Comprehensive analysis of Twitter activity on #Incontinence.

AIM: The aim of this study is comprehensive analysis of the Twitter activity on #Incontinence. MATERIAL AND METHODS: The following six functional-urology hashtags on Twitter were analyzed from 2015 to 2018 to gain a comprehensive insight into the topic: #Incontinence, #InterstitialCystitis, #OAB, #FPMRS, #BPH, and #UroBPH. For the Twitter analysis, Symplur Signals was used, which is a health care social media analytics tool. RESULTS: In total 191 383 tweets by 54 094 users in 2015 through 2018 were analyzed. A rise in the number of tweets could be identified for all six analyzed hashtags on functional urology, in summary, the numbers raised from 25 629 tweets in 2015 to 66 551 tweets in 2018. For the hashtag incontinence (#Incontinence), the number of tweets raised from 13 823 in 2015 to 19 996 in 2018 (+44.7%). Main influencers on functional urology topics identified by the Symplur algorithm were individuals from the health care sector in 44.6% of the cases and health care organizations in 36.5% of the cases, whereas for #Incontinence, only 7% of influencers were patients in 2018. The ten most common words connected to #Incontinence were Incontinence, Urinary, Women, Help, New, Bladder, Stress, Treatment, Pelvic, and Sex. Of the tweets, 66% were categorized as positive statements and 34% were categorized as negative. CONCLUSION: Social media is an emerging tool of communication in urology, whereas discussions on #Incontinence are underrepresented compared to the high prevalence of urinary incontinence. In addition, patients' activity is low.

An innovative technique of robotic-assisted/laparoscopic re-pyeloplasty in horseshoe kidney in patients with failed previous pyeloplasty for ureteropelvic junction obstruction.

OBJECTIVES: To describe an innovative laparoscopic/robotic-assisted re-pyeloplasty technique in patients with recurrent ureteropelvic junction obstruction (UPJO) in horseshoe kidneys. PATIENTS AND METHODS: Data from five patients (37-65, median 54 years) with symptomatic recurrence of UPJO in horseshoe kidney who underwent laparoscopic/robotic-assisted re-pyeloplasty at our institution since 2004 were evaluated retrospectively. The upper ureter together with wedge resection of the pelvis at the lower calyx was performed. The ureter is spatulated till beyond the isthmus and anastomosed to lower calyx. Rotational renal pelvis flap is used for reconstruction and conisation of the pelvis. RESULTS: Median operative time was 137 min (92-180) with a negligible blood loss. There was no need for conversion or revisions. Perioperative periods were uneventful. The intraoperatively inserted JJ was left for 6-8 weeks. Median postoperative differential function of affected kidney at 3 months (MAG III) was 38 % (26-42 %), unchanged from 35 % (21-41 %), preoperatively. This was stable in three patients and higher in two (5 and 7 %). There were no obstructive elements indicating anatomical ureteric obstruction. After convalescence period, three patients recurred to their work at 5 weeks, while all at 8 weeks. All patients remained asymptomatic and have not required any further interventions during whole follow-up. CONCLUSIONS: Described technique of laparoscopic/robotic-assisted re-pyeloplasty in horseshoe kidneys is technically feasible, safe and effective with high patient satisfaction and early convalescence. Its success rate is comparable with the results after primary pyeloplasty in horseshoe and heterotopic kidneys. Larger series may be required to allow for more accurate comparison.

Do we need the nerve sparing radical prostatectomy techniques (intrafascial vs. interfascial) in men with erectile dysfunction? Results of a single-centre study.

OBJECTIVES: To report effect of different nerve sparing techniques (NS) during radical prostatectomy (RP) (intrafascial-RP vs. interfascial-RP) on post-RP incontinence outcomes (UI) in impotent/erectile dysfunction (ED) men. PATIENTS AND METHODS: A total of 420 impotent/ED patients (International Index of Erectile Function-score <15) with organ-confined prostate cancer were treated with bilateral-NS [intrafascial-RP (239) or interfascial-RP (181)] in our institution. Intrafascial-RP was indicated for biopsy Gleason score ≤6 and PSA ≤10 ng/ml while interfascial-RP for Gleason score ≤7 and higher serum PSA. Seventy-seven patients with bilateral non-NS-RP were taken for comparison. No patient received pre-/postoperative radiation/hormonal therapy or had prostatic enlargement surgery. UI was assessed 3, 12 and 36 months postoperatively by third party. Continence was defined as no pads/day, safety 1 pad/day as separate group, 1-2 pads/day as "mild-incontinence" and >2 pads/day as "incontinence". RESULTS: All groups had comparable perioperative criteria without significant preoperative morbidities. International Prostate Symptom Score showed severe symptoms in 5 % of patients without correlation to UI. UI-recovery increased until 36 months. Full continence was reported from 56 versus 62 and 53 % patients after intrafascial-RP versus interfascial-RP and wide excision at 3 months, respectively (p = 0.521). Corresponding figures at 12 months were 70 versus 61 versus 51 % (p = 0.114) and at 36 months 85 versus 75 versus 65 % (p = 0.135), respectively. After 12 and 36 months, there was tendency to better UI-results in advantage of NS-technique; best results were achieved in intrafascial-RP group. UI-recovery was age-dependant. Advantage was found in NS-group compared with non-NS-group in older patients (>70 years, p = 0.052). CONCLUSIONS: Impotent/ED patients have higher chances of recovering full continence after NS-RP. NS should be planned independently of preoperative potencystatus whenever technically and oncologically feasible. Age and lower urinary symptoms are not restrictions. Current data should be considered in preoperative patient counselling.

Laparoscopic reconstruction of an iatrogenic perforation of the neovagina and urinary bladder by a neovaginal dilator in a patient with Mayer-Rokitansky-Küster-Hauser syndrome.

INTRODUCTION AND HYPOTHESIS: Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) is a rare genital aplasia syndrome. Patients with MRKH regularly dilate their neovagina with vaginal dilatators. METHODS: A 23-year-old MRKH syndrome patient came to our department complaining of a lost vaginal dilator, which she had inserted 2 days previously. She had no bleeding or abdominal pain, but did have occasional urine loss. She had a history of abdominal exploration for an acute abdomen and the creation of a neovagina at the age of 16. An abdominal CT scan located the dislocated dilator intravesically. After diagnostic laparoscopy, the dilator was removed through the vesico-neovaginal perforation. The vagina was closed and covered by a pedicled peritoneal flap, followed by closure of the urinary bladder. An omental J-flap was then fixed between the vagina and bladder. RESULTS: The operative time was 185 min, with no significant blood loss, injuries or need for conversion/revision. The indwelling catheter was removed 7 days later after cystography, followed by normal micturition and an adequate bladder capacity. Vaginal dilation and sexual activity was resumed 1 month postoperatively. Follow-up was uneventful. CONCLUSIONS: Laparoscopic vaginal dilator removal with immediate repair of the perforation of the neovagina and the urinary bladder directly after an acute trauma in a patient with MRKH syndrome may be a management option. It is a feasible, safe and viable operation in the hands of experienced laparoscopists.

Outcomes of a bladder preservation technique in female patients undergoing pelvic exenteration surgery for advanced gynaecological tumours.

INTRODUCTION AND HYPOTHESIS: The purpose of the study was to report the feasibility of the bladder preservation technique (BPT) during pelvic exenteration for primary advanced gynaecological pelvic tumours (PRSGT) as an alternative for continent urinary diversion. METHODS: Sixteen consecutive female patients underwent BPT during PRSGT. Median age was 50.8 years (range 37-65). Tumours included cervical (5 patients), corpus/vaginal (9), and ovarian (2) carcinomas. In resectable tumours, the excision of the distal ureters and the posterior bladder wall with an inverted "V" incision into the trigone down to the vaginal wall was performed with bladder blood and nerve supply preservation. The remaining mobilized leaflets were fixed to the psoas muscle/sacral promontory. Average follow-up was 34 months (range 24-108). Follow-up parameters included postoperative continence grade (full [no pads], stress incontinence grade I [1-2 pads], and grade II [>2 pads]), urinary tract infections, micturation problems/residual urine, ureteric reflux as well as patients' global satisfaction (PGS). RESULTS: All surgeries were done successfully. One patient developed a vesicovaginal fistula 4 weeks postoperatively and was managed conservatively. Fifteen patients (94 %) were able to empty their bladders postoperatively. Prolonged full continence was reported from 8 patients (50 %), incontinence grade I in 3 (18.8 %), and grade II in 5 (31.3 %). Two patients (incontinence grade II) developed cystoceles necessitating transvaginal bladder neck suspension with a fascia lata sling and were continent postoperatively. Another patient (6 %) underwent re-excision of a recurrent pelvic tumour necessitating intermittent self-catheterization. Postoperative hydronephrosis (grade I-II) was observed in 4 patients (25 %) and vesico-ureteral reflux (grade IV) in 4 (25 %) without the need for intervention. PGS and willingness to recommend their procedure to others were favourable. CONCLUSIONS: In patients for whom complete bladder resection is not indicated for oncological reasons, BPT during PRSGT with ureteric reimplantation is feasible and safe and provides good functional results as well as patient global satisfaction. Lower tract surgeries could be safely carried out afterward. Long-term functional results support durable good PGS.

Efficacy and safety of Ho:YAG laser lithotripsy for ureteroscopic removal of proximal and distal ureteral calculi.

BACKGROUND: Laser lithotripsy is an established endourological modality. Ho:YAG laser have broadened the indications for ureteroscopic stone managements to include larger stone sizes throughout the whole upper urinary tract. Aim of current work is to assess efficacy and safety of Ho:YAG laser lithotripsy during retrograde ureteroscopic management of ureteral calculi in different locations. METHODS: 88 patients were treated with ureteroscopic Ho:YAG laser lithotripsy in our institute. Study endpoint was the number of treatments until the patient was stone-free. Patients were classified according to the location of their stones as Group I (distal ureteric stones, 51 patients) and group II (proximal ureteral stones, 37). Group I patients have larger stones as Group II (10.70 mm vs. 8.24 mm, respectively, P = 0.020). RESULTS: Overall stone free rate for both groups was 95.8%. The mean number of procedures for proximal calculi was 1.1 ± 0.1 (1-3) and for distal calculi was 1.0 ± 0.0. The initial treatment was more successful in patients with distal ureteral calculi (100% vs. 82.40%, respectively, P = 0.008). No significant difference in the stone free rate was noticed after the second laser procedure for stones smaller versus larger than 10 mm (100% versus 94.1%, P = 0.13). Overall complication rate was 7.9% (Clavien II und IIIb). Overall and grade-adjusted complication rates were not dependent on the stone location. No laser induced complications were noticed. CONCLUSIONS: The use of the Ho:YAG laser appears to be an adequate tool to disintegrate ureteral calculi independent of primary location. Combination of the semirigid and flexible ureteroscopes as well as the appropriate endourologic tools could likely improve the stone clearance rates for proximal calculi regardless of stone-size.

Patients' perception of surgical outcomes and quality of life after retroperitoneoscopic and open pyeloplasty.

PURPOSE: To report postoperative health-related quality of life (HRQoL) and patients' subjective evaluations of open pyeloplasty (OP) and retroperitoneoscopic pyeloplasty (RP) and influences on preoperative counselling. METHODS: 107 patients (age 16-80 years, mean 31.5) with symptomatic primary ureteropelvic junction obstruction who underwent OP (32) or RP (75) were evaluated prospectively. HRQoL was evaluated using Short Form 36 (SF-36) questionnaires with 1 year follow-up. Operative outcomes were evaluated using a self-designed questionnaire regarding cosmetic outcomes, objective postoperative/current pain, convalescence and return to work. RESULTS: The mean operative time was 174.4 vs. 161.4 min for RP versus OP, respectively, without intraoperative complications/conversions. There was an advantage for RP--except for two domains--without significance in any of the eight SF-36 domain scores. An advantage favouring RP in all aspects of the second questionnaire with significance in four aspects (cosmetic results, scar length, pain and convalescence) was found. Five weeks postoperatively, 58.7% (RP) vs. 25.8% (OP) were fully convalescent compared to 87.0% (RP) vs. 71.0% (OP) at 8 weeks. Similarly, 58.7 vs. 45.1% returned work 5 weeks postoperatively while 93.5 vs. 74.2% did so after 8 weeks, respectively. The small sample size, more questions on satisfaction/regret and mixed design are the main study limitations. CONCLUSION: RP provides the same functional results beside earlier convalescence, better HRQoL and patients' convenience with surgery, which favours its inclusion in preoperative counselling providing patients with realistic postoperative expectations.

Outcome of laser-assisted laparoscopic partial nephrectomy without ischaemia for peripheral renal tumours.

OBJECTIVES: Evaluation of clamp-off laser-assisted laparoscopic partial nephrectomy technique (LLPN) compared to the clamp-off laparoscopic (LPN) and open (OPN) techniques. PATIENTS AND METHODS: Between September 2008 and July 2011, 36 patients suffering from small peripheral renal tumours (RT) underwent LLPN (n = 12), LPN (n = 12) and OPN (n = 12) in a prospective single-centre study. RT were excised with laser, Sonosurg or monopolar scissors during LLPN, LPN and OPN, respectively. Blood vessels are identified and sutured before opening them; alternatively, laser energy was used to coagulate them (LLPN). Early and late postoperative complications were assessed. Follow-up was done according to EAU-guidelines. RESULTS: Mean age was 64.9 years. Mean operative time was 135.8 min (100-180) versus 144.2 (85-255) versus 113.6 (50-170) for LLPN versus LPN versus OPN, respectively. Median estimated blood loss (EBL) was 170.8 ml (50-600) versus 245.2 (50-700) versus 425.8 (100-900) for LLPN versus LPN versus OPN, respectively. Tumours (19 right and 17 left) were located in upper (11), midparenchyma (13) and lower pole (12). Mean tumour size was 2.7 cm (1.2-5.5). There were no reported perioperative complications/conversions. There were no positive margins. Histological evaluations were not compromised in any LLPN-case. Compared to LPN, LLPN offered significant lower EBL, shorter operative time, otherwise, comparable results. Follow-up was uneventful without tumour recurrences. CONCLUSION: Current prospective comparative study shows that LLPN is a reproducible efficient alternative to LPN/OPN. Besides the absence of renal ischaemia, LLPN offered lower EBL, good haemostasis and minimal parenchyma damage. Surgical and oncological outcomes are comparable to LPN and OPN.

The 1,318-nm diode laser supported partial nephrectomy in laparoscopic and open surgery: preliminary results of a prospective feasibility study.

Warm ischemia (WI) and bleeding during laparoscopic partial nephrectomy (LPN) place technical constraints on surgeons. Our aim was to develop a safe and effective laser-assisted LPN-technique without the need for WI. In this study, a diode laser-emitting light at a wavelength of 1,318 nm at output powers between 45 and 70 W in continuous-wave mode was used. Light was coupled into a flexible 600-µm bare fiber to be transported to the tissues. After dry lab experience, 13 patients (six males, seven females) underwent five open and eight laparoscopic/retroperitoneoscopic partial nephrectomies. Postoperative renal function and serum C-reactive protein (CRP) were monitored and coagulation depth and effects on resection margins (RR) were evaluated. Demographic, clinical, and follow-up data are presented. Mean operative time was 116.5 min (range 60-175 min) with mean blood loss of 238 ml (range 50-600 ml). Laser light application took a maximum of 17 min. All patients had a favorable outcome. The locations of the treated tumors (eight left and five right) were central (two), upper pole (two), lower pole (three) and middle kidney parenchyma (six anterior, two posterior, and five peripheral). Mean tumor size was 3.3 cm (range 1.8-5 cm). Two WI (19 and 24 min) were needed. Immediate postoperative serum creatinine and CRP were elevated within 0.1 to 0.6 mg/dl (mean 0.18) and 2.1-10 mg/dl (mean 6.24), respectively. Coagulation depth ranged from <1 to 2 mm without an effect on histopathological evaluation of tumors or RR. One patient had positive RR. During follow-up (2-6 months), one patient developed an A-V fistula that needed embolization. This prospective in-vivo feasibility study showed that the diode laser is a safe and promising device for LPN. Its advantages are minimal gas formation, good hemostasis, and minimal parenchymal damage. Oncological safety appears to be warranted by the use of a diode laser.

Risk factors for pelvic lymphoceles post-radical prostatectomy.

BACKGROUND: Lymphoceles (LC) represent a well-described rare complication post-radical prostatectomy (RP). Our aim was to determine risk factors and to develop possible prevention strategies for LC in a community-based study. METHODS: Data from 1163 RP-patients from 67 clinics between January 2002 and December 2004 were retrospectively evaluated. Patients underwent pelvic imaging procedures/LC-management during 3 weeks of rehabilitation post-RP. RESULTS: LC were identified in 304 patients (26%). Lymphadenectomy was carried out in 92% of patients (1001/1086 patients), from which 28% had LC (n = 277) versus 14% without lymphadenectomy (12/85, P = 0.007). Complications (lower limb edema, pain, thrombosis, infection and bladder compression) were observed in 9% of patients (28/304; 2.4% of total patients); necessitating therapy. LC therapy was carried out in 59 patients (5.9%) with pelvic lymph node dissection (PLND) and in no patients (0%) without PLND (P = 0.021). Risk factors included were patients' age, body mass index, prostate volume, TNM-classification, number of removed lymph nodes, previous surgery/therapy, heparin prophylaxis, surgical instruments and pelvic lymphadenectomy. Univariate analysis showed lymphadenectomy as the only significant risk factor for the development of LC post-RP (P = 0.007). When applying multivariate analyses using stepwise logistic regression, only lymphadenectomy was associated with a significant risk for lymphoceles (odds ratio = 2.6, 95% CI = 1.3-4.9, P = 0.004). Adjusting for other factors, no other factor came close to being significant (P < 0.05). All symptomatic LC were successfully treated without further sequelae. CONCLUSIONS: Subclinical LC post-RP are more common than thought, and rarely necessitate intervention. Pelvic lymphadenectomy represents the only significant factor contributing to LC-development. Because of this, prevention remains difficult.

Single-Incision Laparoscopic Surgery (SILS) in Reconstructive Urological Cases.

Single-incision laparoscopic surgery (SILS) is a recent development in minimally invasive surgery. This is an initial SILS experience in reconstructive urology to prove feasibility and provide a comparison with conventional laparoscopy during perioperative and convalescent periods. A single surgeon performed two complex SILS operations (psoas bladder hitch with Boari flap for high ureteric stricture [SILS-PB] and nephropexy for severe nephroptosis [SILS-Np]). A group of 6 patients with previous experience with conventional laparoscopy by the same surgeon with the same operation complexity was selected for retrospective comparison. SILS was performed through multichannel port (intraumbilical or retroperitoneal). There was no conversion to laparoscopy. Operative time (Or-t) was 365 and 185 minutes for SILS-PB and SILS-Np, respectively. Blood loss was 100 ml for SILS-PB without any intraoperative complications. Baseline demographics, Or-t, blood loss, and hospital stay were comparable to the laparoscopic group. Except for prolonged Or-t, patients undergoing SILS had similar surgical outcomes and comparable convalescent periods. Follow-up was uneventful for both groups. Patients' global satisfaction and willingness to recommend their procedure to others were favorable and equivalent between groups. Thus, SILS-reconstructive operations for high ureteric strictures and severe nephroptosis are feasible. It seems equally as efficacious as conventional laparoscopy maintaining surgical standards without differences in perioperative outcomes and convalescence.

A 27-Year-Old Primigravida with a Right Renal Cell Carcinoma Removed at 30 Weeks of Gestation by Robot-Assisted Retroperitoneoscopic Partial Nephrectomy.

BACKGROUND Large renal tumors during pregnancy are rare findings (0.07-0.1%). Current guidelines recommend surgical removal. This surgery should be carefully planned in an interdisciplinary team and involves special risks for mother and fetus. This report describes a case of a 27-year-old primigravida woman with a right renal cell carcinoma involving the lower pole of the kidney, which was removed at 30 weeks of gestation by robot-assisted retroperitoneoscopic partial nephrectomy (RARPN). CASE REPORT The patient was referred by the treating obstetrician with a newly diagnosed right lower pole renal mass of 6×4 cm in greatest diameter extending deeply into the parenchyma. No metastasis or enlarged lymph nodes were described in subsequent magnetic resonance tomography. Clinical and laboratory examinations documented a healthy mother and fetus. A right-sided RARPN was advised and planned by an interdisciplinary team of treating physicians (gynecologists, oncologists, and urologists). The surgery was conducted under general anesthesia with an obstetrician on stand-by. Surgery was performed without any complications (operation time 95 min, renal-ischemia time 15 min, and negligible blood loss) and histopathology confirmed the diagnosis of a chromophobe renal cell carcinoma. Further follow-up consultations showed regular wound healing and normal progression of pregnancy, and the patient gave birth to a healthy child at term. Follow-up examinations of the patient were uneventful. CONCLUSIONS This case shows that RARPN can be a safe and effective surgical procedure for partial nephrectomy during pregnancy, where surgery is performed in a specialist center and by an interdisciplinary experienced surgical team. It seems to offer advantages and better risk profile over the laparoscopic approach.

Retrospective Evaluation of the Clinical Values of Minimally Invasive Marsupialization of Symptomatic Giant Renal Cysts.

Background: To evaluate the indication and benefit of minimally invasive laparoscopic marsupialization (MIS) of symptomatic giant renal cysts. Materials and Methods: Sixty-four consecutive patients who underwent MIS for large renal cysts (Bosniak I; 4 × 5-16 × 12 cm) by one surgeon were included in the study. Presenting symptoms were renal pain (100%), associated with hypertension (28%), renal dysfunction (4.7%), hematuria (4.7%), ureteropelvic junction obstruction (UPJO) (7.8%), ipsilateral urolithiasis (4.7%), polycystic kidney (6.3%), adrenal cyst (1.6%), and retroperitoneal cysts (1.6%). Seven patients with peripelvic cysts and previous retroperitoneal operations were treated by a laparoscopic approach; all other patients underwent retroperitoneoscopic marsupialization. Single-port retroperitoneoscopy was performed in 4 patients. Follow-up included clinical examination, abdominal ultrasound, and computed tomography scan. Postoperative radiologic success was defined as a minimum of 50% in size reduction and no recurrence. Results: Mean patients' age was 46 (21-65) years. All procedures were successfully completed without conversion or revision. Mean operative time was 55 (40-85) minutes with a mean hospital stay of 3 days. All patients underwent uneventful postoperative recovery. Observed minor complications (transitory fever/pain) were found in 4 patients during the first postoperative month. Median follow-up was 12 months (10 months-2 years). About 98.5% of patients reported of no relevant postoperative pain. A relief from UPJO and hematuria was achieved in 100% of patients. Ten patients with known hypertensive disease (55.6%) had a significant reduction of mean blood pressure resulting in a reduction of antihypertensive medication. Ureterorenoscopic stone extractions were performed successfully afterward. No cyst recurrences were detected during the follow-up period. Conclusion: Treatment indications for symptomatic renal cysts could include not only symptoms but also associated diseases like UPJO and hypertension. Retroperitoneoscopic MIS may be curative for these cyst-associated pathologies. The feasibility, safety and efficacy of these techniques could be demonstrated.

The growth rate of large renal masses opposes active surveillance.

OBJECTIVE: To retrospectively determine the growth rate of renal masses with a diameter of > or =4 cm at the time of surgery, as the average growth rate of untreated small (<4 cm) renal masses is assumed to be 0.1-0.7 cm/year, but little is known about the progression of large masses. PATIENTS AND METHODS: Of 256 patients who had their renal tumour surgically removed between January and December 2008, we identified nine (five men and four women; median age 65.2 years, range 29.2-74.2) with solitary large renal masses (>4 cm) who had abdominal imaging with identification of renal masses >6 months before admission. In none of the patients had the initial imaging led to admission, either by accident or because the masses were overlooked. The tumour growth rate was calculated based on images taken > or =6 months before admission and actual imaging, as well as histological results. RESULTS: All patients had surgical resection of their renal masses in 2008. The median (range) follow-up from initial diagnosis to surgery was 14.6 (6.5-58.4) months. The median observed tumour growth rate was 6.41 (2.47-8.66) cm/year. The histological diagnosis was clear cell renal cell carcinoma (RCC) in seven patients, papillary in one and clear cell RCC with portions of sarcomatoid de-differentiation in one; two patients had lymph node metastases and one had pulmonary metastases, and five had tumours of > or =T3. CONCLUSIONS: The growth rate of large tumours is much higher than of small renal masses and most patients present with advanced disease. Thus, tumours of > or =4 cm seem not to be candidates for active surveillance but require immediate therapy. Further studies are warranted to determine the clinical relevance of progressive tumour growth and the underlying mechanisms.

Quality of life and perioperative outcomes after retroperitoneoscopic radical nephrectomy (RN), open RN and nephron-sparing surgery in patients with renal cell carcinoma.

OBJECTIVE: To prospectively evaluate health-related quality of life (HRQoL) and perioperative outcomes in patients with T1 and T2 renal cell carcinoma (RCC) after retroperitoneoscopic radical nephrectomy (RRN), open RN (ORN) or open nephron-sparing surgery (NSS). PATIENTS AND METHODS: The data of 117 patients who had undergone RRN (36), ORN (37) or NSS (44) were evaluated. RRN data were obtained at Basel University Hospital, Switzerland, while the ORN and NSS data were collected at the University of Munich, Germany. Perioperative outcomes were analysed and compared. HRQoL was prospectively evaluated based on the Short Form 36 questionnaire with a mean follow-up of 22 months. RESULTS: Operative duration was significantly longer in the RRN group compared with the ORN and NSS groups, at a mean (sem) of 146 (42) min vs 113 (48) min and 114 (42) min (P < 0.001). In the RRN group intraoperative blood loss was lower than in the ORN and NSS groups, at a mean (sem) of 231 (153) mL vs 424 (361) mL and 494 (360) mL (P < 0.001). Morbidity rates were 13.9% for RRN, 16.2% for ORN and 20.5% for NSS, the most relevant complications being bleeding requiring transfusions in RRN and NSS patients and haemorrhage (5% of patients in each group). Creatinine values at 6 months after surgery only recovered completely in the NSS group. Patients in the ORN group had a trend towards higher mental well-being scores than patients in the RRN and NSS groups, with a mean Mental Component Summary Score of 48.3 vs 48.0 and 44.5, respectively (not statistically significant), while all patients were in similar physical condition after surgery, with a mean Physical Component Summary Scores of 48.0 (ORN), 47.4 (RRN) and 47.2 (NSS). The physical condition scores of patients in all groups were higher than scores reached by an age and sex-matched population (45.8). CONCLUSION: These real-world data show that each of the surgical techniques can be considered safe. Importantly, after surgery patients reported high QoL scores independent of the technique used.

A prospective randomised comparison between the transperitoneal and retroperitoneoscopic approaches for robotic-assisted pyeloplasty in a single surgeon, single centre study.

Literature data comparing robotic-assisted laparoscopic versus retroperitoneoscopic approaches are still lacking, probably due to difficulties with the retroperitoneoscopic approach. The objective is to compare the results of robotic-assisted pyeloplasty using transperitoneal and retroperitoneal approaches in a prospective randomised single surgeon study. 80 consecutive patients with primary ureteropelvic junction obstruction were prospectively randomised between transperitoneal (40 patients, group 1) and retroperitoneal (40 patients, group 2) robotic-assisted pyeloplasty. All patients underwent preoperative clinical evaluation, retrograde urography, and diuretic isotope renography. All operations were performed by a single-experienced surgeon. Patients were followed up by postoperative clinical examination, sonography, and diuretic renography at 3-6 months. Both approaches were compared with regard to patients' demographic data, radiological and operative findings, and functional outcomes, and correlations were statistically evaluated. Preoperative demographic, clinical, and renal scintigraphy data were comparable for both groups. No open/laparoscopic conversions were necessary. Mean operative times (skin to skin) were 125 (70-305) and 118 (60-345) min for groups 1 and 2, respectively (p = 0.726). Only minor complications were found in three and four patients from groups 1 and 2, respectively. Pyeloplasty technique included a renal pelvis flap in three patients from either group,; otherwise, the Anderson-Hynes technique was employed. None of perioperative patient and operative parameters, including approach, had a significant impact on operative time or functional outcomes. Median follow-up was 3 months for both groups. Success was recorded in 39 and 38 patients from groups 1 and 2, respectively, while equivocal results were obtained in 3 cases. Postoperative 3 month renal scintigraphy showed no significant GFR or split renal function differences between the groups. There was no detectable postoperative deterioration in ipsilateral split renal function or hydronephrosis grade. Robotic-assisted retroperitoneoscopic pyeloplasty exhibits low morbidity and satisfactory operative and functional outcomes comparable to the usually preferred laparoscopic approach. Robotic-assisted pyeloplasty has high success rates regardless of the used approach. Accordingly, every surgeon should use the approach which he/she feels most comfortable with.

In-vitro investigations on laser-induced smoke generation mimicking the laparoscopic laser surgery purposes.

Intraoperative smoke-generation limits the quality of vision during laparoscopic/endoscopic laser-assisted surgeries. The current study aimed at the evaluation of factors affecting this phenomenon. As a first step, a suitable experimental setup and a test tissue model were established for this investigation. The experimental setup is composed of a specific sample container, a laser therapy component suitable for the ablation of model tissue at different treatment wavelengths (λ = 980 nm, 1350 nm, 1470 nm), a suction unit providing continuous smoke extraction, and a detection unit for smoke quantification via detection of light (λ = 633 nm) scattered from smoke particles. The ablation rate (AR) was calculated by dividing the ablated volume by the ablation time (60 sec). The laser-induced scattering signal intensity of the smoke (SI) was determined from time-charts of the signal intensity as a measure for vision, in addition a delay-time tdelay could be derived defining the onset of SI after the laser was switched on. The ratio SI/AR is used as a measure for smoke generation in relation to the ablation rate. Additionally the light transmission of the tissue samples was used to estimate their optical properties. In this set-up, smoke generation using λ = 980 nm as ablation laser wavelength was detected after a delay-time tdelay = (121.6 ± 24.8) sec which is significantly longer compared to the wavelengths λ = 1350 nm with tdelay = (89.8 ± 19.3) sec and λ = 1470 nm with tdelay = (24.7 ± 5.4) sec. Thus, the delay Experimental set-up consisting of sample container, laser therapy component, suction unit and scattered-light detection compartment. time is wavelength-dependent. The SI/AR ratio was significantly different (p < 0.001) for 1470 nm irradiation compared to 980 nm irradiation [SI/AR(1470) = (11.8 ± 2.6) · 10(3) vs. SI/AR(980) = (8.6 ± 2.0) · 10(3) ]. The ablation crater for 980 nm irradiation was comparable with 1470 nm irradiation, but the coagulation rim was thicker in the 980 nm case. In conclusion, it could be shown experimentally that smoke-generation depends on the wavelength used for laser ablation.

Prospective comparison of one year follow-up outcomes for the open complete intrafascial retropubic versus interfascial nerve-sparing radical prostatectomy.

Current work provides a prospective direct comparison between Open complete intrafascial-radical-prostatectomy (OIF-RP) and interfascial-RP in all outcomes in single centre series. Both techniques were done prospectively in 430 patients. Inclusion criteria for OIF-RP (n=241 patients) were biopsy Gleason-score ≤6 and PSA ≤10 ng/ml while for interfascial-RP (n=189) were Gleason-score ≤7 and PSA ≤15. The perioperative parameters (e.g. operative time, complications etc.), pathologic results, surgical margins and revisions were reviewed. Pre- and postoperative (3 and 12 months) evaluation of continence and potency was performed. All patients have preoperative IIEF-score of ≥15. Continence was classified as complete (no pads), mild (1-2 pads/day) and incontinence (>2 pads/day). Median patients' age was 63.7 vs. 64.5 years for OIF-RP vs. Interfascial-RP, respectively. Preoperative PSA-level was significantly lower in OIF-RP (5.8 vs. 7.1), otherwise, similar perioperative data in both groups except for more frequent pT3-tumors in interfascial-RP group (18%). No statistical significance regarding continence was observed between OIF-RP vs. Interfascial-RP groups at 3 (82% vs. 85%) and 12 months (98% vs. 96%) postoperatively. Potency rates (IIEF ≥15) after OIF-RP were 96% (≤55 years), 72% (55-65), and 75% (>65 years) at 12 months. The respective rates for interfascial-group were 58%, 61% and 51%. There was an advantage for OIF-RP potency-outcomes without significance over Interfascial-RP in weak potency patients (IIEF=15-18). We conclude that OIF-RP is associated with better functional results without compromising early oncological results compared to interfascial-RP. Complete preservation of periprostatic fasciae provides significantly better postoperative recovery of sexual function even for weak potency patients. Longer follow-up is mandatory to further evaluate the outcome results of this technique.

In vitro comparisons of retropulsion and fragmentation efficacy of 2 cordless, handheld pneumatic and electromechanical lithotripsy devices.

OBJECTIVE: To compare, in vitro, probe velocity/displacement, retropulsion, and fragmentation capacity of the cordless electromechanical (LithoBreaker) (hard vs soft probe guide) and pneumatic (StoneBreaker). MATERIALS AND METHODS: Probe velocities/displacements were measured using high-speed resolution camera (100.000 frames/s). The lithotripsy probes were projected through a 7.5F ureteroscope against a nonfrangible led ball placed in a 15F horizontally mounted silicone tube immersed in water bath as an in vitro ureter model. Retropulsion is considered as displacement distance of led ball. Fragmentation efficiency was quantified as number of shots required to break Bego-stone phantoms (hard [15:3] and soft [15:6], average size 7.5 × 5.5 mm) placed on metal mesh into <3-mm fragments. Mean and standard deviation of repetitive measurements were statistically analyzed. RESULTS: StoneBreaker yielded higher probe velocity (22 ± 1.9 m/s) compared with LithoBreaker with hard (14.2 ± 0.5 m/s) and soft (11.5 ± 0.5 m/s) probe. Maximum probe displacement for StoneBreaker was 1.04 mm vs 0.9 mm and 1.1 mm (hard vs soft LithoBreaker-probe, respectively). Retropulsion using 1-mm probes showed no statistical differences. Using harder 2-mm probe decreased Lithobreaker retropulsion significantly compared with Stonebreaker. The amount of shots (1-mm probe) to fragment soft Bego stones was significantly higher for LithoBreaker with soft (mean 31.5 ± 11.31) and hard (mean 21.5 ± 5.29) probe guide vs StoneBreaker (mean 11.2 ± 2.65). Fragmentation efficiency for hard Bego stones showed similar statistically significant outcome. Comparison of the 2 probe guides showed higher velocity linked to harder-probe that improved LithoBreaker fragmentation performance and reduce propulsion. CONCLUSION: Both examined lithotripters are effective in cracking stone phantoms with relatively low pulse number. They produce comparable retropulsions. Fragmentation improved substantially using LithoBreaker with hard probe guide. More tests are required to assess differences in stone clearance time.