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Introduction: Bladder leiomyoma is a very rare neoplasm and are estimated at about < 0.5% of all urinary bladder tumors. Most patients complain of lower urinary track symptoms. In 20% of cases patients remain asymptomatic. Objective: The aim of this study was to investigate the topic of bladder leiomyomas, present our experience in the management of this neoplasm and review the published data concerning this rare entity. Material and methods: From March 2018 to February 2021 three patients (2 females, 1 male) aged 39 to 58 years (mean 49.3 years) were treated for bladder leiomyoma in our center. Results: Two patients underwent en bloc transurethral resection of bladder tumor and one had laparoscopic partial cystectomy. Tumors were located in favourable positions with the mean diameter of 37.67 mm. The mean operative time was 46.67 min (range from 15 to 95 min). At the mean follow-up time of 36 months. None of our patients had a recurrence of bladder leiomyoma. Conclusions: Properly performed removal of bladder leiomyoma gives satisfactory results. Transurethral resection of bladder tumor is the gold standard of treatment, highly valued for its safety and minimal invasiveness, however in cases of unfavourable located or large tumors laparoscopic approach or EBRT with defragmentation or morcellation may be preferred.

Abdominal surgery on patients with significant body malformation is often a challenge for an operative team. Particularly, when patient presents lesions suspected for malignancy but benign disease cannot be excluded. In the reported case the patient suffered from cerebral palsy and had extreme spinal distortion with significant displacement of internal organs. Solid renal mass was detected incidentally, but because of body deformation the biopsy to asses pathological status could not be performed. The decision to perform surgery was made and the patient underwent successful laparoscopic partial nephrectomy. Pathology examination of the specimen revealed renal cell carcinoma grade 2.

IntroductionIn the majority of Western European countries, the coronavirus disease (COVID-19) pandemic has led to a dramatic reduction in urooncological surgeries. Our objective was to evaluate the impact of the pandemic on volume and patterns of urooncological surgery in Poland.Material and methodsThis is a retrospective analysis of 10 urologic centres in Poland. Data regarding major oncological procedures performed after the COVID-19 pandemic outbreak (March 15, 2020 – May 31, 2020) were evaluated and compared with data from the respective period in 2019.ResultsBetween March 15, 2020 and May 31, 2020, a total of 968 oncological procedures were performed in participating centres. When compared to the respective period in 2019 (1063 procedures) the overall number of surgeries declined by 8.9%. The reduction was observed for transurethral resection of bladder tumour (TURBT) (20.1%) and partial nephrectomies (PN) (16.5%). Surgical activity considering radical nephrectomy (RN), nephroureterectomy (NU), and radical prostatectomy (RP) remained relatively unchanged, whereas radical cystectomy (RC) burden showed a significant increase (90.9%). Characteristics of patients treated with TURBT, RC, NU, PN, and RN did not differ significantly between the compared periods, whereas RP in the COVID-19 period was performed more frequently in patients with a higher grade group (p = 0.028) and positive digital rectal examination (p = 0.007).ConclusionsSurgical activity for urological cancers in Poland has been maintained during the first wave of the COVID-19 pandemic. The Polish strategy in the initial period of the COVID-19 crisis mirrors the scenario of hard initial lockdown followed by adaptive lockdown, during which oncological care remained undisrupted and did not require particular priority triage.

The case describes an 86-year-old man with thrombosis of the deep dorsal vein and corpora cavernosa of the penis who developed symptoms 4 months before hospitalisation. An accurate imaging diagnostics supplemented with a biopsy of the corpus cavernosum confirmed the initial diagnosis. Moreover, an adenocarcinoma of the hepatic flexion of the colon with numerous metastatic lesions, including those to the crus of penis were found. Diagnostic and therapeutic difficulties were described and the results obtained were discussed in the context of available literature.

Introduction The aim of the study was to identify predictors of surgical complications of transurethral resection of bladder tumour (TURBT). Material and methods We prospectively recruited 983 consecutive patients undergoing TURBT within 7 months in six academic institutions. All patients were followed up from the surgery up to 30 days postoperatively with at least one telephone contact at the end of the observation. The primary study endpoint was any intra- or postoperative surgical complication. For the identification of predictors of complications, univariate and multivariate logistic regression models were used. Trial registration: ClinicalTrials.gov (NCT03029663). Registered 24 January 2017. Results Surgical complications were noticed in 228 (23.2%) patients, including 83 (8.4%) patients with more than one complication and 33 cases of Clavien-Dindo grade 3 complications (3.3%). The most common in-hospital complications were bleeding (n = 139, 14.1%) and bladder perforation (n = 46, 4.7%). In a multivariate analysis, nicotine use, high ASA score, and the presence of high-grade tumour were the most significant predictors of high-grade complications. The stage of the disease was the strongest predictor of bleeding, while the presence of muscle in the specimen and resident surgeon were the strongest predictors for bladder perforation. Conclusions TURBT poses a significant risk of surgical complications, the majority of which are of low grade.

Background: Numerous different molecules of prostate-specific membrane antigen (PSMA) ligands are used to detect prostate cancer (PCa), most approaches utilize gallium PET and a few reports describe the role of SPECT/CT. [99mTc]Tc-PSMA-T4 is a new radiopharmaceutical designed for the diagnosis of patients with PCa. Methods: We conducted a single site, prospective, preliminary case series study that included 31 patients with PCa, all had undergone clinical, biochemical or imaging examination and exhibited clear or suspicious active disease or clinical/biochemical recurrence of PCa. Whole-body (WB) SPECT/CT after i.v. administration of [99mTc]Tc-PSMA-T4 was utilized, acquisition images were obtained at three time points. Results: The clinical value of the images was assessed in regard to the evaluation of tumor extent in patients with confirmed PC that qualified for initial therapy and the evaluation of tumor recurrence, both provided encouraging results. The late acquisition of WB-SPECT resulted in better lesions delineation. The results of the analysis of the sensitivity/specificity were: 92%/100% in cases of primary cancer, 83%/100% in terms of pelvic lymph nodes disease, 100%/95% in other lymph nodes and soft tissue involvement, respectively, and bone mets were both 100%. Conclusion: An oncotropic SPECT [99mTc]Tc-PSMA-T4 can help in selecting a rational therapeutic strategy for a patient with an initial diagnosis of PCa by assessing the extent of cancer and also after complex radical or palliative therapy in case of biochemical recurrence for re-staging.

IntroductionSurgical oncology strives to remove the primary cancer tumor together with its local lymphatic tissue. One of the techniques improving the staging of lymph nodes is sentinel node biopsy. The most common agent used in SNB is indocyanine green (ICG). Indocyanine green is characterized by its high affinity for human serum albumin (HSA). In practice, the visualization of the sentinel node is enhanced by attaching a relatively large carrier to the ICG molecule. The aim of this study was to investigate whether the covalent linking of ICG to a nanocolloid would extend the time of detection of the dye as it binds to HSA, assessed by fluorescence measurements in vitro.Material and methodsThe influence of the molar concentration of ICG on its ability to form a complex with HSA was investigated. The dye luminescence was measured, with an increasing amount of dye in the presence of a constant concentration of HSA. The stability of the ICG:HSA complex was also investigated.ResultsThe binding of ICG and human protein in a solution ratio of 3 : 1 made it possible to detect the ICG luminescence with better and prolonged visibility. In the case of the two lowest ratios, complex formation was not observed. The use of ICG bound to a nanocolloid based on human serum albumin increases the luminescence of the HSA:ICG complex up to 98%.ConclusionsProperly selected proportions of human albumin protein and ICH allowed higher and longer luminescence to be achieved. Nevertheless, further studies are necessary to establish the optimal concentration ratio.

Introduction: Vesicorectal fistula (VRF) is a rare but devastating condition that may develop after surgery or radiotherapy. Many surgical methods to treat VRF have been described, but there is still no gold standard of VRF treatment. Aim: The aim of the study is to present our experience in the treatment of VRFs and analyze different surgical techniques applied in our center retrospectively. Material and methods: From June 2016 to June 2020, 7 patients (5 males and 2 females) aged 59–73 years (average 67.3 years) were treated for VRF in our center. The primary causes of VRFs were complications after laparoscopic radical prostatectomy (LRP), sigmoidectomy, laparotomy with removal of the tumour of the vaginal stump and anterior rectal resection and colostomy, Hartmann’s operation due to rectosigmoid carcinoma, radiotherapy, treatment of cervical cancer and transurethral resection of bladder tumor (TURBT). The patients were treated with one of the following methods: transvesical laparoscopic single-site surgery (T-LESS), transanal minimally invasive surgery (TAMIS), transurethral fulguration and radical cystectomy with the Bricker’s ileal conduit. Results and discussion: Five patients underwent T-LESS, 2 TAMIS, 1 transurethral fulguration and 1 radical cystectomy with the Bricker’s ileal conduit. The mean postoperative hospital stay was 4 days (range 2–8 days). The mean operative time was 139 minutes (range 100–285 minutes). Only 1 patient had a recurrence of a fistula. Conclusions: Surgical management of VRFs is obligatory to prevent possible complications. Currently, there is no gold standard for treatment of VRFs. Therefore, this condition requires further investigation.

Iatrogenic vesicorectal fistula (IVRF) is a serious complication of prostate and colorectal surgery. Fistula repair is a highly challenging procedure. Multiple surgical techniques for IVRF repair have been proposed, but there is as yet no consensus as to which method should be recognised as the gold standard. The aim of the paper is to present our own experience in the treatment of IVRF with reference to the most up-to-date literature reports. Different methods of IVRF treatment are discussed based on 3 patients, aged 68, 67 and 72 years, in whom vesicorectal fistula occurred after radical prostatectomy (2 cases) and rectal resection due to cancer (1 case). Before starting treatment in the urology department, all the patients underwent several unsuccessful surgical procedures performed via various operative techniques. The techniques and patient outcomes are discussed in the context of selected literature reports. Two patients with IVRF after radical prostatectomy were successfully treated by transrectal repair, while the patient with IVRF developing after the treatment of rectal cancer underwent transvesical laparoendoscopic surgery and is currently followed up. The patients’ follow-up periods are 36, 8 and 1 month, respectively. IVRF treatment is a major challenge and requires the medical team to be familiar with a variety of operative techniques. Often, multidisciplinary collaboration is essential for optimal patient management. Therapeutic failures occur regardless of the treatment used. Modern minimally invasive surgical treatments seem to occupy an important place in the therapeutic armamentarium for IVRF.

Objectives To determine the feasibility and safety of performing transvesical laparoendoscopic single-site surgery (T-LESS) in patients with medium-size, hard stones or multiple stones with high burden. Methods In this case series study, 12 patients (11 males and one female) with a mean age of 66.8 years were operated on from February 2016 to May 2017 due to bladder calculi, using the T-LESS approach with a single-port device (Tri-Port + , Olympus, Germany). Indications for this procedure were hard, medium-size, solitary stones after previous unsuccessful endoscopic lithotripsy or the presence of multiple high-burden stones. In two patients, additional procedures (diverticulectomy or a ureterocele incision) were performed simultaneously. Results All stones were removed intact. No serious complications were observed. The mean operative time was 46 min and the postoperative hospital stay was 22 h. The mean diameter of the largest stone and the mean stone volume of each case were 24 mm and 11 cm3, respectively. At the mean follow-up time of 15 months, there was significant improvement of the symptoms. Conclusions The T-LESS technique is an efficient, safe and minimally invasive procedure for intact bladder stone removal in selected patients. The method avoids the risk of urethral injury. Nevertheless, further investigation is needed to assess the wider applicability of the procedure.

Although a variety of techniques have been used to manage the distal ureter during laparoscopic radical nephroureterectomy (LNU), a consensus has not yet been established. Recently, some authors have used a single-port transvesical approach to excise the distal ureter and bladder cuff following LNU. The aim of the study was to present our initial experience in "en bloc" dissection of the distal ureter and bladder cuff during LNU, using a transvesical single-port approach (T-LESS) and standard laparoscopic instruments. From April to October 2012, 5 patients aged 45 to 73 years with upper urinary tract urothelial tumors were subjected to LNU/T-LESS. After a standard LNU was performed, a TriPort+(®) device was introduced into the bladder and the pneumovesicum was established. A bladder cuff with a distal ureter was dissected and put in the paravesical tissue. The bladder wall defect was closed with the V-loc(®) 3/0 suture. The LNU was then completed in the flank position. All procedures were completed successfully. No significant blood loss or complications were observed. The mean operative time was 250 min (range: 200-370) for a total procedure and 59 min (range: 42-80) for the T-LESS stage. The postoperative hospital stay was 5.2 days (range: 4-9). Pathologic examination revealed no positive margin in any of the cases. The LNU/T-LESS approach is an efficient and safe procedure. A well-visualized dissection of the distal ureter, closing the defect of the bladder, the use of standard laparoscopic instruments and a good cosmesis are advantages of the method.

Background Bladder diverticula are usually encountered in males, and they are a rarity in women, especially in the absence of obstruction. Open surgery, as well as laparoscopic or robotic, or single-port surgery have been applied successfully to remove bladder diverticula.1-3 To the best of our knowledge, no single-port diverticulectomies have been performed in women. Objective To present the case of using the transvesical laparoendoscopic single-port surgery (T-LESS) for excision of 2 bladder diverticula in a woman. Materials In August 2016, we carried out the T-LESS access on a 67-year old woman to remove 2 symptomatic bladder diverticula in 1 session. The patient was placed in the lithotomy position and was under general anesthesia. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device (Tri-Port+) via a 1.5-cm incision made 3 cm above the pubic symphysis. Standard 10-mm optic and straight laparoscopic instruments were used. The diverticula were dissected and removed from the bladder with a combination of standard laparoscopic and endoscopic instruments introduced through the TriPort+ or the urethra. The bladder wall openings were closed by running absorbable 2/0 polyglactin sutures. An 18F Foley catheter was left in place for 6 days. Results The operation lasted 120 minutes. Blood loss was minimal, and no complications were observed. The postoperative period was uneventful. The patient was discharged within 19 hours of surgery. During a 9-month follow-up, the patient reported the significant improvement in the severity of symptoms. Laboratory examination results were all within the normal range. Conclusion The T-LESS procedure can be considered as a valuable option for diverticulectomies in female patients because of its minimal invasiveness, short hospital stay, and fast recovery time.

Foreign bodies in the bladder are quite common disorders of the lower urinary tract. Most of them originate from various surgical procedures but rarely are a consequence of transurethral self-insertion, as a result of sexual curiosity or autoerotic stimulation. From 2006 to 2015, in our center the prevalence of this condition was 0.05%, but only six (0.02%) of the cases were due to sexual curiosity. Transurethral endoscopic procedures as well as open or laparoscopic, or single-port techniques, have been successfully applied to remove bladder foreign bodies. We present the case of using the transvesical laparoendoscopic single-port surgery (T-LESS) for removal of an unusual metallic foreign body.

Some minimally invasive techniques have been introduced to decrease morbidity related to standard laparoscopic procedures. One such approach is laparoendoscopic single-site surgery (LESS), which can also be applied for transvesical surgery. The aim of the study was to present our initial clinical experience of using this technique for transvesical vesicovaginal fistula (VVF) repair. In August 2011, we carried out the LESS repair of a 3-mm in diameter vesicovaginal fistula on a 72-year-old woman, who failed the conservative treatment with Foley placement. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device (4-channel, TriPort+, Olympus Winter&IBE GMBH) via a 1.5-cm incision made 2 cm above the pubic symphysis. A standard 10-mm optic and straight laparoscopic instruments were used. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with running absorbable V-Loc (Covidien, Norwalk, CT, USA) suture. Ureteral catheters were left for 5 days and the Foley catheter for 14 days. The operative time was 170 min. The blood loss was minimal. No complications were observed. The postoperative period was uneventful. During a 6-month follow-up the patient reported no involuntary discharge of urine into the vagina. Diagnostic scans revealed no presence of VVF and laboratory examination results were all within the normal range. Although substantial development of the instruments and skills is needed, the transvesical LESS vesicovaginal fistula repair appeared to be feasible and safe. Nevertheless, further experience and observations are necessary.

Complications of mid-urethral sling procedure such as erosion into the bladder are not very common. However, when they occur, removal of the tape may be necessary. To date, this complication has usually been managed by retropubic exploration or operative cystoscopy, which can often be associated with disproportionate morbidity or even failure. We present 2 cases of a laparoendoscopic single-site surgery (LESS) approach for removal of polypropylene tape eroded into the bladder. We report two female patients aged 41 years and 47 years who underwent treatment with this novel technique. A TriPort® single-site access system was placed through the apex of the bladder under cystoscopic control. Carbon dioxide was used for insufflations of the bladder. A combination of straight and articulating laparoscopic instruments was used to dissect and completely remove the foreign body. Both patients were managed adequately in the manner presented above. The length of the skin incision was 20 mm. Time of intervention was 35 min and 40 min. No blood loss or complications occurred. A Foley 18 F catheter was left for seven days and the patients were discharged on the 1 st postoperative day. The follow-up period (4 months and 7 months) showed no events related to the method. Removal of foreign bodies of the bladder through a single transvesical laparoscopic port is technically feasible. This procedure offers excellent visualization inside the bladder, especially near the bladder neck where polypropylene tapes often reside, and provides patients with a minimally invasive approach through a single small incision.

We present a case of a patient with supranumerary kidney diagnosed after laparoscopic radical nephrectomy. Urinary leakage, an unusual complication that appeared postoperatively, led to complementary examination and making the right diagnosis. The reevaluation of the preoperative CT (computed tomography) in enhancement phase and the new CT scan confirmed the presence of a real accessory organ connected to the main unit with a small bridge of tissue. The latter right nephrectomy was performed. Despite the scarceness of this anomaly, a thorough interpretation of images obtained during investigative procedures can provide a clue about the presence of this rare entity.

To present a one-center clinical experience of using the transvesical laparoendoscopic single-site surgery (T-LESS) to repair selected urinary tract injuries after vaginal or pelvic surgery.From November 2009 to August 2013, 22 women underwent the treatment with the use of the T-LESS technique to repair various complications after gynecologic or uro-gynecologic surgery. Thirteen patients were operated on for iatrogenic foreign bodies, 8 patients underwent a vesicovaginal fistula repair and 1 woman a ureteral reimplantation due to ureterovaginal fistula. In all cases, the TriPort system was established intravesically and standard laparoscopic instruments were used. When needed, bladder and vaginal wall defects were closed with barbed V-Loc suture.The treatment was successful in all patients. In one case the procedure was converted to open approach. No blood loss or complications were observed. Mean operative time was 78 min. and mean hospitalization time was 3.6 days. The postoperative pain was 0.7 (Visual Analogue Scale) on postoperative day 1. During the average follow-up of 78 months no adverse events related to the method except for one small asymptomatic mesh erosion were noticed.The T- LESS approach for repair of selected urinary tract injuries after vaginal or pelvic surgery is a feasible, efficient and safe procedure. It offers excellent visualization inside the bladder, availability of intracorporeal watertight suturing and minimal postoperative pain. Nevertheless, substantial development of the instruments and further investigations are necessary to assess the usefulness of this technique.

Various minimally invasive techniques have been developed for bladder diverticulectomy. One of the newest is transvesical laparoendoscopic single-site (T-LESS) surgery. In this article, we present points of technique with initial clinical results after a minimum of 7 months of follow-up. The aim of the study was to assess our first series of patients who underwent T-LESS surgery for transvesical excision of symptomatic bladder diverticula.From March 2011 to February 2012, we successfully operated on five men aged 61 to 76 years (mean 66 years) for symptomatic (infections, residual of urine, neoplasm) bladder diverticula, with the use of the T-LESS approach. The procedures were performed using single-port TriPort+, standard laparoscopic instruments, and V-loc suture. All patients underwent follow-up of 6 weeks after surgery and every 3 months thereafter. The follow-up included urine tests, ultrasonography, and cystoscopy when needed.The average operative time was 122 minutes (range 80-175 min), and the blood loss was minimal. Patients were discharged on the third (range 2-4 day) postoperative day with no intra- or postoperative complications. The average 14-month follow-up (range 7-19 mos) confirmed good operative results in all cases. An insignificant small recurrent diverticulum was observed in one patient. The patients did not need transurethral resection of the prostate or reoperation.We consider this technique to be a feasible and safe procedure, and a valuable treatment option for bladder diverticulectomy.

Introduction Various minimally invasive techniques have been developed to decrease morbidity related to laparoscopic port placement and to improve cosmetic results while maintaining the same standards and efficacy of surgical care. One such approach is laparoendoscopic single-site surgery. We describe our initial clinical experience of using this technique for transvesical ureteral reimplantation. Technical Considerations The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device (3-channel) via a 1.5-cm incision made 2 cm above the pubic symphysis. A standard 10-mm laparoscope was used with either straight or articulating instruments. The ureter was dissected, shortened, passed through the submucosal tunnel, and fixed in place with a running absorbable V-Loc suture. The operative time was 250 minutes. No significant bleeding or other complications were observed. Conclusion Although further development of the instruments and skills is needed laparoendoscopic single-site surgery transvesical reimplantation of the ureter appeared to be feasible and safe. Nevertheless, further experience and observations are necessary.

We present our single-center experience with three patients who were undergoing laparoendoscopic single-site (LESS) diverticulectomy through a single-port device introduced directly into the bladder.During March and April 2011, we operated on three men aged 62 to 76 years (mean 67 y) for symptomatic bladder diverticula using a standard lithotomy position and general anesthesia. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device (four-channel) via a 1.5-cm incision made 2 cm above the pubic symphysis. Standard 10-mm optic and rigid laparoscopic instruments were used. The defect of the bladder wall was closed with an absorbable 3/0 running V-Loc suture. An 18F Foley catheter was left for 4 to 7 days.The average operative time was 128 minutes (range 80-175 min). The blood loss was minimal. Patients were discharged on the third postoperative day with no intra-, nor postoperative complications. The 3-month follow-up confirmed good operative results in all cases.We consider laparoendoscopic single-port transvesical excision of bladder diverticulum as a feasible and safe procedure and a valuable treatment option for bladder diverticulectomy.