Perioperative and reproductive outcomes' comparison of mini-laparotomy and laparoscopic myomectomy in the management of uterine leiomyomas: a systematic review.

OBJECTIVE: To evaluate and compare mini-laparotomy (MLPT) with laparoscopic (LPS) myomectomy perioperative and reproductive outcomes. METHODS: We systematically searched for related articles in the MEDLINE, Embase, Web of Science and the Cochrane library databases. Nine studies (4 randomized, 3 retrospective, 1 prospective and 1 case-control study) which involved 1723 patients met the inclusion criteria and were considered eligible for inclusion. RESULTS: Demographic characteristics were similar between the two groups. LPS was associated with shorter hospital stay (p = 0.04), lower blood loss (p < 0.00001), shorter duration of median ileus (p < 0.00001) and fewer episodes of postoperative fever (p = 0.04). None of the reproductive factors examined (pregnancy rate, preterm delivery, vaginal delivery and delivery with caesarean section) in women diagnosed with unexplained infertility and/or symptomatic leiomyomas reached statistical significance although the results represent a small size effect. CONCLUSION: Our analysis demonstrated that LPS seems to be an alternative, safe and reliable surgical procedure for uterine leiomyoma treatment and in everyday practice seems to offer improved outcomes-regarding at least the perioperative period-over MLPT.

Implementation of Active Surveillance for Prostate Cancer: A Story of Little Pride and Much Prejudice in the Greek Health Care System.

The healthcare system in Greece consists of a mixed public and private sector that contributes to varying extents to the provision of general or specialized health services. Despite intertemporal efforts and investments by the government, the health system remained predominantly underdeveloped in comparison with most European countries. An accurate mirror of the imbalances in cancer care is the underutilization of active surveillance (AS) for prostate cancer. Although AS (a monitoring method to delay or even avoid unnecessary treatment) is becoming the de facto standard of care for low-risk prostate cancer, it remains unpopular in some countries. Focusing on efforts to expand knowledge among the urological community, continuous patient education, and quality improvement of health services will eventually boost national awareness and compliance and promote a radical change of attitude towards AS.

Reed Miller Nesbit: Broadening the Horizon of Genitourinary Surgery.

Nesbit has made his name synonymous with transurethral prostate resection and attained eminence by popularizing his technique, although his lifetime achievements and contributions reach many aspects of genitourinary surgery and pediatric urology. We believe our history article will bring memories back to more senior urologists, allow the youngsters to recall a true innovator and versatile surgeon, and appeal to a broad audience such as the readership of Surgical Innovation Journal.

Synchronous Bilateral Carcinoma of the Ureters. Report of a Case and a Short Discussion of the Literature.

BACKGROUND/AIM: The strategy for treatment of bilateral simultaneous renal pelvic and/or ureteral tumors has not been established and is dependent on individual decision. CASE REPORT: We herein report the case of an elderly man who was examined for fatigue at the emergency department and subsequently diagnosed with bilateral ureteral cancer. The most common histologic type of ureteral cancer is urothelial (transitional epithelium) cancer and though it is rare, it can be synchronously present in the contralateral ureter. Computed tomography-urography (CTU) has very good results regarding diagnosis and surgical treatment and -though not preferred in our case-, it has shown promising results. CONCLUSION: We believe that conservative treatment is a viable therapeutic option for simultaneous bilateral renal pelvic and/or ureteral tumors in selected patients. Yet, this treatment has seldom been performed, although standard therapy with bilateral nephroureterectomy inevitably requires the support of hemodialysis or renal transplantation.

Laparoscopic and Robotic Management of Ureteral Stricture in Adults.

BACKGROUND/AIM: The aim of this review was to provide an update on the status of minimal invasive treatment of ureteral stricture either with a laparoscopic or robotic surgery. MATERIALS AND METHODS: Eligible studies, published until November 2019 were retrieved through Medline, Cochrane and Pubmed databases. Predetermined inclusion and exclusion criteria were used as selection method for data synthesis and acquisition. The study was performed in accordance with the PRISMA statement. RESULTS: A total of 19 retrospective studies met the inclusion criteria. All of them demonstrated the safety, feasibility and success of both laparoscopic and robotic ureteral reconstruction. Individual case series or cumulative comparison analysis of the available studies showed at least equivalent success rates and a trend favoring laparoscopic and robotic groups in terms of estimated blood loss and length of hospital stay to the detriment of longer operative times and possibly higher cost. CONCLUSION: Current evidence suggests the effectiveness, safety and increasing incorporation of minimally invasive techniques for complex stricture repair and reconstruction.