Double opposite tape incision for obstructive sling.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence affects about 34% of all adult women. The mid-urethral sling (MUS), considered the gold-standard treatment, has widespread use but also potential complications. This study aims to demonstrate a new surgical technique that releases urethral obstruction caused by MUS with urinary continence maintenance. METHODS: This video presents a 43-year-old patient with acute urinary retention after a suburethral sling procedure treated with a double opposite tape incision through a "U"-shaped inverted incision at the anterior vaginal wall. RESULTS: The patient resumed her usual activities 1 week later with urinary continence. After 6 weeks, she was allowed to resume physical activities and sexual intercourse. At 3-month follow-up, she is still satisfied without urine leakage recurrence. CONCLUSIONS: The double opposite tape incision is feasible and effective for urethral loosening after the MUS procedure. Concerned that this is a unique case, further studies are required to compare this technique to other surgical treatment options.

COVID-19 impact on bladder cancer-orientations for diagnosing, decision making, and treatment.

The world is going through an unprecedented time in history, and Urologists are, like many other healthcare professionals, facing and combating on two fronts: against the pandemic itself and cancer. When looking at the fatality rates, bladder cancer overcomes Coronavirus disease 2019 (COVID-19) by far and can be as high as 52%, so Urologists must not postpone investigation. Cystoscopy remains the gold standard for the investigation of bladder cancer and computed tomography (CT) urography for obtaining images of the upper tract in cases of macroscopic hematuria. Whenever transurethral resection of bladder tumor (TURB) is necessary, extra care must be taken to assure muscle sample, avoiding another surgical intervention and hospitalization, but when necessary it should not be postponed due to the elevated progression rate of the disease. Follow-up cystoscopies can be postponed for 6 months for low risk, 3 months for intermediate, 6 weeks for high risk, and not beyond 24 hours in case of emergencies as life-threatening hematuria, anemia, and urinary retention. Regarding chemotherapy, more than ever the key point is to evaluate each case individually. Bacille Calmette Guerin (BCG) must be considered only as an inducing course, in selected intermediate and most high-risk cancers. Whenever possible patients should be tested before surgery. Based on the current literature on optimal bladder cancer patients approach we comprehensively synthetize the major societies guidelines on the issue so far, adding a critical view to the topic. This article aims to guide Urologists on decision making against bladder cancer in the COVID-19 era.

Analysis of surgical complications of percutaneous nephrolythotomy, in the first three years, in a teaching hospital.

PURPOSE: To clarify the existing relationships between the characteristics of the patients and calculi and the rate of complications associated with contemporary percutaneous nephrolithotomy (PCNL). METHODS: Retrospective cohort study of 126 consecutive patients who underwent PCNL at the academic medical center of the State Hospital of Sumaré-University of Campinas from 2016 to 2019. This study examined the correlation of pre-existing comorbidities and calculi characteristics with the incidence of postoperative complications. RESULTS: 72 (57.14%) needed complementary procedure for the residual stone fragments (defined as fragments size >3 mm). Complications occurred in 28 patients (22.22%). Of the patients who did not present any complications (n=98, 77.77%), 61 (62.24%) stayed in the hospital for 1-3 days. The length of hospital stays significantly correlated with higher grade of complication (P=0.018). Grade III staghorn calculi demonstrated a greater number of residual stone fragments (P<0.001). In this group of staghorn calculi (n=27, 21.42%), 24 (88.88%) presented with residual stone fragments after the PCNL procedure (P<0.001). CONCLUSIONS: PCNL complications are related to longer hospital stay and calculus complexity is directly related to the rate of residual stone fragments, especially in cases of grade III staghorn calculi.