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Intrauterine contraceptive devices (IUCDs) are a popular treatment choice for contraception. We report a case of a woman in her forties who presented to a urology clinic with visible haematuria. Flexible cystoscopy revealed a bladder lesion, suspicious for a tumour. However, subsequent imaging determined that this was in fact the arm of an IUCD, sited 7 years previously, which had migrated into the bladder. The patient underwent an uneventful robotic-assisted laparoscopic removal of the device. IUCD-related complications are infrequent and can present atypically, warranting a broad diagnostic approach. Robotic-assisted laparoscopic removal of devices migrating into pelvic structures offers all the advantages of minimally invasive surgery, with the added benefits of three-dimensional views and endowrist movement facilitating tasks such as intracorporeal suturing. We report the first documented case of utilizing the da Vinci robotic system in safely assisting the removal of a migrated IUCD., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2021.)

Objective: The objective of this study was to evaluate the efficacy of TachoSil (Nycomed UK, Oxford, Buckinghamshire, UK), a hemostatic sponge, to seal major collecting system injuries (in addition to providing an adjunct to hemostasis) after partial nephrectomy in a porcine chronic survival model., Materials and Methods: Laparoscopic upper-pole partial nephrectomies were performed in 10 farm pigs (>40 kg). After hilar clamping, an energyless incision was made at a point halfway between the hilum and the upper pole of the kidney and the collecting system was opened widely. TachoSil was applied to cover the defect; 15 to 20 minutes after the application of TachoSil, the hilar clamp was removed, hemostasis confirmed, and the pig survived. Assessment was made for hematoma and urinoma. Four weeks postoperatively, the pigs were euthanized. Ex-vivo retrograde studies were performed to assess collecting system leak. Weight, blood pressure, estimated blood loss, the weight of the partial and completion nephrectomy specimen, presence/absence of urinary leak on retrograde study, histopathologic findings, and complications were recorded., Results: All pigs survived. Mean warm ischemia time was 18 minutes, mean blood loss was 90 mL, and mean resected weight was 13.7 g. There was no evidence of leak on retrograde study. Histologically, nonspecific changes were noted in all specimens, which included dystrophic calcification, scarring, and areas of fibrosis at the partial nephrectomy surgical margin., Conclusion: TachoSil seals the collecting system after partial nephrectomy on a porcine chronic survival model, in addition to providing an adjunct to hemostasis. More studies, including human trials, are warranted to evaluate this observation further.

Objective: To present the UK experience to date with laparoendoscopic single-site surgery (LESS) simple nephrectomy., Patients and Methods: Five female patients underwent LESS nephrectomy; three procedures were carried out with the umbilicus as the port of entry (U-LESS)., Results: All cases were completed uneventfully. The operative duration was 45-150 min and blood loss was negligible. There were no conversions to conventional multi-port laparoscopy or open surgery. Recovery was uneventful with only minor complications in two patients; convalescence was rapid., Conclusion: LESS nephrectomy offers a safe, cosmetic alternative to conventional multi-port laparoscopy, with younger female patients being especially happier with the 'scarless' outcome of U-LESS. LESS certainly appears to be more in these situations.

Objective: To assess risk factors and predictors of failure of the Hem-o-lok(TM) vascular clip (Weck Closure Systems, Research Triangle Park, NC, USA) using vessels harvested from a porcine model., Materials and Methods: Vessels of various diameters were harvested from a porcine model, clipped at 90 degrees or 45 degrees using the Hem-o-lok clip and then cut either flush or with a 1-mm cuff. The vessels were then connected to a burst-pressure device and pressures required to burst the clip or to cause it to leak were measured., Results: The Hem-o-lok clip leaked or burst when the vessel to which it was applied was cut flush. The clip became even more likely to fail if the angle of application of the clip was not at 90 degrees to the vessel surface., Conclusion: The Hem-o-lok vascular clip is safe if it is applied at 90 degrees to the vessel surface and, more importantly, if a 1-mm cuff is left between the clip and the point at which the vessel is divided. We would therefore discourage the practice of not leaving this cuff of tissue, in an attempt to maximize vessel length during laparoscopic donor nephrectomy.

A 64-year-old woman presented to a dermatologist with male pattern hair loss and was found to have grossly elevated testosterone levels at 22.3 nmol/l (normal range, 0.0-2.9 nmol/l). The diagnosis of an androgen-secreting adrenal tumour was made and she underwent a laparoscopic retroperitoneal right adrenalectomy with an uneventful speedy recovery, being discharged in less than 48 h, underlining the clear advantage of this approach.

A group of 20 patients with intraperitoneal rupture of the bladder was compared with a group of 20 patients with haematuria due to renal injury. In patients admitted to hospital within 24 h of sustaining an intraperitoneal bladder rupture, the mean serum levels of creatinine and potassium were increased and the mean serum sodium level was decreased. However, the individual serum creatinine values were within normal limits in six of the 11 patients in this group. Patients presenting more than 24 h after intraperitoneal bladder rupture had an increased mean serum urea, creatinine and potassium level and a decreased mean serum sodium and CO2 content. The individual serum urea and creatinine values on admission to hospital were higher than normal in all nine patients in this group but the serum urea/creatinine ratio was not significantly elevated. A dramatic decrease in serum urea and creatinine levels was seen within 24 h after laparotomy and suturing of the bladder rupture. In patients with abdominal symptoms and signs, haematuria and the biochemical features of renal failure (elevated serum urea, creatinine and potassium, decreased serum sodium and CO2 content), the clinician should suspect an intraperitoneal rupture of the bladder.

Spontaneous (non-traumatic) intraperitoneal rupture of the bladder in a 37-year-old pregnant woman was repaired at laparotomy. Nine months later she again presented with an intraperitoneal bladder rupture during pregnancy and fatal sepsis. Histological examination of the resected bladder wall showed acute ulcerative and necrotising cystitis. All patients with apparently spontaneous bladder rupture should undergo full urological evaluation to identify possible disease which might lead to recurrent rupture.

A 60-year old female pseudohermaphrodite with congenital adrenal hyperplasia presented with acute retention of urine and a lower abdominal mass. At laparotomy a large uterus with multiple leiomyomas was removed. Transurethral resection of the obstructing bladder neck revealed benign prostatic hyperplasia. This patient demonstrates that benign prostatic hyperplasia may develop in the presence of androgens from an extratesticular source.