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Plant-based diets have grown in popularity owing to multiple health and environmental benefits. Some evidence suggests that plant-based diets are associated with benefits for urological health. In genitourinary oncology, most research has focused on prostate cancer. Clinical trial results suggest a favourable influence of healthy lifestyle modifications including plant-based diets before and after prostate cancer treatment. Epidemiological evidence shows that a diet higher in plant-based and lower in animal-based food is associated with a lower risk of aggressive prostate cancer and better quality-of-life scores than a diet with less plant-based and more animal-based food. Studies on bladder and kidney cancer are scarce, but limited data suggest that vegetarian or plant-forward dietary patterns (increased consumption of fruits and vegetables and minimizing meat) are associated with a lower risk of development of these cancers than dietary patterns with fewer fruits and vegetables and more meat. With respect to benign urological conditions, epidemiological studies suggest that plant-based dietary patterns are associated with a lower risk of benign prostatic hyperplasia and urinary tract infections than non-plant-based dietary patterns. Compared with diets high in animal-based foods and low in plant-based foods, a substantial body of epidemiological evidence also suggests that increased consumption of healthy plant-based food is associated with a lower risk of erectile dysfunction. Plant-based dietary patterns that are high in fruits and vegetables with normal calcium intake, while limiting animal protein and salt, are associated with a lower risk of kidney stone development than dietary patterns that do not follow these parameters. Overall, increasing consumption of plant-based foods and reducing intake of animal-based foods has favourable associations with multiple urological conditions., (© 2024. Springer Nature Limited.)

Introduction: Kidney stones are common and morbid conditions in the general population with a rising incidence globally. Previous studies show substantial limitations of online sources of information regarding prevention and treatment. The objective of this study was to examine the quality of information on kidney stones from artificial intelligence (AI) chatbots. Methods: The most common online searches about kidney stones from Google Trends and headers from the National Institute of Diabetes and Digestive and Kidney Diseases website were used as inputs to four AI chatbots (ChatGPT version 3.5, Perplexity, Chat Sonic, and Bing AI). Validated instruments were used to assess the quality (DISCERN instrument from 1 low to 5 high), understandability, and actionability (PEMAT, from 0% to 100%) of the chatbot outputs. In addition, we examined the reading level of the information and whether there was misinformation compared with guidelines (5 point Likert scale). Results: AI chatbots generally provided high-quality consumer health information (median DISCERN 4 out of 5) and did not include misinformation (median 1 out of 5). The median understandability was moderate (median 69.6%), and actionability was moderate to poor (median 40%). Responses were presented at an advanced reading level (11th grade; median Flesch-Kincaid score 11.3). Conclusions: AI chatbots provide generally accurate information on kidney stones and lack misinformation; however, it is not easily actionable and is presented above the recommended reading level for consumer health information.

Background: Plant-based diets are increasingly popular and have many well-established benefits for health and environmental sustainability. Our objective was to perform a systematic review of plant-based diets and prostate cancer., Methods: We performed a systematic database and citation search in February 2022. Studies were included if they reported primary data on plant-based dietary patterns (i.e., vegan, vegetarian, plant-based) and incidence among at-risk men for prostate cancer, or oncologic, general health/nutrition, or quality of life outcomes among patients with prostate cancer or caregivers., Results: A total of 32 publications were eligible for the qualitative synthesis, representing 5 interventional and 11 observational studies. Interventional studies primarily focused on lifestyle modification including plant-based diets for men on active surveillance for localized prostate cancer or with biochemical recurrence after treatment, showing improvements in short-term oncologic outcomes alongside improvements in general health and nutrition. Observational studies primarily focused on prostate cancer risk, showing either protective or null associations for plant-based dietary patterns. Studies of the vegan diet consistently showed favorable associations with risk and/or outcomes. Gaps in the current literature include impact for long-term disease-specific outcomes., Conclusions: Interventional studies showed generally favorable results of lifestyle modifications incorporating a plant-based diet with prostate cancer outcomes as well as improvements in nutrition and general health. Observational studies demonstrated either a lower risk of prostate cancer or no significant difference. These results are encouraging in light of the many benefits of plant-based diets for overall health, as well as environmental sustainability and animal welfare., (© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Objective: Patients with kidney stones are counseled to eat a diet low in animal protein, sodium, and oxalate and rich in fruits and vegetables, with a modest amount of calcium, usually from dairy products. Restriction of sodium, potassium, and oxalate may also be recommended in patients with chronic kidney disease. Recently, plant-based diets have gained popularity owing to health, environmental, and animal welfare considerations. Our objective was to compare concentrations of ingredients important for kidney stones and chronic kidney disease in popular brands of milk alternatives., Design and Methods: Sodium, calcium, and potassium contents were obtained from nutrition labels. The oxalate content was measured by ion chromatography coupled with mass spectrometry., Results: The calcium content is highest in macadamia followed by soy, almond, rice, and dairy milk; it is lowest in cashew, hazelnut, and coconut milk. Almond milk has the highest oxalate concentration, followed by cashew, hazelnut, and soy. Coconut and flax milk have undetectable oxalate levels; coconut milk also has comparatively low sodium, calcium, and potassium, while flax milk has the most sodium. Overall, oat milk has the most similar parameters to dairy milk (moderate calcium, potassium and sodium with low oxalate). Rice, macadamia, and soy milk also have similar parameters to dairy milk., Conclusion: As consumption of plant-based dairy substitutes increases, it is important for healthcare providers and patients with renal conditions to be aware of their nutritional composition. Oat, macadamia, rice, and soy milk compare favorably in terms of kidney stone risk factors with dairy milk, whereas almond and cashew milk have more potential stone risk factors. Coconut milk may be a favorable dairy substitute for patients with chronic kidney disease based on low potassium, sodium, and oxalate. Further study is warranted to determine the effect of plant-based milk alternatives on urine chemistry., (Copyright © 2021 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Prior to the COVID-19 pandemic, urology was one of the specialties with the lowest rates of telemedicine and videoconferencing use. Common barriers to the implementation of telemedicine included a lack of technological literacy, concerns with reimbursement, and resistance to changes in the workplace. In response to the COVID-19 pandemic declared in March 2020, the delivery of urological services globally has quickly shifted to telemedicine to account for the mass clinical, procedural, and operative cancellations, inadequate personal protective equipment, and shortage of personnel., Objective: The aim of this study was to investigate current telemedicine usage by urologists, urologists' perceptions on the necessity of in-person clinic appointments, the usability of telemedicine, and the current barriers to its implementation., Methods: We conducted a global, cross-sectional, web-based survey to investigate the use of telemedicine before and after the COVID-19 pandemic. Urologists' perceived usability of telemedicine was assessed using a modified Delphi approach to create questions based on a modified version of the validated Telehealth Usability Questionnaire (TUQ). For the purposes of this study, telemedicine was defined as video calls only., Results: A total of 620 urologists from 58 different countries and 6 continents participated in the survey. Prior to COVID-19, 15.8% (n=98) of urologists surveyed were using telemedicine in their clinical practices; during the pandemic, that proportion increased to 46.1% (n=283). Of the urologists without telemedicine experience, interest in telemedicine usage increased from 43.7% (n=139) to 80.8% (n=257) during the COVID-19 pandemic. Among urologists that used telemedicine during the pandemic, 80.9% (n=244) were interested in continuing to use it in their practice. The three most commonly used platforms were Zoom, Doxy.me, and Epic, and the top three barriers to implementing telemedicine were patients' lack of technological comprehension, patients' lack of access to the required technology, and reimbursement concerns., Conclusions: This is the first study to quantify the use, usability, and pervading interest in telemedicine among urologists during the COVID-19 pandemic. In the face of this pandemic, urologists' usage of telemedicine nearly tripled, demonstrating their ability to adopt and adapt telemedicine into their practices, but barriers involving the technology itself are still preventing many from utilizing it despite increasing interest., (©Justin M Dubin, W Austin Wyant, Navin C Balaji, William LK Ong, Reda H Kettache, Malik Haffaf, Skander Zouari, Diego Santillan, Ana Maria Autrán Gómez, Hossein Sadeghi-Nejad, Stacy Loeb, James F Borin, Juan Gomez Rivas, Jeremy Grummet, Ranjith Ramasamy, Jeremy Y C Teoh. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 05.11.2020.)

Standard of care for large or complex renal stones is percutaneous nephrolithotomy. Robotic pyelolithotomy, however, may be a feasible alternative, but limited data exist on its outcomes and complications. Our study objective was to describe the outcomes and peri-operative complications of robotic pyelolithotomy for complex renal calculi. We performed a retrospective analysis of robotic pyelolithotomy at our tertiary academic institution from 2015 to 2018. Demographics, stone clearance rates, complications, estimated blood loss, operative time, and length of stay were reported. 15 patients were included with a median age of 59 years (SD 15.3, 27-80) and BMI 25 kg/m 2 (SD 4.6, 20.9-35.7). Median follow-up was 4 months. Median stone size was 3 cm (SD 1.2 cm, 2-5 cm). Concomitant pyeloplasty was performed in 2 patients, complete stone clearance in 11 (73%) cases and 4 out of 5 (80%) with a solitary stone. Median operative time was 191.5 min (SD 64.8 min, 110-303 min), with no open conversion. Median EBL was 70 ml (SD 65 ml, 20-250 ml) and median length of stay was 1 day (SD 1 day, 1-5 days). Median change in creatinine and eGFR were - 0.02 mg/dl and + 3 ml/min/1.73 m 2 . There were no cases of sepsis or post-operative fever and only one case of transfusion. Robotic pyelolithotomy appears safe and effective. Ultimately, less bleeding, lower septicemia, renal parenchymal preservation, and favorable stone-free rates in a single procedure make this as an attractive option in the management of select patients with large renal stone disease.

Although there is a large amount of user-generated content about urological health issues on social media, much of this content has not been vetted for information accuracy. In this article, we review the literature on the quality and balance of information on urological health conditions on social networks. Across a wide range of benign and malignant urological conditions, studies show a substantial amount of commercial, biased and/or inaccurate information present on popular social networking sites. The healthcare community should take proactive steps to improve the quality of medical information on social networks. PATIENT SUMMARY: In this review, we examined the spread of misinformation about urological health conditions on social media. We found that a significant amount of the circulating information is commercial, biased or misinformative., (Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Objective: To determine whether patient-specific 3D printed renal tumor models change pre-operative planning decisions made by urological surgeons in preparation for complex renal mass surgical procedures., Materials and Methods: From our ongoing IRB approved study on renal neoplasms, ten renal mass cases were retrospectively selected based on Nephrometry Score greater than 5 (range 6-10). A 3D post-contrast fat-suppressed gradient-echo T1-weighted sequence was used to generate 3D printed models. The cases were evaluated by three experienced urologic oncology surgeons in a randomized fashion using (1) imaging data on PACS alone and (2) 3D printed model in addition to the imaging data. A questionnaire regarding surgical approach and planning was administered. The presumed pre-operative approaches with and without the model were compared. Any change between the presumed approaches and the actual surgical intervention was recorded., Results: There was a change in planned approach with the 3D printed model for all ten cases with the largest impact seen regarding decisions on transperitoneal or retroperitoneal approach and clamping, with changes seen in 30%-50% of cases. Mean parenchymal volume loss for the operated kidney was 21.4%. Volume losses >20% were associated with increased ischemia times and surgeons tended to report a different approach with the use of the 3D model compared to that with imaging alone in these cases. The 3D printed models helped increase confidence regarding the chosen operative procedure in all cases., Conclusions: Pre-operative physical 3D models created from MRI data may influence surgical planning for complex kidney cancer.

Objective: To generate a high-resolution map of periprostatic somatic nerves. Periprostatic nerves are at risk of injury during radical prostatectomy; this study aimed to establish the location of somatic nerves with respect to the prostate and the neurovascular bundle., Materials and Methods: Hemiprostates from patients in whom a wide local excision was performed were evaluated. Representative sections from the base, midzone, and apex of the prostate were stained with Masson's trichrome and antineuronal nitric oxide synthase antibodies, to identify myelinated and parasympathetic nerves, respectively. Somatic nerves were identified as neuronal nitric oxide synthase negative myelinated nerves. Stained slides were scanned (40× objective) for digital analysis. Location of nerves was described with reference to 6 equal sectors per hemiprostate., Results: Somatic nerves account for almost 5% of all nerve fibers in the periprostatic tissue. This study found a mean somatic nerve count of 5.83, 5.25, and 3.67 at the level of the prostate base, midzone, and apex, respectively. These nerves are most frequently located either anteriorly or in the region of the neurovascular bundle (posterolateral)., Conclusion: Somatic nerves in the periprostatic region are at risk of injury during radical prostatectomy. Further research is required to clarify their functional relevance., (Copyright © 2016. Published by Elsevier Inc.)

Smokers develop metastatic prostate cancer more frequently than nonsmokers, suggesting that a tobacco-derived factor is driving metastatic progression. To identify smoking-induced alterations in human prostate cancer, we analyzed gene and protein expression patterns in tumors collected from current, past, and never smokers. By this route, we elucidated a distinct pattern of molecular alterations characterized by an immune and inflammation signature in tumors from current smokers that were either attenuated or absent in past and never smokers. Specifically, this signature included elevated immunoglobulin expression by tumor-infiltrating B cells, NF-κB activation, and increased chemokine expression. In an alternate approach to characterize smoking-induced oncogenic alterations, we also explored the effects of nicotine in human prostate cancer cells and prostate cancer-prone TRAMP mice. These investigations showed that nicotine increased glutamine consumption and invasiveness of cancer cells in vitro and accelerated metastatic progression in tumor-bearing TRAMP mice. Overall, our findings suggest that nicotine is sufficient to induce a phenotype resembling the epidemiology of smoking-associated prostate cancer progression, illuminating a novel candidate driver underlying metastatic prostate cancer in current smokers., (©2015 American Association for Cancer Research.)

We describe flexible ureteroscopy-directed retrograde nephrostomy access using a puncture wire to achieve renal access. This is a natural extension of modern retrograde intrarenal surgical techniques and a modernization of the original Lawson technique for retrograde nephrostomy tract creation. In appropriately selected patients, this approach is safe and permits reduced radiation exposure. We believe this technique is easy to learn and may overcome the difficult learning curve of antegrade nephrostomy techniques faced by urologists who have not undergone subspecialty training in endourology.

We previously reported that miR-1 is among the most consistently down-regulated miRs in primary human prostate tumors. In this follow-up study, we further corroborated this finding in an independent data set and made the novel observation that miR-1 expression is further reduced in distant metastasis and is a candidate predictor of disease recurrence. Moreover, we performed in vitro experiments to explore the tumor suppressor function of miR-1. Cell-based assays showed that miR-1 is epigenetically silenced in human prostate cancer. Overexpression of miR-1 in these cells led to growth inhibition and down-regulation of genes in pathways regulating cell cycle progression, mitosis, DNA replication/repair and actin dynamics. This observation was further corroborated with protein expression analysis and 3'-UTR-based reporter assays, indicating that genes in these pathways are either direct or indirect targets of miR-1. A gene set enrichment analysis revealed that the miR-1-mediated tumor suppressor effects are globally similar to those of histone deacetylase inhibitors. Lastly, we obtained preliminary evidence that miR-1 alters the cellular organization of F-actin and inhibits tumor cell invasion and filipodia formation. In conclusion, our findings indicate that miR-1 acts as a tumor suppressor in prostate cancer by influencing multiple cancer-related processes and by inhibiting cell proliferation and motility.

Objective: • To describe six steps for haemostasis and collecting system closure ('six degrees of haemostasis') that are reproducible and that minimize the two most concerning complications of laparoscopic partial nephrectomy: haemorrhage and urine leakage., Methods: • A retrospective study of 23 consecutive laparoscopic partial nephrectomy cases performed by a single surgeon between 2005 and 2008 using the 'six degrees of haemostasis' was carried out., Results: • There were no cases of intraoperative, postoperative or delayed bleeding. • There were no cases of urine leakage., Conclusion: • The 'six degrees of haemostasis' technique for laparoscopic partial nephrectomy described in the present study provides a reliable and reproducible method to reassure the surgeon of haemostasis and provide a decreased risk of urine leakage., (© 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.)

OBJECTIVE To assess a prototype ureteric 'buoy' stent with a 10 F upper body tapering to a 3F tail, developed to potentially reduce stent-related irritative symptoms while providing an adequate mould for healing after endopyelotomy. MATERIALS AND METHODS Eighteen Yucatan minipigs had the stent placed either into the intact ureter (phase I) or after Acucise proximal endoureterotomy (phase II). Buoy stents were compared to 10/7 F endopyelotomy stents and to standard 7 F stents in phases I and II, respectively. The pigs were assessed for vesico-ureteric reflux, hydronephrosis and infection, before stent insertion and at harvest. Stents were weighed before and after placement and the removal force was measured. Pressure/flow studies, antegrade nephrostograms and specimens for histopathology from the renal pelvis, ureter and vesico-ureteric junction (VUJ) were obtained at harvest. RESULTS Thirteen minipigs survived the entire study. Ureteric flow with the stents in situ was better for buoy stents than for 10/7 F stents (P < 0.005). Ureteric flow after endoureterotomy and subsequent stent removal was similar for buoy stents and standard 7 F stents. None of the stents refluxed. There was no difference between stents in removal force, weight change or incidence of hydronephrosis. At 1 and 12 weeks, buoy stents tended to produce lower histopathological alteration scores than control stents, especially at the VUJ (phase I, 2.0 vs 3.9, P = 0.092; phase II, 0.6 vs 1.7, P = 0.18). CONCLUSIONS The novel buoy stents are easily placed and removed via the urethra. They can cause less VUJ inflammation than standard stents while allowing for adequate ureteric flow and healing after proximal endoureterotomy.

Introduction: Bowel injury is an uncommon, although potentially devastating, intraoperative laparoscopic complication. Questions have been raised about the possible use of a tissue adhesive to repair injured bowel. We compared glued repair and sutured repair of both large bowel (LB) and small bowel (SB) electrosurgical injuries in a rabbit model., Methods: Pneumoperitoneum was obtained, and four laparoscopic ports were placed in each of 48 New Zealand rabbits. The hook electrode was used in a specified manner to create an equal number of uniform full-thickness injuries to either the SB or the LB. Laparoscopic repair was performed with a 3-0 silk Lembert suture (LS), fibrin glue (FG), or BioGlue (BG), or repair was not performed (i.e., no repair, NR); the animals were monitored for 3 weeks. Adverse clinical outcomes and findings at laparotomy were recorded. Pathologic assessment included an objective scaled evaluation of the intensity of the inflammatory response and degree of healing., Results: In the SB injury group, deteriorating clinical condition necessitated early euthanasia in one animal repaired with FG, one animal repaired with BG, and two animals with NR. LS repair animals had no adverse clinical outcomes. The LB injury group had no adverse clinical outcomes regardless of the method of repair, including the control group. Of the animals that survived for 3 weeks, the animals repaired with BG had more intraabdominal adhesions (100%) than LS (33%), FG (55%), and NR (50%) (p = 0.001). The pathologic assessment revealed that BG induced a more intense inflammatory response (p < 0.05)., Conclusion: In the rabbit, suture repair of an electrosurgical SB injury appears to have improved outcomes when compared with a glued repair. In contrast, LB injury responded well to any form of treatment. The data suggest that suture is superior to biological glues when dealing with a laparoscopic electrosurgical bowel injury.

Purpose: Sealing the lymphatic vessels during abdominal and pelvic surgery is important to prevent the leakage of lymphatic fluid and its resultant sequelae. To our knowledge we compared for the first time the quality of lymphatic sealing by each of 4 commonly used laparoscopic dissection devices., Materials and Methods: A total of 12 domestic pigs were used to test dissecting devices, including monopolar scissors (Ethicon Endo-Surgery, Cincinnati, Ohio), Harmonic ACE Scalpel, LigaSure V, EnSeal and Trissector. A midline incision was made from mid sternum to umbilicus, the diaphragm was divided and the porcine thoracic duct was isolated. In all animals each device was used to seal an area of the duct and each seal was placed at least 2 cm from the prior seal. In group 1 the thoracic duct of 6 pigs was cannulated with a 5Fr catheter and the seal was subjected to burst pressure testing using a burst pressure measuring device (Cole-Parmer, Vernon Hills, Illinois). In the 6 pigs in group 2 each seal was immediately sent for histopathological evaluation. Specimens were given a score for the extent of cautery damage, including 0-none, 1-minimal, 2-moderate, 3-severe and 4-extreme., Results: A total of 64 seals were created, of which 35 were subjected to burst pressure testing. Mean size of the thoracic duct was 2.6 mm. No acute seal failures were observed with any bipolar device or the harmonic shears. However, 2 immediate failures (33%) were seen with monopolar scissors. Mean burst pressure for monopolar scissors, Harmonic ACE Scalpel, LigaSure V, EnSeal and Trissector was 46 (range 0 to 165), 540 (range 175 to 795), 258 (range 75 to 435), 453 (range 255 to 825) and 379 mm Hg (range 175 to 605), respectively (p <0.05). Trissector, Harmonic ACE Scalpel and EnSeal generated seals with significantly higher burst pressure than that of monopolar scissors (p <0.05). Histopathological evaluation revealed that LigaSure caused less thermal damage than Trissector and EnSeal (p <0.05)., Conclusions: Each device tested except monopolar scissors consistently produced a supraphysiological seal and should be suitable for sealing lymphatic vessels during laparoscopic surgery.

Background and Purpose: There have been several reports of rhabdomyolysis occurring after prolonged laparoscopic procedures in the flank position. Accordingly, we evaluated interface pressures between the skin and three commonly used operating room table surfaces. The aim of our study was to determine if pressure changes could be related to body mass index (BMI), sex, position, and/or the table surface material., Patients and Methods: Ten men and 10 women were grouped according to BMI <25 or >or=25, with five participants in each group. Subjects were placed in the left lateral decubitus position with the operating table flat, half flexed, fully flexed, half flexed with the kidney rest elevated, and fully flexed with the kidney rest elevated. Interface pressures were recorded, using an X-Sensor pressure sensing mat, for 5-minute periods in each of the described positions on each surface., Results: Sex and BMI were statistically significant predictors of increased pressures (P= 0.0042 and 0.0402, respectively). The parameter estimate for the difference between men and women was 4.63 mm Hg (P= 0.0002), and the difference for BMI >or= 25 compared with <25 was also significant (P < 0.0209). Full table flexion (50-degree) produced significantly higher pressures than both flat (P= 0.0001) and the half-flexed (25-degree) position (P < 0.0001). Positions with the kidney rest elevated were associated with significantly higher pressures than without elevation (P < 0.0001). With regard to the surface used, egg crate provided lower pressures than gel pads (P= 0.0117)., Conclusion: Women have significantly lower interface pressures when compared with men. BMI >or= 25 also increases interface pressures. The use of the kidney rest is associated with markedly increased pressure; use of a half-flexed position is preferable to a full-flexed position. These data have implications for patient positioning and identification of persons at risk for rhabdomyolysis during laparoscopic renal surgery.

Purpose: Laparoscopic partial/wedge nephrectomy, similar to laparoscopic radical prostatectomy, is a technically challenging procedure that is performed by a limited number of expert laparoscopic surgeons. The incorporation of a robotic surgical interface has dramatically increased the use of minimally invasive pelvic surgery such that robotic laparoscopic radical prostatectomy is commonly performed even by laparoscopically naïve surgeons. This analysis compares the outcomes of our initial experience with robot-assisted laparoscopic partial nephrectomy (RLPN) performed by an experienced open surgeon to that of standard laparoscopic partial nephrectomy (LPN) performed by two experienced laparoscopic surgeons., Patients and Methods: We reviewed the medical records of 11 consecutive patients who underwent 12 standard LPNs (EMM, RVC) (one patient had two unilateral tumors) and 10 consecutive patients (representing the first 11 of such robotic procedures performed at our institution) who underwent 11 RLPNs (one patient had bilateral tumors managed in an asynchronous manner) (DKO)., Results: The mean tumor size was 2.3 cm (range 1.7-6.2 cm) for LPN and 3.1 cm (range 2.5-4 cm) for RLPN. The mean total procedure time was 289.5 minutes (range 145-369 min) for LPN and 228.7 minutes (range 98-375 min) for RLPN (P=0.102). The mean estimated blood loss was 198 mL (range 75-500 mL) for LPN v 115 mL (25-300 mL) for RLPN (P=0.169). The mean warm ischemia time was 35.3 minutes (range 15-49 min) in the LPN group and 32.1 minutes (range 30-45 minutes) in the RLPN group (P=0.501)., Conclusions: Introducing a robotic interface for laparoscopic partial/wedge resection allowed a fellowship-trained urologic oncologist with limited reconstructive laparoscopic experience to achieve results comparable to those for laparoscopic partial/wedge resection performed by experienced laparoscopic surgeons. In this regard, the learning curve appears truncated, similar to that with robot-assisted laparoscopic prostatectomy.

Purpose of Review: Concurrent with the rise of laparoscopic radical nephrectomy as the gold standard for managing renal cell carcinoma, awareness has increased regarding the value of nephron-sparing surgery, even in the presence of a normal contralateral kidney. Therefore, whereas fewer radical nephrectomies will be performed for T1a tumors, there is a move towards handling more advanced pathology laparoscopically; that is, very large tumors, T3b disease, and limited lymph-node involvement. This review will highlight the long-term outcomes and recent developments in laparoscopic radical nephrectomy reported over the past year., Recent Findings: There were several papers reiterating the excellent long-term outcomes of laparoscopic radical nephrectomy in the form of retrospective comparisons with cohorts of patients undergoing open radical nephrectomy. None of these studies demonstrated any differences in 5-year cancer-specific or overall survival. Surgeons continue to expand upon the current technique and indications., Summary: Long-term studies repeatedly support the superiority of laparoscopic radical nephrectomy over open radical nephrectomy for the majority of renal cell cancers due to equivalent oncologic control, low morbidity and shorter convalescence time. Experienced surgeons are able to manage more advanced pathologies laparoscopically without compromising cancer control or patient safety.

Purpose: We compared healing after laparoscopic cystotomy using fibrin glue, sutures, or a combination to determine whether fibrin glue can obviate the need for sutures and whether there is any detriment when glue is used in the presence of sutures., Materials and Methods: In 24 Yorkshire pigs, a 3.5 cm vertical cystotomy was created laparoscopically and repaired as follows: Group 1--no closure; group 2--fibrin glue closure; group 3--suture repair; group 4--combined fibrin glue and suture repair. All animals had a Foley catheter for 1 week. In each group, three animals were harvested at 1 week (acute) and three animals were harvested at 6 weeks (chronic)., Results: Acute: Group 1--all pigs had an unhealed defect that leaked when evaluated by cystography. Groups 2, 3, 4--mean leak pressures were 80, 97, and 60 cm H(2)O (P = 0.36), respectively. Mean bladder capacity was not significantly different between groups. Chronic: No leakage seen on a cystogram at 1 week; at 6 weeks, bladders were filled at > or =95 to 100 cm H(2)O without leakage. Histologically, there was more inflammation in the acute group v chronic group pigs. In the acute group pigs repaired with glue or suture + glue, there was more inflammation and less epithelial continuity than in the suture alone group. At 6 weeks, there was no difference between groups., Conclusion: Fibrin glue provoked an intense inflammatory response that might have delayed healing acutely, resulting in a lower burst pressure in both scenarios in which it was used (i.e., alone or in combination with sutures). However, by 6 weeks, there did not seem to be any difference between groups either clinically or histopathologically.

Objectives: The processing of standard flexible cystoscopes is time-consuming and potentially hazardous to healthcare staff. We evaluated a novel flexible cystoscope system containing a disposable sheath, which obviates the need for chemical processing., Methods: A total of 100 patients undergoing office cystoscopy were randomized into a "sheath" or a control group (n = 50 for each group). Disposable Slide-On sheaths and the CST-2000 Flexible Cystoscope System were used in the former group. A standard 16F flexible cystoscope, manually cleaned and disinfected with Cidex OPA or Rapicide, was used in the control group and the preparation times were recorded. Questionnaires to assess cystoscope setup, handling, optical quality, and patient comfort were completed by the physician, nursing staff, and patients., Results: Data were available for 97 patients. The mean total time required for preparation of the cystoscopes was 10.7, 14.7, and 42.2 minutes for the sheath (n = 49), Rapicide (n = 21), and Cidex OPA (n = 27), respectively (P <0.01 for all comparisons). The control group scored better than the sheath group with regard to ease of cystoscope insertion (9.1 versus 7.7), cystoscope handling (8.8 versus 8.1), and irrigation setup (8.8 versus 8.2; all P < or = 0.01). No statistically significant difference was found between groups for procedure time, optical quality, or patient comfort, either during or after the procedure., Conclusions: The EndoSheath System can save 4 to 31 minutes of processing time while avoiding exposure to irritants found in conventional soaking methods. Although maneuvering of the sheathed cystoscope was slightly more difficult, the optical quality and patient comfort were similar to those of standard flexible cystoscopy.

Intraperitoneal bladder rupture usually is caused by blunt external trauma to a distended bladder. Although such injuries generally necessitate a formal laparotomy, advances in minimally invasive surgery have allowed successful laparoscopic repair. We describe our preoperative evaluation and laparoscopic technique in a case of isolated intraperitoneal bladder rupture secondary to trauma.

Background and Purpose: The effects of commonly used reprocessing methods on flexible ureteroscope longevity have never been examined. We prospectively studied the effects of Steris 1 sterilization and Cidex ortho-phthalaldehyde (OPA) high-level disinfection (HLD) on the image quality, physical structure, and deflective properties of two new flexible ureteroscopes., Materials and Methods: Two identical "out-of-the-box" Storz 11278AU1 flexible ureteroscopes (Karl Storz Endoscopy, Tuttlingen, Germany) were sterilized individually using the Steris 1 system (Steris Mentor, Ohio) or disinfected with Cidex OPA (Advanced Sterilization Products, J&J, Irvine, CA) for 100 trials followed by a crossover to the other method for another 100 trials over a period of 1 year. After every five trials, optical quality, angle of deflection, and fiber damage were analyzed in the laboratory. Throughout the study, neither of these ureteroscopes was used clinically., Results: After 100 trials, ureteroscope 1, which was sterilized initially in the Steris system, had a 12-mm tear on its shaft (noted after the 17th trial), 297 damaged fibers, and a 37% drop in resolution (loss of 3.75 lines/mm). There was no change in deflection from baseline. In contrast, after 100 cycles, ureteroscope 2, which was subjected to HLD with Cidex OPA, had no visible external damage, a 0% change in resolution, 10 damaged fibers, and no change in deflection. After the crossover, ureteroscope 2 developed a semilunar defect that obscured the endoscopic view, whereas there was no further significant damage to ureteroscope 1., Conclusion: After 100 cycles, the Steris 1 system rendered the flexible ureteroscope unusable, whereas HLD with Cidex OPA had minimal adverse impact.

Introduction: We previously reported the benefit of meticulous apical dissection in reducing positive surgical margins (SM+) at the apex. Herein we assess whether a more aggressive urethral transection will reduce positive margins and whether reduced urethral length affects return to continence., Technical Considerations: All data were collected prospectively. A positive surgical margin was defined by the presence of cancer cells with ink on them. Continence, defined as no pads, was assessed with validated Expanded Prostate Cancer Instrument Composite questionnaires. Evaluation of 200 consecutive cases (group 1) revealed that 75% of surgical margins occurred at the apex. Concomitantly we assessed visual cues for urethral length, which demonstrated that even patients with very short urethral stumps requiring perineal pressure during anastomosis had equivalent times to continence as those with long, accessible stumps. We altered the point of transection, distally, to include 3 to 6 mm more of striated external urethral sphincter. The SM+ rate and time to continence for the ensuing 200 cases (group 2) were tracked. The overall SM+ and apical SM+ rates were significantly reduced (SM+ 17.6% versus 7.5%, P = 0.003; and apical SM+ 13% versus 5.5%, P = 0.01). Kaplan-Meier times to continence curves were not significantly different., Conclusions: A more aggressive apical resection resulted in marked reduction in overall SM+ rates without measurable change in time to continence or overall continence.

A percutaneous approach to cryoablation of renal masses is not without a risk of complications. We describe a case in which selective, single lung intubation of an obese patient with an upper pole left renal mass allowed for percutaneous cryoablation with avoidance of pleural and pulmonary injury. We accomplished this by minimizing the ventilation-induced renal motion and collapsing the ipsilateral lung so that it remained out of harm's way.

Image-guided percutaneous nephrostomy tube placement can be a challenging procedure, particularly in a nondilated system or in the morbidly obese patient. Herein, we report the routine use of ureteroscopy-guided percutaneous renal access. With this method, rapid, accurate creation and dilation of the nephrostomy tract is assured in all patients regardless of body habitus or stone burden.

Background: We present initial data on the construct, content, and face validity of the LAPMentor (Simbionix), virtual reality laparoscopic surgical simulator., Study Design: Medical students (MS), residents and fellows (R/F), and experienced laparoscopic surgeons (ES), with < 30 laparoscopic cases per year (ES<30) and those with > 30 laparoscopic cases per year (ES>30), were tested on 9 basic skill tasks (SK) including manipulation of 0-degree and 30-degree cameras (SK1, SK2), eye-hand coordination (SK3), clipping (SK4), grasping and clipping (SK5), two-handed maneuvers (SK6), cutting (SK7), fulguration (SK8), and object-translocation (SK9)., Results: Mean MS (n=23), R/F (n=24), ES<30 (n=26), and ES>30 (n=30) ages were 26 years (range 21 to 32 years), 31 years (range 27 to 39 years), 49 years (range 31 to 70 years) and 47 years (range 34 to 69 years), respectively. In the lower level skill tasks (SK3, SK4, SK5, and SK6) the ES>30, ES<30, and R/F had similar scores, but were all substantially better than the MS scores. In the higher level skill tasks (SK7, SK8, and SK9), the ES>30 scores tended to be better than the R/F and ES<30, which were similar, and these, in turn, were markedly better than the MS. The ES>30 had notably higher SK8 scores than the R/F and ES<30, who had similar scores, and these had notably better scores than the MS., Conclusions: The noncamera skills (SK3 to 9) of the LAPMentor surgical simulator can distinguish between laparoscopically naive and ES. SK8 showed the highest level of construct validity, by accurately differentiating among the MS, R/F, ES<30 and ES>30.

Ureteral obstruction caused by extrinsic compression by a malignancy generally can be overcome initially with a ureteral stent. However, the long-term failure rate is high, usually necessitating placement of a nephrostomy tube. Herein, we present the initial case, in this country, of intractable ureteral obstruction managed successfully with the newly developed all-metal Resonance stent (Cook Ireland Ltd., Limerick, Ireland) constructed of MP35N alloy, a composite of nonmagnetic nickel-cobalt-chromium-molybdenum. The patient is a 64-year-old woman with metastatic breast cancer causing retroperitoneal fibrosis and ureteral obstruction diagnosed laparoscopically. The obstruction failed to respond to placement of a single 7F double-J stent and then of two 6F double-J stents in the left ureter. As a last resort, in order to avoid nephrostomy-tube placement, the 6F metal stent was placed; this provided unobstructed flow of urine, as documented on a subsequent Whitaker test and, most recently, on a renal scan, 4 months after initial stent placement.

Background and Purpose: Advances in electro-optics continue to improve the urologist's ability to perform minimally invasive procedures. While the development of flexible fiberoptic cystoscopes more than 20 years ago greatly impacted the practice of urology, distal-sensor digital technology may represent the next step in the evolution of endoscopy. We compared a new distal-sensor digital flexible cystoscope with two standard fiberoptic flexible cystoscopes., Materials and Methods: We evaluated the resolution, contrast, and color discrimination of a new ACMIICN distal-sensor digital cystoscope with >165,000 effective pixels in its clear aperture (viewing area), a new ACMI-ACN II fiberoptic cystoscope with <15,000 pixels in its clear aperture, and a Storz 1127 office fiberoptic cystoscope. Five subjects compared each cystoscope across 13 test parameters., Results: There was no difference in the performance of the two fiberoptic cystoscopes. The ICN cystoscope was statistically superior to one or both fiberoptic cystoscopes across 12 of the 13 tests, including color differentiation between shades of dark red (P < 0.05), contrast discrimination along a 15-step grayscale gradient (P < 0.001 compared with the 1127 fiberoptic cystoscope only), resolution at 10 mm (7.52 line pairs/mm [lp/mm] (ICN) nu 3.58 lp/mm for both fiberoptic cystoscopes; (P < 0.001), and clear resolution of a 1-mm target at a distance of 6.1 cm (ICN) nu 3.3 cm (1127) and 3.8 cm (ACN II) (P < 0.001)., Conclusions: The ICM distal-sensor all-digital cystoscope was clearly superior to two representative fiberoptic cystoscopes in vitro in terms of resolution, contrast discrimination, and red color differentiation. In-vivo performance remains to be assessed.

We describe using hemostatic gelatin matrix (FloSeal; Baxter Inc., Irvine, CA) to provide hemostasis of the tract after percutaneous nephrolithotomy, thereby obviating a nephrostomy tube. For patients who are rendered stone free, a 7F, 11.5-mm occlusion balloon catheter, passed retrograde, is used to occlude the collecting system at the level of entry of the 30F Amplatz sheath. FloSeal is then injected through the partially retracted Amplatz sheath while withdrawing the applicator and the sheath in tandem. The guidewire is withdrawn per urethra until its tip resides in the renal pelvis. A 36-cm, 7F tail stent is passed retrograde, and the skin is closed with cyanoacrylate adhesive (Ethicon, Somerville, NJ). A Foley catheter is placed, to be removed the next morning; the patient can be discharged on postoperative day 1. The ureteral stent is removed in 5 to 7 days as an outpatient procedure.

Background: Although somatostatin is recognized as an inhibitor of neuroendocrine cell secretion, its effect on cell proliferation has not been well defined. Generation of low acid and hypergastrinemia through irreversible H2-receptor blockade (loxtidine) in the African rodent mastomys results in gastric carcinoids (ECLomas) within 4 months. This study was undertaken to evaluate and characterize the precise somatostatin receptor (SSTR) subtype on the mastomys enterochromaffin-like (ECL) cell and to define its role in the regulation of ECL cell secretion and proliferation., Methods: A pure preparation (approximately 90%) of ECL cells was derived by a combination of pronase digestion and density gradient separation. We assessed the effect of somatostatin (10(-15) to 10(-7) mol/L) on gastrin-stimulated ECL cell histamine secretion and DNA synthesis (bromodeoxyuridine uptake). SSTR2 subtype was evaluated by reverse transcription-polymerase chain reaction (RT-PCR) using gene specific primers and mRNA isolated from normal and hypergastrinemia-induced ECLoma. The polymerase chain reaction product was confirmed by Southern analysis, subcloned, and sequenced., Results: Somatostatin inhibited both gastrin-stimulated histamine secretion (IC50, 5 x 10(-13) mol/L) and DNA synthesis (IC50, 10(-10) mol/L). SSTR2 was identified in the mastomys' brain, and both normal and tumor ECL cells and comparison of the brain and ECL cell SSTR2 nucleotide sequences revealed homology of 99%., Conclusions: The SSTR2 is expressed by the mastomys' ECL cell and ECLoma. Receptor activation inhibits both ECL cell secretory and proliferative functions.