In vivo assessment of a novel biodegradable ureteral stent

Purpose: To perform an in vivo assessment of a newly developed biodegradable ureteral stent (BUS) produced with natural-based polymers. Methods: The BUS is based on a patented technology combining the injection process with the use of supercritical fluid technology. The study was conducted at ICVS-University of Minho (Braga, Portugal) and a total of ten domestic pigs were used. In seven animals, the experimental BUS stent was inserted, whereas in the remaining a commercially available stent was used (6-Fr Biosoft(®) duo stents, Porges Coloplast, Denmark). Post-stenting intravenous pyelogram was used to evaluate the degree of hydronephrosis. The in vivo stent degradation was measured as a function of the weight loss. Moreover, the tensile properties of the BUS were tested during in vivo degradation. After maximum 10 days, animals were killed and necropsy was performed. Tissues were compared between the stented groups as well as between the non-stented contralateral ureters and stented ureters in each group. Biocompatibility was assessed by histopathological grading. Results: In all cases, the BUS was only visible during the first 24 h on X-ray, and in all cases, the BUS was completely degraded in urine after 10 days, as confirmed on necropsy. During the degradation process, the mechanical properties of the BUS decreased, while the commercial ureteral stents remained constant. At all time-points after stent insertion, the level of hydronephrosis was minimal. Overall, animals stented with BUS had an average grade of hydronephrosis which was lower compared to the controls. The BUS showed better pathological conditions, and hence better biocompatibility when compared with commercial stents. Conclusions: Notwithstanding the limitations of the present study, the in vivo testing of our novel natural origin polymer-based BUS suggests this device to feature homogeneous degradation, good urine drainage, and high biocompatibility. Next steps will be to increase its stability and to improve the radiopacity without compromising its degradation. Ultimately, clinical studies will be required to determine the safety and feasibility of its use in humans.FCT -Fuel Cell Technologies Program(POCI-01-0145-FEDER-007038)info:eu-repo/semantics/publishedVersio

Retropubic, laparoscopic and mini-laparoscopic radical prostatectomy : a prospective assessment of patient scar satisfaction

Published online: 26 October 2014PURPOSE: To compare patient scar satisfaction after retropubic, standard laparoscopic, mini-laparoscopic (ML) and open radical prostatectomy (RP). METHODS: Patients undergoing RP for a diagnosis of localized prostate cancer at a single academic hospital between September 2012 and December 2013 were enrolled in this prospective nonrandomized study. The patients were included in three study arms: open surgery, VLP and ML. A skin stapler was used for surgical wound closure in all cases. Demographic and main surgical outcomes, including perioperative complications, were analyzed. Surgical scar satisfaction was measured using the Patient and Observer Scar Assessment Questionnaire (POSAS) and the two Body Image Questionnaire (BIQ) scales, respectively, recorded at skin clips removal and either at 6 months after surgery. RESULTS: Overall, 32 patients were enrolled and completed the 6 month of follow-up. At clips removal, laparoscopic approaches offered better scar result than open surgery according to the POSAS. However, at 6 months, no differences were detected between VLP and open, whereas ML was still associated with a better scar outcome (p = 0.001). This finding was also confirmed by both BIQ scales, including the body image score (ML 9.8 ± 1.69, open 15.73 ± 3.47, VLP 13.27 ± 3.64; p = 0.001) and the cosmetic score (ML 16.6 ± 4.12, open 10 ± 1.9, LP 12.91 ± 3.59; p = 0.001). Small sample size and lack of randomization represent the main limitations of this study. CONCLUSIONS: ML RP offers a better cosmetic outcome when compared to both open and standard laparoscopic RP, representing a step toward minimal surgical scar. The impact of scar outcome on RP patients' quality of life remains to be determined

Laparoscopic partial nephrectomy: state of the art review

Izak Faiena, Christopher Sejong Han, Ephrem O Olweny Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA Introduction: The surgical management of small renal masses (<4 cm) has greatly evolved over the last few decades, with the paradigm shifting from radical to partial nephrectomy. Laparoscopic partial nephrectomy (LPN) is increasingly utilized, and has achieved similar outcomes to open partial nephrectomy with decreased patient morbidity in experienced hands. The aim of this review was to examine the current status and future direction of LPN. Materials and methods: We performed a nonsystematic review of the literature using a free-text protocol in the PubMed database, using the terms “laparoscopic partial nephrectomy”, “robot-assisted partial nephrectomy”, “robotic partial nephrectomy”, and “laparoscopic partial nephrectomy oncologic and functional outcomes”. Only English language articles were selected. Evidence synthesis: Our search results yielded 1,136. Three authors reviewed the results, and articles with information on patient and tumor selection, surgical techniques, and oncologic and functional outcomes were included. With regard to outcomes, only series with the largest cohorts and longest follow-up were selected. Conclusion: LPN has evolved rapidly over the past 2 decades, and advances in technique as well as innovations in surgical technologies have facilitated its increased adoption in urologic practice. However, limitations remain, such as inadequacy of techniques to achieve cold ischemia laparoscopically, high technical demands of intracorporeal suturing, and limited ability to assess surgical anatomy beyond the field of view. These comprise goals of research aimed at improving future surgical precision and outcomes, while further decreasing the invasiveness of LPN. Keywords: nephrectomy, robotics, kidne

Irreversible Electroporation (IRE) in Renal Tumors

Small renal masses (SRMs) have been traditionally managed with surgical resection. Minimally invasive nephron-sparing treatment methods are preferred to avoid harmful consequences of renal insufficiency, with partial nephrectomy (PN) considered the gold standard. With increase in the incidence of the SRMs and evolution of ablative technologies, percutaneous ablation is now considered a viable treatment alternative to surgical resection with comparable oncologic outcomes and better nephron-sparing property. Traditional thermal ablative techniques suffer from unique set of challenges in treating tumors near vessels or critical structures. Irreversible electroporation (IRE), with its non-thermal nature and connective tissue-sparing properties, has shown utility where traditional ablative techniques face challenges. This review presents the role of IRE in renal tumors based on the most relevant published literature on the IRE technology, animal studies, and human experience