Minimally Invasive Therapies for Female Stress Urinary Incontinence: the Current Status of Bioinjectables/New Devices (Adjustable Continence Therapy, Urethral Submucosal Collagen Denaturation by Radiofrequency)

The aim of this review is to provide an update on the current status of evolving minimally invasive therapies for stress urinary incontinence. Bioinjectables have been available for some time and their current status is reviewed. The adjustable continence device has been used as a salvage procedure for females for a number of years in clinical trials, yet many are unfamiliar with it. Lastly, radiofrequency via a transurethral route has also been utilized in small numbers and will be updated. These later two emerging technologies need further exposure to better define their role in our clinical practice

Virtual reality navigation system for prostate biopsy

Prostate cancer is the most common non-cutaneous cancer in America. Tumor detection involves non-invasive screening tests, but positive results must be confirmed by a prostate biopsy. About twelve random samples are obtained during the biopsy, which is a systematic procedure traditionally performed with trans-rectal ultrasound (TRUS) guidance to determine prostate location. Recently, methods of fusion between TRUS and preoperative MRI have been introduced in order to perform targeted biopsies aimed to reduce the number of samples to few suspicious areas. Since the TRUS displaces the prostate during the procedure, the preoperative MRI does not match patient anatomy. Therefore, complex MRI deformation algorithms are needed. However, despite the substantial increase in complexity and cost, there is no strong evidence that the TRUS-MRI fusion actually improves accuracy and surgical outcomes. This paper presents an innovative virtual reality surgical navigation system for performing targeted prostate biopsies, without the need of the uncomfortable TRUS. Both biopsy needle and patient anatomy are constantly tracked by an electromagnetic tracking system that provides their 3D position and orientation with respect to the surgical bed. Multiple fiducial markers are placed on the patient skin (at the iliac crest and pubic bone) during MRI scanning. Once in the operative room, the surgeon is presented a stereoscopic 3D volumetric rendering and multiple orthogonal views of the patient anatomy, as well as a virtual representation of the tracked needle. After a simple registration process between the MRI and the tracker coordinate system, the navigation system guides the needle insertion in the patient perineum through several anatomical layers towards the biopsy targets

Pilot evaluation of a perfused robot-assisted partial nephrectomy procedural simulation platform for single port robotic retroperitoneal approaches

Objective: In this study our objective was to develop a simulation platform for use cases in Laparoendoscopic Single Site (LESS) Surgery intended for patient-specific rehearsal prior to Robot-assisted Partial nephrectomy procedures. Patients and Surgical Procedure: This represents a simulation platform requiring no patients, although the fabrication process allows for the platform to be patient-specific. Tissue phantom 3D models were developed from de-identified CT imaging fulfilling the criteria of tumors located in the posterior lower pole of the kidney. Results: Respondents completed surveys on platform novelty and effectiveness. Agreement on simulator novelty was unanimously positive (100% agree or better). Performance evaluations reached a minimum of 80% agreement for all categories, with zero respondents. Conclusions: We have developed a highly realistic simulation platform for use in single-port robot-assisted partial nephrectomy that can be produced in a patient specific manner, which we believe will be highly useful for trainees as well as experts attempting to transfer skills to the newer platform

Prostate cancer assessment using MR elastography of fresh prostatectomy specimens at 9.4 T

Purpose: Despite its success in the assessment of prostate cancer (PCa), in vivo multiparametric MRI has limitations such as interobserver variability and low specificity. Several MRI methods, among them MR elastography, are currently being discussed as candidates for supplementing conventional multiparametric MRI. This study aims to investigate the detection of PCa in fresh ex vivo human prostatectomy specimens using MR elastography. Methods: Fourteen fresh prostate specimens from men with clinically significant PCa without formalin fixation or prior radiation therapy were examined by MR elastography at 500 Hz immediately after radical prostatectomy in a 9.4T preclinical scanner. Specimens were divided into 12 segments for both calculation of storage modulus (G ' in kilopascals) and pathology (Gleason score) as reference standard. Sensitivity, specificity, and area under the receiver operating characteristic curve were calculated to assess PCa detection. Results: The mean G ' and SD were as follows: all segments, 8.74 ± 5.26 kPa; healthy segments, 5.44 ± 4.40 kPa; and cancerous segments, 10.84 ± 4.65 kPa. The difference between healthy and cancerous segments was significant with P ≤ .001. Diagnostic performance assessed with the Youden index was as follows: sensitivity, 69%; specificity, 79%; area under the curve, 0.81; and cutoff, 10.67 kPa. Conclusion: Our results suggest that prostate MR elastography has the potential to improve diagnostic performance of multiparametric MRI, especially regarding its 2 major limitations: interobserver variability and low specificity. Particularly the high value for specificity in PCa detection is a stimulating result and encourages further investigation of this method

New multiport robotic surgical systems: a comprehensive literature review of clinical outcomes in urology

Over the past 20 years, the field of robotic surgery has largely been dominated by the da Vinci robotic platform. Nevertheless, numerous novel multiport robotic surgical systems have been developed over the past decade, and some have recently been introduced into clinical practice. This nonsystematic review aims to describe novel surgical robotic systems, their individual designs, and their reported uses and clinical outcomes within the field of urologic surgery. Specifically, we performed a comprehensive review of the literature regarding the use of the Senhance robotic system, the CMR-Versius robotic system, and the Hugo RAS in urologic procedures. Systems with fewer published uses are also described, including the Avatera, Hintori, and Dexter. Notable features of each system are compared, with a particular emphasis on factors differentiating each system from the da Vinci robotic system

Lezioni latine per l' Eurozona. Analisi comparativa della crisi del debito sovrano in America Latina e nell' Europa mediterranea

Questo elaborato si propone di analizzare le somiglianze e le differenze tra due crisi dei mercati finanziari che hanno interessato vaste aree geografiche: l'America Latina (anni ottanta del XX secolo) e l'Europa meditteranea (secondo decennio del XXI secolo). Particolare attenzione sarà prestata anche al ruolo dei paesi beneficiari di queste crisi: Usa nel primo caso, Germania nel secondo. Obiettivo della tesi è fornire evidenza tanto quantitativa quanto qualitativa della somiglianza tra due avvenimenti macroeconomic

Single-port robotic radical cystectomy with ileal conduit urinary diversion: technique and review of the early outcomes in literature

The introduction of the da Vinci single port (SP) surgical system (Intuitive Surgical, Sunnyvale, CA, USA) has meant a necessary evolution in the surgical techniques used to perform various Urologic surgeries, such as robotic-assisted radical cystectomy (RARC). In this paper, we describe a step-by-step technique for RARC with intracorporeal ileal conduit urinary diversion using the SP system at our institution and summarize early outcomes in the literature. The surgery was performed utilizing the standard institutional approach for radical cystectomy for the multiport robot, modified for the SP where appropriate. A total of 3 articles were found that included early patient outcomes after SP RARC. Including our institution, a total of 21 patients were included in the final analysis. The average patient age was 68 years old, 16 of the 21 patients were male, 13 of the patients had intracorporeal urinary diversions, the average operative time was 366 min with an average estimated blood loss of 185. The average length of stay was 5.4 days. Among these patients, there were three 30-day complications noted and five 90-day complications, all of which were Clavian II or lower. We conclude that RARC utilizing the SP approach is both feasible and offers several theoretical advantages over the open and multiport approaches, but further study is necessary before advocating for widespread adoption of this modality