Enhancing bladder cancer diagnosis through transitional cell carcinoma polyp detection and segmentation: an artificial intelligence powered deep learning solution.

Background: Bladder cancer, specifically transitional cell carcinoma (TCC) polyps, presents a significant healthcare challenge worldwide. Accurate segmentation of TCC polyps in cystoscopy images is crucial for early diagnosis and urgent treatment. Deep learning models have shown promise in addressing this challenge. Methods: We evaluated deep learning architectures, including Unetplusplus_vgg19, Unet_vgg11, and FPN_resnet34, trained on a dataset of annotated cystoscopy images of low quality. Results: The models showed promise, with Unetplusplus_vgg19 and FPN_resnet34 exhibiting precision of 55.40 and 57.41%, respectively, suitable for clinical application without modifying existing treatment workflows. Conclusion: Deep learning models demonstrate potential in TCC polyp segmentation, even when trained on lower-quality images, suggesting their viability in improving timely bladder cancer diagnosis without impacting the current clinical processes.

Female anterior wall onlay urethroplasty with lower lip buccal mucosal graft: Importance of the laterally extended incision.

Objective: To describe the outcome of female anterior wall (pubic side) onlay urethroplasty with buccal mucosal graft using laterally extended surgical dissection in patients with previously failed minimally invasive techniques. Methods: From January 2016 to April 2018, 17 symptomatic patients with previously failed minimally invasive procedures were enrolled in the study. The diagnosis of urethral stricture was confirmed based on a combination of patients' symptoms, post-void residual urine, video-urodynamics, and cystoscopy. Urethroplasty with lower lip mucosal graft was performed using the modified laterally extended dissection. Patients were evaluated pre-operatively and 12-month post-operatively with the American Urological Association symptom score, post-void residual urine, and maximum flow rate. Results: Despite the previously failed minimally invasive procedures, urethroplasty with lower lip buccal graft and laterally extended dissection resulted in favorable outcomes (success rate=94%). The mean±standard deviation of American urological association symptom score improved from pre-operative levels at the 12-month post-operative follow-up (25.82±3.97 to 10.88±5.57); so did postvoid residual urine (71.12±74.98 mL to 15.00±28.30 mL), and maximum flow rate (7.88±1.72 mL/s to 25.82±5.59 mL/s) with all statistically significant (p<0.05). Conclusion: The current study showed that female urethroplasty with buccal graft could be highly successful in experienced hands. An anterior approach could be superior to the posterior one due to higher mechanical support and lower sacculation rate. A laterally extended incision may improve visualization and better graft placement by providing wider working space. The results should be evaluated in the future studies with larger sample size.

Introducing the POPVESL Score for Intrarenal Vascular Complications of Percutaneous Nephrolithotomy: Experience from a Single high-volume Referral Center.

PURPOSE: Percutaneous-nephrolithotomy (PCNL), is the current modality of choice for large renal stones. Delayed post-op bleeding may herald pseudo aneurysm (PA) or arteriovenous fistula (AVF) necessitating costly and inconsistently available angioembolization, or prolonged hospitalization. The goal of this study is to identify criteria that may predict response to conservative therapy, for delayed bleeding from post PCNL intrarenal vascular lesions. MATERIALS AND METHODS: We reviewed all data on patients re-admitted for post PCNL gross hematuria at our high volume center between 2011 and 2016. Perioperative findings, factors related to the stone and management details, were subjected to multifactorial analysis. Logistic regression for multivariable analysis and ROC curves to find thresholds predicting mandatory angioembolization. RESULTS: Of 4403 PCNLs, 83 (1.9%) with delayed bleeding were diagnosed with intrarenal vascular lesions: Arteriovenous fistulas in 54 (AVF, 65%) and pseudoaneurysm in 29 (PA, 35%). Overall 49 (59%) responded to conservative management but 34 (41%) eventually required angioembolization. On multivariable analysis, predictive factors for poor response to conservative treatment were requiring transfusion beyond initial stabilization, pseudoaneurysm, history of open renal surgery, longer interval-to-second-admission, and size of vascular lesion. The proposed POPVESL score (short for Post PNL Vascular Embolization selection) when below 11, correctly predicts success of conservative management with 81.6% sensitivity and 100% specificity. CONCLUSIONS: Our findings including the proposed POPVESL score have the potential for clinical application and enhancing practical guidelines on the management of post-PCNL bleeding.

Involvement of haptoglobin phenotypes and genotypes in non-muscle invasive bladder cancer: A possible prognostic marker for risk stratification.

The association of haptoglobin (Hp) with various cancers has been reported and also it has been documented that the Hp phenotypes/genotypes have different functional ability. So, we examined phenotypes/genotypes of Hp in newly diagnosed, untreated non-muscle invasive bladder cancer (NMIBC) patients and investigated its prognostic value for risk stratification of the cancer. In eighty NMIBC patients and 80 healthy individuals the Hp genotypes and phenotypes were analyzed using polymerase chain reaction (PCR) and two-dimensional gel electrophoresis (2D-GE), respectively. Besides, the presence of the Hpα1, α2, and ß chains in the sera was confirmed by Mass Spectrometry (MS). The frequencies of the 1-1 and 2-2 genotypes/phenotypes were respectively higher and lower in healthy subjects compared to the patients. Our results revealed that the 2-2 genotype/phenotype could increase the risk of NMIBC. There was a positive association between the 2-2 genotype/phenotype with the T category/grade of cancer (p<0.05). The present study implied a strong association between the Hp phenotypes and genotypes with NMIBC. It was found that the 2-2 genotype and phenotype could be a risk factor for NMIBC incidence, as well as, progression. This study introduced Hp genotyping as a possible cost-effective and precise method for prognosis of individuals at the risk of NMIBC.

Inflammatory cytokines in bladder cancer.

The presence of inflammatory cells and their products in the tumor microenvironment plays a crucial role in the pathogenesis of a tumor. Releasing the cytokines from a host in response to infection and inflammation can inhibit tumor growth and progression. However, tumor cells can also respond to the host cytokines with increasing the growth/invasion/metastasis. Bladder cancer (BC) is one of the most common cancers in the world. The microenvironment of a bladder tumor has been indicated to be rich in growth factors/inflammatory cytokines that can induce the tumor growth/progression and also suppress the immune system. On the contrary, modulate of the cancer progression has been shown following upregulation of the cytokines-related pathways that suggested the cytokines as potential therapeutic targets. In this study, we provide a summary of cytokines that are involved in BC formation/regression with both inflammatory and anti-inflammatory properties. A more accurate understanding of tumor microenvironment creates favorable conditions for cytokines targeting to treat BC.

Cancer stem cells as a therapeutic target in bladder cancer.

Bladder cancer is one of the most prevalent genitourinary cancers responsible for about 150,000 deaths per year worldwide. Currently, several treatments, such as endoscopic and open surgery, appended by local or systemic immunotherapy, chemotherapy, and radiotherapy are used to treat this malignancy. However, the differences in treatment outcome among patients suffering from bladder cancer are considered as one of the important challenges. In recent years, cancer stem cells, representing a population of undifferentiated cells with stem-cell like properties, have been eyed as a major culprit for the high recurrence rate in superficial papillary bladder cancer. Cancer stem cells have been reported to be resistant to conventional treatments, such as chemotherapy, radiation, and immunotherapy, which induce selective pressure on tumoral populations resulting in selection and growth of the resistant cells. Therefore, targeting the therapeutic aspects of cancer stem cells in bladder cancer may be promising. In this study, we briefly discuss the biology of bladder cancer and then address the possible relationship between molecular biology of bladder cancer and cancer stem cells. Subsequently, the mechanisms of resistance applied by cancer stem cells against the conventional therapeutic tools, especially chemotherapy, are discussed. Moreover, by emphasizing the biomarkers described for cancer stem cells in bladder cancer, we have provided, described, and proposed targets on cancer stem cells for therapeutic interventions and, finally, reviewed some immunotargeting strategies against bladder cancer stem cells.

The role of blood neutrophil count and the neutrophil-to-lymphocyte ratio as a predictive factor for prostate biopsy results.

BACKGROUND:: It is apparent that prostate cancer has harmful effects on the erythrocytes, leucocytes, and platelets. In addition, it has been suggested that the toxic granules in neutrophils lead to inflammation in the cancerous tissues besides the activation of monocytes, so in this study we aimed to evaluate the blood neutrophil count besides the neutrophil-to-lymphocyte ratio as a predictive factor for prostate biopsy results and their relationship with prostate cancer grade in patients undergoing biopsy of the prostate. METHODS:: For all men with irritative lower urinary tract symptoms visiting Hasheminezhad Hospital from January to July 2015, in case of having a suspicious digital rectal examination or aged above 40 years, prostate-specific antigen was requested and in case of abnormal results, they underwent prostate biopsy. In order to examine the study hypothesis, the blood neutrophil count and the neutrophil-to-lymphocyte ratio were measured and compared with the abnormal prostate-specific antigen results and suspicious digital rectal examination. RESULTS:: Among the 500 referred samples for biopsy, 352 (70.4%) had a negative biopsy result, while it was positive in the other 148 (29.6). The mean neutrophil count showed no statistical difference regarding the biopsy results (p = 0.381). When measuring the neutrophil-to-lymphocyte ratio again with biopsy results, no statistically significant difference was obtained based on the biopsy results (p = 0.112). CONCLUSION:: Neutrophil count and neutrophil-to-lymphocyte ratio cannot be predictive factors for positive prostate cancer biopsy.

Comparing the Efficacy of Tolterodine and Gabapentin Versus Placebo in Catheter Related Bladder Discomfort After Percutaneous Nephrolithotomy: A Randomized Clinical Trial.

PURPOSE: The purpose of this study was to compare the efficacy of tolterodine and gabapentin vs placebo in catheter related bladder discomfort (CRBD) following percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: This study was a double-blind parallel group randomized clinical trial. Patients who were candidates of PCNL were enrolled. Patients were randomized to treatment groups of tolterodine 2 mg orally (PO) (group T, n = 50), gabapentin 600 mg PO (group G, n = 50), and placebo (group P, n = 70) 1 hour before operation using balanced block randomization. The primary endpoint of interest was visual analog pain scale in 1, 3, 12, and 24 hours after the operation. Secondary endpoints included rescue analgesic use (opioid and nonopioid). RESULTS: The frequency of severe CRBD in 1,12, and 24 hours after the operation was 4%, 4%, and 6% in group T vs 4%, 0%, and 2% in group G vs 47%, 14%, and 6% in the P group (p < 0.001). The number of paracetamol injections for CRBD in the T and G groups was significantly lower than the placebo group (1.8 ± 0.8 vs 1.8 ± 0.7 vs 3.6 ± 0.7, p < 0.001). Likewise the number of pethidine injections in the T and G groups was significantly lower than the placebo group (0.42 ± 0.54 vs 0.68 ± 0.62 vs 2.4 ± 0.64, p < 0.001). In patients with history of Double-J insertion, the severity of CRBD was lower in all treatment groups. CONCLUSIONS: Preoperative administration of oral tolterodine or gabapentin reduces postoperative CRBD and the need for rescue analgesics as much as 24 hours after surgery. Patients with history of Double-J insertion experience less CRBD.

Abobotulinum - a toxin injection in patients with refractory idiopathic detrusor overactivity: injections in detrusor, trigone and bladder neck or prostatic urethra, versus detrusor - only injections

ABSTRACT Purpose: To evaluate if the injections of abobotulinum-A toxin in trigone and bladder neck/prostatic urethra in addition to detrusor provides better symptoms relief and urodynamic findings in patients with idiopathic detrusor overactivity (IDO) refractory to medical treatment. Materials and Methods: A total of 74 patients with IDO refractory to anticholinergics received injections in detrusor, trigone and bladder neck/prostatic urethra (Group A, N=36) versus detrusor only injections (Group B, N=38) of abobotulinum-A toxin. All patients were evaluated by a standard overactive bladder symptom score (OABSS) questionnaire and cystometrography before and 6 weeks after the operation. OABSS questionnaire was also completed 20 weeks after the operation. Results: The magnitude of OABSS reduction from baseline to 6 weeks after operation in groups A and B patients was 13.4±2.2 versus 11.7±2.1 (p=0.001). Cystometry results were similar in both groups except for higher volume at urgent desire to void in Group B patients (p <0.001). The mean±SD change in residual volume in Group A at 6 weeks after the operation was −4.8±28.6mL (p=0.33) compared to 21.3±16.9mL in Group B patients (p <0.001). Conclusions: In patients with IDO, adding trigone, and bladder neck/prostatic urethra as sites of abobotulinum- A toxin injection produces greater reductions in OABSS score and less residual urine volume but a lower volume at urgent desire to void in comparison with detrusor only injections.

Abobotulinum - a toxin injection in patients with refractory idiopathic detrusor overactivity: injections in detrusor, trigone and bladder neck or prostatic urethra, versus detrusor - only injections.

PURPOSE: To evaluate if the injections of abobotulinum-A toxin in trigone and bladder neck/prostatic urethra in addition to detrusor provides better symptoms relief and urodynamic findings in patients with idiopathic detrusor overactivity (IDO) refractory to medical treatment. MATERIALS AND METHODS: A total of 74 patients with IDO refractory to anticholinergics received injections in detrusor, trigone and bladder neck/prostatic urethra (Group A, N=36) versus detrusor only injections (Group B, N=38) of abobotulinum-A toxin. All patients were evaluated by a standard overactive bladder symptom score (OABSS) questionnaire and cystometrography before and 6 weeks after the operation. OABSS questionnaire was also completed 20 weeks after the operation. RESULTS: The magnitude of OABSS reduction from baseline to 6 weeks after operation in groups A and B patients was 13.4±2.2 versus 11.7±2.1 (p=0.001). Cystometry results were similar in both groups except for higher volume at urgent desire to void in Group B patients (p <0.001). The mean±SD change in residual volume in Group A at 6 weeks after the operation was -4.8±28.6mL (p=0.33) compared to 21.3±16.9mL in Group B patients (p <0.001). CONCLUSIONS: In patients with IDO, adding trigone, and bladder neck/prostatic urethra as sites of abobotulinum- A toxin injection produces greater reductions in OABSS score and less residual urine volume but a lower volume at urgent desire to void in comparison with detrusor only injections.

Laser Treatment for Urethral Hemangiomas: Report of Three Cases.

To present our experience with coagulation/laser treatment of urethral hemangiomas. Three cases with small to medium sized urethral hemangiomas in penile and posterior urethra presented with hematuria or urethral bloody discharge. All patients were male. They were treated with thermal or Holmium-YAG laser coagulation in the first session. Recurrence of hematuria/bloody discharge happened in two patients within one month from the first treatment that was managed with a second session of laser coagulation. No third session of intervention for hematuria/bloody discharge was required in any patient during 10-39 months of follow up. In cases of relapse after thermal or laser coagulation of small to medium sized urethral hemangiomas, after appropriate consultation with the patient, a second session of laser coagulation can be successful before contemplating more invasive measures like open surgery.

In Vivo Trial of a Novel Atraumatic Urinary Catheter Design for Prevention of Catheter-Induced Trauma.

PURPOSE: Clinically significant urinary tract infection may be the most familiar complication of urinary catheterization; however, catheter-associated trauma can entail even more significant morbidity. We have designed and patented a novel atraumatic urinary catheter (AUC) and through this study, we compare its efficacy with the conventional Foley catheter (FC) in vivo. MATERIALS AND METHODS: Forty male rabbits were divided into two equal groups for FC and AUC. The animals were catheterized on day 4 for 8 hours to compare the maintenance of the tubes and sedated before standardized forcible extraction of the catheter under sedation with the balloon still inflated. They were then examined visually and by cystoscopy. RESULTS: In a number of animals in either group, the catheters failed to drain urine effectively due to anatomical issues. Those were excluded from the study. At the extraction phase, evidence of urethral trauma was found in 13 of 15 FC rabbits, but only in 4 of 14 in the AUC group (p = 0.009). Major trauma, however, was exclusively seen in the FC group, with 12 of 15 subjects sustaining deep lacerations or urethral disruption. CONCLUSION: The two catheters bear similar efficacy for maintaining urine drainage; however, traumatic injury is significantly less common following forceful extraction of the AUC than a conventional Foley.

A Comparison of the Progression and Recurrence Risk Index in Non-Muscle-Invasive Bladder Tumors Detected by Narrow-Band Imaging Versus White Light Cystoscopy, Based on the EORTC Scoring System.

BACKGROUND: Transitional cell carcinoma of the bladder, the second most common urologic malignancy, is amenable to early diagnosis. This study presents the potential prognostic benefit for a less invasive modification to the standard endoscopic approach. OBJECTIVES: To evaluate the risk index for the progression and recurrence of additional tumors detected with narrow-band imaging (NBI) cystoscopy compared to standard white light imaging (WLI) cystoscopy in non-muscle-invasive bladder cancer (NMIBC), based on the European organization for research and treatment of cancer (EORTC) scoring system. PATIENTS AND METHODS: Patients with NMIBC, who were scheduled for resection between May 2012 and May 2013, were studied and mapped under NBI and WLI cystoscopy by independent surgeons prior to resection. Detection rates and tumor characteristics, including EORTC progression and the recurrence risk index, were compared. RESULTS: Fifty patients, aged 63.86 ± 10.05 years, were enrolled. The overall detection rate was 98.9% for NBI vs. 89.4% for WLI (P = 0.001), and the false-positive rates were 9.6% and 5.8%, respectively (P = 0.051). Ten tumors were detected by NBI alone, including four grade I tumors, four grade III tumors, and two carcinomas in situ. The tumor progression index was not significantly reduced with NBI compared to WLI (P > 0.05); however, the recurrence index was significantly lower in the NBI group (P < 0.05). CONCLUSIONS: NBI cystoscopy improved the detection rate. Although false positives were more common with NBI, this was not statistically significant. NBI found additional aggressive tumors, which underscores the impact of detection in EORTC recurrence risk scoring.

Well differentiated liposarcoma of spermatic cord: report of 3 rare cases.

Spermatic cord liposarcomas are very rare tumors. Patients usually present with painless growing scrotal swellings which are clinically misdiagnosed as hernia. The correct diagnosis is not common and usually they present as operative or histological surprises. To our knowledge, there are about 186 similar cases reported in the literature. Herein we report three cases of spermatic cord liposarcoma with clinical presentation of scrotal bulging, mimicking inguinal hernia in one case and resembling a testicular tumor in the other two cases. The patients were operated and all of them underwent radical orchiectomy and tumor resection.

A Novel Unsupervised Approach for Minimally-invasive Video Segmentation.

Temporal segmentation of laparoscopic video is the first step toward identifying anomalies and interrupts, recognizing actions, annotating video and assessing the surgeons' learning curve. In this paper, a novel approach for temporal segmentation of minimally-invasive videos (MIVS) is proposed. Illumination variation, shadowing, dynamic backgrounds and tissue respiratory motion make it challenging to extract information from laparoscopic videos. These challenges if not properly addressed could increase the errors of data extraction modules. Therefore, in MIVS, several data sets are extracted from laparoscopic videos using different methods to alleviate error effects of data extraction modules on MIVS performance. Each extracted data set is segmented temporally with Genetic Algorithm (GA) after outlier removal. Three different cost functions are examined as objective function of GA. The correlation coefficient is calculated between objective values of the solutions visited by GA and their corresponding performance measures. Performance measures include detection rate, recognition rate and accuracy. Cost functions having negative correlations with all mentioned performance measures are selected. Finally, a multi-objective GA is executed on the data sets to optimize the selected cost functions. MIVS is tested on laparoscopic videos of varicocele and ureteropelvic junction obstruction surgeries collected from hasheminejad kidney center. Experimental results demonstrate that MIVS outperforms the state-of-the-art methods in terms of accuracy, detection rate and recognition rate.

Prospective clinical trial to compare standard colon-reflecting with transmesocolic laparoscopic pyeloplasty.

UNLABELLED: Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Laparoscopic pyeloplasty has replaced open pyeloplasty as the new standard of care and we, among others, have even proven its applicability to redo surgery. The focus is now on limiting morbidity. One technical modification to this end is transmesocolic (TM) exposure of the PUJ. This randomized study pinpoints the objective benefits of TM exposure of the PUJ compared with standard colon reflection, and its results showed a 23% conservation in operating time. OBJECTIVE: • To compare the efficacy and safety of colon-reflecting (CR) and transmesocolic (TM) laparoscopic pyeloplasty approaches in a prospective randomized non-selective setting. PATIENTS AND METHODS: • Excluding only those patients with a history of abdominal surgery, all consenting patients scheduled for laparoscopic pyeloplasty of left-sided pelvi-ureteric junction (PUJ) obstruction between December 2004 and November 2007 were randomized into one of two groups: laparoscopic pyeloplasty using the standard CR approach or laparoscopic pyeloplasty through the TM aperture. • All patients underwent dismembered repair by a single expert and were followed by diuretic renogram and urography at 4 months postoperatively and by annual diuretic renogram thereafter. • Four discrete task phases were timed for comparison: trochar to PUJ, dismembering and spatulation, stenting and anastomosis. RESULTS: • Sixty-four patients were randomized into two groups, TM or CR, with 32 patients in each. • The groups were similar, with no significant difference in sex, age, initial renal function or body mass index. Forty-seven patients were ≤ 15 years old. • The mean (sd) operating time was 23% shorter in the TM group, owing mostly to the much shorter trochar to PUJ phase (5.0 [3.2] min in the TM group vs 35.8 [10.3] in the CR group; P < 0.001). The mean hospitalization time was shorter in the TM group than in the CR group (2.9 vs 3.6 days; P < 0.001). • Thirty-one of 32 patients in each group (96.9%) achieved a durable cure. CONCLUSION: • Transmesocolic exposure of left-sided PUJ obstruction is superior to standard CR exposure, in that it saves anaesthesia time, hospitalization time and has lower morbidity with no compromise in efficiency, and could be considered as the new standard approach.

Is laparoscopic re-evaluation justified in cryptorchidism with previous negative open exploration?

OBJECTIVES: Nonpalpable testes account for 20% of cryptorchidism. Laparoscopy is now the mainstay in management, but open surgery has been the only option for many patients in the past and even today. We suspected that open exploration may have missed gonads in presumed negative open exploration. As abdominal gonads are even more prone to cancerous degeneration, we proposed laparoscopic re-evaluation to patients with previous inconclusive open exploration for impalpable testis. PATIENTS AND METHODS: All boys presenting to our referral center with past history of inconclusive open exploration for nonpalpable testis or with clinical or lab evidence of functional testicular tissue were consecutively offered laparoscopic re-exploration. Standard diagnostic laparoscopy with same-stage laparoscopic orchiopexy or one stage Fowler procedure was employed as required. The presence, number, and site of detected gonads were recorded. RESULTS: 141 male patients with nonpalpable testis comprising 171 nonpalpable gonads were laparoscopically explored with no adverse events. Sixteen patients (19 gonads) already had a negative open exploration. Seven gonads were discovered in these boys, 5 iliac and 2 retrovesical. CONCLUSION: Although a modest number of samples, our results underscore the prevalence of missed diagnosis. Obviously, laparoscopic re-exploration is indicated when a child with previous bilateral inguinal exploration presents with hormonal evidence of functioning gonadal tissue. Further we now recommend laparoscopic re-evaluation in most patients with nonpalpable testis and history of negative open exploration altogether.

A 22-year-old woman with hypertension and hypokalemia due to a juxtaglomerular cell tumor.

Secondary hypertension is responsible for less than 10% of cases of hypertension. If associated with hypokalemia, it may be due to primary or secondary hyperaldostronism, the latter being rarely caused by renin-secreting tumors. We present a 22-year-old woman with a history of hypertension and repeated hypokalemia, who was finally diagnosed with a small renin-secreting tumor after extensive paraclinical workup and imaging studies.

Laparoscopic redo pyeloplasty after failed open surgery.

PURPOSE: To report our experience in treating patients with failed previous open pyeloplasty by transperitoneal laparoscopic pyeloplasty. MATERIALS AND METHODS: Eleven patients with previous failed open pyeloplasty were reviewed, all of whom had undergone transperitoneal laparascopic pyeloplasty. All procedures were performed by a single team. Depending on the anatomic situation, either dismembered or a flap technique was utilized. Subsequent follow-up was by ultrasonography initially, and diuretic renal scintigraphy and/or intravenous urography at least 12 months after the re-operation. Data were collected from the medical records. RESULTS: The study group consisted of 7 men and 4 women with the mean age of 41.4 years (range, 27 to 55 years). Mean operation time was 208 minutes (range, 165 to 250 minutes) and mean hospital stay was 3.6 days (range, 3 to 5 days). Mean follow-up was 24.1 months (range, 12 to 42 months). The overall success rate for these salvage laparoscopic pyeloplasties was 90.9%. Only one female patient developed dull flank pain 3 months after stent removal. There was no conversion to open surgery. None experienced major complications or required blood transfusion. CONCLUSION: Laparoscopic pyeloplasty can be a valid and feasible option in treating patients with failed prior open pyeloplasty.