Diagnosis and overdiagnosis of prostate cancer: a personal view

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Transurethral resection of the prostate: reaffirming the gold standard

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Current status of robot-assisted surgery

The introduction of robot-assisted surgery, and specifically the da Vinci Surgical System, is one of the biggest breakthroughs in surgery since the introduction of anaesthesia, and represents the most significant advancement in minimally invasive surgery of this decade. One of the first surgical uses of the robot was in orthopaedics, neurosurgery, and cardiac surgery. However, it was the use in urology, and particularly in prostate surgery, that led to its widespread popularity. Robotic surgery, is also widely used in other surgical specialties including general surgery, gynaecology, and head and neck surgery. In this article, we reviewed the current applications of robot-assisted surgery in different surgical specialties with an emphasis on urology. Clinical results as compared with traditional open and/or laparoscopic surgery and a glimpse into the future development of robotics were also discussed. A short introduction of the emerging areas of robotic surgery were also briefly reviewed. Despite the increasing popularity of robotic surgery, except in robot-assisted radical prostatectomy, there is no unequivocal evidence to show its superiority over traditional laparoscopic surgery in other surgical procedures. Further trials are eagerly awaited to ascertain the long-term results and potential benefits of robotic surgery.published_or_final_versio

Evaluating haematuria: ultrasonography and the day case diagnostic service

Haematuria may herald the presence of sinister underlying disease, notably malignancy of the urinary tract. Applying the conventional management pathway involving numerous clinic visits and referrals, waiting list for imaging studies of the upper tract, diagnostic cystoscopy and then therapeutic endoscopy in different venues often leads to substantial delay in diagnosis and appropriate intervention. A rapid access haematuria clinic is therefore advocated. The day case haematuria diagnostic service combining diagnostic imaging and flexible cystoscopy has proven to be highly effective. In this connection, transabdominal ultrasonography has been employed increasingly as the primary imaging modality.published_or_final_versio

The efficacy of extracorporeal shock wave lithotripsy in the treatment of ureteric stones

This study was conducted to evaluate the efficacy of in situ extracorporeal shock wave lithotripsy treatment of ureteric stones using the Dornier MFL 5000 lithotripter. From March 1991 to June 1994, 184 patients received in situ extracorporeal shock wave lithotripsy treatment. The overall success rate was 76% (77% for upper; 69% for middle; and 81% for lower ureteric stones, respectively). The level and size of the stones did not affect the final outcome significantly. An average of 1.23 sessions were required for each patient and the rate of major auxiliary intervention was 21%. We conclude that extracorporeal shock wave lithotripsy is an effective treatment for ureteric stones.published_or_final_versio

Robot-assisted versus standard laparoscopic partial nephrectomy: comparison of perioperative outcomes from a single institution

OBJECTIVE: To evaluate the perioperative outcomes of robot-assisted laparoscopic partial nephrectomy and standard laparoscopic partial nephrectomy in a teaching hospital. DESIGN: Retrospective study. SETTING: Division of Urology, Department of Surgery, Queen Mary and Tung Wah hospitals, Hong Kong. PATIENTS: The first 10 consecutive patients who had robot-assisted laparoscopic partial nephrectomy for renal tumours between January 2008 and September 2009 with prospective data collection were evaluated. Their outcomes were compared with the last 10 consecutive patients in our database, who had standard laparoscopic partial nephrectomy between November 2004 and October 2007. MAIN OUTCOME MEASURES: Demographics, tumour characteristics, perioperative outcomes, renal function, and pathological outcomes. RESULTS: There were no differences between the groups with regard to age (63 vs 56 years; P=0.313) and tumour size (2.7 vs 2.8 cm; P=0.895). No significant difference was found between the two groups with respect to the operating room time (376 vs 361 min; P=0.722), estimated blood loss (329 vs 328 mL; P=0.994), and length of hospital stay (7 vs 14 days; P=0.213). A statistically significant shorter mean warm ischaemic time for the robot-assisted group was noted (31 vs 40 minutes; P=0.032). Respective renal functional outcomes as shown by the difference between day 0 and day 60 serum creatinine levels were comparable (+10 vs +7 mmol/L; P=0.605). In both groups, there were no intra-operative complications or instances of surgical margin tumour involvement. Three patients endured postoperative complications in the standard laparoscopic group (a perinephric haematoma, urine leakage, and lymph leakage) compared with one in the robot-assisted group (a perinephric haematoma). These complications all resolved with conservative treatment. CONCLUSIONS: Robot-assisted laparoscopic partial nephrectomy is a technically feasible alternative to standard laparoscopic partial nephrectomy, and provides comparable results. Robot-assisted laparoscopic partial nephrectomy appears to offer the advantage of decreased warm ischaemic time. Longer follow-up is required to assess renal function and oncological outcomes. Further experience and randomised trials are necessary to compare robot-assisted with standard laparoscopic partial nephrectomy.published_or_final_versio

Subinguinal microsurgical varicocelectomy for male factor subfertility: a ten-year experience

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Disease spectrum and treatment patterns in a local male infertility clinic

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Management of ureteric calculi: the pendulum swings

Extracorporeal shock wave lithotripsy (ESWL) for treatment of ureteral calculi has gained wide popularity because of its non-invasive and ambulatory nature. The success rate using the Dornier MFL 5000 is about 77%, but retreatment is often required and stone clearance is gradual. Ureteroscopic lithotripsy (URSL) used to be performed as an in-patient procedure. With the introduction of Holmium laser and establishment of day surgery service, out-patient URSL carries a success rate of 93% and offers immediate stone clearance. It is an attractive alternative for low surgical risk patients as a primary treatment modality.published_or_final_versio

Disease spectrum and treatment patterns in a local male infertility clinic

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