Usage of Modified Makuuchi Incision for Surgical Management of Complex Renal and Adrenal Lesions.

BACKGROUND:  Modified Makuuchi (MM) incision is less popular among the urological fraternity as Chevron, subcostal, flank, and midline incisions are commonly used for most of the complex renal and adrenal conditions. We present our experience and report the outcomes of patients operated using this incision. MATERIALS AND METHODS:  The records of patients who underwent open surgery for upper abdominal urological conditions using MM incision over the last five years in our department were retrospectively reviewed. Patient demographics, laterality of the lesion, size of the lesion, level of inferior vena caval (IVC) thrombus, intraoperative blood loss, local tumor invasion, need for concomitant hepatectomy, need of diaphragmatic resection, use of self-retaining retractors, operative time, hospital stay, wound-related complications, and readmissions were analyzed. RESULTS:  Some 18 patients underwent open surgery by this incision for various complex renal and adrenal conditions during the study period. Patients included those with large upper pole renal and adrenal masses, renovascular conditions like renal artery aneurysm, renal/adrenal masses with liver and diaphragmatic infiltration requiring hepatectomy, diaphragmatic resections, or IVC thrombectomy. The mean size of renal and adrenal masses was 13.8 (±6.3) cm, mean operative time was 370 (±210.6) minutes, mean blood loss was 1124 (±990.3) mL, and mean hospital stay was 11.65 (±13.2) days. Four patients had surgical site infection (SSI) and one had readmission. CONCLUSION:  The MM incision can be widely adapted for complex renal and adrenal surgeries and should become a part of the various commonly used incisions by urologists.

Emphysematous Prostatitis With Secondary Psoas Abscess-A Lethal Outcome Following Prostate Biopsy.

Emphysematous prostatitis is a rare, clinical condition characterized by gas and abscess formation in the prostate often associated with features of sepsis. We report a case of 60-year-old gentleman presenting with emphysematous prostatitis complicated with secondary psoas abscess and florid sepsis following prostate biopsy.

Outcomes of Robot-Assisted Ureterocalicostomy in Secondary Ureteropelvic Junction in Adults: Initial Experience Using Da Vinci Xi System with Near-Infrared Fluorescence Imaging.

Aim: To report the surgical technique and early outcomes of robot-assisted ureterocalicostomy (RAUC) with near-infrared fluorescence (NIRF) in the management of secondary pelvi-ureteric junction obstruction (PUJO) in adults. Materials and Methods: The data of 6 patients who underwent RAUC using Da Vinci Xi system with NIRF technology between November 2017 and April 2019 were retrospectively reviewed. Indication was secondary PUJO due to previous failed pyeloplasty. The outcome variables evaluated include operative time (total and console), length of hospital stay, blood loss, and complications. Success was defined as the absence of pain and radionuclide scan demonstrating nonobstructive drainage and improvement/stabilization of split function of the renal moiety. Results: The mean (range) patient age was 33.7 (18-41) years. Total mean (range) operating time was 178 (140-240) minutes and mean console time was 135 minutes. Estimated mean blood loss was 115 (50-200) mL and average hospital stay was 6.1 (5-8) days. There were no conversions to open or laparoscopic surgery. Clavien-Dindo complications occurred in 2 patients. (Grade I-1 and Grade II-1). After a median (range) follow-up of 15 (6-22) months, all 6 patients had successful clinical and radiological outcomes. Conclusion: RAUC is a safe and feasible technique with acceptable outcomes in the setting of secondary PUJO. The utility of NIRF in determining vascularity of the ureter seems to be promising in this setting. Multi-institutional prospective studies with large patient cohort are necessary to validate the role of robotic platform in ureterocalicostomy in the reoperative settings.