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Purpose The main objective was to compare minor (Clavien I-II) and major (Clavien >= III) intra- and postoperative complications of living donor robotic assisted kidney transplantation (RAKT) in obese (>= 30 kg/m(2)BMI), overweight (< 30/ >= 25 kg/m(2)BMI) and non-overweight recipients (< 25 kg/m(2)BMI). Methods For the present retrospective study, we reviewed the multi-institutional ERUS-RAKT database to select consecutive living donor RAKT recipients. Functional outcomes, intra- and postoperative complications were compared between obese, overweight and non-overweight recipients. Results 169 living donor RAKTs were performed, by 10 surgeons, from July 2015 to September 2018 in the 8 European centers. 32 (18.9%) recipients were obese, 66 (39.1%) were overweight and 71 (42.0%) were non-overweight. Mean follow-up was 1.2 years. There were no major intra-operative complications in either study group. Conversion to open surgery occurred in 1 obese recipient, in 2 overweight recipients and no conversion occurred in non-overweight recipients (p = 0.3). Minor and major postoperative complications rates were similar in the 3 groups. At one-year of follow-up, median eGFR was similar in all groups [54 (45-60) versus 57 (46-70) versus 63 (49-78) ml/min/1.73 m(2)in obese, overweight and non-overweight recipient groups, respectively,p = 0.5]. Delayed graft function rate was similar in the 3 groups. Only the number of arteries was an independent predictive factor of suboptimal renal function at post-operative day 30 in the multivariate analysis. Conclusion RAKT in obese recipients is safe, compared to non-overweight recipients and yields very good function, when it performed at high-volume referral centers by highly trained transplant teams.

Introduction: RAKT from living donors (LD) is increasingly performedin selected centers with experience in robotic surgery and kidneytransplantation (KT). Of note, KT from LD using right-sided graft (RSG)is challenging due to the brevity of the right renal vein and has beenassociated with a higher riskof perioperative complications in selectedseries. In this scenario, RAKT may facilitate the performance ofvascular anastomoses in case of short renal vessels thanks to theadvantages of the robotic platform. However, the evidence on thesafety and feasibility of RAKT using RSGs is lacking. The aim of thisstudy is to compare the surgical andearly perioperative outcomes after RAKT from LD using right- vs. left-sided grafts in a large prospectivemulticenter cohort (ERUS-RAKT working group).

Introduction & Objectives: RAKT from living donors (LD) is increasingly performed in selected centers with experience in robotic surgery and kidney transplantation (KT). Of note, KT from LD using right-sided graft (RSG) is challenging due to the brevity of the right renal vein and has been associated with a higher risk of perioperative complications in selected series. In this scenario, RAKT may facilitate the performance of vascular anastomoses in case of short renal vessels thanks to the advantages of the robotic platform. However, the evidence on the safety and feasibility of RAKT using RSGs is lacking. The aim of this study is to compare the surgical and early perioperative outcomes after RAKT from LD using right- vs. left-sided grafts in a large prospective multicenter cohort (ERUS-RAKT working group).

Background Kidney transplantation using grafts with multiple vessels (GMVs) is technically demanding and may be associated with increased risk of complications or suboptimal graft function. To date, no studies have reported on robot-assisted kidney transplantation (RAKT) using GMVs. Objective To report our experience with RAKT using GMVs from living donors, focusing on technical feasibility and early postoperative outcomes. Design, setting, and participants We reviewed the multi-institutional, prospectively collected European Association of Urology (EAU) Robotic Urology Section (ERUS)-RAKT database to select consecutive patients undergoing RAKT from living donors using GMVs between July 2015 and January 2018. Patients undergoing RAKT using grafts with single vessels (GSVs) served as controls. In case of GMVs, ex vivo vascular reconstruction techniques were performed during bench surgery according to the case-specific anatomy. Intervention RAKT with regional hypothermia. Outcome measurements and statistical analysis Intraoperative outcomes and early (30 d) postoperative complications and functional results were the main study endpoints. Multivariable logistic regression analysis evaluated potential predictors of suboptimal renal function at 1 mo. Results and limitations Overall, 148 RAKTs were performed during the study period. Of these, 21/148 (14.2%) used GMVs; in all cases, single arterial and venous anastomoses could be performed after vascular reconstruction. Median anastomoses and rewarming times did not differ significantly between the GMV and GSV groups. Total and cold ischemia times were significantly higher in the GMV cohort (112 vs 88 min, p = 0.004 and 50 vs 34 min, p = 0.003, respectively). Overall complication rate and early functional outcomes were similar among the two groups. No major intra- or postoperative complications were recorded in the GMV cohort. At multivariable analysis, use of GMVs was not significantly associated with suboptimal renal function at 1 mo. Small sample size and short follow-up represent the main study limitations. Conclusions RAKT using GMVs from living donors is technically feasible and achieved favorable perioperative and short-term functional outcomes. Larger studies with longer follow-up are needed to confirm our findings. Patient summary In this study, we evaluated for the first time in literature the results of RAKT from living donors using kidneys with multiple arteries and veins. We found that, in experienced centers, RAKT using kidneys with multiple vessels is feasible and achieves optimal results in terms of postoperative kidney function with a low number of postoperative complications.

Resumen Objetivos Revisar nuestra experiencia en cistectomia radical robotica, valorando las complicaciones, resultados oncologicos y funcionales. Material y metodos Desde el 2007 al 2014 realizamos 67 cistectomias radicales roboticas asociadas a linfadenectomia en 61 casos. En 37 pacientes por tumor musculo-invasivo y en 30 por no musculo-invasivo de alto riesgo. La derivacion urinaria se realizo de forma extracorporea, siendo con neovejiga tipo Studer en 47 casos. Resultados La perdida hematica media fue 300 ml. Ningun caso requirio conversion a cirugia abierta. La mediana de ganglios extraidos fue 16 (rango: 3-33). La anatomia patologica revelo 16 pT0, 15 (pTis,-pT1-pTa) y 44 tumores musculo-invasivos, 8 pN+ y uno con margenes positivos. La estancia media hospitalaria fue 9 dias. Con una mediana de seguimiento de 16 meses, 9 (13%) reingresaron tras el alta, la mayoria por infecciones asociadas a cateteres y sonda vesical. Cuarenta pacientes (59,7%) presentaron complicaciones (la mayoria Clavien 1-2). En 4 casos (6%) hubo recurrencia durante el seguimiento y fallecieron por enfermedad oncologica 4 (5,9%). Diecinueve (28,3%) pacientes tuvieron complicaciones despues de 30 dias, siendo en su mayoria infecciones urinarias. De 47 pacientes con neovejiga presentan una correcta continencia diurna 45 (95%) y nocturna del 89%. De los pacientes con funcion sexual previa normal o disminuida un 90% y 64% respectivamente conservan funcion sexual con o sin uso de tratamiento farmacologico. Conclusiones La cistectomia radical mas linfadenectomia robotica, con reconstruccion extracorporea de la derivacion urinaria, ofrece buenos resultados oncologicos y funcionales sin aumentar el numero de complicaciones.

Objectifs L’objectif etait de comparer les resultats chirurgicaux peroperatoires et postoperatoires precoces de la transplantation renale robot-assistee (TRRA) de donneur vivant chez des receveurs obeses et non obeses. Methodes Nous avons inclus tous les patients ayant eu une transplantation renale robot-assistee de donneur vivant, prealablement inclus dans l’European Robotic Urological Section-TRRA database. Les Resultats fonctionnels, les complications intra- et postoperatoires ont ete compares entre les patients obeses (IMC ≥ 30 kg/m2) et non obeses (IMC Resultats Cent soixante-neuf TRRA de donneurs vivants ont ete realise de juillet 2015 a septembre 2018. Trente-deux patients avaient un IMC > 30. Le temps operatoire etait statistiquement plus court dans le groupe des receveurs obeses (214,5 ± 12,6 contre 282,3 ± 8 minutes, p Conclusion Chez les receveurs obeses, la TRRA presente des resultats fonctionnels optimaux et des taux de complications similaires a ceux des receveurs non obeses.

Resumen Introduccion La cistectomia radical (CR) con linfadenectomia ampliada es el tratamiento quirurgico de eleccion para el cancer de vejiga musculo invasivo. Las mejoras tecnicas y tecnologicas, asi como los buenos resultados de la cirugia robotica renal y prostatica han propiciado el progresivo desarrollo de la CR robotica (CRR). Proporcionamos una vision global estructurada y una puesta al dia de las complicaciones de la CCR, recogidas segun la clasificacion de Clavien-Dindo. Adquisicion de evidencia Realizamos la busqueda en PubMed de todas las publicaciones sobre CRR hasta la actualidad (2014). De las 259 publicaciones encontradas se excluyeron los articulos de revision y de analisis de costes, publicaciones con menos de 30 casos, las actualizaciones de estudios previos y aquellas cuyo objetivo principal era el estudio de otros temas relacionados con la CRR distintos de las complicaciones, quedando para el analisis final un total 38 articulos. Sintesis de evidencia Las complicaciones mas frecuentemente asociadas a la CRR son las gastrointestinales, infecciosas y genitourinarias, principalmente Clavien 1-2, seguidas de las Clavien 3-4, con tasas globales menores que en la cistectomia radical abierta (CRA) y laparoscopica (CRL), y con menor incidencia de complicaciones graves, menor sangrado intraoperatorio y mejor recuperacion postoperatoria. Conclusiones Aunque se requiere mayor evidencia cientifica, la CCR es una tecnica cada vez mas extendida que parece reducir las complicaciones, la necesidad de transfusion y mejora el tiempo de recuperacion.

Introduction Radical cystectomy with extended lymphadenectomy is the surgical treatment of choice for muscle-invasive bladder cancer. The technical and technological improvements and the positive results from robot-assisted kidney and prostate surgery have led to the progressive development of robot-assisted radical cystectomy (RARC). We provide a global structured overview and an update on the complications of RARC, recorded according to the Clavien-Dindo classification system. Acquisition of evidence We conducted a search on PubMed of all publications on RARC to date (2014). Of the 259 publications found, we excluded review articles and cost analyses, publications with less than 30 cases, updates of previous studies and those whose main objective was the study of other issues related to RARC other than complications, leaving a total of 38 articles for the final analysis. Summary of the evidence The most common complications associated with RARC are gastrointestinal, infectious and genitourinary system, mainly Clavien 1–2, followed by Clavien 3–4. RARC had lower overall complication rates than open radical cystectomy and laparoscopic radical cystectomy and had a lower incidence of severe complications, less intraoperative bleeding and better postoperative recovery. Conclusions Although further scientific evidence is needed, RARC is an increasingly widespread technique that appears to reduce complications as well as the need for transfusion, and it improves recovery times.

Background: Robot-assisted kidney transplantation (RAKT) has recently been introduced to reduce the morbidity of open kidney transplantation (KT). Objective: To evaluate perioperative and early postoperative RAKT outcomes. Design, setting and participants: This was a multicenter prospective observational study of 120 patients who underwent RAKT, predominantly with a living donor kidney, in eight European institutions between July 2015 and May 2017, with minimum follow-up of 1 mo. The robot-assisted surgical steps were transperitoneal dissection of the external iliac vessels, venous/arterial anastomosis, graft retroperitonealization, and ureterovesical anastomosis. Outcome measurements and statistical analysis: Descriptive analysis of surgical data and their correlations with functional outcomes. Results and limitations: The median operative and vascular suture time was 250 and 38 min, respectively. The median estimated blood loss was 150 ml. No major intraoperative complications occurred, although two patients needed open conversion. The median postoperative estimated glomerular filtration rate was 21.2, 45.0, 52.6, and 58.0 ml/min on postoperative day 1, 3, 7, and 30, respectively. Both early and late graft function were not related to overall operating time or rewarming time. Five cases of delayed graft function (4.2%) were reported. One case (0.8%) of wound infection, three cases (2.5%) of ileus, and four cases of bleeding (3.3%; three of which required blood transfusion), managed conservatively, were observed. One case (0.8%) of deep venous thrombosis, one case (0.8%) of lymphocele, and three cases (2.5%) of transplantectomy due to massive arterial thrombosis were recorded. In five cases (4.2%), surgical exploration was performed for intraperitoneal hematoma. Limitations of the study include selection bias, the lack of an open control group, and failure to report on patient cosmetic satisfaction. Conclusions: When performed by surgeons with robotic and KT experience, RAKT is safe and reproducible in selected cases and yields excellent graft function. Patient summary: We present the largest reported series on robot-assisted kidney transplantation. Use of a robotic technique can yield low complication rates, rapid recovery, and excellent graft function. Further investigations need to confirm our promising data. (c) 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Resumen Contexto La capacidad de un receptor para aceptar un injerto renal se debe a la regulacion del sistema inmunologico por los farmacos inmunosupresores. Dichos tratamientos se han relacionado con la promocion y la progresion tumoral. Adquisicion de evidencia Se realizo una revision sistematica de la literatura en PubMed, de los articulos referidos a «tumores urologicos en pacientes trasplantados renales». Se resumen los aspectos mas importantes en cuanto a incidencia, caracteristicas especificas de cada tumor urologico y aspectos relevantes del tratamiento. Sintesis de evidencia Las neoplasias urologicas representan un 15% de los tumores en el TR, ademas de ser en algunas series la principal causa de muerte de origen neoplasico. Dicha poblacion tiene 15 veces mas probabilidades de presentar cancer de celulas renales (CCR), 3 veces de cancer de celulas transicionales de vejiga (CCTV), 3 veces de cancer testicular (CT) y 2 de cancer de prostata (CP). Los tratamientos son similares a la poblacion no trasplantada; en caso del CCR predomina la indicacion de nefrectomia radical en el rinon nativo y cirugia conservadora en el injerto. En el CP localizado la prostatectomia radical es tecnicamente factible. En el CCTV la inmunosupresion no representa una contraindicacion para la administracion de BCG o MMC. Conclusiones Existe un incremento en la incidencia de tumores urologicos en la poblacion TR. Dichos tumores se pueden abordar de la misma manera que en la poblacion general, por lo que debido al potencial peor pronostico en relacion con la inmunosupresion se requiere en esta poblacion especifica un seguimiento mas estrecho.

Objectives: To review our experience in robot-assisted radical cystectomy, assessing the complications and oncological and functional results. Materials and methods: From 2007 to 2014, we performed 67 robot-assisted radical cystectomies combined with lymphadenectomy in 61 cases. The operations were performed on 37 patients due to muscle-invasive tumours and on 30 due to high-risk nonmuscle-invasive tumours. Urinary diversion was conducted extracorporeally, using a Studer neobladder in 47 cases. Results: The mean blood loss was 300 nnL. No case required conversion to open surgery. The median number of lymph nodes extracted was 16 (range 3-33). Pathology revealed 16 pT0, 15 pTis,-pT1-pTa and 44 muscle-invasive tumours, 8 pN+ and 1 with positive margins. The mean hospital stay was 9 days. With a median follow-up of 16 months, 9 (13%) patients were readmitted after the discharge, most for infections associated with the vesical catheter and other catheters. Forty patients (59.7%) presented complications (most were Clavien grade 1-2). There was recurrence during the follow-up in 4 cases (6%), and 4 (5.9%) patients died from cancer. Nineteen (28.3%) patients had complications after 30 days, most of which were urinary tract infections. Of the 47 patients with a neobladder, 45 (96%) had proper daytime continence and 42 (89%) had proper nighttime continence. Ninety percent and 64% of the patients with previously normal, sexual function and reduced sexual function, respectively, were able to preserve sexual function with or without drug treatment. Conclusions: Robot-assisted radical cystectomy plus lymphadenectomy, with extracorporeal reconstruction of the urinary diversion, offers good oncological and functional results without increasing the number of complications. (C) 2016 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

Kidney transplantation is the preferred treatment for patients with end-stage renal disease. In order to reduce the morbidity of the open surgery, a robotic-assisted approach has been recently introduced. According to the published literature, the robotic surgery allows the performance of kidney transplantation under optimal operative conditions while maintaining the safety and the functional results of the open approach. We present the case of a mother donating to her daughter affected by end-stage renal disease (ESRD) due to Alport disease (creatinine: 353 umol/l; GFR: 13 ml/min per 1.73 m2). A robotic-assisted kidney transplant (RAKT) was successfully performed. Surgical time was 120 min with 53 min for vascular suture. The estimated blood loss was

Radical cystectomy with extended lymphadenectomy is the surgical treatment of choice for muscle-invasive bladder cancer. The technical and technological improvements and the positive results from robot-assisted kidney and prostate surgery have led to the progressive development of robot-assisted radical cystectomy (RARC). We provide a global structured overview and an update on the complications of RARC, recorded according to the Clavien-Dindo classification system.We conducted a search on PubMed of all publications on RARC to date (2014). Of the 259 publications found, we excluded review articles and cost analyses, publications with less than 30 cases, updates of previous studies and those whose main objective was the study of other issues related to RARC other than complications, leaving a total of 38 articles for the final analysis.The most common complications associated with RARC are gastrointestinal, infectious and genitourinary system, mainly Clavien 1-2, followed by Clavien 3-4. RARC had lower overall complication rates than open radical cystectomy and laparoscopic radical cystectomy and had a lower incidence of severe complications, less intraoperative bleeding and better postoperative recovery.Although further scientific evidence is needed, RARC is an increasingly widespread technique that appears to reduce complications as well as the need for transfusion, and it improves recovery times.

Context The ability of a transplant recipient to accept a graft depends on the ability of immunosuppressive drugs to regulate the immune system. Such treatments have been associated with tumor promotion and progression. Evidence acquisition A systematic literature review was carried out. Electronic searches were performed in PubMed database. The searching criterion was “urological tumors in kidney transplant recipients”. The most important issues regarding incidence, urological tumor-specific features, and relevant ones about the treatment are summarized. Synthesis of evidence In renal transplant, 15% of all tumors are urological neoplasias; furthermore, they are the leading neoplastic cause of death. In transplant population the incidence rate of renal cell carcinoma (RCC), transitional cellbladder carcinoma (TCBC), testicular carcinoma (TC) and prostate cancer are increased 15, 3, 3 and 2 times respectively. Treatments used in transplant patients are similar to those employed in the general population: radical nephrectomy for the native kidney and conservative surgery for the graft are indicated for RCC. Radical prostatectomy is technically feasible for localized PC. Regarding transitional cell carcinoma BCG or MMC is not contraindicated. Conclusions The incidence rate of cancer has increased among transplant population. These tumors can be managed following the same criteria than in general population. Because in this population the prognosis is worse for the immunosuppression, closer monitoring is required.

We report the case of a 67 years old woman who presented with a renocutaneous fistula as a complication of extracorporeal shock wave lithotripsy.

Laparoscopy has become the standard of care for kidney recovery during live donor nephrectomy (LDN) because of the well-documented better outcomes of minimally invasive surgery compared with the open approach [1-4]. Especially in the donor population, the cosmetic results are of great importance; therefore, an effort to reduce the incision size should be attempted while maintaining the safe general principles of surgery. We present our initial experience with the use of 3-mm instruments for laparoscopic LDN. (C) 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Purpose: Describe morbidity and survival in patients older than 80 years with muscle invasive bladder cancer (MIBC) treated with radical cystectomy (RC) or transurethral resection (TUR) in our institution. Materials and Methods: We reviewed our database of all patients older than 80 years treated with RC and TUR for MIBC between 1993 and 2005 in our institution. Twenty-seven patients were submitted to RC, with mean age of 82 years and mean follow-up of 16.4 months. RC was carried out following diagnosis of previous MIBC in 14 cases (51.9%). The American Society of Anesthesiology (ASA) score was III or IV in 23 patients (85.1%). Seventy-two patients with a mean age of 84 years and mean follow-up of 33 months, diagnosed with MIBC, were managed by means of TUR. The ASA score was III-IV in 64 (88.8%) patients. Results: Pathological stage of the RC specimen was pT3 in 18 cases (66.7%). Mean hospital stay was 16 days. Early complications were assessed in 8 patients (29.6%), with an overall survival (OS) of 42.94%, and cancer-specific survival (CSS) of 60.54%. In patients submitted to TUR, clinical stage was T2 in 36 cases (50%). The mean hospital stay was 7 days, with a readmission rate (RR) of 87.5%. OS and CSS was less than 20%. Conclusions: RC in octogenarian patients is a safe procedure, with complication and survival rates comparable to RC series in general population. Transurethral resection (TUR) for patients with MIBC within this age range is a much less morbid procedure, but disease specific survival is lower.

OBJECTIVE To review the results of parastomal hernia repair with a simplified technique of translocation of the stoma with no need for a midline incision. METHODS A total of 405 radical cystectomies with creation of an ileal conduit were reviewed at our institution. The primary goal of the review was to determine the incidence of parastomal hernias in a large series of cystectomies and their management at our institution. Surgical correction of parastomal hernia was indicated in case of pain, discomfort, risk of bowel obstruction, and/or distortion of the abdominal wall. The simplified technique includes an elliptical incision around the stoma and dissection of the hernia's sac down to the level of the fascia. The sac is incised and the peritoneum is entered. The ileal conduit is thereafter mobilized to guarantee sufficient length. This is crucial to be able to transpose the conduit 5-10 cm superiorly and to obtain a tension-free ileostomy. RESULTS Sixty-three patients (16%) presented during the follow-up after ileal conduit a palpable defect or bulge adjacent to the stoma. The review highlighted 19 patients (4.69%) who developed a parastomal hernia and underwent surgical repair. Four cases (21%) recurred at a median follow-up of 55 months. Recurrence was not found to be related to gender, age, body mass index, protein level, radiotherapy, adjuvant chemotherapy, or previous abdominal surgery on univariate analysis. Postoperative complications included one wound infection (5.2%) and one stomal necrosis (5.2%). CONCLUSIONS The technique herein proposed simplifies the management of parastomal hernia repair by avoiding a midline incision, which implies a reduction in surgical trauma with acceptable recurrence and postoperative complication rate. UROLOGY 77: 1491-1494, 2011. (C) 2011 Elsevier Inc.

Objective: To evaluate a bladder preservation strategy in patients with either muscle-invasive bladder cancer (MIBC) or development of MIBC cancer due to progression of non-muscle-invasive bladder cancer (NMIBC). Methods: Between October 1982 and March 1998, 48 patients (mean age 61 years, range 45–75) with MIBC (T2a–b and T3a) were treated using transurethral resection followed by three cycles of systemic chemotherapy. 42 patients (87.5%) had primary MIBC and 6 (12.5%) had MIBC subsequent to NMIBC. After chemotherapy, 39 patients (81.25%) achieved complete remission and 4 (8.3%) partial remission. Results: With a median follow-up of 98.5 months (13–246), the overall survival of the 48 patients was 62.6%. The cancer-specific survival (CSS) of the 39 patients with complete remission was 80.8%. Among the 39 patients with complete remission, 19 had invasive recurrence during follow-up with a CSS of 53.2%; by comparison, among patients with preserved bladders, CSS was 72.1% (p = 0.046). Predictive factors analysed were age, sex, tumour size >3 cm, grade, associated carcinoma in situ (CIS), number of tumours and number of previous recurrences. In multivariate analysis only tumour size and CIS were significant predictive factors for progression after preservation. Of the 6 patients with MIBC after NMIBC, 3 (50%) had no remission and underwent cystectomy and 15 patients (38.6%) had NMIBC recurrences during follow-up. CIS and high-grade tumours were treated with bacillus Calmette-Guérin. A bladder preservation rate of 81% and a CSS rate of 89% were obtained in the group with NMIBC recurrences. Conclusions: Conservative management of MIBC cancer is a feasible alternative to cystectomy in selected cases. Patients with MIBC after progression of primary NMIBC are not good candidates for a bladder preservation approach. NMIBC recurrences after bladder preservation in patients with MIBC respond to transurethral resection and bacillus Calmette-Guérin instillations.

to evaluate the frequency of reoperation caused by massive hematuria in the postoperation of open prostatectomy in benign prostatic hyperplasia (BHP) at our hospital. At the same time, we also want to evaluate the effectiveness and possible secondary effects of using transurethral approach to solve this surgical complications.we analyzed retrospectively 540 open surgeries in benign prostatic hyperplasia, carried out from 1998 to 2005. We evaluated effectiveness, average surgery time and complications in case of endoscopic review.a reoperation was necessary in 2.5% of all 540 cases. In all the cases reoperated, hemorrhage was controlled using transurethral approach. Average surgery time was 37 minutes and secondary effects observed were not important.transurethral approach is a simple and effective technique in the treatment of massive hematuria after open prostatectomy in BPH. Surgery time spent is acceptable, and early and delayed complications observed have been few and cannot, in our opinion, be imputed only to this tech

Urethral hemangiomas are benign vascular tumors that are found in perimontanal prostatic localization and less frequently in the urethra. Although different urethral procedures have been postulated for its treatment, the best results are achieved using lasers. A patient who underwent endoscopic holmium laser treatment for such hemangiomas is presented. Total disappearance of the lesions without any complications was achieved.

To analyze the presenting features, diagnosis and management of uncommon cystic lesions located at the midline of the prostate.From 1990 to 1999, 8 patients with medial prostatic cyst were treated in our hospital. Vesicorenal ultrasound evaluation was the first procedure that was performed and was diagnostic in most of the cases. Only those patients that underwent surgery required admission to hospital.The most common presenting features were irritative and obstructive voiding syndromes. Treatment achieved cure or clinical improvement.Vesicorenal ultrasound assessment is the first procedure that should be considered in the diagnosis of this disease. Before ascribing the symptoms to a prostate cyst, other urological conditions with more prognostic relevance should be excluded. Treatment should be instituted only in the symptomatic patients and should be individualized according to the characteristics of each case.

To report a case of acute lobar nephronia, an unusual form of localized renal infection, and review the literature with special reference to the clinical features, ultrasound and CT findings that distinguish this condition from other renal masses (abscess, infected cyst and renal carcinoma).A female patient presented at the emergency services with symptoms and signs compatible with pyelonephritis. An admission abdominal ultrasound scan demonstrated a solid mass in the left inferior renal pole. CT showed a renal mass with peripheral enhancement after infusion of contrast and central striation. Blood and urine analyses were compatible with renal infection. Acute lobar nephronia was suspected and antibiotic treatment was administered. Control ultrasound and CT examinations performed one month after instituting antibiotic treatment showed the mass had disappeared.Acute lobar nephronia should be considered in all patients with a renal mass detected during an episode of urinary infection. Correlation of the clinical and radiological findings, and resolution of the mass with appropriate antibiotic therapy will confirm the diagnosis.

To discuss the clinical presentation, complementary evaluation procedures and treatment of ileovesical fístula, an uncommon complication of Crohn's disease.After the clinical presentation, complementary evaluation procedures were performed to confirm the diagnosis in all cases. Treatment was based on the patient's general condition; surgery was performed in two cases and one case was carefully followed.Ileovesical fístula is an uncommon complication of Crohn's disease. Occasionally, the urological symptoms may precede the digestive symptoms, therefore this condition should be suspected particularly if the complementary evaluation procedures are not very sensitive. Surgery is the treatment of choice.