Flexible ureterorenoscopy in position or fusion anomaly: Is it feasible?

OBJECTIVE: To analyze the results of flexible ureterorenoscopy (F-URS) with holmium laser in the treatment of kidney stones with ectopic and fusion anomalies (horseshoe kidney and rotation anomalies). METHOD: We reviewed data from 13 patients with fusion and ectopic renal anomalies that underwent F-URS from April 2011 to April 2017. We analyzed demographic and clinical data (age, gender, BMI, anatomical abnormality, location and dimension of the renal calculi) and perioperative data (method of treatment, stone-free rate, number of days with DJ catheter and perioperative complications). RESULTS: The mean stone size was 12.23 +/- 5.43 mm (range 6-22mm), located in the inferior (58.33%) and middle (16.76%) calyceal units, renal pelvis (16.67%) and multiple locations (8.33%). All 13 patients were treated with Ho-Yag laser, using dusting technique (25%), fragmentation and extraction of the calculi (58.33%) and mixed technique (16.67%). We did not have any severe perioperative complication. After 90 days, nine patients (75%) were considered stone free. CONCLUSION: Our data suggest that F-URS is a safe and feasible choice for the treatment of kidney stones in patients with renal ectopic and fusion anomalies.

Is a safety guidewire needed for retrograde ureteroscopy?

INTRODUCTION: It is generally advised to have a safety guidewire (SGW) present during ureteroscopy (URS) to manage possible complications. However, it increases the strenght needed to insert and retract the endoscope during the procedure, and, currently, there is a lack of solid data supporting the need for SGW in all procedures. We reviewed the literature about SGW utilization during URS. METHOD: A review of the literature was conducted through April 2017 using PubMed, Ovid, and The Cochrane Library databases to identify relevant studies. The primary outcome was to report stone-free rates, feasibility, contraindications to and complications of performing intrarenal retrograde flexible and semi-rigid URS without the use of a SGW. RESULTS: Six studies were identified and selected for this review, and overall they included 1,886 patients where either semi-rigid or flexible URS was performed without the use of a SGW for the treatment of urinary calculi disease. Only one study reported stone-free rates with or without SGW at 77.1 and 85.9%, respectively (p=0.001). None of the studies showed increased rates of complications in the absence of SGW and one of them showed more post-endoscopic ureteral stenosis whenever SGW was routinely used. All studies recommended utilization of SGW in complicated cases, such as ureteral stones associated with significant edema, ureteral stricture, abnormal anatomy or difficult visualization. CONCLUSION: Our review showed a lack of relevant data supporting the use of SGW during retrograde URS. A well-designed prospective randomized trial is in order.

Can video endoscopic inguinal lymphadenectomy achieve a lower morbidity than open lymph node dissection in penile cancer patients?

BACKGROUND AND PURPOSE: Radical lymphadenectomy improves survival in penile cancer patients, but the morbidity of the classic open procedure exceeds 50%. We report the updated results of Video Endoscopic Inguinal Lymphadenectomy (VEIL), an original minimally invasive procedure recently reported for extended inguinal node dissection in clinical settings. PATIENTS AND METHODS: Fifteen consecutive patients who underwent the VEIL technique were prospectively followed and included in this study. The first 10 patients underwent bilateral inguinal dissection for nonpalpable lymph nodes: VEIL at one side and standard open lymph node dissection at the other side. A second cohort consisted of five patients who underwent bilateral VEIL, either for nonpalpable or for palpable (N1) inguinal nodes. Operative data and postoperative outcomes were assessed, and VEIL and the open technique were compared. RESULTS: Twenty limbs underwent VEIL and 10 limbs underwent the open procedure. Mean operative time was 120 minutes for VEIL and 92 minutes for the open procedure. There was no difference in the number of nodes removed or in the positivity for metastatic lymph nodes. Complications were observed in 70% of limbs that underwent open surgery and in 20% of limbs that underwent VEIL (P 0.015). Patients who underwent a bilateral VEIL could be discharged from the hospital after an average of 24 hours (range 12-36 hrs), while patients who underwent an open dissection in addition to contralateral VEIL were discharged after an average of 6.4 days (range 5-10 d) There were no recurrences detected during a mean follow-up of 31.9 months (median 33 months). CONCLUSION: This preliminary series suggests that VEIL can reduce morbidity, including hospitalization times,compared with standard open surgery. Oncologic results are premature but seem similar to the results from the conventional open operation. VEIL is a promising minimally invasive approach for radical inguinal dissection in penile cancer patients with nonpalpable or low-volume palpable inguinal disease.

Video endoscopic inguinal lymphadenectomy: a new minimally invasive procedure for radical management of inguinal nodes in patients with penile squamous cell carcinoma.

PURPOSE: Video endoscopic inguinal lymphadenectomy is a recently described lymphadenectomy with the same template of the open technique but performed with laparoscopic instruments under video guidance. It was developed to decrease procedure related morbidity while maintaining good oncological results. We report our initial results in a trial comparing video endoscopic inguinal lymphadenectomy with standard inguinal lymphadenectomy. MATERIALS AND METHODS: From 2003 to 2005, 10 patients with penile carcinoma who were at high risk for inguinal metastases underwent bilateral inguinal lymphadenectomy. We performed standard lymphadenectomy in 1 limb and video endoscopic inguinal lymphadenectomy on the contralateral side. Perioperative results and followup data were compared. RESULTS: No intraoperative complications occurred. Mean operative time was 92 and 126 minutes for open and endoscopic surgery, respectively (p=0.00002). Despite the small number of patients we noted a decrease in cutaneous complications with video endoscopic inguinal lymphadenectomy (0% vs 50%, p=0.017) and a trend toward decreased overall morbidity with this endoscopic technique (20% vs 70%, p=0.059). The mean number of retrieved and positive lymph nodes were similar for the 2 techniques. At a mean followup of 18.7 months (range 12 to 31) no signs of recurrence or disease progression were noted. In the postoperative period 9 of the 10 patients identified video endoscopic inguinal lymphadenectomy as the preferred technique in terms of surgical morbidity. CONCLUSIONS: Video endoscopic inguinal lymphadenectomy is a safe and feasible technique in patients with penile carcinoma and nonpalpable nodes. These preliminary results suggest that video endoscopic inguinal lymphadenectomy may decrease postoperative morbidity without compromising oncological control. Future studies should include the bilateral procedure, longer term followup and a greater number of patients.