Laparoscopic Extraperitoneal Simple Prostatectomyfor Benign Prostate Hyperplasia:A Two-Year Experience

PURPOSE: To evaluate the feasibility of laparoscopic simple prostatectomyfor large volume prostates.MATERIALS AND METHODS: Between October 2007 and July 2009, laparoscopicsimple prostatectomy was performed on 16 patients with the prostates over 80mL. All the patients were operated with transvesical method. Peri-operativeand 3rd postoperative month data were recorded and evaluated.RESULTS: The mean prostate volume was 147 mL (range, 80 to 200 mL). Themean operation time, blood loss, duration of hospitalization, and duration ofdrain placement was 133 minutes (range, 75 to 210 minutes), 134 cc (range,50 to 300 cc), 3.9 days (range, 2 to 7 days), and 2.1 days (range, 2 to 3 days),respectively. Only one patient required blood transfusion due to postoperativebleeding and clot obstruction in the catheter lumen. Postoperative infectionwas not seen and recatheterization was not needed in any of the patients.All the patients’ pathology reports were noted as benign. Pre-operative andpostoperative International Prostate Symptom Score were 9.2 and 25.4,respectively. Maximum urinary flow rate was 4.0 mL/sec pre-operatively,but 24.7 mL/sec postoperatively.CONCLUSION: Laparoscopic simple prostatectomy is a feasible method withlow morbidity and improved postoperative outcomes

Robotic-assisted simple prostatectomy: A systematic review

Contemporary minimally invasive surgical (MIS) treatment options of patients with male Lower Urinary Tract Symptoms (LUTS) in men with prostate glands >80 mL include Holmium Laser Enucleation Prostate (HoLEP), Thulium laser VapoEnucleation Prostate (ThuVEP), and Laparoscopic (LSP) or Robotic-Assisted Simple Prostatectomy (RASP). Implementing new laser technologies is costly, and the steep learning curve of these laser techniques limit their wide range use. This promoted the use of LSP and RASP in centers with readily established laparoscopy or robotic surgery programs. The aim of this study is to review case and comparative series of RASP. We systematically reviewed published data from 2008 to 2020 on RASP and have identified 26 non-comparative and 9 comparative case series. RASP has longer operation time but less time spent in hospital and less blood loss. The outcomes of improvements in symptom score, post-voiding residual urine (PVR), postoperative PSA decline, complications, and cost are similar when compared to open and laser enucleation techniques. These outcomes position RASP as a viable MIS treatment option for patients with male LUTS needing surgical treatment for enlarged prostates. Nevertheless, prospective, randomized controlled trials (RCTs) with multicenter and large sample size are needed to confirm the findings of this systematic review

Renal Autotransplantation at Three Academic Institutions in Turkey

Objective: The objective of this study is to present the experience of 3 institutions performing renal autotransplantation (RAT) and to discuss surgical techniques employed and the results in the light of the medical literature. Materials and Methods: A total of 14 patients (11 male and 3 female) with a mean age of 47 +/- 8 years (35-61 years), who underwent RAT procedure at 3 different institutions between October 2006 and November 2014, in Turkey, were evaluated retrospectively. Indications for RAT procedure are ureteral avulsion, renal artery aneurysm and intimal dissection caused by percutaneous transluminal renal artery angioplasty (PTRA). Twelve patients with ureteral avulsion, 1 patient with renal artery aneurysm and 1 patient with intimal dissection caused by PTRA were followed-up for 103 months. Seven (50%) open and 7 (50%) laparoscopic nephrectomies were performed. Nine patients (64.3%) were right-sided and 5 patients (35.7%) were left-sided. Complications of grade III and above as per Clavien-Dindo classification were assessed. Results: Mean time from injury to RAT was 21.2 +/- 40.1 days. However, 5 (35.7%) patients were treated on the same day of the injury. As per Clavien-Dindo classification, 2 (14.2%) grade IVa and 1 (7.1%) grade IIIa complications were reported. However, no significant correlation was observed between the complications and graft loss regarding type and side of the nephrectomy performed (p = 0.462 and p = 0.505, respectively) and timing of the intervention (p = 0.692). Conclusion: RAT is a safe procedure in combination with minimally invasive laparoscopic technique in carefully selected patients; however, it requires expertise and proficiency in laparoscopy, reconstructive urology and transplantation. Nevertheless RAT should be considered as the last resort, when other modalities fail. (C) 2016 S. Karger AG, Base

Renal Autotransplantation at Three Academic Institutions in Turkey

Objective: The objective of this study is to present the experience of 3 institutions performing renal autotransplantation (RAT) and to discuss surgical techniques employed and the results in the light of the medical literature. Materials and Methods: A total of 14 patients (11 male and 3 female) with a mean age of 47 +/- 8 years (35-61 years), who underwent RAT procedure at 3 different institutions between October 2006 and November 2014, in Turkey, were evaluated retrospectively. Indications for RAT procedure are ureteral avulsion, renal artery aneurysm and intimal dissection caused by percutaneous transluminal renal artery angioplasty (PTRA). Twelve patients with ureteral avulsion, 1 patient with renal artery aneurysm and 1 patient with intimal dissection caused by PTRA were followed-up for 103 months. Seven (50%) open and 7 (50%) laparoscopic nephrectomies were performed. Nine patients (64.3%) were right-sided and 5 patients (35.7%) were left-sided. Complications of grade III and above as per Clavien-Dindo classification were assessed. Results: Mean time from injury to RAT was 21.2 +/- 40.1 days. However, 5 (35.7%) patients were treated on the same day of the injury. As per Clavien-Dindo classification, 2 (14.2%) grade IVa and 1 (7.1%) grade IIIa complications were reported. However, no significant correlation was observed between the complications and graft loss regarding type and side of the nephrectomy performed (p = 0.462 and p = 0.505, respectively) and timing of the intervention (p = 0.692). Conclusion: RAT is a safe procedure in combination with minimally invasive laparoscopic technique in carefully selected patients; however, it requires expertise and proficiency in laparoscopy, reconstructive urology and transplantation. Nevertheless RAT should be considered as the last resort, when other modalities fail. (C) 2016 S. Karger AG, Base

Mikroskopik hematüri ile mesane kanserinin ilişkisi: Bugün için kullanılan tanı yöntemleri güvenilir mi?

Amaç: Bu çalışmada, mikroskobik hematürisi olan hastalarda mesane kanseri tanısında radyolojik tanı metodları, idrar tümör belirleyicileri ve idrar sitolojisinin duyarlılık ve özgüllüğünün değerlendirilmesi amaçlanmıştır. Gereç ve yöntem: İlk inceleme sonrası mikroskobik hematüri tanısı alan toplam 150 hasta çalışmaya alınmıştır. Hastalar prospektif olarak idrar semptomatolojisi ve sigara alışkanlığı yönünden sorgulanarak fizik muayene, intravenöz pyelografi (IVP), batın ultrasonografisi (USG), Nükleer Matriks protein 22 (NMP22), idrar sitolojisi ve NMP22 BladderChek® testleri ile değerlendirildi. NMP22 testi için eşik değer olarak 10 U/mL alındı. Bulgular: Yaş ortalaması 49.8±10.79 yıl olup çalışma grubundaki erkek/kadın oranı 1.08 oranında tespit edilmiştir (78/72). Hastaların %10.7 sinde (n=16) alınan biyopsi sonucunda mesane kanseri tespit edilirken %89.5’inde mikrohematüri için bir sebep bulunmamıştır. IVP, mesane kanseri teşhisinde en duyarlı ve özgül test olarak bulunmuştur. Ancak idrar işeme sitolojisi IVP ile aynı özgüllük değerine sahip olmasına rağmen en az duyarlı test olarak izlenmiştir. İkili test kombinasyonlarında, en yüksek duyarlılık ve özgüllük değerleri NMP22 ve batın USG testleriyle sağlanmıştır. Sonuç: Mikroskobik hematüride radyolojik tanı yöntemlerinin, NMP22 BladderChek® testi gibi tümör belirteçleriyle kombine kullanılması %100 duyarlılık sağlarken hastaların yaklaşık yarısını gereksiz sistoskopiden korumaktadır.Objective: This study aimed to evaluate the sensitivity and specificity of radiological diagnostic methods, urinary biomarkers and urine cytology for patients with microscopic hematuria in the diagnosis of bladder cancer. Materials and methods: A total of 150 patients with the initial diagnosis of microscopic hematuria were included in the study. Patients were prospectively evaluated in terms of urinary symptomatology, physical examination, smoking habits, intravenous pyelography (IVP), abdominal ultrasonography (USG), Nuclear Matrix Protein 22 (NMP22), urine cytology and NMP22 BladderChek® test. The cut-off point for NMP22 test was accepted as 10 U/mL. Results: Mean age of the study population was 49.8±10.79 years with a male to female ratio of 1.08 (78/72). Overall, 10.7% (n=16) of patients had pathological diagnosis of bladder cancer, whereas 89.5% of the study population had no etiology for microhematuria. IVP was considered as the most sensitive and specific test in the diagnosis of bladder cancer. However, voided urine cytology was the least sensitive test, although it has the same specificity with IVP. The best sensitivity and specificity values were demonstrated when NMP22 and abdominal USG were used in double-test combinations. Conclusion: In microscopic hematuria, the combination of radiological methods with tumor markers such as NMP22 BladderChek® test, provides 100% sensitivity, and protects nearly half of cases from unnecessary cystoscopies

Laparoscopic heminephrectomy for benign and malignant diseases of the horseshoe kidney

Objectives: In the current study, we present our pure laparoscopic heminephrectomy experience in 13 patients with horseshoe kidney (HK). Material and Methods: A total of 13 patients with HK underwent pure laparoscopic heminephrectomy (Transperitoneal= 7, Retroperitoneal = 6) due to benign and malign renal conditions (non-functional hydronephrotic and/or infected kidney = 12, kidney mass = 1). Results: The mean age of the patients was 45.8 years. The mean operating time was 140 minutes, and estimated blood loss was 131 ml. The mean hospital stay was 2.3 days. Division of istmus was performed with stapler in 5 patients, ultrasonic scalpel in 3, 15 mm Hem-o-lok clip in 3, 10 mm LigaSure vessel seal system in one and endoscopic suture by 0 polyglactin in one patient without bleeding. Twelve patients underwent pure laparoscopic heminephrectomy due to nonfunctional hydronephrotic and or infected kidney. One patient underwent transperitoneal laparoscopic right heminephrectomy due to kidney mass. According to modifies Clavien classification, Grade I complication (wound infection) occurred in one patient (7.7%) who underwent heminephrectomy due to non-functional kidney. Conclusions: Laparoscopic heminephrectomy seems to be technically feasible and safe for benign and malignant diseases in patients with HK

Robotic-assisted simple prostatectomy: A systematic review

Contemporary minimally invasive surgical (MIS) treatment options of patients with male Lower Urinary Tract Symptoms (LUTS) in men with prostate glands >80 mL include Holmium Laser Enucleation Prostate (HoLEP), Thulium laser VapoEnucleation Prostate (ThuVEP), and Laparoscopic (LSP) or Robotic-Assisted Simple Prostatectomy (RASP). Implementing new laser technologies is costly, and the steep learning curve of these laser techniques limit their wide range use. This promoted the use of LSP and RASP in centers with readily established laparoscopy or robotic surgery programs. The aim of this study is to review case and comparative series of RASP. We systematically reviewed published data from 2008 to 2020 on RASP and have identified 26 non-comparative and 9 comparative case series. RASP has longer operation time but less time spent in hospital and less blood loss. The outcomes of improvements in symptom score, post-voiding residual urine (PVR), postoperative PSA decline, complications, and cost are similar when compared to open and laser enucleation techniques. These outcomes position RASP as a viable MIS treatment option for patients with male LUTS needing surgical treatment for enlarged prostates. Nevertheless, prospective, randomized controlled trials (RCTs) with multicenter and large sample size are needed to confirm the findings of this systematic review

Effects of Obesity on the Perioperative Results and Continence Status in Laparoscopic Radical Prostatectomy

Objective: To assess the effects of obesity on the surgical success and perioperative results and continence status in laparoscopic radical prostatectomy (LRP). Materials and Methods: The results of 300 consecutive patients undergoing LRP between April 2004 and January 2014 were analyzed retrospectively. Twenty patients were excluded from the study, thus, 280 patients remained. The patients were separated into 3 groups according to their body mass index. Based on this classification, group 1 (30 kg/m2) was obese. The demographic data, intraoperative results, pathological results, and states of continence were compared among the groups. Results: There were 81 patients in group 1, 152 patients in group 2, and 47 patients in group 3. There were no significant differences when the groups were compared according to age and prostate specific antigen values. The intraoperative blood loss was high in group 3 only. Moreover, the estimated blood loss, transfusion, operative time, bilateral nerve-sparing rate, hospitalization days, and complication rate were similar between the groups. There were no significant differences when the pathological results were compared according to the positive surgical margins and Gleason scores. Although the continence rates in group 3 were significantly low 6 months after the operation (p<0.05), the results were similar at 1 year (p=0.738). Conclusion: LRP can be applied confidently in obese patients as well as normal and overweight patients

Penile Plication With or Without Degloving of the Penis Results in Similar Outcomes

Background: Penile plication techniques with or without degloving offer a minimally invasive option for the treatment of penile curvature. Aim: To review the outcomes of penile plication surgery and patient satisfaction with and without degloving of the penis. Methods: We conducted a retrospective analysis of 52 patients who underwent penile plication for the treatment of Peyronie disease or congenital penile curvature. Outcomes: Surgical success rates, complications, and patient satisfaction determined with the Treatment Benefit Scale were compared between groups. Results: The overall surgical success rate was 92.3% at a mean follow-up of 18.84 ± 23.51 months. There were no intraoperative complications. In the degloving group, 42.6% of patients were greatly satisfied and 42.6% had better outcomes; in the without degloving group, 61.5% of patients were greatly satisfied and 30.8% had better outcomes. Comparison of outcomes was not statistically significant between groups. Clinical Implications: The results of the present study indicate the two techniques can be used for penile plication. Conclusion: With or without degloving, penile plication is safe and effective and provides high patient satisfaction. Kadirov R, Coskun B, Kaygisiz O, et al. Penile Plication With or Without Degloving of the Penis Results in Similar Outcomes. Sex Med 2017;5:e142–e147