A giant inguinoscrotal hernia containing urinary bladder repaired with use of robotic-assisted laparoscopy: a case report.

The aim of this report is to underline proper differential diagnosis of scrotal enlargement and to highlight feasibility of minimally invasive robotic-assisted treatment of giant urinary bladder containing inguinoscrotal hernia. A 48-year-old patient was referred to the outpatient urology clinic with diagnosis of hydrocele. During the diagnostic procedures, it was confirmed that the scrotal enlargement is a giant inguinal hernia containing most of the urinary bladder. Robotic-assisted laparoscopic transabdominal preperitoneal hernia repair (TAPP) has been performed. The patient remains asymptomatic after 18 months of observation. Minimally invasive repair should always be considered due to better perioperative and postoperative outcomes.

The role of a template-assisted cognitive transperineal prostate biopsy technique in patients with benign transrectal prostate biopsies: a preliminary experience.

INTRODUCTION: Urologists are commonly facing the dilemma of elevating prostate-specific antigen (PSA) levels despite a series of negative prostate biopsy results. Although fusion biopsies are being used increasingly, they are not available in many centers. We evaluated the prostate cancer detection rate using transperineal magnetic resonance imaging (MRI) template-guided cognitive biopsy. MATERIAL AND METHODS: Twenty-two patients with a suspicious lesion on MRI were enrolled into this study and underwent a repeated biopsy. All procedures were done under anesthesia and with antibiotic prophylaxis. Brachytherapy template was applied in each case. RESULTS: The median age, PSA and prostate volume were 67 years, 9.2 ng/ml, and 65 ml, respectively. The average number of biopsy cores was 24. Nine patients (41%) were diagnosed with prostate cancer. The grade distribution was Gleason score 7 for 5 patients, and Gleason score 6 for 4 patients. No major complications occurred. CONCLUSIONS: Transperineal MRI template-guided cognitive prostate biopsy appears to be a safe procedure, which helps to detect significant cancer. The biopsy-associated adverse events are negligible.

Preservation of continence in radical prostatectomy patients: a laparoscopic surgeon's perspective.

INTRODUCTION: Preserving continence in patients who underwent radical prostatectomy is of utmost importance. Therefore, modification of surgical technique that would contribute to the regaining of continence with a shortest possible delay after the procedure and adequate evaluation of chances of continence recovery should be considered. MATERIAL AND METHODS: A PubMed database search was performed to review the current literature concerning the physiology and anatomy of sphincter mechanisms, perioperative risk factors, the effects of surgical techniques on post-prostatectomy continence and post-operative management. RESULTS: Modifications of surgical approach with an aim to minimize damage to the sphincter complex, maintenance of maximal urethral length to enable safe anastomosis, and the reconstruction of the urethral support system appears necessary. The patient should also be informed about the chances of regaining continence after surgery. CONCLUSIONS: There is a need to develop a predictive model to stratify patients according to risk of incontinence and implement adequate action to minimize those risks including preoperative pelvic floor muscle training and/or surgical technique modification.

Preliminary results of using a voice-controlled robotic camera driver during 3D laparoscopic radical prostatectomy.

INTRODUCTION: During laparoscopic procedures, the surgeon's control on target field visualization as well as optimal and steady vision can be achieved by using a camera holder. The article presents our preliminary experience with the use of a voice controlled robotic camera holder during 3D laparoscopic radical prostatectomy (3D LRP). MATERIAL AND METHOD: Thirty patients were prospectively enrolled and underwent either 3D LRP with the use of a voice controlled robotic camera holder (study group) or 3D LRP with the surgeon holding the camera (control group). Oncological, demographic data and surgical parameters were evaluated. RESULTS: Voice-controlled 3D LPR produces a more stable visual field that subjectively decreases the surgeon's fatigue, enables precise preparation, especially along big vessels during lymphadenectomy, urethral stump preparation and urethro-vesical anastomosis. In the fifteen cases analyzed, voice-controlled 3D LRP saved 47 hours of surgeon's time. CONCLUSIONS: In this study, the preliminary experience with a robotic arm for camera positioning revealed that the positioner is effective, easy to use and provides a steady and reliable visual field for laparoscopic urological procedures.

[Uretero-uterine fistula as complication of the cesarean section]. / Przetoka moczowodowo-maciczna jako powiklanie ciecia cesarskiego.

CASE PRESENTATION: 26 y.o woman 3 weeks after cesarean section complained of urine leakage from vagina. Urography revealed uretero-uterine fistula. Surgery was performed--3 dexon sutures attaching strictured ureter to the uterine were localized and then cut off. Distally obliterated ureter was separated out of adjacent tissues. The strictured part of ureter was then incised on the length of ca 8 cm, pig tail catheter was induced and human dura mater allograft was put on and sewed in into the strictured segment. In the long term follow-up the woman gave birth to two more children in the vaginal delivery without any complications. Urographies revealed no fistula, no stricture recurrency and normal urine passage.

Reconstructive surgery of the extensive ureter strictures using human dura mater allografts.

OBJECTIVE: To present and evaluate our experiences with use of human dura mater allografts in reconstructive surgery of long ureter strictures; first human derived, collagen based, oligocellular biomaterial utilized in genitor-urinary reconstructive surgery. To describe on the basis of our experiences with dura mater preferable from a technical and biological standpoint features of biomaterial as a matrix for the ureter regeneration in this condition. We also assessed a technical aspects, suitability and efficacy of the new operative method. PATIENTS AND METHODS: Between 1980 and 1992, in our search for ideal biomaterial useful for reconstructive surgery of extensive ureter obstruction we used to apply human dura mater allografts. A total of 6 females and 2 males were treated with reconstructive surgery with human dura mater allografts utilized for supplementation of the ureter wall defect. Diagnosis was based on ultrasonography, excretory urography and retrograde ureteropyelography. Imaging studies revealed obstructed ureter segment of at least 4 cm length. RESULTS: In all cases procedure was completed without any complications. Hospitalization after the surgery lasted approximately 8-10 days. Early and late follow-up excretory urography demonstrated lack of obstruction in the operated ureter segment. Long term follow-up of 12 months to 18 years (meanly 8,75 years) showed no signs of renal function deterioration, without urine obstruction on the operated side in all patient. Fluoroscopy scans showed signs of peristaltic wave in the operated ureter segment. CONCLUSIONS: Both a supplementary biomaterial used and a new operative method proved to be a promising option in reconstruction of long ureter strictures. Unfortunately a threat of prion related diseases, which resulted in exclusion dura mater grafts and all biomaterial originated from nervous system from transplantology, forced us to search for new suitable material.

Reconstruction of long ureteral obstructions using xenogenic acellular collagen membranes.

OBJECTIVE: Extensive stricture of ureter still poses a difficult challenge for urologic surgons, especially when its middle part is affected. We present a reconstructive method of long ureteral strictures with use of xenogenic collagen membranes as a scaffolding to promote new tissue growth in the area of extensive ureter defect. PATIENTS AND METHODS: Between 1980 and 2002 we applied and evaluated results of the new procedure in a total of 7 females and 3 males suffering from a various degree of hydronephrosis caused by extensive ureter stricture. RESULTS: Early and long-term follow-up excretory urography demonstrated lack of obstruction in the operated ureter segment in all cases. CONCLUSIONS: Easy surgical procedure, no complications after surgery excellent short and long-term results prove the efficacy and usefulness of the presented therapeutic option.

Reconstructive surgery of male urethra using human amnion membranes (grafts)--first announcement.

OBJECTIVE: Assessment of technical aspects of the surgical procedure and usefulness, suitability and efficacy of human amnion grafts as a biomaterial in reconstructive surgery of strictured male urethra. PATIENTS AND METHODS: Human amnion membranes were used in 2 men suffering from long, recurring strictures of urethra. Narrowed part of urethra was careful prepared and cleaned of adjacent tissue. Then a longitudinal incision was performed through the whole length of strictured segment and then it was covered with human amnion membrane. RESULTS: Hospitalization time 4 to 5 days. The Foley catheter was removed 2 weeks after surgery 3 months after surgery controlled urethrographies and urethroscopies show wide urethra lumen, wider than in adjacent parts. In urethroscopy operated place covered with epithelium, smooth, without scare. CONCLUSIONS: Human amnion grafts and described technique seem to be a promising method of managing long, recurring male urethra strictures but need long-term follow-up and analysis of more cases.