Stone free rate and clinical complications in patients submitted to retrograde intrarenal surgery (RIRS): Our experience in 571 consecutive cases.

INTRODUCTION: The purpose of this study is to report the stone free rate (SFR) and clinical complications in patients submitted to retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS: A total of 571 procedures of upper urinary stones treated using flexible ureteroscopy and holmium laser lithotripsy from January 2014 to February 2020 have been analyzed. Overall SFR was evaluated after 3 months following the procedure by means of a non-contrast computed tomography. Success was considered as stone-free status or ≤ 0.4 cm fragments. RESULTS: The overall SFR was 92.3% in group 1 (stone size: < 1 cm), 88.3% in group 2 (stone size: > 1 ≤ 2 cm), 56.7% in group 3 (stone size: 2-3 cm) and 69.6% in group 4 (multiple stones). Post-operative complications, according to the Clavien- Dindo (CD) classification system, were recorded in 32 (5.6%) procedures. The major complications recorded were: one case of subcapsular hematoma (SRH) associated with pulmonary embolism two days after the procedure (CD Grade IIIa) treated conservatively and one case of hemorrhagic shock 2 hour with multiple renal bleedings requiring urgent nephrectomy (CD Grade IVA). CONCLUSIONS: The RIRS is an effective and safe procedure with a high SFR significantly correlated with the stone size; at the same time, RIRS could be characterized by severe clinical complications that require rapid diagnosis and prompt treatment.

Flexible ureteroscopy using a 120-w holmium laser: The low-energy/high-frequency approach. / Ureteroscopia flexible utilizando laser holmium 120 W: baja energía/alta frecuencia.

OBJECTIVES: With the spread of more powerful lasers and the advent of new technologies, endoscopic interventions for urolithiasis are continuously evolving. The aim of this study is to present our experience and technique regarding Low Energy (LE)/High Frequency (HF) lithotripsy by using a 120-W Holmium laser (Lumenis®). METHODS: We retrospectively analysed our prospectively maintained Retrograde Intra Renal Surgery (RIRS) database. Lithotripsy was performed using LE/HF settings with a Long Pulse Width (LPW) and consisted of the following steps: 1) contact Laser lithotripsy (LE/HF/LPW dusting - 0,5 J/50 Hz or 02 J/70 Hz); 2) extraction ofmain fragments; 3) non-contact Laser lithotripsy (LE/HF/Short Pulse Width Pop Dusting - 0,5 J /80Hz). Pre-operativeand peri-operative outcomes were collected. Post-operative complications were recorded according to Clavien-Dindo Grading System. Finally, all patients under went a CT scan at three months after RIRS to assess the success of procedure, defined as stone-free or presence of ≤4 mm fragments (Clinical Insignificant Residual Fragments - CIRF). RESULTS: Overall, 104 LE/HF/LPW RIRS from December 2017 to January 2019 were performed. Mean operative time was 59 (SD ±23) minutes, median post-operative stay was two days (IQR 2-3). The post-operative complication rate was 4,8%: one patient had nausea and vomiting (Clavien-Dindo I) and four patients developed urosepsis (Clavien-Dindo II). The success rate was 88,5% (71,2% stone-free and 17,3% CIRF). CONCLUSIONS: LE/HF/LPW RIRS seems to be safe and effective in terms of positive success rate, safety and standard operative time. However, randomized clinical trials are needed to compare this technique to standard RIRS.

OBJETIVOS: Con la aparición de láseres de alta potencia y las nuevas tecnologías, las intervenciones endoscópicas para las urolitiasis continúan evolucionando. El objetivo de este estudio es presentar nuestra experiencia y técnica de baja energía (BE), alta  frecuencia (AF) de litotricia utilizando el laser holmium120 W (Lumenis®). MÉTODOS: Retrospectivamente analizamos nuestra base de datos prospectiva de ureteroscopia retrograda intrarenal. La litotricia fue realizada utilizando BE/AFcon pulsos amplios y largos (LPW). La técnica consistió en los siguientes pasos: 1) Contacto litotricia laser (BE/AF/LPW polvo- 0.5J/50 Hz o 02 J/70 Hz); 2) extracción de los fragmentos principales; 3) litotricia laser sin contacto (BE/AF/pulso corto polvo- 0,5 J /80Hz). Los resultados preoperatorios y perioperatorios fueron recogidos. Las complicaciones postoperatorias fueron recogidas por el sistema Clavien-Dindo. Finalmente, todos los pacientes recibieron un TAC a los 3 meses después de la ureteroscopia retrograda para evaluar el éxito del procedimiento, que se definió como la no existencia de litiasis o de fragmentos de menos de 4 mm (fragmentos clínicamente insignificantes). RESULTADOS: 104 BE/AF/LPW ureteroscopias retrógradas se realizaron entre diciembre de 2017 y enero de 2019. El tiempo operatorio medio fue de 50 minutos( SD ± 23), la estancia media postoperatoria fue de 2 días (IQR 2-3). La tasa de complicaciones postoperatorias fue de 4,8%: un paciente tuvo nauseas y vómitos (Clavien I) y 4 pacientes desarrollaron urosepsis (Clavien II). La tasa de éxito fue de 88%, 71,2% libre de litiasis y 17,3% fragmentos clínicamente insignificantes. CONCLUSIONES: BE/AF/LPW ureteroscopia retrógrada es un procedimiento seguro y efectivo en términos de tasa de éxito, seguridad y tiempo quirúrgico. Aunque, estudios randomizados son necesarios para comparar esta técnica con la ureteroscopia retrógrada estándar.

Flexible ureteroscopy using a 120-w holmium laser: the low-energy/high-frequency approach / Ureteroscopia flexible con láser de holmio de 120 w: el abordaje de baja energía/alta frecuencia

Objetives: With the spread of morepowerful lasers and the advent of new technologies,endoscopic interventions for urolithiasis are continuouslyevolving.The aim of this study is to present our experience andtechnique regarding Low Energy (LE)/High Frequency(HF) lithotripsy by using a 120-W Holmium laser (Lumenis®).Methods: We retrospectively analysed our prospectively maintained Retrograde Intra Renal Surgery (RIRS)database. Lithotripsy was performed using LE/HF settings with a Long Pulse Width (LPW) and consisted of the following steps: 1) contact Laser lithotripsy (LE/HF/LPWdusting – 0,5 J/50 Hz or 02 J/70 Hz); 2) extraction ofmain fragments; 3) noncontact Laser lithotripsy (LE/HF/Short Pulse Width Pop Dusting - 0,5 J /80Hz). Pre-operative and peri-operative outcomes were collected.Post-operative complications were recorded accordingto Clavien-Dindo Grading System. Finally, all patientsunderwent a CT scan at three months after RIRS to assessthe success of procedure, defined as stone-free or presence of ≤4 mm fragments (Clinical Insignificant ResidualFragments – CIRF).Results: Overall, 104 LE/HF/LPW RIRS from December 2017 to January 2019 were performed. Mean op-erative time was 59 (SD ±23) minutes, median post-operative stay was two days (IQR 2-3). The post-operativecomplication rate was 4,8%: one patient had nauseaand vomiting (Clavien-Dindo I) and four patients developed urosepsis (Clavien-Dindo II). The success rate was88,5% (71,2% stone-free and 17,3% CIRF).Conclusions: LE/HF/LPW RIRS seems to be safeand effective in terms of positive success rate, safety andstandard operative time. However, randomized clinicaltrials are needed to compare this technique to standardRIRS.(AU)

Objetivos: Con la aparición de láseresde alta potencia y las nuevas tecnologías, las intervenciones endoscópicas para las urolitiasis continúanevolucionando. El objetivo de este estudio es presentarnuestra experiencia y técnica de baja energía (BE), alta frecuencia (AF) de litotricia utilizando el laser holmium120 W (Lumenis®).Métodos: Retrospectivamente analizamos nuestrabase de datos prospectiva de ureteroscopia retrogradaintrarenal. La litotricia fue realizada utilizando BE/AFcon pulsos amplios y largos (LPW). La técnica consistióen los siguientes pasos: 1) Contacto litotricia laser (BE/AF/LPW polvo- 0.5J/50 Hz o 02 J/70 Hz);2) extracción de los fragmentos principales; 3) litotricia laser sincontacto (BE/AF/pulso corto polvo- 0,5 J /80Hz). Losresultados preoperatorios y perioperatorios fueron recogidos. Las complicaciones postoperatorias fueron recogidas por el sistema Clavien-Dindo. Finalmente, todoslos pacientes recibieron un TAC a los 3 meses despuésde la ureteroscopia retrograda para evaluar el éxito delprocedimiento, que se definió como la no existencia delitiasis o de fragmentos de menos de 4 mm (fragmentosclínicamente insignificantes).Resultados: 104 BE/AF/LPW ureteroscopias retrógradas se realizaron entre diciembre de 2017 y enerode 2019. El tiempo operatorio medio fue de 50 minutos (SD ± 23), la estancia media postoperatoria fue de2 días (IQR 2-3). La tasa de complicaciones postoperatorias fue de 4,8%: un paciente tuvo nauseas y vómitos (Clavien I) y 4 pacientes desarrollaron urosepsis(Clavien II). La tasa de éxito fue de 88%, 71,2% libre delitiasis y 17,3% fragmentos clínicamente insignificantes.Conclusiones: BE/AF/LPW ureteroscopia retrógrada es un procedimiento seguro y efectivo en términos detasa de éxito, seguridad y tiempo quirúrgico. Aunque,estudios randomizados son necesarios para compararesta técnica con la ureteroscopia retrógrada estándar.(AU)

Interstitial cystitis with plasma cell bladder infiltration: case report and literature review.

We report the case of a 76 ys-old woman with overactive bladder syndrome, determined by an histological exam of interstitial cystitis with plasma cell infiltration. To the best of our knowledge, in literature only a similar case has been described. The patient has been treated with corticosteroid therapy allowing a transitory benefit; despite this fact, after side effects have been shown, this therapy has been interrupted leading to the worsening of the previous sintomatology. Therefore the patient has undergone to radical cystectomy with orthotopic ileal neobladder. The phlogistic infiltration of the bladder wall is represented by the plasma cells for over 90% of the whole population. In addition, blood specimen was positive for perinuclear antineutrophil cytoplasmic antibodies (p-ANCA). All these elements could hint at a chronic cystitis due to autoimmune aetiology.

Penile dermal flap in patients with Peyronie's disease: long-term results.

PURPOSE: In 1995 a penile dermal flap was described as an ideal operation for penile curvature due to Peyronie's disease. We report our experience with penile dermal flaps in patients with penile curvature due to Peyronie's disease. MATERIALS AND METHODS: Between January 2001 and May 2004, 26 potent white men with Peyronie's disease underwent corporoplasty with a penile dermal flap. They were evaluated at 3, 6 and 12 months, and yearly thereafter by determination of penile length changes and residual curvature, and the International Index of Erectile Function-5. RESULTS: At the maximum followup (mean 95 months, range 81 to 108) 22 of 26 patients (85%) were available for examination, of whom 14 (63.6%) had no residual curvature, and 2 (9.1%) and 7 (31.8%) had improved and worse erectile function, respectively. Nine patients (40.9%) had inclusion cysts at the surgical site, including 5 who underwent surgical cyst removal with no cyst recurrence. Only 9 of 22 patients (40.9%) were satisfied with the cosmetic and functional outcome. CONCLUSIONS: Despite the attractiveness of the operation to our knowledge no other experience with this technique has been reported. Our results differ from those reported, although we tried to exactly follow the original technique of dermabrading the flap with sandpaper. Based on these results we abandoned the penile dermal flap in patients with Peyronie's disease.

Urinary and sexual outcomes in long-term (5+ years) prostate cancer disease free survivors after radical prostatectomy.

BACKGROUND: After long term disease free follow up (FUp) patients reconsider quality of life (QOL) outcomes. Aim of this study is assess QoL in prostate cancer patients who are disease-free at least 5 years after radical prostatectomy (RP). METHODS: 367 patients treated with RP for clinically localized pCa, without biochemical failure (PSA or= 5 years were recruited.Urinary (UF) and Sexual Function (SF), Urinary (UB) and Sexual Bother (SB) were assessed by using UCLA-PCI questionnaire. UF, UB, SF and SB were analyzed according to: treatment timing (age at time of RP, FUp duration, age at time of FUp), tumor characteristics (preoperative PSA, TNM stage, pathological Gleason score), nerve sparing (NS) procedure, and hormonal treatment (HT).We calculated the differences between 93 NS-RP without HT (group A) and 274 non-NS-RP or NS-RP with HT (group B). We evaluated the correlation between function and bother in group A according to follow-up duration. RESULTS: Time since prostatectomy had a negative effect on SF and a positive effect SB (both p < 0.001). Elderly men at follow up experienced worse UF and SF (p = 0.02 and p < 0.001) and better SB (p < 0.001).Higher stage PCa negatively affected UB, SF, and SB (all: p

The use of a surgical patch in the prevention of lymphoceles after extraperitoneal pelvic lymphadenectomy for prostate cancer: a randomized prospective pilot study.

PURPOSE: Pelvic lymphadenectomy is frequently performed simultaneously with radical prostatectomy to determine lymph node status and the most frequently recorded postoperative complication is the development of a symptomatic lymphocele. This study evaluated TachoSil as an adjunct treatment in preventing lymphoceles after extraperitoneal pelvic lymphadenectomy for prostate cancer. MATERIALS AND METHODS: A total of 60 consecutive patients who had undergone radical prostatectomy and pelvic lymphadenectomy were prospectively enrolled in this study. The patients were randomly assigned to a standard technique with the use of clips and electrocoagulation plus TachoSil, or to standard technique only. All patients underwent ultrasound examination on postoperative days 7, 14 and 28 to test for the development of symptomatic or asymptomatic lymphoceles. Drainage volume and duration were also recorded. RESULTS: The baseline characteristics of the 2 randomized groups were well matched. Those patients in whom we used TachoSil showed a lower drainage volume with a mean total volume of 64 +/- 45 ml (range 0 to 110) vs 190 +/- 62.72 ml (range 70 to 270, p = 0.009), and had significantly fewer symptomatic and asymptomatic lymphoceles (5 vs 19, p = 0.001). Only 5 percutaneous surgical procedures to drain the lymphoceles proved necessary, 1 of which occurred in the group with TachoSil. CONCLUSIONS: TachoSil seems to provide a useful additional treatment option for reducing drainage volume and preventing lymphocele development after extraperitoneal radical retropubic prostatectomy with pelvic lymphadenectomy.

Lingual mucosal graft urethroplasty for anterior urethral reconstruction.

OBJECTIVE: Evaluate the use of lingual mucosal graft (LMG) in anterior urethral strictures. METHODS: From January 2001 to December 2006, 29 men (mean age, 48.5 yr) with anterior urethral strictures underwent graft urethroplasty with LMG. The mean length of stricture was 3.6cm. Patients with bulbar, penile, or bulbopenile strictures received one-stage dorsal free graft urethroplasties. In patients with failed hypospadias repair we performed a two-stage urethroplasty. Criteria for successful reconstruction were spontaneous voiding with no postvoid residual urine and no postoperative instrumentation of any kind. Clinical assessment included the donor site morbidity. RESULTS: Mean follow-up was 17.7 mo. One-stage bulbar and penile urethroplasties without meatal involvement had an 81.8-100% success rate. Bulbopenile urethroplasties were successful in 60% of the cases, whereas one-stage urethral reconstructions in patients with meatal involvement were successful in 66.6%. The two cases of two-stage urethral reconstruction with LMG and buccal mucosal graft after failed multiple hypospadias repairs were unsuccessful. The overall early recurrence rate was 20.7%. Patients with the graft harvested from the tongue reported only slight oral discomfort at the donor site and difficulty in talking for 1 or 2 d. CONCLUSIONS: The mucosa of the tongue, which is identical to the mucosa of the rest of the oral cavity, is a safe and effective graft material in the armamentarium for urethral reconstruction with potential minor risks of donor site complications. LMG may be used alone for short strictures (<5cm) or in combination with buccal mucosa when longer grafts are needed.