Laparoscopic extraperitoneal radical prostatectomy--learning curve of a laparoscopy-naive urologist in a community hospital.

OBJECTIVES: To describe the training approach that a laparoscopy-naive general urologist working in a nonteaching hospital used to successfully learn to perform laparoscopic extraperitoneal radical prostatectomy and describe the results obtained in the first 114 cases performed. METHODS: The urologist assisted an experienced laparoscopic surgeon for 20 extraperitoneal radical prostatectomies. During this time, he modified his technique of performing open radical retropubic prostatectomy to facilitate the acquisition of the laparoscopic techniques. Intracorporeal suturing was learned with the aid of a pelvic trainer. The clinical records of the first consecutive 114 cases were examined to evaluate the outcomes in terms of morbidity and oncological and functional concerns. A similar analysis was performed on a subgroup of 15 patients who had undergone laparoscopic extraperitoneal radical prostatectomy after previous transurethral resection of the prostate. RESULTS: The operating time progressively decreased during the learning curve. The mean duration of surgery was 160 minutes. Two conversions to open surgery were required owing to failure to progress. Of the 114 patients, 14% experienced complications, most of which were minor. The positive surgical margin rate was 17%. The average follow-up was 16 months. Undetectable serum prostate-specific antigen levels were observed in 82%, 87%, and 79% at 6, 12, and 18 months, respectively; 96% of patients used 0 to 1 pad per day for incontinence at 6 months of follow-up. The results in the transurethral resection subgroup were similar. CONCLUSIONS: Laparoscopic extraperitoneal radical prostatectomy can be successfully learned by a general urologist with no prior laparoscopic experience.

Ureteral drainage with double-J catheters in obstructive uropathy during pregnancy. A report of 3 cases.

Acute dilatation of the upper urinary tract during pregnancy is a common cause of renal colics and urinary tract infections, leading, rarely, to renal insufficiency. We describe 3 cases with symptomatic hydronephrosis at 28 weeks of gestation who underwent placement of an internal urinary drainage by so-called double-J ureteral stents which rapidly reduced obstruction and symptoms and allowed pregnancies to continue to term. We conclude that double-J ureteral stenting is an effective, simple, safe, and economical method to treat acute hydronephrosis during pregnancy.

[Echographic evaluation of urinary lithiasis before and after treatment with extracorporeal lithotripsy using the method of repeated sessions and low kilovoltage]. / Valutazione ecografica nella litiasi urinaria pre e post trattamento di litotrissia extracorporea con metodica a sedute ripetute e basso kilovoltaggio.

The Authors report their experience in the treatment of urinary lithiasis with low voltage ESWL. 50 patients underwent multiple treatments (2-10, mean 4) with low energy (max Kv 16.9). Ultrasonography, bland examinations.