First Canadian experience with robotic single-incision pyeloplasty: Comparison with multi-incision technique.

INTRODUCTION: We compared the outcomes of single-incision, robot-assisted laparoscopic pyeloplasty vs. multiple-incision pyeloplasty using the da Vinci robotic system. METHODS: We reviewed all consecutive robotic pyeloplasties by a single surgeon from January 2011 to August 2015. A total of 30 procedures were performed (16 single:14 multi-port). Two different single-port devices were compared: the GelPort (Applied Medical, Rancho Santa Margarita, CA) and the Intuitive single-site access port (Intuitive Surgical, Sunnyvale, CA). RESULTS: Patient demographics were similar between the two groups. Mean operating time was similar among the single and multi-port groups (225.2 min vs. 198.9 minutes [p=0.33]). There was no significant difference in length of hospital stay in either group (86.2 hr vs. 93.2 hr [p=0.76]). There was no difference in success rates or postoperative complications among groups. CONCLUSIONS: Single-port robotic pyeloplasty is non-inferior to multiple-incision robotic surgery in terms of operative times, hospitalization time, success rates, and complications. Verifying these results with larger cohorts is required prior to the wide adoption of this technique. Ongoing objective measurements of cosmesis and patient satisfaction are being evaluated.

Optimal management of distal ureteric strictures following renal transplantation: a systematic review.

Our objective was to define optimal management of distal ureteric strictures following renal transplantation. A systematic review on PubMed identified 34 articles (385 patients). Primary endpoints were success rates and complications of specific primary and secondary treatments (following failure of primary treatment). Among primary treatments (n = 303), the open approach had 85.4% success (95% CI 72.5-93.1) and the endourological approach had 64.3% success (95% CI 58.3-69.9). Among secondary treatments (n = 82), the open approach had 93.1% success (95% CI 77.0-99.2) and the endourological approach had 75.5% success (95% CI 62.3-85.2). The most common primary open treatment was ureteric reimplantation (n = 33, 81.8% success, 95% CI 65.2-91.8). The most common primary endourological treatment was dilation (n = 133, 58.6% success, 95% CI 50.1-66.7). Fourteen complications, including death (4 weeks post-op) and graft loss (12 days post-op), followed endourological treatment. One complication followed open treatment. This is the first systematic review to examine the success rates and complications of specific treatments for distal ureteric strictures following renal transplantation. Our review indicates that open management has higher success rates and fewer complications than endourological management as a primary and secondary treatment for post-transplant distal ureteric strictures. We also outline a post-transplant ureteric stricture evaluation and treatment algorithm.

Vaginal entrapment of bathwater: a source of extra-urethral incontinence.

This report presents 2 cases of females (a prepubertal and a pre-menopausal female) with dribbling "incontinence" caused by vaginal entrapment of bathwater. In the first case, an 8-year-old girl presented with a history of bothersome wetness of her underwear, noted mainly in the morning. History revealed that she bathed almost nightly. She was instructed to shower or bath only, each for one week. The wetting occurred only after bathing. In the second case, a 39-year-old female, G2P2 with normal genitalia noted occasional, yet significant, dribbling into her underwear only after baths. She concluded this to be bathwater accumulating in her vagina, which she evacuates digitally. The differential diagnosis of dribbling incontinence in females of any age should include the extra-urethral cause of entrapped fluids of immersion. Although this condition may be rare, it is simple to rule out on history based on its temporal association with fluid immersion. Once diagnosed, the management is behavioural.

Effects of expectation on amygdala-kindled convulsions and interictal behaviour in rats: confirmation of a Pavlovian mechanism.

We found evidence that the effects of exposure to the stimulation environment on the convulsions and interictal behaviour of basolateral amygdala (BA)-kindled rats are the result of Pavlovian conditioning. In Experiment 1, the rats first received 45 BA stimuli in one environment (CS+) and 45 sham stimuli in another environment (CS-). During this first phase of the experiment, the CS+ and CS- began to exert differential effects on interictal behaviour and convulsions. Then, during the second phase, rats received 45 stimuli and 45 sham stimuli, either as before in their original CS+ and CS- (nonreversal rats) or with their original CS+ and CS- interchanged (reversal rats). During the second phase, the CS+ and CS- continued to exert the same pattern of differential effects on the interictal behaviour and convulsions of the nonreversal rats, whereas the reversal rats began to display the reverse pattern. In Experiment 2, rats received 60 sham stimuli in one environment (CS1). Then, half of the rats received 30 stimuli in a second environment (CS2) and 30 sham stimuli in CS1 (no-pre-exposure rats), whereas the other half (pre-exposure rats) received 30 stimuli and 30 sham stimuli in CS1. Pre-exposure to the stimulation environment attenuated the kindled convulsions. These findings confirm that the conditioned effects of kindling are mediated by a Pavlovian mechanism.