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Background: The recent plethora of reports of "free-hand" transperineal prostate biopsy (fTP-Bx) under local anesthesia (LA) demonstrate that many centers consider this technique to be a safer and possibly more accurate approach to prostate biopsy in the clinic setting. Materials and Methods: The literature was searched for fTP-Bx, and summary tables were compiled. Studies on the costs of postprostate biopsy sepsis were also researched. Results: The search found 11,999 cases of fTP-Bx under LA with and without sedation over 29 mutually exclusive studies. Pooled averages calculated for age, prostate-specific antigen (PSA), prostate volume, PSA density, and cores sampled were 67.3 years, 10.4 ng/mL, 47.7 mL, 0.24 ng/mL/cc, and 15.3 cores, respectively. Detection of overall prostate cancer (PCa) and clinically significant (Gleason score ≥7) prostate cancer (csPCa) averaged 45.5% (3796/8338) and 25.1% (1141/4541), respectively. After subgrouping the studies by biopsy technique, studies that used MRI/ultrasound fusion-targeted biopsy in some or all biopsy cases averaged an overall PCa and csPCa detection rate of 50.0% (741/1483) (p < 0.0001) and 42.8% (635/1483) (p < 0.0001), respectively. Visual analog scale pain ratings and procedure times averaged 3.17 and 13.1 minutes, respectively. Averages for complications of sepsis and acute urinary retention were 0.0% (0/7396) and 2.1% (120/5693), respectively. A total of 10.2% (1055/10,334) of cases received no antibiotic prophylaxis. If fTP-Bx under LA replaced transrectal prostate biopsy (TR-Bx) in the United States, the estimated annual savings would be $341,676,800–$752,540,000 through the virtual elimination of admissions for postbiopsy sepsis. Conclusions: Many centers around the world have adopted fTP-Bx because it virtually eliminates sepsis, may improve detection rates of csPCa and can be easily integrated into a normal clinic workflow using only LA. If all urologists in the United States abandoned TR-Bx for fTP-Bx, the potential savings in health care costs of complications would be significant. [ABSTRACT FROM AUTHOR]

The United States Coronavirus Aid, Relief, and Economic Security Act (CARES Act) led to creation of the Paycheck Protection Program, as well as an expansion of reimbursements for telemedicine. CARES Act drafters over emphasized maintaining employment and overlooked negative downstream effects the policies had on outpatient clinics. The misalignment between this financial aid package and public health policy is most apparent in the pressure administrators face to maintain clinic operations, without a transition plan to adopt telemedicine and associated best practices. If this continues, the result will be suboptimal clinical practices and an increased risk of COVID-19 infection to both staff and patients. Particularly in times of crisis, financial aid packages should not be evaluated in isolation; policymakers should consider their implications for public health while designing, enacting, and implementing such measures. [ABSTRACT FROM AUTHOR]

Aim: To show if lower urinary tract symptoms (LUTS) could be symptoms of COVID‐19 with validated questionnaires. Methods: The 96 COVID‐19 patients who were hospitalised at a tertiary centre were collected retrospectively. After the exclusion criteria, 46 patients consisted the study population. All patients then fill formed the International Prostate Symptom Score and Urinary Symptom Profile respectively. All patients responded to these questions for the three period. Results: Twenty‐seven female (58.6%) and 19 male (41.4%) COVID‐19 patients answered the questions. In the male patients, while there were no statistically significant differences in the total IPSS, the voiding IPSS score, and quality of life between the three periods (P =.148; P =.933, P =.079, respectively), the storage IPSS scores had a significant difference between the three periods (P =.05). In female patients, low stream scores were similar between the three periods (P =.368). The scores of stress incontinence and an overactive bladder had a significant difference between the three periods (P =.05 and P =.05). Conclusion: LUTS, especially storage symptoms, might be one of the initial symptoms of COVID‐19 and the clinicians should evaluate LUTS with other known symptoms of the virus when a patient is suspected of having COVID‐19. [ABSTRACT FROM AUTHOR]

Robotic-assisted radical cystectomy (RARC) has been gaining momentum as an alternative to its conventional open radical cystectomy (ORC) for the management of invasive bladder cancer. Although RARC, in general, demonstrated less blood loss and shorter hospital stay than ORC, whether there is any significant difference in the overall complication rate still requires further investigation. Thus, both RARC and ORC share a similar oncology outcome, with comparable positive surgical margin rates, disease-free survival, and overall survival. Techniques of intracorporeal urinary diversion (ICUD) have not yet been standardized. ICUD may result in a lower risk of ureteroileal anastomotic stricture than extracorporeal urinary diversion (ECUD). However, ECUD is still a valid and commonly practiced option according to the available data. In general, RARC has been demonstrated to provide promising results. Long-term data and functional outcome after RARC and ICUD are needed to further validate the role of RARC in the management of bladder cancer. [ABSTRACT FROM AUTHOR]

Introduction: We introduced a nurse-led telephone-based virtual stone clinic (VSC) follow-up for the surveillance of patients with asymptomatic renal calculi or those at a high risk of recurrent kidney stone disease (KSD). The aim of this study was to look at the outcomes of VSC and its role in the post-COVID era. Methods: Prospective outcomes audit was done for all patients referred to the VSC for a 6-year period (March 2014–April 2020). VSC is led by specialist stone nurses for on-going surveillance of KSD patients. Results: A total of 290 patients were seen (468 individual appointments; 1.6 ± 1.0 per patient), with a mean age of 57.0 ± 15.8 years (range: 17–92) and a men–women ratio of 3:2. The referral was for surveillance of asymptomatic small renal stones (230, 79.3%); history of recurrent stone disease (45, 15.5%); solitary kidneys (5, 1.7%); cystine stones; young age; and other conditions (10, 3.4%). The mean stone size was 5.0 ± 2.7 mm, followed up with kidney, ureter, and bladder radiograph (225, 77.6%) and ultrasound scan (USS) (65, 22.4%), for median duration of 12 months (range: 3–24 months). At the end, 132 patients (45.6%) remained in VSC, 106 (36.6%) were discharged, 47 (16.2%) returned to face-to-face clinic or treatment, and 5 (1.7%) had emergency admissions. Of 47 patients who returned, 23 (48.9%) developed new symptoms, 21 (44.6%) had stone growth, and 3 defaulted to face-to-face appointment. Thirty-five patients needed surgical intervention (URS-21, SWL-13, and PCNL-1) and 10 were managed conservatively. VSC reduced the cost per clinic appointment from £27.9 to £2 per patient (93% reduction), equating to a total saving of £12,006 for the study period. Conclusion: Nurse-led VSC not only provided a safe follow-up but also allowed to substantially reduce the cost of treatment by allowing patients to be either discharged or return to a face-to-face clinic or surgical intervention if needed. Post-COVID, this model using telemedicine will have a much wider uptake and further help to optimize health care resources. [ABSTRACT FROM AUTHOR]

With the widespread dissemination of robotic surgical platforms, pathology previously deemed insurmountable or challenging has been treated with reliable and replicable outcomes. The advantages of precise articulation for dissection and suturing, tremor reduction, three-dimensional magnified visualization, and minimally invasive trocar sites have allowed for the management of such diverse disease as recurrent or refractory bladder neck stenoses, and radiation-induced ureteral strictures, with excellent perioperative and functional outcomes. Intraoperative adjuncts such as near-infrared imaging aid in identification and preservation of healthy tissue. More recent developments include robotics via the single port platform, gender-affirming surgery, and multidisciplinary approaches to complex pelvic reconstruction. Here, we review the recent literature comprising developments in robotic-assisted genitourinary reconstruction, with a view towards emerging technologies and future trends in techniques. [ABSTRACT FROM AUTHOR]

Introduction During the COVID-19 led lockdown, a reliable system to monitor ureteral stent insertion and timely removal became an important facet of their use. This study looks at the use of 'Urostentz' smartphone application (app) for stent procedures and whether it improved patient communication and safety during the lockdown. Material and methods The 'Urostentz' app was used for patients who underwent ureteric stent after ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) procedure. It is a smartphone app developed to improve patient safety, facilitate data collection, and provide an efficient interface to simplify ureteral stent tracking and patient communication. It also helps clinicians track stent-related symptoms (SRS) and provide digital remote assistance. Results A total of 33 patients registered with a mean age of 47.8 years (range:18-80) and a male: female ratio of 4.5:1. Of these, 29 (87.9%) used the Urostentz app, and 55.2% had SRS. The number of effective communication episodes ranged from 1-7/patient. Based on the symptoms and communication, stent was removed during lockdown (n = 2), within 1 week of lockdown lifted (n = 24) and within 2 weeks of lockdown lifted (n = 5). None of the patients suffered any stent-related complications and there were no cases of forgotten stents or readmissions despite the lockdown and lack of communication using standard practices. Conclusions The Urostentz app proved to an effective medium of communication to provide guidance and personalized digital remote healthcare. It also allowed prompt removal of stents avoiding prolonged stent symptoms or forgotten stents. Such apps can have a much wider application in the post-COVID-19-era to reduce unnecessary post-procedural visits and reduce health care costs. [ABSTRACT FROM AUTHOR]

Robotic assistance in laparoscopic surgery was introduced at the turn of this millennium, marking a milestone in the history of surgery. Urologists were early adopters of robotic technology and the indications of robot-assisted surgery in urology are expanding. Over the last 20 years, the da Vinci surgical system was the dominant system in the robotic surgical market. However, the recent expiration of Intuitive patents has allowed new systems to enter the market more freely. We performed a nonsystematic literature review using the PubMed/MEDLINE search engines. The aim of this review was to briefly summarize the currently available robotic surgical systems for laparoscopic urologic surgery. New surgical devices have already been launched in the robotic market and the da Vinci systems have some competition. The innovation of robotic technology is continuing, and new features such as an openconsole design, haptic feedback, smaller instruments, and separately mounted robotic arms have been introduced. A new robotic era is rising, and new systems and technologies enhancing patient care are welcomed. [ABSTRACT FROM AUTHOR]

Objectives: To analyze predictors of open conversion during minimally invasive partial nephrectomy (MIPN) for cT1 renal masses. Methods: The National Cancer Database (NCDB) was investigated for kidney cancer patients who underwent partial nephrectomy (PN) between 2010 and 2015. Patients who underwent MIPN were stratified into converted and nonconverted groups. Sociodemographics, facility characteristics, and surgical outcomes were compared between the two groups, and multivariate logistic regression model was fitted to identify independent predictors of open conversion. Results: In total, 54,246 patients underwent PN for kidney cancer during the 6-year period. Of those, 18,994 (35%) were open partial nephrectomies (OPNs) and 35,252 (64%) were MIPN. Overall, 1010 (2.87%) of MIPNs were converted to OPN. There was an increasing utilization of MIPN from 50.35% in 2010 to 74.73% in 2015. Patients who had open conversion had more 30-day readmissions (5.95% vs 3.31%, p < 0.01). On multivariate analysis; high-volume facility (>30 MIPNs/year), year of surgery (2015 vs 2010), and robotic approach predicted a lower likelihood of conversion (odds ratio [OR] 0.52, confidence interval [CI] 0.44–0.62; OR 0.59, CI 0.47–0.73; and OR 0.31, CI 0.27–0.35; respectively, p < 0.001 for all). Conversely, Medicaid (vs private insurance; OR 1.75, CI 1.39–2.19, p < 0.001) and male sex (OR 1.26, CI 1.11–1.44, p < 0.001) were independent predictors of conversion. Conclusions: Open conversion in MIPN occurred in 2.87% of cases. There was an increasing utilization of MIPN associated with decreased conversion rates. Higher volume hospitals and progressing year of surgery were associated with less likelihood of conversion. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has caused a global health threat. This disease has brought about huge changes in the priorities of medical and surgical procedures. This short review article summarizes several test methods for COVID-19 that are currently being used or under development. This paper also introduces the corresponding changes in the diagnosis and treatment of urological diseases during the COVID-19 pandemic. We further discuss the potential impacts of the pandemic on urology, including the outpatient setting, clinical work, teaching, and research. [ABSTRACT FROM AUTHOR]

Objective: To describe the crucial factors related to the implementation of the da Vinci single‐port (SP) system (Intuitive Surgical Inc., Sunnyvale, CA, USA), and the early outcomes after the introduction of this robot for robot‐assisted radical prostatectomy (RARP). Patients and methods: We prospectively collected data from 50 consecutive patients with prostate adenocarcinoma who underwent RARP using this robot. The median follow‐up was 53 days. We performed a transperitoneal technique. The robotic (multiport) trocar was placed on the supra‐umbilical midline 20 cm from the pubis and an assistant trocar placed in the right lower quadrant. We report our initial experience describing the intra‐ and postoperative outcomes associated with this new robot. Also, we report the early functional and oncological outcomes in the follow‐up period considered. Continuous variables were described as medians and interquartile ranges, while categorical variables as frequencies and proportions. Results: The median total operative time was 118 min, median console time was 80 min, and median estimated blood loss was 50 mL. There were no intraoperative complications or blood transfusions. The final pathology reported 18% Grade Group (GrGp)1, 58% GrGp2, 18% GrGp3, 2% GrGp4, and 4% GrGp5. In all, 40 patients (80%) were pT2 and 20% were ≥pT3a. The overall positive surgical margin rate was 14%. In all, 39 patients (78%) achieved full continence at median of 21 days after RARP. The median pain scale (0–10) score at 8, 12 and 16 h after RARP was 2, 2, and 0, respectively. Conclusion: The use of the da Vinci SP robot with an additional assistant port for RARP is technically safe and feasible, with acceptable short‐term functional and oncological outcomes. However, there is a technical learning curve for this new platform due to the smaller scope of the operative field and the decreased flexibility and strength of the surgical instruments. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relationship between urodynamic study (UDS) data and recovery of urinary incontinence (UI) in elderly patients who underwent robot-assisted radical prostatectomy (RARP).Materials and Methods: Seventy-five prostate cancer (PCa) patients received UDS before and at 3 months after RARP. They were divided into two groups; a younger group (<70 years old, n = 47) and older group (≥70 years, n = 28), and each was classified according to urinary continence (UC) or UI at 3 months post-RARP. Continence was defined as being pad-free or 1-safety pad usage per day.Results: In the older group, preoperative maximum urethral closure pressure (MUCP) in the UI group was significantly lower than that in the UC group. Detrusor overactivity (DO) rate was significantly higher in the older UI group than in the older UC group at both pre- and 3 months post-RARP. Persistent DO rate pre- and post-RARP was significantly higher in the older group than in the younger group. Regardless of age, postoperative DO was an independent predictor of UI 6 months post-RARP.Conclusions: In elderly patients, low preoperative MUCP and both pre- and postoperative DO are associated with postoperative UI. [ABSTRACT FROM AUTHOR]

Objective: To compare the surgical feasibility, oncological and functional results between sutureless and suture techniques in retroperitoneal laparoscopic nephron-sparing surgery (LNSS). Materials and Methods: This retrospective study collected consecutive patients with a renal mass who underwent retroperitoneal LNSS in two high-volume centers. Propensity score matching (PSM) analysis was conducted to select two baseline homogeneous cohorts. Descriptive statistics was performed both before and after PSM. Moreover, univariate and multivariate logistic analyses were carried out to identify the risk factors of postoperative acute kidney injury (AKI), whereas Kaplan-Meier analysis for functional deterioration (new-onset stage 3 chronic kidney disease [CKD], estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2, or CKD upstaging after surgery) was utilized to compare the two cohorts. Results: After PSM at a ratio of 1:3, the sutureless group (n = 65) was compared with the suture group (n = 152) with no remaining statistically significant differences in baseline characteristics. With regard to patient outcomes, differences in warm ischemia time (WIT) (P < .001), estimated blood loss (P < .001), AKI (P = .002), length of hospital stay (P = .020), and eGFR at discharge (P < .001) were statistically significant. Meanwhile, the postoperative complication rates (9.2% versus 13.8%, P = .378) and positive surgical margins (0% versus 2.0%, P = .556) were not statistically different. At the last follow-up, the eGFR decline percent was the same (-1.5% versus -2.2%, P = .192). No difference was detected on Kaplan-Meier analysis for functional deterioration (log-rank test, P = .304). Conclusions: Sutureless technique in LNSS is safe and feasible, compared with the traditional suture method, with shorter WIT, lower AKI rate, and comparable long-term oncological and functional outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous cryoablation (PCA) has emerged as an alternative to extirpative management of small renal masses (SRMs) in select patients, with a reduced risk of perioperative complications. Although disease recurrence is thought to occur in the early postoperative period, limited data on long-term oncologic outcomes have been published. We reviewed our 10-year experience with PCA for SRMs and assessed predictors of disease progression. Materials and Methods: We reviewed our prospectively maintained database of patients who underwent renal PCA from March 2005 to December 2015 (n = 308). Baseline patient and tumor variables were recorded, and postoperative cross-sectional imaging was examined for evidence of disease recurrence. Disease progression was defined as the presence of local recurrence or new lymphadenopathy/metastasis. Results: Mean patient age was 67.2 ± 11 years, mean tumor size was 2.7 ± 1.3 cm, and mean nephrometry score was 6.8 ± 1.7. At mean follow-up of 38 months, local recurrence and new lymphadenopathy/metastasis occurred in 10.1% (31/308) and 6.2% (19/308) of patients, respectively. Excluding patients with a solitary kidney and/or von Hippel–Lindau, local recurrence and new lymphadenopathy/metastasis occurred in 8.6% (23/268) and 1.9% (5/268) of cases, respectively. Kaplan–Meier estimated disease-free survival was 92.5% at 1 year, 89.3% at 2 years, and 86.7% at 3 years post-PCA. Increasing tumor size was a significant predictor of disease progression (hazard ratio 1.32 per 1-cm increase in size, p = 0.001). Conclusions: PCA is a viable treatment option for patients with SRMs. Increasing tumor size is a significant predictor of disease progression following PCA. [ABSTRACT FROM AUTHOR]

Background: Although the use of da Vinci robotic platforms in bariatric surgery is gaining momentum, it is still controversial because of financial concerns. Objectives: The objective of our study is to evaluate the cost of robotically assisted Roux-en-Y gastric bypass (R-RYGB) versus conventional laparoscopic Roux-en-Y gastric bypass (L-RYGB). Methods: We analyzed consecutive primary bariatric patients who underwent R-RYGB and compared them with patients who underwent L-RYGB during the same time period. Primary outcomes were overall cost for length of stay, operating time, and supplies. Direct cost data was generated using the StrataJazz reporting module, which is fed daily from EPIC, our electronic health record system, and contains hospital-based data only. Secondary outcomes were 30-day rates of complications, reoperations, and readmissions. Results: We found no difference in primary or secondary outcomes following R-RYGB and L-RYGB. The overall cost for R-RYGB and L-RYGB was not statistically different (median total cost for R-RYGB and L-RYBG was $6431.34 and $6349.09, P > 0.05, respectively). Operating time cost was significantly higher for R-RYGB compared with L-RYGB ($2248.51 versus $19,836.29, respectively, P < 0.0001, respectively). R-RYGB had lower cost of supplies as well as a shorter length of stay compared with L-RYGB (mean 1.5 versus 1.7 days, respectively). Conclusions: Our study revealed no cost difference between R-RYGB and L-RYGB, with a decreased cost of supplies and trend toward lower hospital stay favoring R-RYGB. Further studies are needed to evaluate the outcomes of R-RYGB compared with L-RYGB; however, the cost of robotic surgery may not be a prohibitive factor. [ABSTRACT FROM AUTHOR]

Purpose: To summarize and analyze the current evidence about surgical, oncological, and functional outcomes between laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN). Materials and Methods: Through a systematical search of multiple scientific databases in March 2020, we performed a systematic review and cumulative meta-analysis. Meanwhile, we assessed the quality of the relevant evidence according to the framework in the Cochrane Handbook for Systematic Reviews of Interventions. Results: A total of 26 studies with 8095 patients were included. There was no statistical difference between the LPN and OPN in the terms of operation time (p=0.13), intraoperative complications (p=0.94), recurrence (p=0.56), cancer-specific survival (p=0.72), disease-free survival (p=0.72), and variations of estimated glomerular filtration rate (p=0.31). The LPN group had significantly less estimated blood loss (P<0.00001), lower blood transfusion (p=0.04), shorter length of hospital stay (p<0.00001), lower total (p=0.03) and postoperative complications (p=0.02), higher positive surgical margin (p=0.005), higher overall survival (p<0.00001), and less increased serum creatinine (p=0.002). The subgroup analysis showed that no clinically meaningful differences were found for T1a tumors in terms of operation time (p=0.11) and positive surgical margin (p=0.23). In addition, the subgroup analysis also suggested that less estimated blood loss (p<0.0001) and shorter length of hospital stay (p<0.00001) were associated with the LPN group for T1a tumors. Conclusions: This meta-analysis revealed that the LPN is a feasible and safe alternative to the OPN with comparable surgical, oncologic, and functional outcomes. However, the results should be applied prudently in the clinic because of the low quality of evidence. Further quality studies are needed to evaluate the effectiveness LPN and its postoperative quality of life compared with OPN. [ABSTRACT FROM AUTHOR]

Laparoscopic partial nephrectomy and robot-assisted partial nephrectomy are attracting increased attention from urologists. They can achieve the same effect of oncology control as radical nephrectomy; moreover, they can offer better preservation of renal function, thus obtaining long-term living benefits. The indications are also expanding, making it possible for larger and more difficult tumors. Laparoscopic partial nephrectomy and robot-assisted partial nephrectomy can be performed by transperitoneal and retroperitoneal approaches, with their individual advantages and limitations. In addition, the renal tumor scoring systems have been widely used and studied in laparoscopic partial nephrectomy and robot-assisted partial nephrectomy. In -order to better preserve renal function, the zero-ischemia technique is widely used. The application of intraoperative imaging technology provides convenience and greater benefits. Besides, whether minimal invasive partial nephrectomy can be performed without stop antiplatelet treatment is still disputed. Clinicians perform substantial exploration and practice to achieve the "trifecta" of surgery: complete resection of the tumor, maximum protection of renal function, and no complications. [ABSTRACT FROM AUTHOR]

Background: Today, the goal of surgery is to achieve oncological efficacy with the lowest complication rate. Computed Tomography (CT)-guided cryoablation is proposed as a safe and effective technique. We report, our series of small renal masses treated with cryoablation in elderly (> 70 years). Methods: From May 2014 to April 2019, 32 patients with median (IQR) age of 75.5 years (range 71-80) with small renal masses (< T1a) diagnosis, clinical anesthesia contraindications to nephron-sparing surgery or patient’s will previous informed consent have been selected at our Urology Department. All patients underwent CT-guided cryoablation, preceded by needle biopsy. The cryoablation consisted in a procedure with an argon/helium gas-based system under local anesthesia. The follow-up included CT abdomen at 3, 6 and 12 months. The definition of incomplete treatment was the persistence of the lesion contrast enhancement (CE) at the end of the scan; the definition of relapse was the appearance of the CE to the 6-month control CT. Results: The median follow-up was 30 months (IQR 1-59). The median size of the tumor was 3.85 cm (IQR 1.6-4.5). All patients underwent lesion biopsy resulting in diagnosis of Renal Cell Carcinoma (RCC) in 29 patients (90.7%) and oncocytoma in 3 patients (9.3%). A median of 2 cryoprobes (IQR 1- 3) was used and 2/3 cycles of freeze-thaw of the duration of 10 minutes or 5 minutes were performed. Complications were: 3 asymptomatic transitional perirenal effusion, 2 lumbar pain well-controlled by analgesic drug. Hospital stay was 2 days (range 1-3). No case showed incomplete treatment and local relapse or meta-states at the CT abdomen-pelvis with contrast medium at 12 months. Conclusions: This study shows the efficacy and safety of percutaneous cryoablation of small renal masses in elderly population. The procedure is easy to perform, with low complication rates and well tolerated by the elderly patients. [ABSTRACT FROM AUTHOR]

Aims: To compare the efficacy of cernitin pollen extract (cernitin) or tadalafil for treating persistent chronic pelvic pain despite α1‐blocker monotherapy in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and lower urinary tract symptoms (LUTS). Methods: A total of 100 patients with refractory CP/CPPS despite ongoing α1‐blocker monotherapy were randomized to receive add‐on therapy with either cernitin (4 capsules/day) or tadalafil (5 mg/d) for 12 weeks. At week 12, changes from baseline in the patients' CP/CPPS, LUTS, and voiding function, as assessed using the National Institutes of Health Chronic Prostatitis Symptom Index (NIH‐CPSI), the International Prostate Symptom Score (IPSS), and uroflowmetry, respectively, were compared between the groups. Results: The final analysis included 42 and 45 patients in the cernitin and tadalafil groups, respectively. Although the NIH‐CPSI total, NIH‐CPSI pain sub‐score, and NIH‐CPSI quality of life sub‐score significantly improved in both groups, the cernitin (vs tadalafil) group showed significantly greater improvements in the NIH‐CPSI total score (−6.8 vs −4.6; P =.02) and NIH‐CPSI pain sub‐score (−4.1 vs −1.5; P <.001). Half (50%) of the patients in the cernitin group showed a reduction greater than 50% in their NIH‐CPSI pain sub‐score; in the tadalafil group, only four patients (8.9%) showed ≥50% improvement (P <.001). In contrast, the improvement in LUTS was significantly superior in the tadalafil group. Conclusion: Both cernitin and tadalafil significantly ameliorated chronic pelvic pain in patients with refractory CP/CPPS. The add‐on of cernitin was more effective than tadalafil for pelvic pain and discomfort. [ABSTRACT FROM AUTHOR]

Research has been consistently showing the role of zinc (Zn) in prostate function. In this article, we review the current literature on the anatomy and main functions of the prostate, highlighting the role of zinc. In particular, we will review the etiology of benign prostate enlargement (BPH), its prevalence in men over 50, the likelihood of BPH becoming prostate cancer (PCa), and explain the relationship of zinc and apoptosis in the prostate cells and the implications for BPH and PCa. We present a model that explains how endogenous factors provoke excretion of zinc or limit zinc absorption, and how exogenous factors like nutrition and drugs regularly used in men over 50 can significantly decrease zinc status and thereby increase the risk of BPH. Finally, we explain how Zn amino acid (AA) complexes may be capable of avoiding antagonists and inhibitors of zinc absorption, thereby increasing the bioavailability of zinc for the necessary biological processes in the prostate. [ABSTRACT FROM AUTHOR]

The world has changed in a very short span of just 6 months. All branches of medical practice including urology have been immensely affected by Covid-19. We have been forced to re-think, re-organize, re-group and reprioritize our definitions, actions and outcomes. The degrees of urgency to intervene have been redefined. There has been a massive reorganization of teams, re-structuring of rotation plans, re-scheduling of outdoor and indoor appointments and re-allocation of roles all over the world. Finding a perfect new normal may not be possible especially with the practice of social distancing and fear to contract the virus. A modified plan has to be in place which can define the new norm in urological practice. The most important aspect would be implementing telemedicine. This could be extremely challenging and at the same time dangerous in countries like Pakistan. We have to rationalize our outpatient appointments, preoperative work-up and indications to operate with least burden on our diagnostic services. Post-operative surgical practices need modifications with less follow-up visits in person. Operations need to be performed by senior surgeons to reduce the operating time, rate of complications and exposure. Role of Interventional radiologists cannot be overstated, more nephrostomies and ante-grade procedures can lessen the burden on operating rooms and wards. Training of urology residents have suffered in current scenario which requires redefining of their curriculum. Judicious use of personal protective equipment by healthcare providers and number of patients in crowded clinics has to be rethought about. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) are commonly used techniques for treating small renal masses. Regarding renal function (RF) preservation, no superiority of one technique over the other has yet been definitely demonstrated. Objective: To compare functional and surgical outcomes of LPN and RAPN. Patients and Methods: Between 2015 and 2019, we prospectively randomized 115 patients with cT1–T2 renal masses to LPN in total ischemia or RAPN in selective ischemia. Primary endpoint was RF preservation, assessed by renal scintigraphy (RS). RS assessments were performed preoperatively and at 6 months follow-up. Secondary endpoints included clinical, histopathologic, and surgical outcomes. Results: One hundred eight patients were included in the final analysis. Patient and tumor characteristics were comparable. No significant difference in RS values after 6 months was observed between both groups. Median (interquartile range) RF change after 6 months was -18.0% (-26.5 to -11.0) in LPN group and -20.0 (-33.2 to -12.0) in RAPN group ( p = 0.3). Mean (standard deviation [SD]) warm ischemia time was 21.1 (6.1) minutes in LPN group and 19.6 (7.7) minutes in RAPN group ( p = 0.2). No positive surgical margins (PSMs) occurred in the LPN group, whereas RAPN group had PSM in 4.9% (n = 3); p = 0.099. Renal volume loss after 6 months was 27.5% (22.7–45.7) in the LPN group vs 37.5 (13.7–54.2) in the RAPN group ( p = 0.5). Mean operative times were lower in the LPN group (192.3 minutes [SD 44.5] vs 230.2 minutes [SD 59.6], p = 0.001). More complications occurred in the LPN group (31% vs 21%, p = 0.075). Transfusion rates were 15% for LPN and 11% for RAPN. Conclusions: In terms of preserving RF, LPN in total ischemia and RAPN in selective ischemia are comparable. In most patients, RF decrease of the affected kidney after PN seems to not exceed 25%, regardless of the surgical approach. [ABSTRACT FROM AUTHOR]

Background: Due to its rarity, little is known about the clinical presentations and responses to systemic chemotherapies in advanced and/or metastatic cases of paratesticular liposarcoma.Case Presentation: Here, we report the case of a 75-year-old Japanese man with giant paratesticular liposarcoma. Imaging studies revealed a 26 cm tumor in his right scrotum and lung metastases at presentation. He underwent radical orchiectomy followed by systemic chemotherapies. Pathological findings of the resected primary tumor confirmed a dedifferentiated liposarcoma. He then started chemotherapy treatment with gemcitabine plus docetaxel. His disease status was stable for 1 year. Eribulin was used for second-line chemotherapy. He had a relapse at 5 months after eliburin and died at 22 months after diagnosis.Conclusion: Early diagnosis and curative radical surgery are important for treatment of paratesticular liposarcoma. However, a giant paratesticular liposarcoma could cause metastases, and systemic chemotherapy may be helpful for prolonging survival in patients with metastatic paratesticular liposarcoma. [ABSTRACT FROM AUTHOR]

The present study aimed to develop an accurate preoperative scoring system to predict the probability of using laparoscopic surgery in radical nephrectomy and thrombectomy. The clinical data of 123 patients with renal cell carcinoma with renal vein or inferior vena cava tumour thrombus admitted to the Department of Urology at Peking University Third Hospital between January 2015 and May 2018 were retrospectively analysed. Univariate and multivariate regression analyses were used to create the scoring system with an emphasis on the area improvement under the receiver operating characteristic curve. A total of 58 (47.2%) patients underwent complete laparoscopic surgery, 56 (45.5%) underwent complete open surgery and 9 (7.3%) underwent laparoscopic conversion to open surgery. The final multivariable model included the following three factors: Clinical node stage (P=0.030), Mayo classification (P<0.001) and tumour diameter (P=0.001). These three variables were then used to construct the score system named Peking University Third Hospital Laparoscopic Probability (PKUTHLP), which ranges from 0–5. The proportion of patients undergoing laparoscopic surgery for each level of the PKUTHLP score were as follows: 0 (n=20), 100%; 1 (n=34), 67.6%; 2 (n=21), 33.3%; 3 (n=21), 19.0%; 4 (n=23), 17.4%; and 5 (n=4), 0.0%. Overall, the PKUTHLP score accurately predicted the probability of using laparoscopic surgery in radical nephrectomy and thrombectomy; however, prospective validation of the PKUTHLP scoring system is required. [ABSTRACT FROM AUTHOR]

Aim: Robotic assisted laparoscopic partial nephrectomy (RALPN) is promising option for RCC treatment with favorable outcomes. In this present study we aimed to compare the incidence of (AKI) acute kidney injury measured by AKIN (Acute Kidney Injury Network) criteria between open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN) and RALPN procedures with zero ischemia periods. Material and Methods: The medical records of 88 patients with renal mass who underwent OPN, LPN and RALPN at our institution [24 female/64 male; median age of 55 (IQR: 46–65) years] were evaluated retrospectively. AKI was defined by AKIN criteria. Results: Twenty-six patients underwent OPN, 32 LPN and 30 patients RALPN. Mean preoperative creatinine was 0.92 ±0.43 mg/dl, mean hemoglobin level was 14.0±1.9 g/dl. Total of 19 patients developed AKI according to the AKIN criteria, all of those had stage 1 AKI, 10 (53%) in OPN, 7 (3%) in LPN and 2 (11%) in RALPN group (p=0,004). Multivariate regression analysis adjusted by age and gender showed that operation time per minute [1.02 (CI 95%, 1.00, 1.04) p=0.04], fluid administered as ml/kg/hour [1.003 (CI 95%, 1.000, 1.006) p=0.04], red blood cell transfused as unit [1.27 (CI 95%, 1.07, 1.52) p=0.006] and operation type as RALPN surgery versus OPN and LPN [0.11 (CI 95%, 0.02, 0.58) p=0.01] were significantly associated with development ıf AKI. Conclusion: Robot assisted partial nephrectomy is more favorable approach compared to OPN and LPN with lower operation time and lower hemoglobin loss. [ABSTRACT FROM AUTHOR]

Objectives: To compare perioperative, oncological and functional outcomes of Laparoscopic Transperitoneal Partial Nephrectomy (LTPN) and Retroperitoneal Laparoscopic Partial Nephrectomy (LRPN) for posterior, cT1 renal masses (RMs). Materials and methods: Databases of two urologic institutions applying different laparoscopic surgical approaches on posterior cT1 RMs between June 2016 and November 2018 were retrospectively evaluated. Data on patient demographics, perioperative data and tumor histology were collected and further analyzed statistically. Results: Each group consisted of 15 patients. Baseline characteristics were comparable in each group. When compared to LTPN, LRPN was associated with significantly shorter operative time (OT) (115 min versus 199 min, p < 0.05). No significant differences were detected in the other outcomes. Conclusions: LRPN is associated with a significantly shorter OT compared to LTPN for posterior cT1 RMs. Both surgical approaches are safe, feasible and credible, demonstrating optimal results. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate surgical outcomes in a series of laparoscopic retroperitoneal partial nephrectomies. Methods: A total of 147 patients who underwent laparoscopic retroperitoneal partial nephrectomy by a single surgeon were evaluated. Pre-operative parameters (body mass index, ASA score, tumour size, cTNM stage, PADUA score risk, surgeon experience) and intraoperative and postoperative outcomes (operative mean time, warm ischemia time, blood loss, transfusion rate, length of hospitalization, and margin-ischaemia-complications [MIC] success rate) were considered. Results: For 134 patients (91.1%) the success of the treatment, defined by a MIC = 3, was obtained. When the statistical significance of each of the independent variables was tested, surgeon’s experience added statistical significance to the prediction of operative time (p = 0.000), warm ischemia time (p = 0.000) and blood loss (p = 0.000); tumour size (p = 0.046) to the prediction MIC (p = 0.010), operative time (p = 0.000), warm ischemia time (p = 0.003) and blood loss (p = 0.010); ASA score to the length of hospitalization (p = 0.009). Conclusions: Laparoscopic retroperitoneal partial nephrectomy represents an adequate and safe technique for the treatment of T1 renal cancer. Optimal MIC success rate can be achieved, although intraoperative outcomes tend to be related to the learning curve even in a very experienced laparoscopic surgeon. Length of hospitalization depends on general health condition of patients. [ABSTRACT FROM AUTHOR]

Background: Enhanced recovery after surgery (ERAS) protocol has been identified to be beneficial in the amount of operations such as gastrointestinal surgery. However, the efficacy and safety in robot-assisted laparoscopic prostatectomy/laparoscopic radical prostatectomy (RALP/LRP) still remain controversial. Method: We searched randomized controlled trials and retrospective cohort studies comparing ERAS versus conventional care for prostate cancer patients who have undergone RALP/LRP. ERAS-related data were extracted, and quality of included studies was assessed using the Newcastle-Ottawa quality assessment scale and the Jadad scale. Result: As a result, seven trials containing 784 prostate cancer patients were included. ERAS was observed to be significantly associated with shorter length of hospital stay (SMD − 2.55, 95%CI − 3.32 to − 1.78, P < 0.05), shorter time to flatus (SMD − 1.55, 95%CI − 2.26 to − 0.84, P < 0.05), shorter time to ambulate (SMD − 6.50, 95%CI − 10.91 to − 2.09, P < 0.05), shorter time to defecate (SMD − 2.80, 95%CI − 4.56 to − 1.04, P < 0.05), and shorter time to remove drainage tube (SMD − 2.72, 95%CI − 5.31 to − 0.12, P < 0.05). Otherwise, no significant difference was reported in other measurements. Conclusions: In conclusion, ERAS can reduce length of hospital stay, time to flatus, time to defecate, time to ambulate, and time to remove drainage tube in prostate cancer patients who have undergone RALP/LRP compared with conventional care. [ABSTRACT FROM AUTHOR]

Objectives: To obtain the most accurate assessment of the risks and benefits of selective clamping in robot‐assisted partial nephrectomy (RAPN) we evaluated outcomes of this technique vs those of full clamping in patients with a solitary kidney undergoing RAPN. Patients and Methods: Data from institutional review board‐approved retrospective and prospective databases from 2006 to 2019 at multiple institutions with sharing agreements were evaluated. Patients with a solitary kidney were identified and stratified based on whether selective or full renal artery clamping was performed. Both groups were analysed with regard to demographics, risk factors, intra‐operative complications, and postoperative outcomes using chi‐squared tests, Fisher's exact tests, t‐tests and Mann–Whitney U‐tests. Results: Our initial cohort consisted of 4112 patients, of whom 72 had undergone RAPN in a solitary kidney (51 with full clamping and 21 with selective clamping). There were no significant differences in demographics, tumour size, baseline estimated glomerular filtration rate (eGFR), or warm ischaemia time (WIT) between the groups (Table 1). Intra‐operative outcomes, including estimated blood loss, operating time, and intra‐operative complications were similar in the two groups. Short‐ and long‐term postoperative percentage change in eGFR, frequency of acute kidney injury (AKI), and frequency of de novo chronic kidney disease (CKD) were also not significantly different between the two techniques. Conclusion: In a large cohort of patients with solitary kidney undergoing RAPN, selective clamping resulted in similar intra‐operative and postoperative outcomes compared to full clamping and conferred no additional risk of harm. However, selective clamping did not appear to provide any functional advantage over full clamping as there was no difference observed in the frequency of AKI, CKD or change in eGFR. Short WIT in both groups (<15 min) may have prevented identification of benefits in the selective clamping group; a similar study analysing cases with longer WIT may elucidate any beneficial effects of selective clamping. [ABSTRACT FROM AUTHOR]

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Purpose: The aim of the present study is to investigate the impact of the near-infrared (NIRF) technology with indocyanine green (ICG) in robotic urologic surgery by performing a systematic literature review and to provide evidence-based expert recommendations on best practices in this field. Methods: All English language publications on NIRF/ICG-guided robotic urologic procedures were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to evaluate PubMed®, Scopus® and Web of Science™ databases (up to April 2019). Experts in the field provided detailed pictures and intraoperative video-clips of different NIRF/ICG-guided robotic surgeries with recommendations for each procedure. A unique QRcode was generated and linked to each underlying video-clip. This new exclusive feature makes the present the first "dynamic paper" that merges text and figure description with their own video providing readers an innovative, immersive, high-quality and user-friendly experience. Results: Our electronic search identified a total of 576 papers. Of these, 36 studies included in the present systematic review reporting the use of NIRF/ICG in robotic partial nephrectomy (n = 13), robotic radical prostatectomy and lymphadenectomy (n = 7), robotic ureteral re-implantation and reconstruction (n = 5), robotic adrenalectomy (n = 4), robotic radical cystectomy (n = 3), penectomy and robotic inguinal lymphadenectomy (n = 2), robotic simple prostatectomy (n = 1), robotic kidney transplantation (n = 1) and robotic sacrocolpopexy (n = 1). Conclusion: NIRF/ICG technology has now emerged as a safe, feasible and useful tool that may facilitate urologic robotic surgery. It has been shown to improve the identification of key anatomical landmarks and pathological structures for oncological and non-oncological procedures. Level of evidence is predominantly low. Larger series with longer follow-up are needed, especially in assessing the quality of the nodal dissection and the feasibility of the identification of sentinel nodes and the impact of these novel technologies on long-term oncological and functional outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The role of robotic surgery in radical nephrectomy is controversial with detractors claiming no benefit over standard or hand-assisted laparoscopic nephrectomy with increased cost. We routinely offered robotic radical nephrectomy (RRN) for all renal masses not amenable to partial nephrectomy regardless of size or complexity and evaluated the success rate for massive tumors (≥15 cm) to assess whether RRN may be justifiable in such cases. Methods: We reviewed our prospective database of RRN by an experienced robotic surgeon (R.A.). All patients with massive renal tumors (≥15 cm) were included without exclusions, and no nephrectomy procedures were performed laparoscopically or open approach by the surgeon such that there was no selection bias. Results: Fifteen patients had tumors of 15-30 cm (mean 19 cm) and underwent RRN without exclusions. Mean age was 62 years (35-78 years) with mean body mass index of 31 kg/m2 (21-41 kg/m2). One required partial liver resection, one splenectomy and distal pancreatectomy, one had a large caval thrombus, one a large renal vein thrombus, and one invaded psoas muscle, but all were completed robotically without conversions and no transfusions, with mean operative time of 235 minutes (72-337 minutes). Midline extraction incisions were used and no patients required intravenous narcotics. Twelve were discharged on the first postoperative day (80%) with median length of stay of 1 day and no 90-day readmissions. The only complication was temporary renal insufficiency in 1 patient. Conclusions: RRN for massive renal tumors (>15 cm) is feasible, and can be safely performed with excellent outcomes even in the setting of locally advanced malignancies. [ABSTRACT FROM AUTHOR]

Objective: To compare and analyze surgical and functional outcomes of transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN) in localized renal tumors, including ≥4 cm renal masses. Methods: Of 566 consecutive patients who underwent robotic partial nephrectomy by a single surgeon from December 2008 through July 2017, records for 523 patients who were preoperatively and 1 year postoperatively evaluated were analyzed for estimated glomerular filtration rate (eGFR). Primary endpoint was a comparison of Pentafecta criteria (negative surgical margin, no 30-day complications, warm ischemic time [WIT] ≤25 minutes, return of eGFR to >90% from baseline, and no upstaging of chronic kidney disease) between TRPN and RRPN. Secondary endpoint was finding predictors for Pentafecta achievement. Results: In all 523 patients, these Pentafecta criteria were lower for RRPN than TRPN: operation time (p < 0.001), WIT (p = 0.008), and estimated blood loss (p = 0.003). In patients with ≥4 cm renal tumors, only operation time was faster in RRPN than TRPN (p = 0.032). RRPN demonstrated more eGFR decrease in all patients (p = 0.006) and patients with ≥4 cm renal tumors (p = 0.008). Pentafecta achievements, complications, and recurrences were not significantly different between TRPN and RRPN in all patients and patients with ≥4 cm renal tumors. Multivariable analysis revealed baseline hemoglobin (p = 0.013) and tumor size (p < 0.001) were predictive for Pentafecta achievement. Conclusions: Pentafecta achievement was similar for TRPN and RRPN. Baseline hemoglobin and tumor size were predictors of Pentafecta achievement. RRPN was properly performed for anterolateral renal tumor. [ABSTRACT FROM AUTHOR]

Purpose: Urothelial carcinoma with squamous differentiation (UCSD) is the most common histologic variant in bladder cancer (BCa). Previously, some studies have linked the presence of UCSD with the risk of worse survival outcomes in BCa patients. However, such association is still controversial. In this study, we performed a meta-analysis to clarify the clinicopathological characteristics and to further investigate the prognostic value of UCSD in BCa. Methods: A systematic literature search was performed in electronic databases including PubMed, Embase, Chinese National Knowledge Infrastructure and Wanfang Data until October 2018. Subgroup analyses were performed according to different treatments and study outcomes. Results: Total of 13,284 patients were enrolled in 19 studies which were included in this meta-analysis. The percentage of female patients with UCSD was significantly higher than those with pure urothelial carcinoma. UCSD was correlated with tumor stage T3/T4, tumor grade 3, positive surgical margin, and lymph node involvement. Moreover, the recurrence rate was higher in patients with UCSD after surgery. UCSD was associated with poorer disease-free survival (DFS). No significant difference of cancer-specific survival (CSS) or overall survival (OS) was found on multivariable analysis between the two groups. Conclusions: Our study demonstrated that UCSD in BCa was associated not only with unfavorable clinicopathological features, but also with high risk of recurrence and poorer prognosis for DFS. However, UCSD is not independently significant for CSS and OS. Well-designed randomized study with larger sample size is warranted to verify the findings and to further explore the role of UCSD in BCa. [ABSTRACT FROM AUTHOR]

Background: A 68-year-old man died of cerebral arterial embolism 6 days after transrectal prostate biopsy with a single p.o. dose of trimethoprim sulfamethoxazole (TMP-SMX) as prophylaxis. The case precipitated analysis of local antibiotic resistance and complication rates. Materials and methods: Data on E. coli resistance from Oslo University Hospital and national data on hospitalizations and mortality after biopsy were retrieved from local microbiology files and the Norwegian Patient Registry (NPR) 2011–2017. Results: Urine E. coli resistance against TMP-SMX increased from 35% in 2013 to more than 60% in 2015. For ciprofloxacin, the resistance increased from 15% in 2013 to about 45% in 2016. The highest annual E. coli resistance in blood cultures for TMP-SMX and ciprofloxacin was 37% and 28%, respectively. 10% of patients were hospitalized with a diagnosis of infection within the first 60 days after biopsy and there was a relative increase in mortality rate of 261% within the first 30 days. Due to the severity of the figures, the story and the NPR data were published in Norway's leading newspaper and were succeeded by a series of chronicles and commentaries. Conclusions: Several critical points of the biopsy procedure were not performed according to current standards. We believe that the patient might have died of septic embolism after biopsy. As a result of the findings and the debate, local practice was changed from transrectal to transperineal prostate biopsies. [ABSTRACT FROM AUTHOR]

Antibiotic resistance is the most challenging clinical and public health problem. Despite of living in the era of novel technologies in biomedical research, many of untreatable infectious diseases are ranked as the main causes of human death worldwide. Increased antibiotic use in human and use in animal production are the two major causes of emergence of resistant bacteria in hospitals, human communities, and also animal farms. Current body of evidences is indicating that major factors that led to existing crisis on antibiotics worldwide are poor educational programs on hygiene and health, inappropriate prescription in addition to the overprescription in clinical settings (mainly in developing countries with easier access to the antibiotics) and lack of accurate diagnostic tools in laboratories in order to control the emergence of antibiotics against widely used drugs in community. It sounds using the antibodies against problematic bacteria in farms has more benefits than treating them with susceptible antibiotics. As best strategy, we pointed that the crisis of antibiotic resistance may be solved when all contributors be acknowledged to their responsibilities and duties to minimize this global problem threatening the human health. China and the USA as the two main antibiotics user in industrial scale should have taken new policy in meat industry. Currently, antibiotic resistance presents a growing health threat worldwide being the cause of many nosocomial and often deadly infections. [ABSTRACT FROM AUTHOR]

Objective: Retrograde intrarenal surgery (RIRS) is a minimally invasive and relatively new method of treatment for kidney stones. We aimed to identify the factors that cause stent migration in patients who have undergone RIRS to treat kidney stones. Materials and Methods: Four hundred and twenty-eight patients who underwent RIRS to treat kidney stones that were less than 2 cm in size and had JJ stents inserted intraoperatively between December 2013 and December 2017 were included in this study. For each patient, demographic data and, if present, JJ stent migration direction and postoperative complications were recorded. Twenty-eight patients who experienced JJ stent migration (group 1) and 400 patients who did not experience the migration (group 2) were compared. Results: Postoperative complications developed in a total of 39 (9.1%) patients. Seventeen complications were evaluated as minor (Clavien 1-2) and 22 (5.1%) were evaluated as major. Almost all of the major complications (n=21) were found to be associated with JJ stent migration. Urosepsis was detected in only one patient (Clavien 4). The mean ages in groups 1 and 2 were 45.4±17.3 years and 44.3±15.1 years, respectively. The mean stone size in group 1 was 16.9±3.0 mm, whereas it was 14.2±5.3 mm in group 2 (p=0.031). A comparison of both the groups showed that the likelihood of an occurrence of JJ stent migration increased significantly with the degree of hydronephrosis (p<0.001). Conclusion: JJ stent migration after RIRS increases the rate of major complications. An association was detected between JJ stent migration and an increase in stone size and the degree of hydronephrosis. [ABSTRACT FROM AUTHOR]

To prospectively evaluate outcomes of robotic-assisted partial nephrectomy (RAPN) following elimination of surgical drains. 100 consecutive drainless RAPN performed by a single surgeon were analyzed following a previously published quantitative assessment of drain creatinine/serum creatinine ratios. This cohort was compared to 100 preceding RAPN with drains. Variables analyzed included pre-operative patient/tumor characteristics and post-operative outcomes including post-operative estimated glomerular filtration rate (eGFR), length of hospital stay (LOS), and complications. There was no significant difference in median patient age, sex, body mass index, ASA score, or pre-operative eGFR between the two groups. The preceding 100 patients with drains did have larger median renal size (3.5 vs 2.6 cm, p < 0.001), higher median RENAL scores (9 vs 8, p < 0.001), and longer warm ischemia time (21 vs 18 min, p = 0.004). Patients without drains had shorter median LOS (2.0 days vs 3.0 days, p < 0.001), fewer Grade III or higher post-operative complications (4% vs 10%, p = 0.007), and no difference in 1 month percent change in eGFR (− 13% vs − 11%, p = 0.84). After adjusting for confounding variables there was no difference in LOS (OR 1.50, p = 0.31), Grade III–V complications (OR 1.49, p = 0.63), or 1 month percent change in eGFR (OR 2.3, p = 0.41) between the two groups. One patient in the drainless group required a post-operative drain for a urine leak diagnosed 10 days following RAPN. Omission of drains is safe in RAPN and does not appear to offer a clinical advantage. [ABSTRACT FROM AUTHOR]

The reports on the performance of robotic surgery in patients with dwarfism are anecdotal; anesthesiological issues and a challenging anatomy are the main factors that lead most of surgeons to prefer a more traditional approach. We present a case of bilateral robotic partial nephrectomy in a patient affected by achondroplastic dwarfism and aim to evaluate risks and issues in this type of surgery. [ABSTRACT FROM AUTHOR]

Objective: To compare the results of robotic partial nephrectomy (RPN) and laparoscopic partial nephrectomy (LPN) operations and to determine whether they have any superiority to each other in terms of oncological and functional outcomes. Materials and Methods: The data of patients who underwent partial nephrectomy due to renal tumor in our clinic were evaluated retrospectively. The data included demographic information, operative technique, tumor size, operative time, duration of warm ischemia, amount of intraoperative bleeding, length of hospital stay and complications. Results: A total of 60 patients were included in the study. There was no significant difference between age (52.5±13.3 years vs 50.1±12.4 years, p=0.48), body mass index (26.9±3.7 vs 27.3±3.3 kg/m², p=0.69) and tumor size (3.2±1.4 cm vs 3.4±1.2 cm, p=0.79) of patients who underwent LPN and RPN. The mean operative time (194.5±44.6 min vs 203.3±22.2 min, p<0.001) and length of hospitalization (5±1.4 days vs 6.2±2.1 days, p=0.009) were significantly shorter in the RPN group. Although intraoperative bleeding was less in RPN patients, it was not statistically significant (p=0.065). Similarly, the duration of warm ischemia was lower in RPN patients than in LPN patients, but it was not statistically significant (14.3±7.8 min vs 16.3±7.3 min, p=0.298). Conclusion: RPN and LPN, which are minimally invasive surgical treatment options, can be used safely in the treatment of kidney tumors. RPN can be recommended to patients for early return to daily life. [ABSTRACT FROM AUTHOR]

We present a 28 year-old patient with insidental intramural stone covered by bladder mass. The pathology was rarely seen cystitis glandularis with intestinal metaplasia. During cystoscopy, stone was not seen, we resected the mass than stone was appeared in buried into the wall and removed from the bladder wall. The stone was fragmented with holmium laser. The pathology of the mass was cystitis glandularis with intestinal metaplasia whish is rarely seen and may be malign by the time. We followed up the patient with cystoscopy every 3 months and no recurrens was detected. [ABSTRACT FROM AUTHOR]