Multicenter experience with nonischemic multiport laparoscopic and laparoendoscopic single-site partial nephrectomy utilizing bipolar radiofrequency ablation coagulator.

Objective. To investigate feasibility of multiport and laparoendoscopic single-site (LESS) nonischemic laparoscopic partial nephrectomy (NI-LPN) utilizing bipolar radiofrequency coagulator. Methods. Multicenter retrospective review of 60 patients (46 multiport/14 LESS) undergoing NI-LPN between 4/2006 and 9/2009. Multiport and LESS NI-LPN utilized Habib 4X bipolar radiofrequency coagulator to form a hemostatic zone followed by nonischemic tumor excision and renorrhaphy. Demographics, tumor/perioperative characteristics, and outcomes were analyzed. Results. 59/60 (98.3%) successfully underwent NI-LPN. Mean tumor size was 2.35 cm. Mean operative time was 160.0 minutes. Mean estimated blood loss was 131.4 mL. Preoperative/postoperative creatinine (mg/dL) was 1.02/1.07 (P = .471). All had negative margins. 12 (20%) patients developed complications. 3 (5%) developed urine leaks. No differences between multiport and LESS-PN were noted as regards demographics, tumor size, outcomes, and complications. Conclusion. Initial experience demonstrates that nonischemic multiport and LESS-PN is safe and efficacious, with excellent short-term preservation of renal function. Long-term data are needed to confirm oncological efficacy.

Laparoendoscopic single-site surgery: complications and how to avoid them.

INTRODUCTION: Laparoendoscopic single-site surgery (LESS) has emerged as a natural progression from standard laparoscopy aiming to further minimize the morbidity of urological procedures. Recent advances in technology and instrumentation coupled with a mastery of laparoscopic surgery by some has led to the incorporation of LESS techniques in a variety of complex urological operations. Given the paucity of published data regarding complications, we review the collective experience as well as share our own results and observations. METHODS: A literature search of published series on LESS was performed focusing on complications and other difficulties associated with this new technique. The experience with LESS at our institution was also evaluated for complications and means of avoiding them. RESULTS: A few complications relating to LESS specifically are reported in the literature. These are generally related to the access site and the ability to manage situations that require added dexterity. Conversion to standard laparoscopy (or open surgery) is rare while insertion of an additional port appears to be more common. CONCLUSIONS: LESS is an evolving platform and may have a steeper learning curve than standard laparoscopy. In experienced hands, the rates of LESS complications appear to be similar to other surgical techniques.

Laparoscopic resection of local recurrence after previous radical nephrectomy for clinically localized renal-cell carcinoma: perioperative outcomes and initial observations.

BACKGROUND AND PURPOSE: Local recurrence is rare after radical nephrectomy for clinically localized renal-cell carcinoma (RCC). Aggressive open surgical resection of isolated local recurrence has been shown to offer durable local control and potential improvement in cancer-specific survival. The objective of this study is to assess early outcomes on a select group of patients who underwent laparoscopic resection of isolated local recurrence after radical nephrectomy for clinically localized RCC. PATIENTS AND METHODS: The perioperative and clinical outcomes of four patients who underwent laparoscopic resection of local recurrence between 2007 and 2009 by a single surgeon were reviewed. RESULTS: Two patients underwent resection of ipsilateral adrenal recurrence while the remaining two underwent resection of recurrence in retroperitoneal lymph nodes. The mean age of patients was 57 years (44-66 y), all had primary tumors with clear-cell histology, and Eastern Cooperative Oncology Group performance status was 0. The mean recurrence size was 5 cm (3-7 cm). All surgical margins were negative. Mean operative time was 195 minutes (170-210 min), and mean estimated blood loss was 187 mL (100-250 mL). No patient needed blood transfusion. Mean length of stay was 2.5 days (2-3 d). At a mean follow-up of 12 months (2-26 mos), 1 patient experienced further recurrence. All patients are alive, and three have no evidence of disease. CONCLUSIONS: Aggressive surgical resection of isolated local recurrence of RCC after radical nephrectomy with curative intent may be beneficial and has traditionally been performed using open surgery. In our limited experience, a laparoscopic approach may be used in selected patients with small well-circumscribed recurrences with low morbidity and excellent short-term outcomes.

Defects in muscarinic receptor cell signaling in bladder urothelial cancer cell lines.

INTRODUCTION: To explore muscarinic receptor signaling in 4 bladder cancer cell lines, bladder urothelial cells (BUC) have been shown to release and respond to various putative neurotransmitters. METHODS: Reverse transcription-polymerase chain reaction was used to detect the presence of m1-m5 transcripts in the J82, RT4, T24, and 5637 lines of cancer BUC. Immunofluorescence was used to detect expression of m3 protein. Cancer and normal BUC were stimulated with carbachol (100 microM), a muscarinic agonist. Carbachol-evoked changes in intracellular calcium ([Ca(2+)](i)) levels were measured using fura-2 ratiometric microfluorimetry. Transfection of J82 cells with m3 plasmid was performed, and changes in carbachol-evoked [Ca(2+)](i) were re-examined. RESULTS: None of the cancer cell lines expressed m3 transcripts, unlike normal BUC, which expressed m3. None of the 4 bladder cancer cell lines responded to carbachol. However, 47% of normal BUC responded to carbachol. The m3-transfected J82 cells expressed both m3 transcript and protein. Thirteen percent of m3-transfected J82 cells responded to carbachol. CONCLUSIONS: This is the first description of altered muscarinic signaling in cancer BUC. Unlike normal BUC, bladder urothelial cancer cells neither expressed m3 transcript nor responded to carbachol, as measured by changes in [Ca(2+)](i). We could partially reverse this defect in one of the cancer cell lines, J82, by transfecting these cells with the m3 plasmid. Although the effects of muscarinic receptor signaling on urothelial cell are unknown, this signaling pathway may play a role in urothelial cell adhesion similar to that in keratinocytes.

Laparoendoscopic single-site surgery in urology.

BACKGROUND: Since its introduction, the role of laparoscopic surgery has grown and it has now become the standard approach for many surgical procedures. The benefits of smaller incisions, improved pain and convalescence, and shorter hospital stays have greatly improved patient care and satisfaction. In an effort to further minimize the morbidity of surgery, laparoendoscopic single-site (LESS) or single-incision laparoscopic surgery (SILS) has emerged. We review the collective experience with this novel technique and share our initial observations and early results. METHODS: We performed a literature search to review the published experience with this new technique including the breadth of applications and perioperative outcomes associated with LESS in urology. We also analysed the experience with this emerging technique at our institution. RESULTS: There are numerous variations with regards to nomenclature as well as types of access to the abdominal cavity as it pertains to LESS. Urologic procedures involving single-port access have acceptable operating room time, blood loss, and postoperative pain, which are in line with standard laparoscopic surgical outcomes with the added benefit of improved cosmesis and smaller incisions. CONCLUSIONS: Further studies and larger cohorts are needed to assess the real benefit of LESS procedures. The additional learning curve needed to master these techniques may be a barrier to wider acceptance, although improvements in instrumentation are likely to bridge this gap.

Prostate cancer in patients with the bladder exstrophy-epispadias complex: insights and outcomes.

OBJECTIVES: With modern reconstructive surgical techniques and better neonatal intensive care unit care, patients with the bladder exstrophy-epispadias complex are now living much longer than they did previously. As these patients age, the men will begin to seek out adult urologists for common conditions such as benign prostatic hyperplasia and prostate cancer screening. We present the first known man with the exstrophy-epispadias complex to be diagnosed with prostate cancer. METHODS: After obtaining institutional review board approval, the computerized charting system at our institution was used to review this patient's medical record. A computerized literature search was then conducted using PubMed to confirm that no other cases of prostate cancer had been reported in the exstrophy-epispadias population. RESULTS: The patient underwent radical retropubic prostatectomy by an adult urologic oncologist assisted by a pediatric urologist with expertise in bladder exstrophy. The patient later required cystectomy and ileal conduit for disease at the bladder neck, as well as external beam radiotherapy and androgen deprivation therapy. During 1 year of follow-up, his prostate-specific antigen level was undetectable. CONCLUSIONS: We have described the first case of prostate cancer in the exstrophy-epispadias population, proving that these patients are at risk and that radical retropubic prostatectomy is a viable treatment option. Practicing adult urologists will need to be aware of this patient population, because they will be seeking out care for common urologic issues as they age. Special considerations of the diagnosis, management, and treatment of prostate cancer in this patient population are discussed.

Duplicate bladder exstrophy with complete duplication of müllerian structures.

The authors report a rare variant of the exstrophy-epispadias complex in which the patient has two bladders and complete duplication of müllerian structures. We also discuss the treatment of the patient's orthopedic and genitourinary conditions. The patient's prognosis is excellent, and she is expected to be fully continent, able to void spontaneously, and conceive children.