Urothelial Carcinoma Recurrence in an Ileal Orthotopic Neobladder 10 Years After Primary Robotic Radical Cystoprostatectomy.

Background: The recurrence of urothelial carcinoma in orthotopic ileal neobladder is an extremely rare entity. We present a case of a patient who developed urothelial carcinoma in a robotically formed ileal neobladder (Studer), 10 years after primary surgery, who was managed with robotic neocystectomy. Case Presentation: A 56 year-old patient presented with gross hematuria 10 years after robotic cystoprostatectomy, lymphadenectomy, and intracorporeal formation of Studer ileal neobladder. After surgery the patient was closely followed up using cytology testing, cystoscopy, and imaging at regular intervals. Ten years later the patient presented gross hematuria. Cystoscopic examination with biopsies was performed, revealing the presence of high-grade urothelial carcinoma. The patient under general anesthesia was placed in a position similar to robotic prostatectomy and robotic neocystectomy with bilateral ureterostomy was performed. Conclusion: Although urothelial carcinoma in an orthotopic neobladder is unusual, recurrence should be considered in patients with hematuria who underwent radical cystoprostatectomy and orthotopic ileal neobladder formation. However, those patients can be managed safely and effectively, performing robotic neocystectomy.

Massive Dilation of the Ureter: An Endoscopic Management of Persistent Urinary Leak After Partial Nephrectomy.

Introduction: The incidence of urinary leakage is increased as nephron sparing surgery becomes more used for the management of small renal masses. We present an endourologic approach in a patient with a persistent urinary leak after partial nephrectomy by placing two synchronous ureteral stents to improve drainage and avoid further potential surgery. Patients and Method: A 39-year-old patient presented with a urine leak on the fifth postoperative day after an open partial nephrectomy. Initially, the leakage was managed with a placement of a 6F Double-J stent. However, due to persistence of leakage after a month, two ureteral stents (a 6F Double-J stent and a 14F endopyelotomy stent) were placed. With this maneuver, the ureter was dilated to 20F and a bladder catheter was placed to complete the drainage. Results: At 3 weeks, a CT urography was performed, which showed complete resolution of the urinary leakage compared with previous examination. The stents were removed the following day and the patient required no further intervention. The follow-up examination was continued for 24 months without any symptom of the patient and any sign of leak recurrence. Conclusion: Endoscopic approach to urinary leak after partial nephrectomy obtaining high ureteral gauge can be a good alternative, avoiding more aggressive surgical approaches.

PVP versus HoLEP current outcomes and future strategies.

Photoselective vaporization of the prostate (PVP) with a potassium titanyl phosphate (KTP) laser and Holmium laser enucleation of the prostate (HoLEP) currently represent the most promising new technologies applied to the treatment of benign prostatic hyperplasia (BPH) associated with benign prostatic obstruction (BPO). The specific laser-light characteristics and the optimal interactions between lasers and prostatic tissue result in an even and efficient ablation of the prostate resulting in the formation of a clearly de-obstructed prostate cavity. PVP and HoLEP can be considered day-case procedures, as they require only a few hours of catheterization and are associated with minimal postoperative discomfort, while at the same time they offer results at least equivalent to the reference standards transurethral resection of the prostate and open prostatectomy. There is no doubt that larger studies with longer follow up are necessary to further define the durability of results of PVP and HoLEP in the management of BPH, this review will address current issues regarding how both techniques are performed, their results and limitations as well as their role in the future management of BPH.

Vaporización fotoselectiva de la prostata (VFP) vs enucleación de la próstata con láser Holmio (HOLEP): resultados actuales y estrategias / PVP vs HOLEP current outcomes and future strategies

La vaporización foto selectiva de la próstata (VFP), con un láser de fosfato de titanio y potasio (KTP) y la enucleación de la próstata con láser Holmio (HoLEP) representan en la actualidad las técnicas más prometedoras en el tratamiento de la hiperplasia benigna de próstata (HBP) asociada con obstrucción benigna de próstata (OBP). Las características específicas del láser y las interacciones óptimas entre el láser y el tejido prostático resultan en una uniforme y eficiente ablación de la próstata con la consiguiente formación de una celda prostática claramente desobstruida. El KTP y el HoLEP pueden ser considerados procedimientos ambulatorios, ya que solo requieren unas pocas horas de cateterización y están asociados con mínimo discomfort postoperatorio, mientras que al mismo tiempo ofrecen resultados al menos equivalentes a los estándares de referencia de la resección transuretral de próstata y la prostatectomía abierta. No hay duda de que se necesitan grandes estudios con seguimiento más largo para definir con mayor precisión la duración de los resultados del KTP y el HoLEP en el manejo de la HBP. Esta revisión abordará cuestiones de actualidad acerca de cómo se llevan a cabo ambas técnicas, sus resultados y limitaciones, así como su papel en el manejo futuro de la HBP(AU)

Photoselective vaporization of the prostate (PVP) with a potassium titanyl phosphate (KTP) láser and Holmium láser enucleation of the prostate (HoLEP) currently represent the most promising new technologies applied to the treatment of benign prostatic hyperplasia (BPH) associated with benign prostatic obstruction (BPO). The specific láser-light characteristics and the optimal interactions between lásers and prostatic tissue result in an even and efficient ablation of the prostate resulting in the formation of a clearly de-obstructed prostate cavity. PVP and HoLEP can be considered day-case procedures, as they require only a few hours of catheterization and are associated with minimal postoperative discomfort, while at the same time they offer results at least equivalent to the reference standards transurethral resection of the prostate and open prostatectomy. There is no doubt that larger studies with longer follow-up are necessary to further define the durability of results of PVP and HoLEP in the management of BPH, this review will address current issues regarding how both techniques are performed, their results and limitations as well as their role in the future management of BPH(AU)

Should percutaneous nephrolithotripsy be considered the primary therapy for lower pole stones?

PURPOSE: The efficacy of percutaneous nephrolithotripsy (PCNL) as a primary therapy for the treatment of lower pole caliceal lithiasis was determined. MATERIALS AND METHODS: We reviewed 144 consecutive files of patients, over a period of 10 years, with noncomplicated lower pole calculi, who underwent PCNL after a single unsuccessful session of extracorporeal shockwave lithotripsy (SWL). RESULTS: The stone-free rate for stones less than 10 mm was 95%. A 97% rate was accomplished for stones between 11 and 20 mm and a 98% rate for stones larger than 20 mm. PCNL achieved a mean overall stone-free rate of 96.7% after a 3-month follow-up, regardless of stone size. PCNL outclasses SWL, when stratified by stone burden and lower pole location. No significant postoperative complications were encountered. CONCLUSION: PCNL is a safe and effective procedure for the management of lower pole caliceal calculi after a single unsuccessful SWL session. This procedure should be considered the primary method for the treatment of lower pole stones.

Treatment of impacted lower third ureteral stones with the use of the ureteral access sheath.

We present our experience with the use of the ureteral access sheath for the management of small impacted lower third ureteral stones, in comparison with more standard techniques. Ninety-eight consecutive patients, aged 18-73 years (mean 48.5), with small (diameter < or = 10 mm) impacted lower third ureteral stones (< 5 mm in 56, and 5-10 mm in 42 patients) were randomly managed with either a 12/14F coaxial ureteral dilator/sheath and a 7.5F flexible ureteroscope (group A; 48 patients), or with balloon dilatation and the 7.5F flexible ureteroscope (group B; 50 patients). In both groups, stones were grasped and extracted with a basket, and when necessary they were disintegrated with a 1.9F electrohydraulic lithotripsy (EHL) probe. Postoperatively, excretory urography was performed at 1 month and patients were followed-up for 1 year. The mean operative time was 45.5 min in group A, and 58.5 min in group B (P<0.05). EHL was performed in 16 (33.3%) patients of group A, and in 12 (24%) patients of group B. In group B, balloon dilatation was performed in 28 (56%) patients. Ureteral perforation was revealed in 4 (8%) patients of group B. The follow-up imaging tests showed stone-free status in 46 (95.8%) patients of group A and in all (100%) patients of group B. No long-term complications were recorded. Endoscopic management of small impacted lower third ureteral stones with the ureteral access sheath is a quicker and safer procedure, in comparison with the more standard approach, bearing comparable efficacy.

Primary paratesticular adult ganglioneuroma.

Ganglioneuroma is a rare benign tumor, usually seen in children and young adults, arising in the central nervous system. Most of the noncranial ganglioneuromas are located in the posterior mediastinum and the retroperitoneum. We report the first case of a primary, adult paratesticular ganglioneuroma that presented as a paratesticular mass. The patient underwent surgical intervention for diagnostic and therapeutic purposes.

Endoscopic and laparoscopic treatment of ureteropelvic junction obstruction.

PURPOSE: Although open pyeloplasty remains the gold standard for treating ureteropelvic junction obstruction, endourology and laparoscopy have revolutionized the management of upper tract stenosis. We present our diagnostic and minimally invasive therapeutic algorithm for the treatment of ureteropelvic junction obstruction. MATERIALS AND METHODS: A total of 13 females and 9 males with a mean age of 34.2 years suffering from ureteropelvic junction obstruction were treated with percutaneous endopyelotomy or laparoscopic dismembered pyeloplasty and followed for 47 to 61 months (mean 53.8) and 47 to 62 months (mean 52.5), respectively. Diagnosis was based on findings of ultrasound, excretory urography, furosemide washout renogram and retrograde ureteropyelography. In cases of ureteral kinking color duplex sonography and spiral computerized tomography were performed. In 14 patients with intrinsic stenosis percutaneous endopyelotomy was performed, while the remaining 8 patients (5 with crossing vessels, 2 with an extremely distended pelvis and 1 with a 2.5 cm. stricture) were treated with a laparoscopic dismembered Anderson-Hynes pyeloplasty. RESULTS: In the endopyelotomy group (success rate 92.8%), mean operation time was 1.2 hours, estimated blood loss was 152 ml., unit doses of analgesics were 5.4 tablets, days of hospitalization were 4.2 and time to return to normal activities was 15.7 days. In the laparoscopic group (success rate of 100%) the aforementioned variables were 3.5 hours (p <0.05), 150 ml., 6.3 tablets, 5 and 17.8 days, respectively. Long-term followup excretory urography and/or diuretic renal scan demonstrated improvement in all patients. CONCLUSIONS: Percutaneous endopyelotomy should be the treatment of choice for intrinsic ureteropelvic junction obstruction. Laparoscopic dismembered pyeloplasty, although technically challenging, provides excellent results for extrinsic or complicated ureteropelvic junction stenosis.