Doppler blood flow analysis of erectile function: who, when, and how.

The underlying processes in vasculogenic erectile dysfunction (ED) are arterial insufficiency, venoocclusive disease, or combinations of both. Doppler blood flow analysis is a diagnostic modality useful in elucidating the cause of ED and the magnitude of its severity. This article describes the procedural techniques, typical findings, and relevant pathophysiology for in-office Doppler studies. Specific conditions include arterial insufficiency, venous occlusive disease, Peyronie's disease, and priapism.

Robot-assisted laparoscopic reconstruction of retrocaval ureter: description and video of technique.

Ureteral obstruction secondary to retrocaval ureter is rarely reported in the urologic literature. Symptomatic retrocaval ureters usually present in the 3rd and 4th decade of life. Standard treatment involves ureteroureterostomy approximating the ureter anterior to the vena cava. We describe the initial presentation, imaging, port placement, and operative technique including video presentation of a robot-assisted laparoscopic repair of a retrocaval ureter.

Safety and peri-operative outcomes during learning curve of robot-assisted laparoscopic prostatectomy: a multi-institutional study of fellowship-trained robotic surgeons versus experienced open radical prostatectomy surgeons incorporating robot-assisted laparoscopic prostatectomy.

PURPOSE: To analyze and compare the safety and peri-operative outcomes of fellowship-trained robotic surgeons (FEL) and experienced open surgeons (OE) incorporating robot-assisted laparoscopic prostatectomy (RALP) into practice. MATERIALS AND METHODS: Multiinstitutional, prospective data were collected on the first 30 RALP performed by FEL and OE (defined as over 1000 prostatectomies) incorporating RALP into practice. Morbidity from the peri-operative course was evaluated as were operative outcomes. The second 30 cases from the OE group were evaluated to assess for improvement with experience. RESULTS: There were no rectal injuries or death in either group. Blood transfusion rates did not differ between the two groups (2% vs. 3%, p = 0.65). Open conversion occurred three times in the OE group but only within the first 30 cases. In the first 30 cases FEL had statistically lower rates of positive margins (15% vs. 34%, p = 0.008) and decreased likelihood of prolonged urethral catheter leakage (5% vs. 19%, p = 0.009). The FEL group had lower rates of failure of prostate-specific antigen to nadir < 0.15 ng/mL (2% vs. 10%, p = 0.056). There were no reoperations in the FEL group but present in 2% of the OE group initially. The second 30 cases of the OE group noted a statistical improvement for all parameters with margin rates and the requirement of prolonged catheterization becoming statistically comparable to those of the FEL group. CONCLUSIONS: OE can safely incorporate RALP into practice and achieve outcomes comparable to FEL quickly. As anticipated, FEL achieve these endpoints earlier in their practice.

Robotic-assisted laparoscopic reconstruction of the upper urinary tract: tips and tricks.

OBJECTIVES: To examine whether simple tips and tricks provided in this manuscript and video make robotic reconstruction of the urinary tract possible from the renal calyx to the bladder. The da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) has been widely accepted by urologists for complex reconstructive maneuvers such as radical prostatectomy and pyeloplasty. METHODS: The manuscript and accompanying video outline tips and tricks for patient selection, patient evaluation, port placement, dissection techniques, robotic docking, ureteral repair, and stent management for complex urinary tract reconstruction of the upper urinary tract from the level of the renal calyx to the bladder. RESULTS: Modifications such as port placement, robotic docking techniques, and ureter reconstruction have simplified the technique of complex robotic-assisted laparoscopic reconstruction of the urinary tract. CONCLUSIONS: Numerous scenarios can be encountered during robotic-assisted laparoscopic repair of the upper urinary tract. Simple tips and tricks provided in this manuscript and video make robotic reconstruction of the urinary tract possible from the renal calyx to the bladder.

Is the Internet a reliable source for dietary recommendations for stone formers?

PURPOSE: Kidney stone formation is influenced by environmental factors, especially diet. Certain dietary modifications, including increased fluid intake, reduced animal protein and sodium consumption, and normal calcium intake, reduce the risk of stone activity. Patients frequently use the Internet for information regarding disease processes. We undertook this study to determine the quality of dietary stone information available in this communication domain. METHODS: The Google search engine was used to survey 458 consecutive sites related to kidney stones and dietary information. The presence or absence of the four aforementioned dietary recommendations was recorded. The sites were analyzed for correctness, information on all four domains present and correct; inaccuracy, something mentioned about all four areas but > or =1 recommendation error(s); deficiency, information on < or =3 or domains and no recommendation errors; deficiency and inaccuracy, information on < or =3 areas and > or =1 recommendation error(s). RESULTS: [Table: see text] There were 10 errors regarding calcium intake and 2 pertaining to protein consumption. The quality of information varied with the reporting source. CONCLUSIONS: Internet-based information regarding four important dietary modifications for kidney stone formers is frequently incomplete. Dietary inaccuracy, while uncommon in this communication domain, is mostly centered on the misconception that calcium restriction is beneficial. The quality of dietary information may depend on the Internet information source.

Robot-assisted laparoscopic excision of bladder wall leiomyoma.

Leiomyoma is the most frequent nonepithelial benign tumor of the bladder, and only about 170 cases have been reported in the literature. Most bladder wall leiomyomas are found incidentally and can be clinically followed if imaging and biopsy findings are consistent with the diagnosis. Resection is usually performed for symptomatic or enlarging masses and is indicated if the diagnosis is in question. We demonstrate imaging characteristics, port placement, operative technique, and surgical pathologic findings of the first reported case of robot-assisted laparoscopic resection of a bladder wall leiomyoma.