. There was no readmission during the postoperative 30-days. Early continence rates at 3-months of nine patients reporting their continence status were favorable as 88.9% of patients (n = 8/9) reported using no pads or only one security pad. The median American Urological Association Symptom score of the six patients at 3-months was 5 (4–8.25). The median percentage of the fullness ","PeriodicalId":92974,"journal":{"name":"Videourology (New Rochelle, N.Y.)","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modification of Laparoscopic Radical Prostatectomy in Prostate Cancer Patient with Giant Median Lobe","authors":"Deniz Demirci, Ahmet Dirik, Emrah Kızılay","doi":"10.1089/vid.2023.0043","DOIUrl":"https://doi.org/10.1089/vid.2023.0043","url":null,"abstract":"Introduction and Purpose: Prostate cancer is the second most common cancer in men and its incidence increases with age. There are different treatment modalities in localized and locally advanced prostate cancers, and curative results can be obtained if early diagnosis is made. In this presentation, we discussed the combined transurethral resection (TUR)-prostatectomy and laparoscopic radical prostatectomy surgery method in a case with localized prostate cancer with a large median lobe. Summary: Multiparametric magnetic resonance imaging findings of a 62-year-old male patient with prostate-specific antigen (PSA) 9.8 showed linear and faint hypodensities in the peripheral zone and were consistent with pi-rads two (prostate imaging reporting and data system). After the transrectal ultrasound biopsy revealed (three+three) adenocarcinoma in three foci on the right quadrant, laparoscopic radical prostatectomy was planned for the patient. The patient, whose median lobe was prominent and indented into the bladder, was first placed in the lithotomy position and prepared for TUR-prostatectomy. The patient's cystourethroscopy was normal and both orifices could not be seen because of the large median lobe. First, the resection anastomosis line was determined by cauterization with a Collins Knife. Median lobe resection was then performed. After the median lobe was completely resected, bilateral orifices were seen. Finally, the anastomosis line was rebuilt for laparoscopic radical prostatectomy, and the procedure was terminated. A three-way urethral catheter was inserted into the patient and continuous bladder irrigation was performed. The surgical time was 70 minutes and the removed tissue was 50 grams. Immediately afterward, laparoscopic radical prostatectomy was performed in the supine position. During laparoscopy, a vesicourethral anastomosis was performed using the border created as the anastomosis line made during the TUR-prostatectomy. The procedure was terminated without complications by placing a drainage catheter in the patient. The procedure time was 4 hours and the removed tissue was 130 grams. The patient's hospital stay was 4 days, with a drainage catheter 6 days, with a urethral catheter 14 days. Since there was no extravasation in the cystogram taken on the 14th postoperative day, the urethral catheter was removed. The PSA value obtained at the postoperative second month was found to be <0.006. Whereas the median lobe resection result was reported as benign prostate tissue in the pathology report, the radical prostatectomy material was reported as (three+three) adenocarcinoma in the right anterior quadrant and right posterior quadrant. Conclusion: In selected cases with prostate cancer with a large median lobe, median lobe TUR-prostatectomy, and laparoscopic radical prostatectomy can be combined first. No competing financial interests exist. Runtime of video: 2 mins 40 secs Patient Consent: Authors have received and archived patient consent for","PeriodicalId":92974,"journal":{"name":"Videourology (New Rochelle, N.Y.)","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135639074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}