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INTRODUCTION AND OBJECTIVE:Extended pelvic lymph node dissection (eLND) at the time of radical prostatectomy has a staging benefit over limited pelvic lymph node dissection (LLND) but an unclear th...

Endourologic procedures such as percutaneous nephrolithotomy (PCNL) employ the use of foot pedals in low-light operating room (OR) settings. These pedals can be especially difficult to locate or distinguish when several pedals are present during a single operation. Improper instrument activation in the OR has led to serious complications ranging from unintentional electrocautery to patient burns and even an intraoperative explosion. This study evaluates the impact of color-coded illumination on speed and efficiency of foot pedal activation.During a simulated PCNL procedure, the foot pedals for a C-arm, laser, and ultrasonic lithotripter (USL) were placed in random positions. Ten participants performed pedal activation in a randomized sequence. Objective outcomes included time to instrument activation, number of attempted pedal presses, number of incomplete pedal presses, and number of incorrect pedal presses. Subjective preferences for pedal illumination were also determined. Data were analyzed using Mann-Whitney U, Wilcoxon signed-rank, and Chi-square tests with p 0.05 indicating statistical significance.Illuminated foot pedals were associated with decreases in the average activation time for all instruments collectively (3.95 seconds vs 6.49 seconds; p = 0.017) and individually (C-arm: 3.07 seconds vs 4.21 seconds; p = 0.006; laser: 13.04 seconds vs 15.18 seconds; p 0.001; USL: 3.28 seconds vs 4.91 seconds; p 0.001) compared with nonilluminated pedals. Illuminated pedals were associated with fewer attempted pedal presses (33.5 vs 39.5; p = 0.007) and incomplete pedal presses (1.5 vs 8.5; p = 0.002). The number of incorrect pedal presses decreased with illumination, but this did not reach statistical significance (0 vs 0.5; p = 0.08). Participants reported that illumination simplified pedal activation and recommended its use (p 0.01).Color-coded illumination improved the speed and efficiency of foot pedal activation during simulated PCNL. Participants subjectively preferred using illuminated foot pedals for endourologic procedures and felt that they improved safety and efficiency.

INTRODUCTION AND OBJECTIVES:Benign ureteroenteric strictures (UES) may occur after radical cystectomy with urinary diversion. Timely treatment is instrumental in preventing renal insufficiency. The...

Background: Ischemia is thought to contribute to benign ureteroenteric stricture (UES) after radical cystectomy with urinary diversion (RCUD). Our institution adopted the use of ureteral perfusion assessment during all RCUDs using real-time indocyanine green angiography using the SPY fluorescence imaging platform (Stryker Corp., Kalamazoo, MI, USA). This guides the location of ureteral transection prior to ureteroenteric anastomosis. We sought to compare UES rates before and after adoption of SPY. Methods: A retrospective chart review was undertaken for the first 47 consecutive cases of RCUD using SPY as well as the previous 47 consecutive cases, which were performed without SPY. Fisher’s exact and Wilcoxon rank-sum tests were used to compare benign UES rates and the length of ureter excised during anastomosis. A p < 0.05 indicated statistical significance. Results: Median follow up was 12.0 months for SPY cases and 24.3 months for non-SPY cases. The UES rate for SPY RCUDs was 0% (0/93 ureters) compared with 7.5% (7/93 ureters) for non-SPY RCUDs ( p = 0.01). Amongst SPY RCUDs, 86 ureters had no hydronephrosis and 7 had mild hydronephrosis with reflux on loopogram. A total of 34.4% of ureters (32/93) had poor distal perfusion, requiring a more proximal anastomosis. The median length excised for ureters with poor distal perfusion was 3.8 cm, compared with 2.2 cm for ureters with good distal perfusion ( p < 0.0001). No complications attributable to the use of SPY were noted. Conclusion: Use of SPY to assess ureteral perfusion was associated with a decrease in the UES rate after RCUD. A total of 34.4% of ureters demonstrated poor distal perfusion, requiring a significantly more proximal ureteroenteric anastomosis.

INTRODUCTION AND OBJECTIVES:Radical cystectomy during multi-visceral resection for locally advanced pelvic malignancy requires urinary diversion. Outcomes with incontinent and continent urinary div...

INTRODUCTION AND OBJECTIVES:A minority of patients undergoing trimodality therapy for bladder cancer will go on to require salvage cystectomy. We report the outcomes in a small cohort of open and m...

Introduction: Volume of renal parenchymal loss is known to affect postoperative renal function after partial nephrectomy (PN). We utilize a novel comparison using donor nephrectomy (DN) pa...

Objective To introduce a grading system (kidney, ureter, and bladder [KUB]) to identify encrusted stents that may require multiple surgeries, multimodal surgery, and operative time > 180 minutes for successful removal. Methods One hundred ten retained encrusted ureteral stents were retrospectively scored using the KUB grading system and this score was correlated with operative time, need for multiple surgeries or multimodal surgery, and stone-free rate. Data analysis was performed with t test, Mann-Whitney U test, and chi-square tests. A P value of Results Average indwelling stent time was 17.2 months (0.7-139.0). There were 83.6% of stents removed in a single surgery, with 63.0% of these requiring multimodal surgery. K score ≥ 3 was associated with multiple surgeries (odds ratio [OR] 3.59, P = .006), multimodal surgery (OR 2.44, P = .04), operative time > 180 minutes (OR 3.80, P = .001), and lower stone-free rate (OR 0.23, P = .02). U score ≥ 3 was associated with operative time > 180 minutes (OR 3.28, P = .003). B score ≥ 3 was associated with lower stone-free rate (OR 0.23, P = .020). Total score ≥ 9 was associated with multiple surgeries (OR 4.19, P = .001), operative time > 180 minutes (OR 3.45, P = .002), and lower stone-free rate (OR 0.13, P = .001). Conclusion The KUB system identifies stents at risk for requiring multiple surgeries, multimodal surgery, and operative time > 180 minutes. It also correlates with stone-free rate. This grading system can help surgeons manage patient expectations and predict surgical complexity.

To compare the outcomes between laparoendoscopic single-site (LESS) and a novel percutaneous externally assembled laparoscopic (PEAL) nephrectomy in an in vivo porcine model.Ten female farm pigs were randomized to LESS nephrectomy (5) or PEAL nephrectomy (5). Operative times, estimated blood loss, and intraoperative and postoperative complications were compared. The surgeons used a Likert scale to grade difficulty of peritoneal access, port placement, tool assembly, hilar dissection, closure, and overall difficulty of surgery. Scar assessment was performed by a blinded plastic surgeon using the Vancouver Scar Scale. Descriptive statistics were reported as median and range. The Mann-Whitney U test was used for continuous and ordinal variables. A p value0.05 was considered significant.Median operative time was significantly shorter in the PEAL group vs the LESS group (85 minutes vs 127 minutes, p = 0.03). Median Likert scores showed overall hilar dissection and nephrectomy to be significantly easier using PEAL compared with LESS (2 vs 9, p 0.01 for both). The PEAL instruments left no visible scar at 5 feet in any animal, and only 1 out of 10 scars could be identified on physical examination.The PEAL surgical paradigm demonstrates nearly scarless outcomes while providing shorter operative times and easier performance than LESS nephrectomy in a porcine model.

Traditional techniques for obtaining percutaneous renal access utilize continuous fluoroscopy. In an attempt to minimize radiation exposure, we describe a novel laser direct alignment radiation reduction technique (DARRT) for percutaneous access and test it in a bench-top model.In this randomized-controlled bench-top study, 20 medical personnel obtained renal accesses using both the conventional bullseye technique and the laser DARRT. The primary endpoint was total fluoroscopy time. Secondary endpoints included insertion time, puncture attempts, course corrections, and subjective procedural difficulty. In the laser DARRT, fluoroscopy was used with the C-arm positioned with the laser beam at a 30° angle. The access needle and hub were aligned with the laser beam. Effective caliceal puncture was confirmed with fluoroscopy and direct vision. The Paired samples Wilcoxon signed rank test was used for statistical analysis with significance at p 0.05.A total of 120 needle placements were recorded. Fluoroscopy time for needle access using the laser DARRT was significantly lower than the bullseye technique in all groups as follows: attendings (7.09 vs 18.51 seconds; p 0.001), residents (6.55 vs 13.93 seconds; p = 0.001), and medical students (6.69 vs 20.22 seconds; p 0.001). Students rated the laser DARRT easier to use (2.56 vs 4.89; p 0.001). No difference was seen in total access time, puncture attempts, or course corrections between techniques.The laser DARRT reduced fluoroscopy time by 63%, compared with the conventional bullseye technique. The least experienced users found the laser DARRT significantly easier to learn. This novel technique is promising and merits additional testing in animal and human models.

and uterus predisposes to this lesion during many gynecological and obstetric procedures. This kind of complication is increasing due to the widespread of cesarian deliveries. The aim of this video is to highlight the technique of vesicouterine fistula repair using vaginal approach. METHODS: A 38-year-old female was admitted to hospital with ciclic hematuria, amenorrhea and no incontinence. She had three previous cesarian deliveries, last one with bladder trauma 3 months before admission. Magnetic Resonance has shown a vesicouterine fistula above cervix. Patient intended to have future pregnancies so a vaginal correction of the vesicouterine fistula without hysterectomy was performed. The patient was prepared and draped in a modified dorsal lithotomy position. Initially, cystoscopy was done with identification of the fistula tract at anterior bladder wall. Uterine cavity was inspected though fistula tract. Next, ureteral catheters were introduced for safety during the procedure. Methylene blue was injected into the bladder to demonstrate the localisation of the fistula in the vaginal wall. A Pozzi clamp was applied to the uterine cervix for good exposure. Next, a supracervical incision was made and dissection was carried out until fistulous tract was identified. A T-clamp was applied to the vaginal wall and the inked fistulous tract was identified and dissected. An Hegar bougie was introduced into the cervical canal facilitating the procedure. Then the bladder wall was dissected in order to allow a tension-free closure of the bladder defect. Both ureters were identified before the vaginal wall was closed. After the closure of the bladder, uterus was closed with interrupted sutures over the Hegar bougie. Finally, vaginal wall was closed and ureteral catheters are removed. RESULTS: Patient was discharged home 1 day after surgery. Urethral catheter was maintained for 14 days. After four months, patient keeps without hematuria, neither incontinence and recovered her normal menstrual cycle. CONCLUSIONS: Vesicouterine fistula is a dreaded complication after cesarian deliveries. Its correction is usually performed through abdominal approach, however, vaginal approach is feasible, safe and less invasive. It may always be considered, mainly if procedure is made early after delivery, when uterus is still movable.

INTRODUCTION AND OBJECTIVES: We designed a novel technique of suctioning flexible ureteroscopy with automatic control of renal pelvic pressure (RPP) by a patented system including a pressuremeasuring ureteral access sheath (UAS) and an irrigation and suctioning platform. We sought to compare RPP values measured by the irrigation and suctioning platform and a nephrostomy catheter at different phases of flexible ureteroscopy when flow rate was set at 100 mL/min. METHODS: Eight young female pigs with a total of 16 macroscopically normal upper urinary tract systems were included .Via a subcostal incision a 6-F catheter was placed into the renal pelvis for RPP measurement by connecting to a pressure monitor. We then introduced the patented UAS (12-15F) retrogradely into the renal pelvis, through which the pressure was measured by the platform. RPP was measured at baseline period, irrigation and suctioning period, and therapeutic period. RESULTS: Twelve renal pelves were successfully established animal models for flexible ureteroscopy and pressure-measuring. Baseline RPP was 26.9 3.8mm Hg in the platform group and 26.3 5.2mm Hg in the nephrostomy group ( p 1⁄4 0.44). There was no significant difference on RPP between the 2 pressure measuring methods either at irrigation and suctioning period (-5.21+/-2.11 vs. -3.59+/-1.45, p1⁄40.42) or therapeutic period (-5.81+/-2.47 vs. -3.73+/-2.19, p1⁄40.39). CONCLUSIONS: Renal pelvic pressure can be accurately and effectively monitored and controlled using the irrigation and suctioning platform with function of pressure feedback and suctioning UAS with function of pressure-measuring.