Robot-assisted extravascular stent for nutcracker syndrome: A case report.

Nutcracker syndrome (NCS) is a rare condition caused by compression of the left renal vein (LRV) between the aorta and superior mesenteric artery. Surgical treatment is reserved for patients with severe symptoms and failure of conservative treatment. A 31-year-old woman diagnosed in adolescence with NCS has had recurrent pain since age 15. For 30 days, she has had severe left flank pain and microhematuria. The patient underwent extravascular stent placement around the LRV with the Da Vinci Xi. In 30 months of follow-up, the patient has no pain and the LRV remained without compressions or thrombosis.

Recommendations on robotic-assisted radical prostatectomy: a Brazilian experts' consensus.

Radical prostatectomy is a commonly adopted treatment for localized/locally advanced prostate cancer in men with a life expectancy of ten years or more. Robotic-assisted radical prostatectomy (RARP) is comparable to open radical prostatectomy on cancer control and complication rates; however, new evidence suggests that RARP may have better functional outcomes, especially with respect to urinary incontinence and erectile dysfunction. Some of the surgical steps of RARP are not adequately described in published literature and, as such, may have an impact on the final outcomes of the procedure. We organized a Brazilian experts' panel to evaluate best practices in RARP. The confection of the recommendations broadly involved: selection of the experts; establishment of working groups; systematic review of the literature and elaboration of a questionnaire; and construction of the final text with the approval of all participants. The participants reviewed the publications in English from December 2019 to February 2020. A one-round Delphi technique was employed in 188 questions. Five reviewers worked on the final recommendations using consensual and non-consensual questions. We found 59.9% of questions with greater than 70% agreement that were considered consensual. Non-consensual questions were reported according to the responses. The recommendations were based on evidence-based literature and individual perceptions adapted to the Brazilian reality, although some issues remain controversial. We believe that these recommendations may help urologists involved in RARP and hope that future discussions on this surgical procedure may evolve over the ensuing years.

Robotic-assisted excision of a prostatic utricle cyst in a 12-month boy with proximal hypospadia and 45X0/ 46XY karyotype.

INTRODUCTION: Prostatic utricle cysts result from incomplete regression of Mullerian duct structures and occur most frequently in males with perineal or peno-scrotal hypospadias. Utricular cysts may present with various signs and symptoms including urinary tract infection, pain and post-void incontinence, a palpable abdominal mass or recurrent epididymitis. MATERIAL AND METHODS: We present a 12 months boy we treated due to proximal hypospadias in two stages, in association to a dysplastic undescended testis that was excised. The karyotype of the patient was 45X0/46XY and after successful hypospadias treatment, the mother complained of purulent discharge in the diapers. A sonogram showed a large cyst behind the bladder with heterogeneous content. The diagnosis of utricle cyst was confirmed by a NMR with detailed anatomy and low confluence of the neck of the cyst to the urethra. RESULTS: We performed a robotic excision of the cyst consisting of careful dissection between bladder and rectum and a safe ligation of the communication of it to the urethra. CONCLUSION: Patient outcome was uneventful. To the best of our knowledge this is the youngest patient with utricle cyst treated with robotic approach reported in the literature.

Diode Laser Vaporization for Benign Prostate Hyperplasia: Outcome After 126 Procedures.

Purpose: Photoselective vaporization of the prostate (PVP) with a 940-nm diode laser is an option for treating symptoms caused by benign prostatic hyperplasia (BPH). Here, we present our experience using this technology. Methods: We prospectively evaluated 126 patients with lower urinary tract symptoms (LUTS) secondary to BPH who underwent PVP with a 940-nm diode laser from January 2011 to January 2014. The patients were assessed using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, prostate-specific antigen (PSA) level, maximum urinary flow (Qmax) by uroflowmetry, postvoid residual volume, and prostate volume by ultrasound at baseline and 3, 6, 12, and 24 months after the procedure. Results: The average patient age was 68.8 ± 8.7 years (range 48-90 years), whereas the average preoperative parameters were as follows: IPSS, 26.1 ± 5.2; IPSS-QoL, 4.9 ± 0.8; Qmax, 4.5 ± 3.1 mL/s; prostate volume, 76.5 ± 35.5 mL; and PSA level, 3.9 ± 2.6 ng/mL. The average catheterization time was 24.7 ± 25.5 hours (range 3-120 hours), and the length of hospital stay was 22.4 ± 17.0 hours (range 8-144 hours). The mean follow-up duration was 17.9 months (range 1-36 months). All parameters showed significant improvement after 12 months. After 24 months, the IPSS (8.8 ± 5.4, p < 0.07), IPSS-QoL (1.6 ± 0.9, p < 0.13), Qmax (15.9 ± 7.3 mL/s, p < 0.11), and PSA level (1.2 ± 0.8 ng/mL, p < 0.11) were improved compared with the baseline, but the difference was not significant, probably due to the small number of patients evaluated in this period. No patients required a transfusion. Conclusions: The results suggest that PVP with a 940-nm diode laser is safe, effective, and durable for the treatment of LUTS secondary to BPH. The patients continue to be monitored for evaluation of the long-term results. A prospective randomized study would allow more solid conclusions regarding the technology to be reached.

Robot-Assisted Infratrigonal Vesicovaginal Fistula Repair.

BACKGROUND: Although relatively rare, vesicovaginal fistula is the most common genitourinary fistula, causing a significant decrease in patients' quality of life. Location of fistula is major supratrigonal, with some cases located in the trigone and rarely below it. Disease treatment is surgical, and repair can be performed by several techniques, including robot-assisted. CASE PRESENTATION: We present a case of a patient who developed an infratrigonal vesicovaginal fistula after treatment of a cervical cancer. The patient was submitted to robotic repair of the vesicovaginal fistula. CONCLUSION: The use of robot-assisted laparoscopy is expanding over all areas of urology and its applicability to repair vesicovaginal fistulas brings good results.

Giant Perineal Solitary Fibrous Tumor: A Rare Case Report.

Background. Solitary fibrous tumor (SFT) is a fibroblastic mesenchymal tumor that was initially described from the pleura but currently arises at almost every anatomic site. It is usually benign, and surgical resection is curative. SFT involving the perineum is extremely rare. This is the third case report of a perineal SFT in the literature. Case Presentation. We reported an uncommon case of a 64-year-old man presenting with a huge perineal mass that started growing 3 years before his arrival in our service. He was asymptomatic. A contrast-enhanced CT scan revealed a heterogeneous well-circumscribed perineal mass with soft-tissue density. Invasion of the surrounding organs, distal metastasis, and lymph node swelling were absent. The complete resection of mass was done successfully. The specimen was a 23.0 × 14.0 × 8.0 cm encapsulated tumor. Mass weight was 1,170 g. After pathological analysis, we confirmed that the mass was a solitary fibrous tumor. The diagnosis was based on clinical findings and histological morphology and immunohistochemistry study. Conclusion. SFTs are usually indolent tumors with a favorable prognosis. The perineal location is extremely rare. Complete resection of the mass is the treatment of choice.

Two Cases of Solitary Fibrous Tumor Involving Urinary Bladder and a Review of the Literature.

Solitary fibrous tumor (SFT) is a rare neoplasia of mesenchymal origin, initially described in visceral pleura and lately discovered to have ubiquitous distribution. SFT of the urogenital tract is uncommon and appears to have similar morphologic features and biologic behaviors as SFTs found elsewhere. We present two new cases of SFT of the bladder and review 22 similar cases published in the literature. Due to the general indolent behavior of these lesions, a complete but organ sparing surgical excision should be considered when technically feasible. Therefore, proper identification and characterization of SFT through morphological and immunohistochemical criteria on biopsy specimens are mandatory in the differential diagnosis from other more aggressive spindle-cell tumors, thus avoiding unnecessary radical surgery.

Reduction in Renal Specimen After Laparoscopic Radical Nephrectomy: A Histopathologic Analysis.

Abstract Background and Purpose: There is no consensus on the most appropriate way to extract the kidney after laparoscopy. A previous study evaluated the reduction in total kidney volume and incision size (40%) after perfusion with a 5% hypertonic solution in a porcine model. The purpose of the current study was to compare the histopathologic renal tumor diagnosis before and after this perfusion. Furthermore, fluid drained from the renal vein was analyzed for the presence of neoplastic cells. Materials and Methods: After radical nephrectomy, specimens of 21 cases of renal tumors were studied. A small piece of the tumor was removed and fixed in formaldehyde. After that, 500 mL of a 5% NaCL solution was infused through the renal artery. The first 10 mL drained from the vein was collected and sent for cytologic study. The specimens and the fragment were analyzed. The parameters studied were histologic subtypes, Fuhrman grade, necrosis, and microvascular invasion. Results: Clear-cell renal carcinoma was found in 81% of the cases. Two cases of chromophobic renal carcinoma, one case of papillary tumor, and one case of oncocytoma were found. There were no differences in histologic subtypes, Fuhrman grade, necrosis, and microvascular invasion before and after perfusion in most of the cases. All cytologic analysis of drained liquid from the renal vein was negative for neoplastic cells. Conclusions: Renal perfusion with 5% NaCL solution after laparoscopic radical nephrectomy did not interfere with the histopathologic and cytologic characteristics of the kidney. In addition, all samples from the liquid drained from the renal vein were negative for neoplastic cells. These findings suggest that renal shrinkage with hypertonic saline after laparoscopic radical nephrectomy is feasible and might be useful for patients with kidney cancer. Validation of our results as well as their impact on clinical outcomes is warranted.