Initial experience with LESS and hybrid LESS in patients with benign urologic disease.

We report our initial experience with 100 laparoendoscopic single site (LESS) and hybrid LESS procedures for benign urologic disease. Between December 2008 and April 2010, we performed LESS and hybrid LESS urologic procedures in 100 cases for various benign urologic diseases. Conversion to standard laparoscopy was necessary in six cases, conversion to hand-assisted laparoscopic surgery occurred in one case, and conversion to open surgery was necessary in one case. Intra- and postoperative complications occurred in nine and four cases, respectively. Totally, the mean operative time was 170 minutes, the mean blood loss was 221 ml, and the mean hospital stay was 5.1 days. The mean patient controlled anesthesia (PCA) equivalents used were 81.5 ml and the mean Visual Analog Pain Scale (VAPS) scores at postoperative day 1 and discharge were 3.8 and 2.1, respectively. The study was limited by retrospective design and short-term follow-up periods. LESS and hybrid LESS procedures are technically feasible in a variety of ablative and reconstructive applications of benign urologic diseases. However, apparent benefits of LESS surgical techniques over conventional laparoscopy are needed to be further explored.

Association of midline prostatic cysts and lower urinary tract symptoms: A case-control analysis of 606 transrectal ultrasound findings.

OBJECTIVE: To evaluate the association between midline prostatic cysts (MPCs) and lower urinary tract symptoms (LUTS). METHODS: A total of 606 patients who underwent transrectal ultrasound of the prostate (TRUS) were retrospectively reviewed. Patients were divided into two groups based on the presence of MPCs for comparison. We used the International Prostate Symptom Score (IPSS) as a LUTS parameter. Multivariate analysis was performed to find out independent predictors for moderate to severe LUTS. An MPC subgroup analysis was done to look for linear correlation between the size of MPCs and LUTS. RESULTS: Patients with no MPCs were of higher age, had more history of diabetes, were taking more urological medications, and had more IPSS storage symptoms. No significant differences were found in body mass index, total IPSS, voiding IPSS, bother score, total prostate-specific antigen level, and the prostate size. Multivariate analysis revealed age, history of diabetes, taking urological medications, and the prostate size as independent predictors of moderate to severe LUTS. The presence of MPCs was not an independent factor. Subgroup analysis failed to show significant correlation between the size of MPCs and the LUTS scores. CONCLUSIONS: The presence of MPCs is not an independent factor for moderate to severe LUTS, and the size of the MPCs does not have any correlation to LUTS scores either.

Detection rate of clinically insignificant prostate cancer increases with repeat prostate biopsies.

To analyze if clinically insignificant prostate cancer (CIPC) is more frequently detected with repeat prostate biopsies, we retrospectively analyzed the records of 2146 men diagnosed with prostate cancer after one or more prostate biopsies. The patients were divided into five groups according to the number of prostate biopsies obtained, e.g. group 1 had one biopsy, group 2 had two biopsies and group 3 had three biopsies. Of the 2146 patients diagnosed with prostate cancer, 1956 (91.1%), 142 (6.6%), 38 (1.8%), 9 (0.4%) and 1 (0.1%) men were in groups 1, 2, 3, 4 and 5, respectively. Groups 4 and 5 were excluded because of the small sample sizes. The remaining three groups (groups 1, 2 and 3) were statistically analyzed. There were no differences in age or prostate-specific antigen level among the three groups. CIPC was detected in 201 (10.3%), 28 (19.7%) and 9 (23.7%) patients in groups 1, 2 and 3, respectively (P<0.001). A multivariate analysis showed that the number of biopsies was an independent predictor to detect CIPC (OR=2.688 for group 2; OR=4.723 for group 3). In conclusion, patients undergoing multiple prostate biopsies are more likely to be diagnosed with CIPC than those who only undergo one biopsy. However, the risk still exists that the patient could have clinically significant prostate cancer. Therefore, when counseling patients with regard to serial repeat biopsies, the possibility of prostate cancer overdiagnosis and overtreatment must be balanced with the continued risk of clinically significant disease.

Laparoendoscopic single-site nephrectomy for single-system ectopic ureters with dysplastic kidneys in children: early experience.

BACKGROUND AND AIM: Single-system ectopic ureter with dysplastic kidney is a rare urologic anomaly. We report our early experience in 4 children who underwent laparoendoscopic single-site (LESS) nephrectomy for single-system ectopic ureters with dysplastic kidney. PATIENTS AND METHODS: We diagnosed 4 consecutive children (aged 18-59 months; mean: 3.2 years) with single-system ectopic ureter with dysplastic kidney. A single, experienced surgeon performed LESS nephrectomy using a homemade single-port device in all patients. RESULTS: LESS nephrectomy was completed successfully in all 4 patients without complications, insertion of an additional port, or open conversion. Blood loss was minimal. Mean operation time was 83.3 minutes (range: 55-125 minutes), and patients began oral intake on the first postoperative day. Mean postoperative hospital stay was 1.3 days (range: 1-2 days). Urine dribbling and wetting resolved immediately after surgery, and no patient has developed a urinary tract infection to date. CONCLUSIONS: LESS nephrectomy for an ectopic ureter with dysplastic kidney is a safe and feasible method with better cosmesis, compared with classic nephrectomy. LESS nephrectomy is a promising method in pediatrics.

Laparoendoscopic Single-Site Pyeloplasty Using Additional 2 mm Instruments: A Comparison with Conventional Laparoscopic Pyeloplasty.

PURPOSE: Despite a recent surge in the performance of laparoendoscopic single-site surgery (LESS), concerns remain about performing LESS pyeloplasty (LESS-P) because of the technical difficulty in suturing. We report our techniques and initial experiences with LESS-P using additional needlescopic instruments and compare the results with conventional laparoscopic pyeloplasty (CL-P). MATERIALS AND METHODS: Nine patients undergoing LESS-P were matched 2:1 with regard to age and side of surgery to a previous cohort of 18 patients who underwent CL-P. In both groups, the operating procedures were performed equally except for the number of access points. In the LESS-P group, we made a single 2 cm incision at the umbilicus and used a homemade port. We also used additional 2 mm needlescopic instruments at the subcostal area to facilitate suturing and the ureteral stenting. RESULTS: The preoperative characteristics were comparable in both groups. Postoperatively, no significant differences were noted between the LESS-P and CL-P cases in regard to length of stay, estimated blood loss, analgesics required, and complications. But, LESS-P was associated with a shorter operative time (252.2 vs. 309.7 minutes, p=0.044) and less pain on postoperative day one (numeric rating scale 3.7 vs. 5.6, p=0.024). The success rate was 94% with CL-P (median, 23 months) and 100% with LESS-P (median, 14 months). CONCLUSIONS: Our initial experiences suggest that LESS-P is a feasible and safe procedure. The use of additional 2 mm instruments can help to overcome the difficulties associated with LESS surgery.