Robot-assisted renal denervation as a new surgical approach for therapy resistant arterial hypertension.

Arterial hypertension is a major cause of mortality and morbidity worldwide. Medical therapy is the most common treatment. However, in some cases there is a persistent high blood pressure despite medical therapy. These patients with medication refractory arterial hypertension can be treated by renal denervation. Until now an endovascular approach has been used. There are however limitations in eligibility based on vascular or anatomical anomalies. For these patients, as well as other patients eligible for renal denervation, robot-assisted renal denervation has the potential to become a surgical treatment option based on our findings.

Fungal Bezoars Mimicking an Enterovesica Fistula: A Unique Case Report.

Fungal colonization or infection of the urinary tract system is relatively common in patients with diabetes or a compromised immune system. However, fungal intravesical bezoars are extremely rare. We present a unique case with multiple, gas-holding fungals bezoars and emphysematous cystitis caused by Candida tropicalis.

The N-shaped orthotopic ileal neobladder: functional outcomes and complication rates in 119 patients.

BACKGROUND: We report our long-term experience with 119 cases of N-shaped orthotopic ileal neobladder. METHODS: Between March 1996 and July 2013, a total of 119 patients (102 men, 17 women) underwent cystectomy with creation of an N-shaped orthotopic ileal neobladder. The Clavien-Dindo classification score was used for grading early (<3 months postoperative), late, and pouch-related and non-pouch-related complications. Daytime and nighttime continence were evaluated for male and female patients separately, with patients subdivided in three groups: completely continent, use of ≤1 pad, and use of >1 pad. RESULTS: Median follow-up was 75 months (range 3-204). Early complications (15 major, 54 minor) occurred in 39.5 % of 119 patients whereas 53.1 % presented with late complications (56 major, 39 minor; 111 patients evaluated). Urinary infection and outlet obstruction were both the most frequent early and late pouch-related complications; early non-pouch-related complications were mainly infectious and gastrointestinal, and the most common late non-pouch-related problem was wound herniation. At 12 months, 96 and 60 % of the men and 84.6 and 66.7 % of the women respectively achieved daytime and nighttime continence. CONCLUSION: Complication rates of the N-shaped orthotopic ileal neobladder were relatively high, probably because of meticulous recording and follow-up. Daytime continence rates were better than nighttime rates. N-shaped orthotopic ileal neobladder can be a good option for urinary diversion in selected patients who undergo radical cystectomy.

Open partial nephrectomy for complex tumours and >4 cm: Is it still the gold standard technique in the minimally invasive era?

The objective of this paper is to discuss the role of open partial nephrectomy (OPN) for complex renal tumours and large renal tumours > 4 cm in the minimally invasive era. The current status of OPN, laparoscopic partial nephrectomy (LPN) and robotic PN are reviewed. The literature search is done using the National Library of Medicine database (PubMed). The indication of OPN has been extended to T1b tumours (4-7 cm). PN and radical nephrectomy (RN) provide equivalent oncological outcomes for these tumours. In addition, there is a growing application of OPN for complex tumours (centrally located, hilar, multifocal). Despite the more challenging cohort of patients, there is no increase in the overall morbidity of OPN. In contemporary cohorts there is an increase in overweight patients and a higher incidence of central tumours treated with OPN. LPN has been extended to select patients with larger renal masses (4-7 cm) and centrally located tumours. LPN for tumours > 4 cm was in the early phase associated with increased complication rate and prolonged warm ischemia time (WIT). Complication rates decreased with improvement of surgical technique and expertise. Early experience with robotic PN is promising and perioperative outcomes are at least comparable to LPN. LPN and robotic PN have to compete with the functional and oncological results of OPN. In the era of nephron-sparing surgery (NSS), OPN remains the established standard for the management of T1 renal tumours in centres without advanced laparoscopic expertise. Complex scenarios with centrally located tumours, tumours in a solitary kidney, and multifocal lesions probably are best managed with OPN. LPN is feasible in numerous clinical scenarios in centres with advanced laparoscopic expertise but remains a challenging operation. Long-term studies are needed to further define the role of the robotic approach for PN.

Nefrectomía parcial abierta para tumores complejos y > 4 cm: ¿Es todavía la técnica de referencia en la era mínimamente invasiva? / Open partial nephrectomy for complex tumours and > 4 cm: is it still the gold standard technique in the minimally invasive era?

El objetivo de este artículo es discutir el papel de la nefrectomía parcial abierta (NPA) en tumores renales complejos y tumores grandes > 4 cm en la era mínimamente invasiva. Revisamos el estado actual de la NPA, la nefrectomía parcial laparoscópica (NPL) y la nefrectomía parcial robótica (NPR). Se realiza una búsqueda de la literatura utilizando la base de datos de la Biblioteca Nacional de Medicina (PubMed). La indicación de NPA se ha extendido a tumores T1b (4-7 cm). La nefrectomía parcial y la radical ofrecen resultados oncológicos equivalentes para estos tumores. Además, hay una aplicación creciente de la NPA para tumores complejos (de localización central, hiliares, multifocales). A pesar de la cohorte de pacientes más exigente, no hay un aumento de la morbilidad general de la NPA. En series contemporáneas hay un aumento de pacientes con sobrepeso y una incidencia mayor de tumores centrales tratados con NPA. La NPL se ha extendido a pacientes seleccionados con masas renales más grandes (4-7 cm) y tumores de localización central. La NPL para tumores > 4 cm se asociaba en la primera fase con un aumento de la tasa de complicaciones y con un tiempo de isquemia caliente prolongado. Las tasas de complicaciones descendieron con la mejora de la técnica quirúrgica y la experiencia. La experiencia temprana con la nefrectomía parcial robótica es prometedora y los resultados perioperatorios son al menos comparables con los de la NPL. La NPL y la robótica tienen que competir con los resultados funcionales y oncológicos de la NPA(AU)

En la era de la cirugía renal conservadora la NPA sigue siendo el estándar establecido para el tratamiento de los tumores renales T1 en centros sin experiencia en laparoscopia avanzada. Los casos complejos con tumores centrales, tumores en riñón único y lesiones multifocales probablemente se manejen mejor con NPA. La NPL es factible en numerosos escenarios en centros con experiencia en laparoscopia avanzada, pero sigue siendo una operación exigente. Son necesarios estudios a largo plazo para definir mejor el papel del abordaje robótico de la NP(AU)

The objective of this paper is to discuss the role of open partial nephrectomy (OPN) for complex renal tumours and large renal tumours > 4 cm in the minimally invasive era. The current status of OPN, laparoscopic partial nephrectomy (LPN) and robotic PN are reviewed. The literature search is done using the National Library of Medicine database (PubMed).The indication of OPN has been extended to T1b tumours (4-7 cm). PN and radical nephrectomy (RN) provide equivalent oncological outcomes for these tumours. In addition, there is a growing application of OPN for complex tumours (centrally located, hilar, multifocal). Despite the more challenging cohort of patients, there is no increase in the overall morbidity of OPN. In contemporary cohorts there is an increase in overweight patients and a higher incidence of central tumours treated with OPN. LPN has been extended to select patients with larger renal masses (4–7 cm) and centrally located tumours. LPN for tumours > 4 cm was in the early phase associated with increased complication rate and prolonged warm ischemia time (WIT). Complication rates decreased with improvement of surgical technique and expertise. Early experience with robotic PN is promising and perioperative outcomes are at least comparable to LPN. LPN and robotic PN have to compete with the functional and oncological results of OPN. In the era of nephron-sparing surgery (NSS), OPN remains the established standard for the management of T1 renal tumours in centres without advanced laparoscopic expertise. Complex scenarios with centrally located tumours, tumours in a solitary kidney, and multifocal lesions probably are best managed with OPN. LPN is feasible in numerous clinical scenarios in centres with advanced laparoscopic expertise but remains a challenging operation. Long-term studies are needed to further define the role of the robotic approach for PN(AU)

Update on the management of invasive bladder cancer 2012.

Muscle-invasive bladder cancer is a deadly disease for which a number of new approaches have become available to improve prognosis. A recent review emphasized the importance of timely indication of surgery and highlighted current views regarding the adequate extent of the surgery and the importance of lymph node dissection. Furthermore, treatment using neoadjuvant and adjuvant systemic chemotherapy has become more prominent, while cystectomy and diversion should be conducted only in experienced centers. Optimal methods of urinary diversion and the use of robot-assisted laparoscopic cystectomy require further study.