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Introduction: we present oncological and functional outcomes of patients who underwent testis-sparing surgery (TSS). Methods: overall, 13 patients were included. Mean patient age was 29.9 +/- 12.5 years. In five patients, TSS was performed for sequential bilateral testicular tumours. One patient underwent concurrent left radical orchiectomy and right TSS. In eight patients with normal contralateral testis, seven underwent left and one underwent right TSS. Results: mean pathological tumour size was 14.6 +/- 12.5 mm. lntraoperative frozen section evaluation of the mass was performed in eight patients that revealed benign lesions. No intraoperative tumour bed biopsies were taken in this patient group. Regarding the remaining five patients, intraoperative tumour bed biopsies were taken and testicular intraepithelial neoplasia (TIN) was reported in two (40%) patients; no local testicular radiotherapy was given postoperatively. Tumour pathology was malignant in all but one lesion, including Leydig cell tumour (n=1), seminoma(n=2), embryonal carcinoma (n=1), and adenomatoid tumour (n=1). During 47.2 +/- 22.5 months of followup, local recurrence was detected in one patient who underwent radical orchiectomy. No additional local recurrence or systemic metastasis was identified in other patients with malignant lesions. For patients with malignant tumours, of the three patients with a normal preoperative testosterone levels, testosterone level was normal in one patient (with no erectile dysfunction [ED]) and was decreased in two patients (with ED) following TSS. No ED was reported in the nine patients with benign lesions. Conclusions: in carefully selected cases, TSS appears to be a safe, feasible procedure with adequate cancer control that could preserve sexual function., NA

To examine the effect of steep Trendelenburg position (ST) on intraocular pressure (IOP), resistive index of the central retinal artery, and venous impedance index of the central retinal vein during robotic prostatectomy and cystectomy. A total of fifty-three male patients were included into the study (prostatectomy: 43, cystectomy: 10). During robotic surgery, the effect of the ST on IOP, resistive index of the central retinal artery (CRA-RI), and venous impedance index of the central retinal vein (CRV-VI) was prospectively examined. The measurement times of IOP are as follows: T1: before anesthesia while supine and awake; T2: anesthetized and supine; T3: anesthetized and ST; T4: anesthetized, ST, and intraperitoneal insufflation; T5: anesthetized in ST at the end of the procedure with CO2; T6: anesthetized in ST after desufflation; and T7: anesthetized supine before awakening. There was no difference between the IOP values of the right and left eyes in both groups. The highest IOP values were reached at T4 and T5. CRA-RI values were different, while CRV-VI values were similar at T1 and T4. Despite staying in the ST for a long time provided that the ophthalmologic examination was normal, ocular complication risk is low in robotic prostatectomy and cystectomy.

Abdullah Erdem Canda,1 Ali Fuat Atmaca,1 Ozer Ural Cakici,2 Bahri Gok,2 Muhammed Ersagun Arslan,2 Serkan Altinova,2 Ziya Akbulut,1 Mevlana Derya Balbay3 1School of Medicine, Yildirim Beyazit University, Department of Urology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey; 2Department of Urology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey; 3Department of Urology, Memorial Sisli Hospital, Istanbul, Turkey Introduction: In this retrospective study, we report outcomes of robot-assisted laparoscopic radical prostatectomy (RARP) in high-risk prostate cancer (HRPC) classified according to a D'Amico risk group with minimum 1-year follow-up. Methods: A total of 34 patients who had at least one preoperative HRPC feature and who underwent RARP were included. Mean patient age and preoperative serum prostate-specific antigen levels were 62.6±6.4 years and 12.2±9.1 ng/mL, respectively. Preoperatively, two (5.8%), one (2.9%), eleven (32.3%), three (8.8%), and 17 (50%) patients had prostate biopsy Gleason scores of 5+4, 4+5, 4+4, 3+5, and

INTRODUCTION We investigated whether anterior periprostatic fat (APPF) tissue removed during robotic radical prostatectomy (RARP) contains any lymph nodes (LNs). MATERIAL AND METHODS APPF tissues removed during RARP in 129 patients were evaluated histopathologically. Correlation with postoperative pathologic stage was made. Patients with a history of previous prostate or bladder surgery and radiation therapy were excluded. RESULTS Mean patient age, serum prostate specific antigen (PSA), prostate weight and body mass index (BMI) were 62.2 ±5.5 (range 45-74), 9.3 ±6.3 ng/dl (range 0.26-30.3), 60.3 ±27.2 grams (range 11.0-180) and 26.6 ±1.9 kg/m(2) (range 20.0-30.3), respectively. Overall, LNs in APPF tissues were detected in 14 (10.9%) patients with a mean LN yield of 1.1 ±0.7 LNs (range, 1-3). Among those found, no metastatic LN was detected. Of the patients with pT2a (n = 22), pT2b (n = 15), pT2c (n = 62) and pT3a (n = 21) disease, LNs in APPF tissues were detected in 1 (4.6%), 1 (6.7%), 11 (17.7%) and 1 (4.8%) patient in each group, respectively. Among the patients, LNs in APPF tissues were detected in 0 (0%), 5 (35.7%), 8 (57.1%) and 1 (7.1%) patients of underweight, optimal weight, overweight and obese patients due to body mass index, respectively. CONCLUSIONS In our series, LNs were detected in around 10% of the patients. Therefore, this fat should, not be pushed back during RARP but should be removed and sent for pathologic evaluation. Although no metastatic LN was detected in our series, the presence of metastatic LNs might have an impact on the oncologic outcomes of the patients and warrants further research.

Ureteropelvic junction obstruction is a common clinical entity in urological practice. The obstruction can result from intrinsic or extrinsic factors. The clinical course is variable due to degree of obstruction. Diagnose is usually made by contrast-enhanced excretory imaging modalities and nuclear scan. Open surgical, laparoscopic and robotic assisted laparoscopic approaches are the available surgical treatment options. In this case report, we present a congenital ureteropelvic junction obstruction treated with robotic assisted transperitoneal pyeloplasty with many intracalyceal stones surprisingly noticed during surgery and successfully treated in the same session.

DOI: 10.4328/JCAM.1094 Received: 11.05.2012 Accepted: 31.05.2012 Printed: 01.09.2013 J Clin Anal Med 2013;4(5): 360-2 Corresponding Author: Muhammet Fuat Ozcan, Iscibloklari Mah. 1489. Cad. 6/43 06530 Cankaya, Ankara, Turkiye. GSM: +905056407025 T.: +90 3122912740 E-Mail: mfuatozcan@hotmail.com Ozet Amac: Parsiyel orsiektomi endikasyonlari ve sonuclarinin gozden gecirilmesi amaclanmistir. Gerec ve Yontem: Subat 2005 –Aralik 2011 tarihleri arasinda parsiyel orsiektomi yapilan hastalarin demografik ve patolojik ozellikleri retrospektif olarak incelendi. Bulgular: Yaslari 2 ile 30 arasinda degisen 7 hastaya parsiyel orsiektomi yapildi. Parsiyel orsiektomi endikasyonlari: 3 hastada soliter testiste kitle, 2 hastada bilateral testikuler kitle, 1 hastada ise travma idi. Travma nedeniyle parsiyel orsiektomi yapilan hastada insidental olarak miks germ hucreli tumor saptandi. Tartisma: Fertilitenin korunmasi, uzun donemde hormon replasman tedavisi gereksinimini ortadan kaldirabilmesi ile testis koruyucu cerrahi secilmis vakalarda tercih edilebilecek tedavi secenegidir.

Open radical cystectomy (RC) is the gold standard surgical approach in the management of muscle invasive bladder cancer in addition to high-grade, recurrent, noninvasive tumors. With the development of surgical robotic technology, robotic-assisted laparoscopic radical cystectomy (RARC) is increasingly being performed as a minimally invasive surgical approach. A learning curve exists with a recommended case number of at least 20 RARC procedures in order to achieve satisfying outcomes in terms of operation time, complication rate, and onco- logical outcomes, including positive surgical margins (SMs) and lymph node (LN) yield. In the current literature, long-term outcomes of RARC are not yet available. Due to the outcomes of the published literature, RARC seems to have satisfactory oncologic and functional outcomes in addition to acceptable complication rates. Intraoperative blood loss and transfusion rates seem to be decreased in RARC series when compared to open approaches. On the other hand, a number of authors have reported decreased complication rates but increased operation time in the robotic approach. Similar oncologic results including positive SM rates and LN yields were detected in most comparative publications. Totally intracorporeal RARC with urinary diversion is a complex procedure and the number of centers performing this type of surgery is currently very limited. Although, it is still too early to make strict conclusions about RARC, RARC with intracorporeal urinary diversion has the potential to be the future of robotic bladder cancer surgery. Therefore, further prospective and randomized studies with increased numbers of patients and with longer follow-up are needed. Lastly, RARC may be related to increased cost when compared to open surgery, although controversial reports exist about this issue.