Robot-assisted pyeloplasty: outcomes for primary and secondary repairs, a single institution experience.

INTRODUCTION: Robotic Pyeloplasty (RAP) is a technique for management of ureteropelvic junction obstruction (UPJO). PURPOSE: To report outcomes of RAP for primary and secondary (after failed primary treatment) UPJO. MATERIALS AND METHODS: Single institution data of adult RAP performed from 2007 to 2009 was collected retrospectively following approval by our IRB. Database analysis included patient age, race, pre and post-operative imaging studies and perioperative variables including operative time, blood loss, pain and complications. RESULTS: Fifty-five adult patients underwent RAP (26 left/29 right) for UPJO including 9 secondary procedures from 2007 to 2009. Average follow-up was 16 months (1-36). Mean age was 41 years (18-71) with an average BMI of 27 (17-42); 32 were female. Most patients were diagnosed with preoperative diuretic renal scintigraphy and the obstructed side demonstrated mean function of 41% and t1/2 of 70 minutes. Mean operative time was 194 minutes with average blood loss less than 100 mL. Mean hospital stay was 1.7 days with an average narcotic equivalent dose of 15 mg. RAP for secondary UPJO took longer with more blood loss and had a lower success rate. Failure was defined as the need of another procedure due to persistent pain and/or obstruction after diuretic renal imaging. One patient (2%) with primary UPJO failed and 2 patients (22%) with secondary UPJO failed. One major complication occurred. CONCLUSION: RAP is a good option for the treatment of patients with UPJO. Reported series have established that endopyelotomy has inferior success rate for the treatment of primary UPJO which compromises the success of subsequent treatment as demonstrated in our higher failure rate with secondary UPJO repair.

Robot-assisted pyeloplasty: outcomes for primary and secondary repairs, a single institution experience

INTRODUCTION: Robotic Pyeloplasty (RAP) is a technique for management of uretero-pelvic junction obstruction (UPJO). PURPOSE: To report outcomes of RAP for primary and secondary (after failed primary treatment) UPJO. MATERIALS AND METHODS: Single institution data of adult RAP performed from 2007 to 2009 was collected retrospectively following approval by our IRB. Database analysis including patient age, race, pre and post-operative imaging studies and perioperative variables including operative time, blood loss, pain and complications. RESULTS: Fifty-five adult patients underwent RAP (26 left/29 right) for UPJO including 9 secondary procedures from 2007 to 2009. Average follow-up was 16 months (1-36). Mean age was 41 years (18-71) with an average BMI of 27 (17-42), 32 were female. Majority were diagnosed with preoperative diuretic renal scintigraphy with obstructed side demonstrating mean function of 41% and t1/2 of 70 minutes. Mean operative time was 194 minutes with average blood loss less than 100 mL. Mean hospital stay was 1.7 days with an average narcotic equivalent dose of 15 mg. RAP for secondary UPJO took longer with more blood loss and had a lower success rate. Failure was defined as necessitating another procedure due to persistent pain and/or obstruction on diuretic renal imaging. One patient (2%) with primary UPJO failed and 2 patients (22%) with secondary UPJO failed. One major complication occurred. CONCLUSION: RAP is a good option for the treatment of patients with UPJO. Reported series have established that endopyelotomy has inferior success as a treatment for primary UPJO which compromises the success of subsequent treatment as demonstrated in our higher failure rate with secondary UPJO repair.

Laparascopic capsulotomy to treat autoinflation of inflatable penile prostheses.

INTRODUCTION: Inflatable penile prosthetic implants are a reliable treatment for erectile dysfunction. Mechanical failures now are the most common reason for revision of this type of device, and autoinflation is a common cause for device revision. There are currently no published surgical treatments for this malfunction. AIM: To describe a simple outpatient surgical revision for an automatically inflating device using laparascopic dissection. MAIN OUTCOME MEASURES: Complete deflation of penile prosthesis on follow-up visit, intraoperative and postsurgical complications, and length of procedure. METHODS: We performed a retrospective review of patients treated for inflatable penile prosthesis autoinflation with laparascopic capsulotomy to release constricting connective tissue rind surrounding the device reservoir at a single institution. We collected information about etiology of impotence, surgical procedures relating to implant and revision of prosthetic devices, and follow-up evaluations. RESULTS: Four patients underwent laparascopic capsulotomy to treat autoinflation. Mean operative time was 45 minutes, and no adverse surgical or perioperative outcomes occurred. All four patients had deflated corporal cylinders at the time of follow-up evaluation. CONCLUSIONS: Laparascopic capsulotomy is an easy and reliable method of treating inflatable penile prosthesis autoinflation that can be performed in the outpatient setting.

Transobturator midurethral sling: surgical technique and outcomes.

Transobturator tape midurethral sling is the latest method for treatment of female urinary incont-inence. The authors describe their technique via an outside-in approach under local anesthetic to ensure proper tightening of the sling. Placement through the obturator foramen is straightforward and virtually eliminates risk of serious intraoperative major organ or vessel injury. Although outcome data lack the long-term follow-up of colposuspension and tension-free vaginal tape, similar short-term continence results are encouraging with less associated operative morbidity.