Learning Curve for Endoscopic Combined Intra-Renal Surgery Using Vacuum-Assisted Device.

INTRODUCTION: The aim of the study was to provide data related to endoscopic combined intra-renal surgery learning curve using minimally invasive techniques with vacuum-assisted devices. Minimal data exist on the learning curve for these techniques. METHODS: We conducted a prospective study monitoring the training of a mentored surgeon learning ECIRS with vacuum assistance. We use varied parameters for improvements. After collection of peri-operative data, tendency lines and CUSUM analysis were used to investigate the learning curves. RESULTS: 111 patients have been included. Guy's Stone Score 3 and 4 stones 51.3% of all cases. The mostly used percutaneous sheath was 16 Fr (87.3%). SFR was 78.4%. 52.3% patients were tubeless, and 38.7% achieved trifecta. High-degree complication rate was 3.6%. Operative time improved after 72 cases. We observed a decrease of complications throughout the case series, with improvement after 17 cases. In terms of trifecta, proficiency was reached after 53 cases. Proficiency seems achievable in a limited number of procedures, but results did not plateau. Higher number of cases might be necessary for excellence. DISCUSSION: A surgeon learning ECIRS with vacuum assistance can obtain proficiency in 17-50 cases. The number of procedures required for excellence remains unclear. Exclusion of more complex cases might positively affect the training, reducing unnecessary complications.

Evolving transurethral resection of the prostate: enucleation-resection of the prostate.

BACKGROUND AND PURPOSE: Enucleation-transurethral resection of the prostate (e-TURP) is our evolution of the conventional TURP. The aim of this study was to report our experience with e-TURP for the endoscopic management of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: The e-TURP combines the basic steps of classic TURP with the technique of holmium laser enucleation of the prostate (HoLEP) but using only the bipolar resector. The charts of 64 patients who underwent e-TURP for BPH in our department between October 2005 and October 2009 were retrospectively studied. RESULTS: The mean resected tissue weight was 27.21 g, and the mean operative time was 75.7 min. The mean decreases in hemoglobin and serum sodium levels were 1.63 g/dL and 0.55 mEq/L, respectively. Mean catheter duration was 2.53 days, and the mean total hospitalization time was 3.75 days. There was a significant improvement in urinary peak flow rate (Qmax) 2 months postoperatively (P = 0.009718), as well as a significant decrease in the International Prostate Symptom Score during the same period (P < 0.0001). No major complications were observed, and the rates for early and late complications were 10% and 5%, respectively, at 14.75-month mean follow-up. CONCLUSION: The e-TURP seems to be a safe and effective method for the endoscopic management of BPH. Further investigation with randomized trials is needed on this matter.

Development of a new geometric bicycle saddle for the maintenance of genital-perineal vascular perfusion.

OBJECTIVE: To identify a bicycle saddle model for cyclists who cover long distances, to minimally reduce the compression on the structures of the pelvic floor, thereby protecting blood perfusion of the penis and avoiding possible consequences on penile erection. MATERIALS AND METHODS: A comparison between a new geometric development of a bicycle saddle model (SMP) and one of the more frequently used models by professional cyclists was made. The measurement of the partial pressure of penile transcutaneous oxygen (PtcO(2)) in 29 healthy voluntary cyclists was recorded to investigate the differences of compression from two different saddles on the vascular structures of the perineum. The PtcO(2) was recorded at 3 and 10 minutes in conditions of static sitting. Then, the values of PtcO(2) were recorded for 15 minutes while the cyclists were in a 60-degree position and in stable hemodynamic conditions. RESULTS: A t-test was performed to measure the level of confidence. The clear superiority of the SMP saddle in preventing vascular compression of the perineal structures was demonstrated to be statistically significant. CONCLUSION: The experiment validated the effectiveness of the SMP saddle in limiting the compression on the pelvic floor. In addition, the SMP saddle introduces compatible seat dimensions that cyclists prefer to cover long distances.