Bladder duplication is a very rare congenital malformation of the urinary system, which is classified as complete or incomplete. This malformation is usually associated with other anomalies, which may be urogenital or nonurogenital. We present a case of incomplete sagittal bladder duplication in an asymptomatic adult female who became pregnant and delivered a healthy baby.

The aim of this study was to evaluate outcomes of robotic partial nephrectomy (RAPN) procedures. At two centers, 42 patients underwent RAPN. Radius, Exo/Endophytic, Nearness, Anterior/Posterior, Location (R.E.N.A.L.) nephrometry and PADUA scores of patients were calculated by computed tomography (CT) or magnetic resonance imaging (MRI). Intra-and perioperative (0-30 days) complications were evaluated using modified Clavien classification. A four-arm da Vinci-S robotic surgical system was used and outcomes were evaluated retrospectively. Mean age of the patients was 52.3 +/- 6.5 years. Mean tumor size was 3.1 +/- 1.0 (1.4-6.6) cm. R.E.N.A.L. nephrometry and PADUA scores were 6.0 +/- 1.5 and 7.5 +/- 0.9, respectively. Mean surgical time was 127.7 +/- 18.7 minutes and estimated blood loss was 100 +/- 18.1 cc. Mean warm ischemia time was 16.0 +/- 8.9 (0-30) minutes. Intraoperative complications did not develop in any patient. Median hospital stay was 3.0 (2-6) days. Except for 17 patients, hilar clamping was performed in 25 patients. Histopathology results included 34 renal cell carcinoma (22 clear cell, 7 chromophobe cell, 4 papillary cell, and 1 clear papillary cell). Oncocytoma (n = 4), adenoma (n = 1), fibroadipose tissue (n = 1), papillary epithelial hyperplasia (n = 1), and chronic pyelonephritis (n = 1) were present. Surgical margins were negative in all patients. During a median follow-up period of 15.5 +/- 10.9 (3-46) months, neither local recurrence nor distant metastasis was detected. In conclusion, RAPN is a safe, minimally invasive surgical approach, with excellent surgical and oncological outcomes in T1 kidney tumors. Zero ischemia off-clamp RAPN is also safe in selected masses with the advantage of avoiding complete renal ischemia. Copyright (C) 2015, Kaohsiung Medical University. Published by Elsevier Taiwan LLC.

Objective: In this study we aimed to compare renal functions in patients who underwent robotic partial nephrectomy (RPN) with on-clamp and zero-ischemia techniques.Material and methods: Between 2009 and 2015, 12 off-clamp and 22 on-clamp RPN procedures were performed on a total of 34 patients in two centers.The main outcome parameters examined were serum creatinine, and estimated glomerular filtration rate (eGFR) during preoperative, immediate postoperative periods, and at postoperative 3 rd months.Results: There were no statistically significant differences between on-clamp and zero-ischemia groups regarding age, ASA score, BMI, PADUA and R.E.N.A.L. nephrometry scores, operation time and tumor size (p>0.05).Significant differences were found in the duration of hospital stay (3.8±0.9 days vs. 3.0±0.9days) and amount of blood loss (85.9±49.6 mL vs. 183.3±176.2mL) between the on-clamp and zero-ischemia groups (p<0.05).Statistically significant differences were found between preoperative and immediate postoperative periods, in terms of eGFR and serum creatinine levels in both groups.Moreover, statistically significant differences were found between preoperative and postoperative 3 rd month periods, in the on-clamp group in terms of eGFR and serum creatinine levels.In the zero-ischemia group, the decrease in eGFR and serum creatinine levels at postoperative 3 rd month relative to the preoperative period was not statistically significant. Conclusion:Off-clamp RPN technique is superior, in short-term outcomes involving renal functions, compared to on clamp approach.However, long-term data regarding the renal functions should be evaluated to arrive at a definitive decision.

In this video, our technique of robotic intracorporeal Studer pouch construction, specifically emphasizing our suturing and stenting techniques, is presented. A 63 year-old female patient with muscle invasive bladder cancer was referred to our hospital for robotic radical cystectomy and intracorporeal Studer-pouch construction. Her pathological stage prior to radical cystectomy was T1GIII and in the endoscopic examination, the tumor was found to have spread all over the bladder mucosa. Her past medical history revealed a laparoscopic cholecystectomy 20 years ago and a cesarean section 30 years ago.

To evaluate the protective role of bosentan (BOS), an endothelin-1 (ET-1) receptor antagonist, and to show the changes in rats with experimentally induced diabetic erectile dysfunction (ED), a total of 24 albino Wistar rats were allocated into four groups. Group 1 was the healthy group and Group 2 had diabetes mellitus (DM) induced by intraperitoneal injection of 60 mg kg-1 streptozotocin (STZ). Following the establishment of DM, Group 3 and Group 4 were treated with oral BOS doses of 50 mg kg-1 and 100 mg kg-1 , respectively, for 60 days. At the end of the treatment, we evaluated yawning and erection response to apomorphine treatment and then the animals were sacrificed. ET-1, eNOS, iNOS, tumour necrosis factor (TNF)-α, ET-RA and ET-RB mRNA expressions were analysed in cavernosal tissue. It was observed that yawning and erection response decreased in the diabetic group; however, both of these improved with BOS treatment. While ET-1, TNF-α and iNOS gene expressions increased, eNOS, ET-RA and ET-RB gene expressions decreased in the DM group compared to the healthy group. DM has a negative impact on cavernosal tissue blood flow through activating vasoconstrictor mediators in cavernosal tissue. BOS regulates significantly eNOS, iNOS and TNF-α expressions in a dose-dependent manner.

Intravascular papillary endothelial hyperplasia (IPEH, Masson's Tumor) of the kidney is an unusual, benign vascular lesion.A rare case of recurrent IPEH in the kidney was presented in this article.A 50-year-old male with a diagnosis of a suspicious mass in the left kidney was referred to our center for robotic partial nephrectomy.Robotic zero ischemia partial nephrectomy was performed due to the suspicion of a renal malignancy.On the basis of the histopathological results, the patient was diagnosed as IPEH.A urinary ultrasound was performed on the 3 rd postoperative month and a hyper echoic solid lesion, which was in the same localization, was detected.Due to the previous atypical pathological result, computed tomography (CT) guided fine-needle aspiration biopsy from the left renal mass was performed but malignant cytology was not confirmed with this biopsy.On follow-up CT done 6 months later, a persistent suspicious left renal mass, measuring 40 x 30 cm in size was detected with no change in its dimensions and appearance.Additionally, magnetic resonance imaging (MRI) scan revealed a bone lesion of 15 x 10 mm in the left hip, which was not present on previous MRI/CT scans.In view of the solid masses in the left kidney, and left hip on CT and MRI scan suspicious for a probably metastatic renal neoplasm, left radical nephrectomy via a left subcostal transperitoneal incision was performed.The ultimate pathological report of the patient was also supported the diagnosis of Masson's tumor and any renal malignancy was not encountered The patient was discharged on the 4 th postoperative day and has been followed up for 4 months without any problems.In this case, we discuss the clinical features, histopathological characteristics, and the management of Masson's tumor of the kidney in the light of the current literature.

This article presents our surgical technique on robotic cystectomy preserving female genitalia. A 59 year-old female patient with muscle invasive bladder cancer was referred to our hospital for robotic radical cystectomy and intracorporeal Studer-pouch construction. An incomplete trans urethral resection of the bladder cancer was performed 2 months earlier at a peripheral hospital and pathological examination revealed muscle invasive, high-grade papillary urothelial carcinoma (T2GIII). She had undergone two open abdominal surgeries (appendectomy and cesarean section) 30 and 35 years previously. Laboratory tests including blood urea nitrogen, serum creatinine, hemogram, ALT, and AST were within normal limits. A CT scan of the abdomen and pelvis revealed several masses within the bladder, measuring up to 1 cm in greatest dimension. However, perivesical fatty tissue and upper urinary tract were normal in appearance.

Introduction: We present our experience with retrograde intrarenal surgery (RIRS) in patients with calculi in congenital anomalies of the upper urinary tract. Methods: A total of 29 patients with urinary stones and congenital anomalies of the kidney and ureter, including duplicated collecting system, horseshoe kidney (HSK), malrotated kidney, ureteropelvic junction stenosis (UPJ-S), and ectopic pelvic kidney (EPK), were treated with RIRS between January 2008 and December 2014. Success was defined as the absence of stone fragments or the presence of only asymptomatic insignificant residual fragments <3 mm. Results: A total of 35 procedures were performed. There was UPJ-S in two of the six patients with HSK and they were both treated with endopyelotomy. There were bilateral stones in two patients with HSK and one of these was treated in two separate sessions. In the UPJ-S group, endopyelotomy and lithotripsy were simultaneously performed in all but three patients who were treated in separate sessions. There was UPJ-S in one patient with an EPK, and endopyelotomy and laser lithotripsy were performed in separated sessions. Significant residual stones were detected in four patients. No major intraoperative or postoperative complications were seen. Conclusion: RIRS is an effective and well-tolerated treatment option in the management of urinary calculi patients with anomalous upper urinary tracts.

Purpose. To ascertain whether retrograde intrarenal surgery (RIRS) is as effective in patients treated previously with open renal stone surgery (ORSS) on the same kidney as in patients with no previous ORSS. Methods. There were 32 patients with renal stones who had previous ORSS and were treated with RIRS in the study group (Group 1). A total of 38 patients with renal stones who had no previous ORSS and were treated with RIRS were selected as the control group (Group 2). Recorded data regarding preoperative characteristics of the patients, stone properties, surgical parameters, outcomes, SFRs (no fragments or small fragments <4 mm), and complications between groups were compared. Results. Mean age, mean BMI, mean hospital stay, and mean operative time were not statistically different between groups. Mean stone size (10.1 ± 5.6 versus 10.3 ± 4.2; p = 0.551) and mean stone burden (25.4 ± 14.7 versus 23.5 ± 9.9; p = 0.504) were also similar between groups. After the second procedures, SFRs were 100% and 95% in groups 1 and 2, respectively (p = 0.496). No major perioperative complications were seen. Conclusion. RIRS can be safely and effectively performed with acceptable complication rates in patients treated previously with ORSS as in patients with no previous ORSS.

Purpose. We aimed to compare and evaluate the outcomes and complications of two endoscopic treatment procedures, semirigid ureteroscopy (SR-URS) and flexible ureteroscopy (F-URS), in the treatment of proximal ureteral stones (PUS). Methods. SR-URS (group 1) was done on 68 patients whereas 64 patients underwent F-URS (group 2) for the treatment of PUS. Success rate was defined as the absence of stone fragments or presence of asymptomatic insignificant residual fragments < 2 mm. Outcomes and complications were recorded. Results. The differences were statistically not significant in age, gender, body mass index (BMI), and stone characteristics between groups. Mean ureteral stone size was 9.1 ± 0.4 mm and 8.9 ± 0.5 mm for groups 1 and 2. Mean operative time was 34.1 ± 1.5 min and 49.4 ± 2.3 min for groups 1 and 2 (p=0.001). SFRs were 76.5% and 87.5% for groups 1 and 2 (p=0.078). Two major complications (ureteral avulsion and ureteral rupture) occurred in group 1. Conclusion. F-URS is safer and less invasive than SR-URS in patients with PUS. There is no statistically significant difference in the efficacy of either technique. Nonetheless we recommend F-URS in the management of PUS as a first-line treatment option in select cases of proximal ureteral calculi.

Objective: To report the outcomes of transperitoneal robotic adrenalectomy (RA) procedures in five initial cases performed at two institutions. Methods: Between March 2012 and November 2014, five patients underwent RA. A transperitoneal approach was taken by using the da Vinci-S four-arm surgical robot. Outcomes were assessed retrospectively. Results: Mean patient age was 42.6±5.1 (range: 34-47) years. Mean body mass index was 30.5±4.5 (range: 23.2-35.2) kg/m². Median tumour size detected on radiological imaging was 3.1±1.7 (range: 1.2-6.0) cm. Mean operation time was 129.0±12.4 (range: 120-150) minutes and median estimated blood loss was 100.0±119.3 (range: 50-350) ml. No intraoperative or perioperative complications occurred according to the modified Clavien complication scale. Median duration of hospital stay was 2.0±1.7 (range: 2-6) days. The fourth robotic arm was used in two patients. Histopathology results demonstrated: metastasis of renal cell carcinoma occurred in 1 case, adrenal cortical adenoma in 2 cases, pheochromocytoma in 1 case, and hyperplasia in 1 case. After a median follow-up of 17.0±15.0 (range: 3-40) months, no local recurrence was detected. Conclusion: RA is a safe minimally invasive surgical approach that has excellent surgical and oncological outcomes in the treatment of adrenal masses <7 cm in size.

INTRODUCTION:We investigated whether anterior periprostatic fat (APPF) tissue removed during robotic radical prostatectomy (RARP) contains any lymph nodes (LNs). MATERIAL AND METHODS:APPF tissues removed during RARP in 129 patients were evaluated histopathologically. Correlation with postoperative pathologic stage was made. Patients with a history of previous prostate or bladder surgery and radiation therapy were excluded. RESULTS:Mean patient age, serum prostate specific antigen (PSA), prostate weight and body mass index (BMI) were 62.2 ±5.5 (range 45-74), 9.3 ±6.3 ng/dl (range 0.26-30.3), 60.3 ±27.2 grams (range 11.0-180) and 26.6 ±1.9 kg/m(2) (range 20.0-30.3), respectively. Overall, LNs in APPF tissues were detected in 14 (10.9%) patients with a mean LN yield of 1.1 ±0.7 LNs (range, 1-3). Among those found, no metastatic LN was detected. Of the patients with pT2a (n = 22), pT2b (n = 15), pT2c (n = 62) and pT3a (n = 21) disease, LNs in APPF tissues were detected in 1 (4.6%), 1 (6.7%), 11 (17.7%) and 1 (4.8%) patient in each group, respectively. Among the patients, LNs in APPF tissues were detected in 0 (0%), 5 (35.7%), 8 (57.1%) and 1 (7.1%) patients of underweight, optimal weight, overweight and obese patients due to body mass index, respectively. CONCLUSIONS:In our series, LNs were detected in around 10% of the patients. Therefore, this fat should, not be pushed back during RARP but should be removed and sent for pathologic evaluation. Although no metastatic LN was detected in our series, the presence of metastatic LNs might have an impact on the oncologic outcomes of the patients and warrants further research.

Introduction We intended to evaluate the feasibility and effectiveness of the simultaneous rigid and flexible ureteroscopic treatment of symptomatic ureteral and ipsilateral small simultaneous calyceal stones. Outcomes of combined therapy were compared with monotherapy alone. Material and methods In this retrospective study, group 1 consisted of 45 patients with middle or lower ureteral and ipsilateral small simultaneous calyceal stones treated by combined therapy. Group 2 included 45 patients with middle or lower ureteral stones only and treated by monotherapy. Stone characteristics, operative time, hospital stay, stone free rates, and complications were compared between groups 1 and 2. Stone free status was defined as no fragments and/or the presence of asymptomatic fragments smaller than 4 mm. Results Mean BMI were 29.3 ±0.9 kg/m2 and 27.6 ±0.6 kg/m2 in groups 1 and 2, respectively. Mean ureteral stone size (7.6 ±0.4 mm vs. 8.0 ±0.4 mm, p = 0.261) and ureteral stone burden (56.0 ±5.5 mm2 vs. 54.8 ±6.1 mm2, p = 0.487) were similar between groups. Mean renal stone size and renal stone burden for group 1 were 7.1 ±0.8 mm and 83.7 ±11.3 mm2. The mean operative time was significantly longer (for a mean of 32.5±1.2 minutes) for group 1 (p = 0.001). Ureteral stents were left in 38 (84.4%) and 19 (42.2%) patients in group 1 and group 2 (p = 0.001). Hospital stay and complication rates were similar between groups. SFRs were 100% for ureteral stones in both groups and 88.9% for renal stones within group 1. Conclusions Simultaneous ureteroscopic treatment of the ureteral and ipsilateral small calyceal stones prolongs operative time and increases use of ureteral stent without leaving any residual renal stones.

The objective of the study was to ascertain whether flexible ureteroscopy with holmium laser lithotripsy and/or extraction of stone fragments is as effective in obese patients as in non-obese patients. The patients were divided into four groups (group 1: normal weight = 79 procedures, group 2: overweight = 123 procedures, group 3: obese = 87 procedures, and group 4: morbidly obese = 20 procedures) according to BMI cohorts. Patient charts were retrospectively reviewed and relevant data collected. A total of 309 operations were included in the present study. The overall mean ± SD (range) age was 41 ± 12 years (18–82), BMI 29 ± 6 kg/m2 (18–52), operative time 64 ± 29 min (20–200), hospital stay 25 ± 11 h (4–168), stone number 3 ± 2 (1–15), stone burden 21 ± 14 mm (4–98), and internal stenting time 26 ± 8 days (2–60). Mean stone size was 10 ± 6, 9 ± 5, 11 ± 8, and 11 ± 8 mm for groups 1 through 4, respectively. There were no differences among groups regarding patients and stone characteristics, and perioperative parameters including patient age, operative time, hospital stay, and complications. Overall SFRs were similar between groups (81, 87, 87.4, and 85 %, respectively; χ 2=3.304, p=0.770) as were the complication rates (12–16 %). Our contemporary Retrograde Intrarenal Surgery (RIRS) series showed that operative times, hospital stays, ancillary equipment use (internal stent, basket, etc.), SFRs, and complication rates were independent of BMI. Therefore, RIRS can be performed as efficiently and efficaciously in obese patients as in non-obese patients.

You have accessJournal of UrologyInfertility: Basic Research, Physiology, Pathophysiology1 Apr 2015MP76-08 THE EFFECT OF BOSENTAN, AN ENDOTHELIN-1 RECEPTOR ANTAGONIST ON TESTICULAR TISSUE OXIDANT AND ANTIOXIDANT LEVELS IN DIABETIC RATS Erdal Alkan, RüstemAnýl Urgan, Mehmet Murad Basar, Zekai Halýcý, Mevlana Derya Balbay, Harun Un, and Hasan Tarik Atmaca Erdal AlkanErdal Alkan More articles by this author , RüstemAnýl UrganRüstemAnýl Urgan More articles by this author , Mehmet Murad BasarMehmet Murad Basar More articles by this author , Zekai HalýcýZekai Halýcý More articles by this author , Mevlana Derya BalbayMevlana Derya Balbay More articles by this author , Harun UnHarun Un More articles by this author , and Hasan Tarik AtmacaHasan Tarik Atmaca More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2793AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We aimed to look into changes in testicular tissue oxidant and anti-oxidant levels in rats with experimentally induced diabetes mellitus, and also the effects of Bosentan an ET-1 receptor antagonist on the testicular tissue oxidative stress reactions. METHODS A total of 24 Albino-Wistar rats were equally allocated in 4 groups. Group 1 consisted of healthy animals as a control group, Group 2 consisted of animals with DM induced with injection of 60 mg/kg of streptozosin intraperiotenally, Groups 3 and 4 included animals with DM treated with oral Bosentan 50 mg/kg, and 100 mg/kg, respectively. At the end of 60 days of the treatment, orhiectomies were done and tissue levels of superoxyde dysmutase (SOD), glutathione synthetase (GSH) and malondialdehyde (MDA) were studied. Seminal parameters measured and testicular histopathological evaluation were also done. RESULTS Tissue levels of oxidant molecules SOD and GS were decreasesd, whereas MDA level was increased. Increase in antioxidant enzyme levels and decrease in MDA levels were most prominent and statistically significant with oral Bosertan 100 mg/kg (p<0.05). Histologically, the length of seminiferous tubules were shortened, the thickness of the basal membrane was increased, degeneration in the interstitial tissue and decrease in the number of Leydig cells were noted as well as decrease in sperm counts and motility in Group 2. Histological changes were found to be alleviated and achieved a much normal looking histology and sperm counts and motility were also found to be increased in Groups 3 and 4 in a dose dependant manner (Figure-1 and Figure-2). CONCLUSIONS Testicular effects of DM a systematic disease is profound, having a negative impact on male infertility. Bosentan prevents detoriating effects of DM on testicular tissue and improves seminal parameters in a dose dependent manner. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e986-e987 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erdal Alkan More articles by this author RüstemAnýl Urgan More articles by this author Mehmet Murad Basar More articles by this author Zekai Halýcý More articles by this author Mevlana Derya Balbay More articles by this author Harun Un More articles by this author Hasan Tarik Atmaca More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Introduction:We present the feasibility of flexible ureteroscopic lithotripsy concomitant with robot-assisted radical prostatectomy and bilaterally extended pelvic lymphadenectomy.Methods: Two patients underwent flexible ureteroscopic lithotripsy, robot-assisted radical prostatectomy, and pelvic lymphadenectomy at one anesthesia session.Flexible ureteroscopic lithotripsy was performed first.Later, robotic prostatectomy and lymphadenectomy were performed with the patient in the exaggerated 30°Trendelenburg position.All relevant preoperative clinical details, intraoperative details, problems encountered, complications, hospital stay, postoperative recovery, pathologic findings, and clinical follow-up were assessed.Results: Both patients were discharged uneventfully from the hospital on the third postoperative day.In the postoperative first month, the double-J stents were removed.Both patients were prescribed hormonal treatment and were also referred for radiotherapy due to final pathology and postoperative prostate-specific antigen levels. Conclusion:Combining robot-assisted radical prostatectomy and flexible ureteroscopy is feasible in patients with urinary stone disease and prostate cancer concomitantly.