Comparison of optical resolution with digital and standard fiberoptic cystoscopes in an in vitro model.

OBJECTIVES: To compare two different distal sensor flexible endoscopes with standard fiberoptic cystoscopes for optical resolution. Distal video sensor flexible endoscopy may represent the cusp of a new endoscopic revolution. METHODS: Twenty-three participants evaluated the optical resolution capabilities of six flexible cystoscopes. The two presently available distal sensor flexible cystoscopes, ACMI DCN-2010 digital flexible cystoscope and Olympus CYF-V EndoEYE flexible video cystoscope, were compared with the four leading fiberoptic cystoscopes, ACMI ACN-2 fiberoptic cystoscope, Olympus CYF-4 Cystofiberscope, Karl Storz 11272CU1 Flexible Cystoscope, and Richard Wolf Flexible Fibre Urethro-Cystoscope, in an in vitro model. The participants recorded the numerical digits they were able to visualize through five solutions with progressively increasing concentrations of hematoxylin dye (C1 to C5). The cystoscopic images were viewed on a 13-in. medical grade Olympus monitor with an Olympus Visera camera system. RESULTS: No differences were detected among the cystoscopes at the lowest concentrations of hematoxylin dye (C1 and C2). At C3 to C5, the mean percentage of visualized numbers for the ACMI and Olympus distal sensor flexible cystoscopes was significantly greater than for all fiberoptic cystoscopes (P <0.01). At the highest concentration (C5), the ACMI distal sensor cystoscope performed significantly better than did the Olympus distal sensor flexible cystoscopes (P <0.01), although at all other concentrations, the two digital video cystoscopes performed equivalently. CONCLUSIONS: The results of this in vitro study suggest that cystoscopes with distal sensor technology improve visibility in a simulated challenging working environment compared with fiberoptic cystoscopes.

Comparison of a novel endoscope holder and traditional camera assistant for laparoscopic simple nephrectomy in a porcine model.

PURPOSE: To establish the feasibility of single-surgeon laparoscopy with application of a novel endoscope-holder device and to compare this technique with traditional assistant-driven laparoscopic camera control. MATERIALS AND METHODS: Bilateral simple nephrectomies were performed in six pigs. On one side, the operating surgeon employed the "scope holder" and performed the surgery without a laparoscopic assistant. On the contralateral side, an experienced camera operator was responsible for control of the laparoscopic field of vision in the traditional manner. The time required for hilar ligation and complete renal mobilization was documented. Pigs were sacrificed immediately after the procedure. RESULTS: The mean operative times for scope-holder and camera person-assisted nephrectomy were 20.7 minutes and 19.3 minutes, respectively. The time to hilar ligation in the scope-holder and camera-operator-assisted cohorts was 13 and 14.5 minutes, respectively. There were no significant differences in operative times or blood loss in the two groups. The operative surgeon perceived some increase in shoulder and neck pain with use of the scope holder. CONCLUSIONS: This novel device provides a means for the operative surgeon to safely perform a laparoscopic nephrectomy alone without significantly increasing operative time or morbidity.

Laparoscopic ureterocalicostomy: development of a technique simplified by application of Nitinol clips and a wet monopolar electrosurgery device.

PURPOSE: We developed a technique for laparoscopic ureterocalicostomy with the use of intracorporeal suturing and subsequently simplified the technique by application of experimental Nitinol clips. MATERIALS AND METHODS: We performed laparoscopic ureterocalicostomy on 16 domestic swine divided into four groups of four animals each. The kidney was exposed laparoscopically, and the renal artery was atraumatically clamped. The lower pole of the kidney was amputated to expose a lower-pole calix, and hemostasis of the cut renal surface was obtained with a wet monopolar electrosurgical device (Floating Ball device [FB]; TissueLink, Dover, NH). Anastomosis of the ureter to the lower-pole calix was performed over a guidewire using 3-0 Vicryl suture in group 1 and Nitinol clips in group 3. A double-J ureteral stent was then deployed retrograde under fluoroscopic guidance. In addition, we evaluated the use of fibrin glue as a sealant over the sutured or clipped anastomotic site (groups 2 and 4, respectively). Ureteral stents were removed after 3 weeks, and the animals were evaluated and sacrificed after an additional 3 weeks. RESULTS: Laparoscopic ureterocalicostomy was completed in all 16 animals. In each case, excellent renal parenchymal hemostasis was obtained with the FB device, with a mean hemostasis time of 4.1 minutes. The mean anastomotic time with standard suture reconstruction was 37.1 +/- 5.4 minutes, while the anastomotic time with the Nitinol clips was 29.0 +/- 8.0 minutes (P = 0.0339). Retrograde pyelograms in groups 1 and 3 (no fibrin glue) showed a patent anastomosis with no hydronephrosis in three of the four animals in each group. One animal in group 1 and one animal in group 3 developed large urinomas secondary to anastomotic failure. The animals that received fibrin glue over the anastomotic site (groups 2 and 4) all showed narrowed anastomoses with severe hydronephrosis. CONCLUSIONS: With available instrumentation, laparoscopic ureterocalicostomy is technically feasible. Nitinol clip technology significantly reduces collecting-system reconstruction time. Application of fibrin glue as a urinary tract sealant resulted in an unexpected adverse outcome.

Sexual dysfunction in female partners of men who have undergone radical prostatectomy correlates with sexual dysfunction of the male partner.

INTRODUCTION: Preservation and restoration of erectile function after radical prostatectomy (RP) for prostate cancer has been extensively studied. However, the influence of RP on the sexual function of female partners is poorly understood. AIM: The purpose of this retrospective study is to assess sexuality in men who have undergone RP for prostate cancer and their female partners. METHODS: Men who underwent RP for localized prostate cancer at our institution from 1996 to 2000 were identified and invited to participate in this study with their female partners. Both partners completed a demographic survey. Men completed the International Index of Erectile Function (IIEF) and female partners completed the Female Sexual Function Index (FSFI) and supplemental questions. MAIN OUTCOME MEASURES: Correlation between IIEF and FSFI domain scores was determined in matched couples using Pearson correlation coefficient. Kappa statistics and Spearman correlation coefficient were calculated for supplemental questions and IIEF domain scores. RESULTS: Of 1,134 men contacted by letter, 90 (8%) couples completed demographic surveys and both the IIEF/FSFI. Pearson correlation coefficients of IIEF and FSFI domain scores in matched couples demonstrated significant correlation (P<0.05) of all IIEF domains with all FSFI domains with the exception of male erectile function and overall sexual function with female sexual desire. There was moderate agreement between partner supplemental questions and IIEF domain scores. CONCLUSIONS: Response rate was very low. FSFI domain scores correlate with IIEF domain scores, indicating an interrelationship between male and female sexual dysfunction in these couples. Evaluation and treatment of sexual dysfunction after RP should involve both partners.

Enhanced renal parenchymal cryoablation with novel 17-gauge cryoprobes.

OBJECTIVES: To evaluate novel, 17-gauge cryoprobes with a modified heat exchange mechanism to evaluate the area of ablation that could be achieved with 17-gauge (1.47-mm) cryoprobes. METHODS: Eleven pigs were divided into four groups. Each animal underwent laparoscopic creation of three cryolesions with an ellipical iceball-generating 17-gauge cryoprobe (group 1), one that generates a teardrop-shaped iceball (group 2), a template of three standard 17-gauge cryoprobes (group 3), or a single, standard, large-caliber (3.4-mm) cryoprobe (group 4). Each cryolesion was created with a standard double-freeze cycle. Intraoperative ultrasonography was used to measure the maximal iceball dimensions, and the renal temperatures were measured with a thermocouple. The animals were killed after 14 days. The gross lesion size and histopathologic area of necrosis were documented. RESULTS: The mean temperature for the surrounding renal parenchyma was not significantly different among the groups. No statistically significant difference was noted in the size of the gross or histopathologic lesions created among the four groups. The gross lesion size correlated statistically significantly with the histologic area of necrosis (P <0.01). CONCLUSIONS: Despite the diminutive size of the 17-gauge cryoprobes tested, the probes ablated tissue volumes equivalent to that ablated using the larger, standard 3.4-mm cryoprobe or a configuration of three standard 17-gauge cryoprobes. These novel 17-gauge cryoprobes may facilitate ablation of small and medium-size renal tumors and may have expanded application for percutaneous ablation owing to the decreased risk of hemorrhage.

The effect of health care coverage on circumcision rates among newborns.

PURPOSE: Social and personal biases are thought to have a role in the decision to circumcise newborns. However, economic factors such as the type of health care coverage may determine which parents are offered circumcision during the newborn period. Therefore, we examined the rates of newborn circumcision among patients with and without insurance at a midwestern community hospital and tertiary care center. MATERIALS AND METHODS: A retrospective analysis of all patients undergoing circumcision at 2 different labor and delivery facilities between January 1997 and December 2001 was performed. Female gender, prematurity and all congenital anomalies comprised exclusion criteria. Circumcision rates were stratified by health care coverage and race. To assess characteristics of patients who did not undergo circumcision during the newborn period the indications for circumcision and insurance status were examined at a children's hospital. RESULTS: Health care coverage differed significantly between the 2 labor and delivery facilities. Medicaid or uninsured patients comprised approximately 72% of the population at the tertiary care facility and slightly less than 10% of the total deliveries at the community hospital. Despite the difference in health care coverage status, there was no statistically significant difference between the rates of circumcision among newborns. The circumcision rates were 81% (4,021 of 4,992 cases) and 82% (8,059 of 9,859) at the community and tertiary care facilities respectively. Similarly, there was no difference between circumcision rates when stratified by health care status or race. At the children's hospital there were 2 distinct populations seeking circumcision. Of Medicaid patients 87% younger than 3 years sought circumcision because they were denied circumcision during the newborn period. In contrast, adoption was cited 90% of the time as the reason for seeking circumcision in the privately insured patients. CONCLUSIONS: Although health care coverage may influence the indications for circumcision in older children, health care coverage does not appear to influence newborn circumcision rates in the Midwest.