[Laparoscopic partial nephrectomy using a technology of augmented reality: new vector of the development of operative urology?]

AIM: to evaluate the efficiency and usefulness of augmented reality (AR) technology using HoloLens glasses for laparoscopic partial nephrectomy (LPN). MATERIALS AND METHODS: From July to December 2019, a total of 5 patients with localized kidney cancer (cT1aN0M0) underwent AR-assisted LRP. The mean RENAL score was 6 points (5-8). Preoperatively, all patients underwent contrast-enhanced multispiral computed tomography (MSCT). The three-dimensional reconstructions of the kidney, tumor, part of the abdominal aorta with the renal artery and its branches, part of the inferior vena cava with the renal vein were segmented with color coding and connected into a single virtual 3D model, which was loaded into the program in order to display image in AR glasses. The duration of surgery and thermal ischemia, type and frequency of intraoperative complications, as well as the time spent on preparing the 3D model and the Microsoft HoloLens device were evaluated. To assess the feasibility of using AR technology intraoperatively, a Likert scale was filled out by the surgeon. RESULTS: It took 10 (9-11) hours to prepare the model, including time to optimize the model and to set up its display and interactions. The setup of HoloLens required an average of 7.8 (5- 12) min. The total duration of the operation and the period of warm ischemia was 108 (90-120) and 20 (15-25) min, respectively, while intraoperative blood loss was 160 (110-250) ml. In all cases, a negative surgical margin was found. The surgeon who performed all the operations assessed the use of AR technology with the HoloLens device as highly beneficial in all clinical cases. CONCLUSION: The use of AR technology with a HoloLens holographic device during LPN can lead to improved treatment outcomes.

[Design and materials for ureteral stents: past, present and future].

Ureteral stents have a long history of use. Their main goal is to provide effective drainage of the upper urinary tract. Morbidity is mostly related to low biocompatibility of materials, from which stents are made. Since stent introduction, there have been many stages of evolution and modernization. However, there is a significant problem associated with their widespread use. Despite technological progress, stent-associated symptoms, incrustation, bacterial infection are the problems that still have to be resolved while creating an "ideal" stent. The continued development of new materials and coatings also will lead to the improvement of such an indispensable urological device as the ureteral stent.

[Conservative management of rectourethral fistula: modern treatment].

INTRODUCTION: & Objectives. Rectal injury and recto-urethral fistula (RUF) formation are severe complications after surgical treatment of prostate cancer . There are various surgical techniques as well as conservative methods for the treatment of RUF. Nonsurgical approach can be used in nontoxic, minimally symptomatic patients. MATERIALS & METHODS: From 2012 to 2016, 825 patients (mean age 68y) with LPR to be performed were recruited in the study. Postoperatively RUF developed in 7 patients (0.8%) in average in 10 days after surgery. Five cases were uncomplicated presented with pneumaturia, dysuria or urine per rectum. Two patients with fecaluria and previous history of radiotherapy or androgen deprivation were excluded from the study group. Conservative management include: 1)bowel rest 2)broad-spectrum antibiotics after urine culture 3) fully absorbable diet (combination of parenteral and enteral nutrition) 4) bladder drainage (urethral catheter or suprapubic tube). Duration of conservative treatment was 4 weeks. After treatment all patients underwent a voiding cystourethrogram. RESULTS: During the treatment one patient has developed severe UTIs and surgical treatment were perfomed. The remaining 4 patients had spontaneous healing of the fistula and normal cystourethrogram. With the median follow up of 24 month after RUF treatment all 4patients had no fistula signs and they were fully continent. Overall RUF closure using nonsurgical treatment was successful in 4 of 5 cases (80%). CONCLUSIONS: Conservative management of RUF is a highly effective option which can be used to avoid major surgery and temporary colostomy. Nonsurgical treatment is a feasible method in selected patients with RUF.