Functional outcome of robotic-assisted intracorporeal versus extracorporeal neobladder following radical cystectomy: Initial experience.

INTRODUCTION: Worldwide, the seventh most commonly diagnosed cancer in the male population is Bladder cancer (BC), while it drops to eleventh when both genders are considered. Radical cystectomy is the surgical treatment of choice for patients with all muscle-invasive and some nonmuscle invasive BCs. An orthotopic continent diversion (neobladder) is preferred whenever possible to achieve a better postoperative quality of life. We attempt to study the functional outcomes of intracorporeal neobladder (ICNB) versus extracorporeal neobladder (ECNB) (ICNB vs. ECNB). MATERIALS AND METHODS: Forty patients who underwent robot-assisted radical cystectomy with neobladder in our institute during the period of March 2016-March 2018 were included in the study. An orthotopic neobladder (Studer method) was created in all our patients. Our main outcomes of interest were peak flow rates, residual urine, attainment of continence, and Pdet at qmax of the neobladder. RESULTS: The mean age of patients in our study group was 54 ± 6 years. The mean body mass index was 23 ± 2 kg/m2. The mean follow-up period was 24 ± 5 months. Twenty patients underwent ICNB and 20 patients underwent ECNB. The urodynamic assessment was done 1-year postprocedure. The same parameters applied to an intact bladder are used, and results analyzed by comparing it with other studies. Common in the initial postoperative period was incontinence which reduced substantially over time. After 1-year, 75% of patients did not require pads in the daytime, and a meager, <10% used more than one pad per day. There was no difference in outcome between both the groups, which was statistically significant. CONCLUSION: Both ICNB and ECNB groups achieved urodynamically proven values of adequate bladder capacity and compliance. Daytime continence was excellent, and night time continence was good in both groups. Furthermore, there was no significant difference between both the groups as regards to urodynamic parameters. However, continence is attained little earlier in the ICNB group. There is no perceived superiority of ICNB over ECNB.

Two cases of non-Hodgkin lymphoma of urinary bladder: Primary and secondary.

Lymphoma of urinary bladder is rare and can be primary (0.2% of all bladder neoplasms) or secondary (1.8% of secondary tumors of the bladder), the latter being more common. Here, we report a case each of primary and secondary lymphoma of the bladder who had undergone treatment at our hospital. Both patients underwent cystoscopy and resection of the bladder growth followed by immunohistochemical staining which revealed them to be lymphomas.

Holmium laser cystolithotripsy under local anaesthesia: Our experience.

OBJECTIVE: To investigate the feasibility and effectiveness of transurethral holmium laser cystolithotripsy (HLC) under local anaesthesia using a flexible cystoscope. PATIENTS AND METHODS: A prospective study was undertaken from January 2013 to June 2015. In all, 37 men with bladder calculi underwent HLC under local anaesthesia, preferably in a lithotomy position using a flexible cystoscope, followed by per urethral Foley catheter placement postoperatively. RESULTS: The mean (SD; range) patient age was 46.6 (5.6; 32-76) years. All patients were rendered stone-free, regardless of stone size. The mean (SD; range) stone size was 2.1 (1.2; 1.4-4.1) cm and operative time was 35 (6; 26-52) min. The whole procedure was well tolerated and there were no major intraoperative complications. The mean (SD; range) hospital stay was 2.4 (1.5; 1-5) days. After a mean follow-up of 6 months, no recurrent stones, urinary retention or urethral strictures had developed. CONCLUSIONS: Transurethral HLC using a flexible cystoscope under local anaesthesia is a safe and effective technique for the treatment of bladder calculi and can be used as an alternative treatment option.

Small renal tumor with lymph nodal enlargement: A histopathological surprise.

Renal cancer with lymph nodal mass on the investigation is clinically suggestive of an advanced tumor. Small renal cancers are not commonly associated with lymph nodal metastasis. Association of renal cell carcinoma with renal tuberculosis (TB) in the same kidney is also rare. We report here a case of small renal cancer with multiple hilar and paraaortic lymph nodes who underwent radical nephrectomy, and histopathology report showed renal and lymph nodal TB too.

Mini percutaneous nephrolithotomy for renal calculi in paediatric patients: A review of twenty cases.

OBJECTIVE: The objective was to report our initial experience of mini percutaneous nephrolithotomy (mPCNL) performed on patients in the pediatric age group (<18 years) using a miniature nephroscope (12F). SUBJECTS AND METHODS: A total of 20 children underwent mPCNL for renal stone extraction in the Department of Urology, Yenepoya Medical College, Mangalore, India, from February 2013 to January 2014. The patients were evaluated on the basis of parameters viz. age at the time of surgery, size and number of stones, duration of surgery, stone clearance, and postoperative complications. RESULTS: A total of 20 mPCNLs were performed on children, with age ranging from 8 to 16 years. Three children had three stones each, six children had two stones each, eight children had one stone each, and three had multiple. The median stone burden was 1.36 cm. The procedure was via single puncture in 15 cases, and two punctures in five cases. Punctures were upper calyceal in seven cases, lower calyceal in seven cases, and combined upper and lower calyceal in six cases. The calculi were accessed by a 12F mini nephroscope, laser lithotripsy was used in 12 cases and pneumatic lithotripsy used for the rest. Total clearance was achieved in 18 out of 20 cases (90%). Postoperative complications developed in one child, in the form of sepsis. CONCLUSION: Our initial experience concludes that mPCNL is a safe and efficacious tool for the management of renal calculi in the pediatric population.

Laparoscopic-assisted mini percutaneous nephrolithotomy in the ectopic pelvic kidney: Outcomes with the laser dusting technique.

INTRODUCTION: The treatment of renal lithiasis has undergone a sea change with the advent of extracorporeal shock wave lithotripsy (ESWL) and endourological procedures such as percutaneous nephrolithotomy (PCNL), ureterorenoscopy and retrograde intrarenal surgery (RIRS). The presence of anatomical anomalies, such as ectopic pelvic kidney, imposes limitations to such therapeutic procedures. This study is aimed to find a simple and effective way to treat the stones in ectopic kidney. MATERIALS AND METHODS: From 2010 to 2014, nine patients underwent laparoscopic-assisted mini PCNL with Laser dusting for calculi in ectopic pelvic kidneys at our hospital. Retrograde pyelography was done to locate the kidney. Laparoscopy was performed and after mobilizing the bowel and peritoneum, the puncture was made in the kidney and using rigid mini nephroscope, and stones were dusted with Laser. RESULTS: The median interquartile range (IQR) stone size was 18 (6.5) mm. Median (IQR) duration of the procedure was 90 (40) min. The median (IQR) duration of postoperative hospital stay was 4 (2) days. The stone clearance in our series was 88.9%, with only one patient having a residual stone. No intra- or post-operative complications were encountered. CONCLUSION: Laparoscopy-assisted mini PCNL with Laser dusting offers advantages in ectopic pelvic kidneys in achieving good stone clearance, especially in patients with a large stone burden or failed ESWL or RIRS.

Holmium laser transurethral resection of bladder tumor: Our experience.

PURPOSE: To compare the safety and efficiency of conventional monopolar and holmium laser en bloc transurethral resection of bladder tumor (CM-TURBT and HoL-EBRBT) while managing primary nonmuscle-invasive bladder cancer. MATERIALS AND METHODS: From January 2012 to October 2015, fifty patients with primary nonmuscle-invasive bladder cancer underwent endoscopic surgery. Among them, 27 patients underwent CM-TURBT and 23 patients underwent HoL-EBRBT. Clinical data, included preoperative, operative, and postoperative management and follow-up, were recorded. RESULTS: Patient demographics and tumor characteristics in both groups were compared before surgery. There was no significant difference in operative duration among the groups. Compared with the CM-TURBT group, HoL-EBRBT group had less intraoperative and postoperative complications, including obturator nerve reflex (P < 0.01), bladder perforation (P < 0.01), as well as bleeding and postoperative bladder irritation (P < 0.01). There were no significant differences among the two groups in the transfusion rate and occurrence of urethral strictures. Patients in the HoL-EBRBT group had less catheterization and hospitalization time than those in the CM-TURBT group (P < 0.01), and there were no significant differences in each risk subgroup as well as the overall recurrence rate among the CM-TURBT and HoL-EBRBT groups. CONCLUSIONS: HoL-EBRBT might prove to be preferable alternatives to CM-TURBT management of nonmuscle-invasive bladder cancer. HoL-EBRBT however did not demonstrate an obvious advantage over CM-TURBT in tumor recurrence rate.

Massive left hemothorax following laparoscopic pyeloplasty.

Laparoscopic pyeloplasty is viable standard minimally invasive alternative to open pyeloplasty for the treatment of ureteropelvic junction obstruction. Intrathoracic bleeding is an extremely rare complication after laparoscopic urological surgery, but it should be suspected and promptly diagnosed in case of worsening hemodynamic status and respiratory parameters during the intra or post-operative course. We report a case of hemothorax complicating an otherwise uneventful LP in an 18-year-old girl.