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Introduction: Robotic assisted laparoscopic radical prostatectomy (RALP) is a common treatment for localized prostate cancer. Despite a primary advantage of improved postoperative pain, patients undergoing RALP still experience discomfort. Belladonna, containing the muscarinic receptor antagonists atropine and scopolamine, in combination with opium as a rectal suppository (B & O) may improve post-RALP pain. This study evaluates whether a single preoperative B & O results in decreased postoperative patient-reported pain and analgesic requirements., Materials and Methods: Patients undergoing RALP at Virginia Mason Medical Center between November 2008 and July 2009 were offered the opportunity to enter a randomized, double-blind, placebo-controlled trial. Exclusion criteria included: glaucoma, bronchial asthma, convulsive disorders, chronic pain, chronic use of analgesics, or a history of alcohol or opioid dependency. Surgeons were blinded to suppository placement which was administered after induction of anesthesia. All patients underwent a standardized anesthesia regimen. Postoperative pain was assessed by a visual analog scale (VAS) and postoperative narcotic use was calculated in intravenous morphine equivalents., Results: Ninety-nine patients were included in the analysis. The B & O and control groups were not significantly different in terms of age, body mass index, operative time, nerve sparing status or prostatic volume. Postoperative pain was significantly improved during the first two postoperative hours in the B & O group. Similarly, 24-hour morphine consumption was significantly lower in patients who received a B & O. No adverse effects secondary to suppository placement were identified., Conclusion: Preoperative administration of B & O suppository results in significantly decreased postoperative pain and 24-hour morphine consumption in patients undergoing RALP.

We describe and demonstrate a simple method to release a stone from a basket that emphasizes the importance of lateral deflection of the ureteroscope while opening and advancing the basket. This technique works well with semirigid and flexible ureteroscopes and all stone baskets, although some difficulty may be encountered with flat-wire baskets.

Background and Purpose: Heads-Up Imaging goggles provide ergonomic advantages to the endourologist. This study was designed to evaluate whether heads-up display impacts task performance for ureteroscopic stone retrieval., Materials and Methods: The ability to capture a 5-mm calculus with a Cook N-Circle 2.2F stone basket from an inanimate caliceal model was tested by three experienced and three novice stone-basket operators. Visual display for initial testing for each operator was randomized to the OptiVu HD3 Heads-Up googles or a 20- inch Sony Triniton monitor (TV). Subsequent testing alternated between the two devices. Camera input was provided by the Storz telecam SL-NTSC. The HD3 was set up to align the direction of view with the operator's hands, while the TV was aligned at an angle 45 degrees lateral and 30 degrees superior to the operator's direction of view to approximate the traditional room set-up for an endourologic procedure. Each operator performed five basketing trials with each display set-up., Results: Expert operators retrieved calculi more rapidly (9.2 +/- 5.9 seconds) than novice operators (50.7 +/- 48.9 seconds), irrespective of whether a TV monitor or goggle display was utilized as the imaging modality. No significant differences were noted in task performance between the two imaging modalities for the expert (P = b0.60), novice (P = 0.77), or overall (P = 0.91) groups., Conclusion: The Optiview Heads-Up goggle display system does not offer advantages in task performance with specific regard to the ability to capture stone fragments with baskets.

Objectives: To compare the rapidity of stone capture and removal by six tipless and four helical baskets in a ureteral model. Expeditious ureteral stone extraction is reliant on the basket size, configuration, and radial dilation force., Methods: A 5-mm feline calculus was placed in a simulated model of the human ureter at a distance of 7.5 cm from the orifice, and saline irrigant instilled. A 6/7.5F Wolf semirigid ureteroscope was used for access and visualization of the stone. Operators were randomized to start stone extraction with 1 of 10 stone baskets, and three extraction attempts were conducted with each device. Six experienced operators tested each device. The tipless baskets tested were the ACMI Sur-Catch NT 3.0F, Bard Dimension 3.0F, Boston Scientific Zerotip 3.0F, Cook N-Circle 3.0F, Cook Delta 2.4F, and Sacred Heart Halo 1.9F. The helical baskets tested were the Cook N-Force 3.2F, Microvasive Gemini 3.0F, ACMI Sur-Catch Helical 3.0F, and Sacred Heart Hercules 3.0F. The time to extraction in seconds was recorded., Results: No statistically significant difference was observed between the tipless (14 +/- 7 seconds) or helical (12.8 +/- 6.6 seconds, P = 0.21) basket groups. All baskets were able to retrieve the ureteral stones successfully. The most efficient basket was the Cook N-Circle with an average time of 8.7 seconds to stone extraction compared with the least efficient basket, the ACMI Sur-Catch NT, at 15.8 seconds., Conclusions: The Cook N-Circle basket provided the most expeditious means to stone extraction in a ureteral model.

Purpose: Tipless stone baskets facilitate caliceal calculi extraction during flexible ureteroscopy. We evaluated the stone capture rate of 9 commercially available tipless stone baskets in an in vitro model using novice and expert operators., Materials and Methods: The Microvasive Zerotip (2.4Fr, 3.0Fr), Cook N-Circle (2.2Fr, 3.0Fr, 3.2Fr), Bard Dimension (3.0Fr, Sacred Heart Medical Halo (1.9Fr), Vantage (1.9Fr) and Circon-ACMI Sur-Catch-NT (3.0Fr) were tested by 3 novice and 3 experienced basket operators. Each operator performed stone extraction of 2, 5 and 8 mm calculi (size determined by digital caliper with 3 repetitions of each basket. The time to extraction of the calculus from a convex based test tube caliceal model was recorded. Statistical analysis was performed using repeated measures ANOVA and Fisher's pairwise comparisons., Results: After a learning curve of 27 basket retrievals, there was no significant difference in stone capture times between novice (38 +/- 54 seconds) and expert operators (32 +/- 49 seconds, p = 0.174). For total stone capture (all sizes) the Sacred Heart Halo resulted in the most rapid stone extraction (17 +/- 14 seconds) by novices and experts, while the Sur-Catch NT resulted in the slowest stone extraction (78 +/- 90, seconds, p = 0.001). The Halo (14 +/- 9 seconds) and Vantage (19 +/- 12 seconds) baskets were significantly faster for 2 mm calculi than the N-Circle (73 +/- 60 seconds, p = 0.006), Sur-Catch (169 +/- 85 seconds, p = 0.0005) and Dimension (73 +/- 70 seconds, p = 0.017). The Zerotip functioned well for 2 mm calculi in the hands of expert operators (15 +/- 9 seconds) but not novice operators (94 +/- 95 seconds). The Sur-Catch NT was significantly slower for 2 mm calculi than the N-Circle (p = 0.01), Dimension (p =.03), Halo (p =.0005), Vantage (p =.001) and Zerotip (p =.002). For 5 mm calculi the Halo was superior (12 +/- 8 seconds), while the Zerotip were superior for 8 mm calculi (8 +/- 3 seconds) compared to the N-Circle (23 +/- 28 seconds, p = 0.026), Halo (26 +/- 18 seconds, p = 0.021) and Vantage (23 +/- 15 seconds, p = 0.006)., Conclusions: The Sacred Heart Halo and Vantage baskets resulted in the most expeditious stone extraction, especially for 2 to 5 mm calculi while the Microvasive Zerotip was optimal for 8 mm calculi. The Sur-Catch NT had the slowest stone capture rate for all stone sizes. Caliceal models of stone basketing may be useful to train novice urology residents and nursing assistants.

To track a moving object, its motion must first be distinguished from that of the background. The center-surround properties of neurons in the middle temporal visual area (MT) may be important for signaling the relative motion between object and background. To test this, we microstimulated within MT and measured the effects on monkeys' eye movements to moving targets. We found that stimulation at "local motion" sites, where receptive fields possessed antagonistic surrounds, shifted pursuit in the preferred direction of the neurons, whereas stimulation at "wide-field motion" sites shifted pursuit in the opposite, or null, direction. We propose that activating wide-field sites simulated background motion, thus inducing a target motion signal in the opposite direction. Our results support the hypothesis that neuronal center-surround mechanisms contribute to the behavioral segregation of objects from the background.