Robot-assisted laparoscopic placement of extravascular stent for nutcracker syndrome

A 20-year-old man complained of debilitating left flank pain for 6 months with an episode of gross hematuria. Computed tomography showed compression of the left renal vein between the aorta and superior mesenteric artery with an aortomesenteric angle of 25 degrees. Venography showed a gradient of 3 mm Hg across the compression and 94.4% luminal compression of the left renal vein. After discussion of all surgical and endovascular options, robot-assisted laparoscopic placement of an extravascular cuff around the left renal vein was performed using the da Vinci X Surgical System (Intuitive Surgical, Sunnyvale, Calif). The patient did well with full resolution of the left flank pain

Relationship between voided volume and the urge to void among patients with lower urinary tract symptoms

<p><i>Objective.</i>The aim of this study was to explore the relationship between voided volume (VV) and urge to void among patients with lower urinary tract symptoms. <i>Material and methods.</i> Consecutive adult patients (aged 23–90 years) were enrolled, and completed a 24 h bladder diary and the Urgency Perception Scale (UPS). Patients were categorized as urgency or non-urgency based on the Overactive Bladder Symptom Score. The relationship between UPS and VV (based on the bladder diary) was analyzed by Spearman’s rho and proportional odds model. <i>Results.</i> In total, 1265 micturitions were evaluated in 117 individuals (41 men, 76 women; 56 individuals in the urgency and 61 in the non-urgency group). The mean (± SD) VV and UPS were 192 ± 127 ml and 2.4 ± 1.2 ml in the urgency group and 173 ± 124 ml and 1.7 ± 1.1 ml in the non-urgency group, respectively. Spearman’s rho (between UPS and VV) was 0.21 [95% confidence interval (CI) 0.13–029, <i>p</i> < 0.001] for the urgency group, 0.32 (95% CI 0.25–0.39, <i>p</i> < 0.001) for the non-urgency group, and 0.28 (95% CI 0.23–0.33, <i>p</i> < 0.001) for the total cohort. Urgency patients had higher UPS [odds ratio (OR) 3.1, 95% CI 2.5–3.8]. Overall, each additional 50 ml VV increased the odds of having a higher UPS with OR 1.2 (95% CI 1.2–1.3). The relationship between VV and UPS score was similar in both groups (<i>p</i> = 0.548 for interaction). <i>Conclusion.</i> Although urgency patients void with a higher UPS score, among both urgency and non-urgency patients there is only a weak correlation between VV and the urge to void. This suggests that there are factors other than VV that cause the urge to void.</p