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Treatment for bladder diverticula may become necessary in case of incomplete bladder emptying or recurrent urinary tract infections (UTI). When bladder outlet obstruction is present, a simultaneous desobstructive procedure can be performed. In this video, we present our technique for a transvesical approach in robot-assisted bladder diverticulectomy (RABD) and discuss its outcomes. We retrospectively analysed the outcomes of 23 patients who underwent a transvesical RABD between March 2015 and May 2020 at the OLV hospital of Aalst. After retrograde filling, a cystotomy is performed. The orifices are identified and the bladder diverticulum is visualized. The mucosa covering the diverticular neck is incised and the plane between the mucosa and the muscularis is identified. The mucosa is separated from the surrounding structures. The base of the diverticulum is transected using cautery. The defect is closed with a barbed suture. Median age was 66 years [Interquartile range (IQR) 60-69)]. The number of diverticula removed ranged from 1 to 3. 10 patients were treated with diverticulectomy alone, 12 underwent a simultaneous adenomectomy, 1 a radical prostatectomy. Median operative was 140 min (IQR 120-180), median estimated blood loss was 250 cc (IQR 28-438). Median catheterization time was 2 days (IQR 1-5), median hospitalization time 3 days (IQR 2-4). 1 patient developed urinary leakage after catheter removal, 1 patient developed a UTI. Median follow-up was 9 months (IQR 3,5-14). No late postoperative complications nor relapse were recorded. Average postvoid residual was 42 cc (IQR 0 to 111), with a median decline of 120cc (IQR -402 to -33). Transvesical approach for RABD is a safe and reliable technique which gives the advantage of a quick localization of the diverticulum and orifices, and direct access to the prostate when simultaneous desobstruction is necessary. Catheterisation time is short. No relapse has been observed.

Current techniques for percutaneous ureteral occlusion are either technically difficult or not satisfactory because of frequent ureteral recanalization. The purpose of this in vitro study was to evaluate the occlusive properties of an "off the shelf" solution (Endoluminal Occlusion System [EOS™]; ArtVentive Medical Group, Inc., Carlsbad, CA) for transrenal ureteral occlusion.Both 8 and 11 mm expanded polytetrafluoroethylene-covered ArtVentive EOS devices were used in 10 porcine models. Experiments were performed in explanted porcine ureters to simulate physiologic conditions. EOS devices were deployed in a midureteral position using a transrenal approach. Contrast agent (Iopamidol 300) diluted in saline solution was infused into the renal pelvis under continuous fluoroscopic guidance. Intrapelvic pressure measurements were performed until leakage, plug dislocation, or until pelvic blow out occurred.All EOS devices were deployed effectively and achieved prompt total ureteral occlusion. Ureteral leakage occurred with intraureteral pressures between 60 to 109 cm HThe ArtVentive EOS occlusive device is an effective tool for "off the shelf" ureteral occlusion. Both the 8 mm and the 11 mm devices fully occluded ureters at pressure levels that are to be expected in vivo.

To assess the necessity of placing a ureteral stent after transperitoneal laparoscopic ureterolithotomy (TPLU).In the period from May 2006 to November 2010, 46 patients underwent TPLU. There were 13 females and 33 males. All patients had an impacted stone larger than 1.5 cm in the upper and middle parts of the ureter. TPLU was performed as either a primary therapy or as a salvage therapy in patients in whom another treatment had failed. The exclusion criteria were pregnancy, a body mass index more than 35, and patients with abnormal results on coagulative tests. In all cases, after removing the stone, the ureter was sutured. In the first 23 patients, no ureteral catheter was placed, but in the second 23 patients, a Double J catheter was inserted through the ureter.In one case, the stone was pushed back. The stone-free rate was 97.8%. There were four cases of prolonged urinary leakage after the surgery. All of them were in the group in whose members the Double J catheter had not been placed. The problem was resolved in one patient spontaneously after 4 days, but for the other three patients, a Double J catheter was placed and the leakage was stopped in 24 hours. There was no case of urinary leakage in the second group of patients with a placed Double J catheter.Placing a Double J catheter during surgery does not increase the time of operation and may play a role in prevention of urinary extravasation after laparoscopic ureterolithotomy.

Background and Purpose: Slings have been successful in the treatment of male stress urinary incontinence (SUI). However, in many situations, the sling may have either an excess of or inadequate tension, producing voiding difficulties or urinary leakage, respectively. The effectiveness of a readjustable sling for the treatment of male SUI has been evaluated. Patients and Methods: Between October 2001 and November 2002, six consecutive male patients with SUI, aged 69 to 81 years, received a readjustable sling (Remeex®) at the Monforte Comarcal Hospital. Results: Five patients (83%) achieved continence, while the remaining patient showed important improvement. All patients were satisfied or very satisfied with the results. The average follow-up time was 18 months (range 12-50 months). There were no postoperative complications. Conclusions: This original treatment allows readjustment of the sling tension in the immediate or mid-term postoperative period. Initial clinical results are encouraging.

One of the challenges of laparoscopic partial nephrectomies is the repair of a collecting system injury. We hypothesized that fibrin glue plus Gelfoam could be sufficient to repair such injuries.Four pigs (eight kidneys) underwent collecting system injuries of various lengths (3, 5, and 10 mm) (N = 8 each) during partial nephrectomy. Gelfoam soaked in the fibrin glue was applied to seal the collecting system and parenchymal defects. After 1 hour of passive filling, the renal pelvis was distended at supraphysiologic pressure to the point of leakage. Each repair site was examined for urinary extravasation during the physiologic and active phases of filling.Hemostasis was achieved, and all collecting system injuries, regardless of size, were free of urinary leakage at physiologic pressures. Moreover, all defects maintained a seal at supraphysiologic pressures of at least 50 cm H(2)O.The combined use of fibrin glue and Gelfoam is an effective means to obtain hemostasis and seal collecting system injuries up to 10 mm at physiologic pressures and up to 50 cm H(2)O in the acute setting. Our hope is that this technique can facilitate both laparoscopic and open partial nephrectomies. New technologies will be employed in an attempt to obtain better seating of the sealant plug in the future. Survival studies are in progress.

Laparoscopic partial nephrectomy (LPN) remains a technically challenging procedure mainly because of the lack of reliable methods of hemostasis. We evaluated the feasibility of using concentrated human albumin with argon-beam coagulation to control hemorrhaging and urinary leakage during LPN.Six domestic swine underwent heparinization, then lower-pole LPN after renal-hilar vascular control had been obtained. The animals received argon-beam coagulation either alone (control) or with 38% albumin. Three days later, an identical procedure was performed on the contralateral kidney. Retrograde pyelography was employed to assess for urine leakage. The animals were then euthanized, and both kidneys were harvested for histologic examination.The mean operative and warm-ischemia times were similar in the two groups and were 27 and 15 minutes, respectively, using albumin with argon-beam coagulation and 25 and 16 minutes with argon coagulation alone. The albumin group required shorter coagulation times (187 v 312 seconds; P = 0.04), which resulted in less thermal injury. By retrograde pyelography, two kidneys (33%) in the albumin group and all six in the control group had urine leakage.Adding concentrated albumin to argon-beam coagulation substantially increases the reliability and durability of parenchymal repair after LPN. The time needed to achieve stable hemostasis and closure of the collecting system was reduced compared with standard argon-beam coagulation.