Background: The recurrence of urothelial carcinoma in orthotopic ileal neobladder is an extremely rare entity. We present a case of a patient who developed urothelial carcinoma in a robotically formed ileal neobladder (Studer), 10 years after primary surgery, who was managed with robotic neocystectomy. Case Presentation: A 56 year-old patient presented with gross hematuria 10 years after robotic cystoprostatectomy, lymphadenectomy, and intracorporeal formation of Studer ileal neobladder. After surgery the patient was closely followed up using cytology testing, cystoscopy, and imaging at regular intervals. Ten years later the patient presented gross hematuria. Cystoscopic examination with biopsies was performed, revealing the presence of high-grade urothelial carcinoma. The patient under general anesthesia was placed in a position similar to robotic prostatectomy and robotic neocystectomy with bilateral ureterostomy was performed. Conclusion: Although urothelial carcinoma in an orthotopic neobladder is unusual, recurrence should be considered in patients with hematuria who underwent radical cystoprostatectomy and orthotopic ileal neobladder formation. However, those patients can be managed safely and effectively, performing robotic neocystectomy.

Introduction: The incidence of urinary leakage is increased as nephron sparing surgery becomes more used for the management of small renal masses. We present an endourologic approach in a patient with a persistent urinary leak after partial nephrectomy by placing two synchronous ureteral stents to improve drainage and avoid further potential surgery. Patients and Method: A 39-year-old patient presented with a urine leak on the fifth postoperative day after an open partial nephrectomy. Initially, the leakage was managed with a placement of a 6F Double-J stent. However, due to persistence of leakage after a month, two ureteral stents (a 6F Double-J stent and a 14F endopyelotomy stent) were placed. With this maneuver, the ureter was dilated to 20F and a bladder catheter was placed to complete the drainage. Results: At 3 weeks, a CT urography was performed, which showed complete resolution of the urinary leakage compared with previous examination. The stents were removed the following day and the patient required no further intervention. The follow-up examination was continued for 24 months without any symptom of the patient and any sign of leak recurrence. Conclusion: Endoscopic approach to urinary leak after partial nephrectomy obtaining high ureteral gauge can be a good alternative, avoiding more aggressive surgical approaches.

PURPOSE:The efficacy of percutaneous nephrolithotripsy (PCNL) as a primary therapy for the treatment of lower pole caliceal lithiasis was determined.MATERIALS AND METHODS:We reviewed 144 consecutive files of patients, over a period of 10 years, with noncomplicated lower pole calculi, who underwent PCNL after a single unsuccessful session of extracorporeal shockwave lithotripsy (SWL).RESULTS:The stone-free rate for stones less than 10 mm was 95%. A 97% rate was accomplished for stones between 11 and 20 mm and a 98% rate for stones larger than 20 mm. PCNL achieved a mean overall stone-free rate of 96.7% after a 3-month follow-up, regardless of stone size. PCNL outclasses SWL, when stratified by stone burden and lower pole location. No significant postoperative complications were encountered.CONCLUSION:PCNL is a safe and effective procedure for the management of lower pole caliceal calculi after a single unsuccessful SWL session. This procedure should be considered the primary method for the treatment of lower pole stones.

You have accessJournal of UrologyTechnology & Instruments: Ureteroscopy1 Apr 20101282 EFFICACY OF HOLMIUM: YAG LASER ENDOURETEROTOMY FOR LONG URETERAL STRICTURES Nick Pardalidis, Nick Andriopoulos, Angelos Karamanis, and Eleni Kosmaoglou Nick PardalidisNick Pardalidis More articles by this author , Nick AndriopoulosNick Andriopoulos More articles by this author , Angelos KaramanisAngelos Karamanis More articles by this author , and Eleni KosmaoglouEleni Kosmaoglou More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.853AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The management of long ureteral strictures (above 2cm) is usually challenging. Endourology techniques, such us laser endoureterotomy is an alternative treatment of long ureteral strictures. ηolmium: YAG laser possesses cutting and coagulating properties contributing to less morbidity. We report our experience with the laser endoureterotomy and evaluate the long term over five years clinical and radiographic success of the method. METHODS 26 patients (18 men and 8 women) underwent holmium laser endoureterotomy for iatrogenic ureteral strictures (13 proximal, 6 mid and 7 distal). The stricture approach was made in a retrograde fashion using either semirigid or flexible ureteroscope and the energy source was a laser micro fiber, set at 1 Joule and 10Hz. A full thickness incision of the stenotic segment up to the periureteral fat was performed. Successful cut was verified with presence of contrast media extravasation. Indwelling stents were left in place in all of our patients for 4-6 weeks postoperatively. Follow up was obtained with radiographic imaging in 1, 3, 6, 12 months and thereafter every year following the procedure. RESULTS Success was defined as both relief of symptoms and radiographic resolution of the obstruction on intravenous pyelography or diuretic renography or both. 6 of the patients developed recurrent strictures in less than six months. These were considered failure and were treated in an open technique. Overall, 20 out of 26 patients (77%) are clinically well with no evidence of stricture recurrence on the radiographic imaging for long ureteral strictures after five years. CONCLUSIONS Holmium laser is an ideal tool for safe and effective endoureterotomy and is associated with a long term success rate for long ureteral strictures. Athens, Greece© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e496 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nick Pardalidis More articles by this author Nick Andriopoulos More articles by this author Angelos Karamanis More articles by this author Eleni Kosmaoglou More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Radical prostatectomy is the treatment of choice for management of organ-confined prostate cancer. Minimally invasive treatments, as an alternative, have refined been recently by the introduction of da Vinci robotic technology which has the potential to improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy. We report on our experience with robotic radical prostatectomy using the first da Vinci robotic system in our country. During 8 months, 40 robotic radical prostatectomies were performed by a single surgical team at Athens Medical Centre (Marousi, Greece). Preoperative data collection included basic demographics, prostate-specific antigen (PSA), clinical stage, and Gleason score. Operative outcomes included operative time, estimated blood loss, and complications. Postoperative outcomes included hospital stay, pain, catheter time, pathology, PSA, return of continence, and potency. Average operative time was 186.25 min with an estimated mean blood loss of 135 ml. There were no intra-operative complications. Ninety per cent of the patients were discharged home on postoperative day 1 with mean haematocrit 36.7 (range 29–43). All patients reported minimal postoperative pain and resumed regular diet on the first postoperative day. Average catheter time was 6.6 days (range 5–10). Early continence was observed in 47.5% of the patients, seven days after catheter removal. Continence at 1, 3, and 6 months was 75, 82.5 and 95%, respectively. The overall positive margin rate was 17.5%. Ninety-five per cent of the patients had undetectable postoperative PSA levels (less than 0.1 ng/ml) at a median follow-up of 6 months. Our initial experience with robotic radical prostatectomy is very promising. The learning curve was approximately 10–12 cases. With a methodical approach we were able to implement the method safely and effectively in our practice, combining minimal morbidity with good oncological and functional outcomes.

PURPOSE:The macroscopic examination of urine constituted a lasting diagnostic method from the time of Hippocrates and Galen until the Renaissance. The Byzantines, as the carriers of ancient Greek medical knowledge, adopted uroscopy.MATERIALS AND METHODS:We reviewed the medical and historical bibliography as well as the original texts of Byzantine doctors.RESULTS:The outcome was impressive since, at that time, uroscopy was considered a main tool of clinical diagnosis. The Byzantines influenced the Arabs and Western Europe, their scriptures were considered points of reference, and they were regarded as experts on the subject of uroscopy.CONCLUSIONS:Byzantine doctors added new elements to the concept of uroscopy, which was based on ancient Greek knowledge. Throughout the centuries uroscopy was established as an irreplaceable diagnostic method which affected medical thinking as well as the perception of examination and cure since it practically isolated doctor and patient, especially in Western Europe.

We present our experience with the use of the ureteral access sheath for the management of small impacted lower third ureteral stones, in comparison with more standard techniques. Ninety-eight consecutive patients, aged 18-73 years (mean 48.5), with small (diameter < or = 10 mm) impacted lower third ureteral stones (< 5 mm in 56, and 5-10 mm in 42 patients) were randomly managed with either a 12/14F coaxial ureteral dilator/sheath and a 7.5F flexible ureteroscope (group A; 48 patients), or with balloon dilatation and the 7.5F flexible ureteroscope (group B; 50 patients). In both groups, stones were grasped and extracted with a basket, and when necessary they were disintegrated with a 1.9F electrohydraulic lithotripsy (EHL) probe. Postoperatively, excretory urography was performed at 1 month and patients were followed-up for 1 year. The mean operative time was 45.5 min in group A, and 58.5 min in group B (P<0.05). EHL was performed in 16 (33.3%) patients of group A, and in 12 (24%) patients of group B. In group B, balloon dilatation was performed in 28 (56%) patients. Ureteral perforation was revealed in 4 (8%) patients of group B. The follow-up imaging tests showed stone-free status in 46 (95.8%) patients of group A and in all (100%) patients of group B. No long-term complications were recorded. Endoscopic management of small impacted lower third ureteral stones with the ureteral access sheath is a quicker and safer procedure, in comparison with the more standard approach, bearing comparable efficacy.

Ganglioneuroma is a rare benign tumor, usually seen in children and young adults, arising in the central nervous system. Most of the noncranial ganglioneuromas are located in the posterior mediastinum and the retroperitoneum. We report the first case of a primary, adult paratesticular ganglioneuroma that presented as a paratesticular mass. The patient underwent surgical intervention for diagnostic and therapeutic purposes.

Retrograde calculus migration during ureteroscopic lithotripsy remains a problem in 5–40% of cases. We assessed the safety and efficacy of the Stone Cone device, in comparison with the standard flat wire basket. A total of 56 consecutive patients with ureteral calculi, suitable for ureteroscopic extraction and/or lithotripsy, where included in this prospective study. Patients were randomly allocated into two groups. In group A (30 patients), we used the Stone Cone, while in group B (26 patients) we used the standard flat wire basket. The Stone Cone was placed through a cystoscope under fluoroscopic guidance, or when necessary under direct ureteroscopic control. Whenever necessary, intracorporeal electrohydraulic lithotripsy took place in both groups. Statistical significance was assessed by the paired t-test. The mean operative time was 48.5 min in group A, and 42.4 min in group B. Intact calculus extraction was possible in 16.6% in group A, and in 7.6% in group B (P<0.01). Retrograde stone migration was revealed in 23% in group B only (P<0.001). Also, residual fragments >3 mm were recorded in 30.7% in group B only (P<0.001). None of the patients in group A required auxiliary procedures, in contrary to 23% in group B (P<0.001). No major complications were recorded in group A, while in group B a case of major ureteral mucosal abrasion was recorded. The Stone Cone is safe and efficient in preventing retrograde stone migration and in minimizing residual fragments during ureteroscopic lithotripsy in comparison with the flat wire basket.

Purpose: Although open pyeloplasty remains the gold standard for treating ureteropelvic junction obstruction, endourology and laparoscopy have revolutionized the management of upper tract stenosis. We present our diagnostic and minimally invasive therapeutic algorithm for the treatment of ureteropelvic junction obstruction.Materials and Methods: A total of 13 females and 9 males with a mean age of 34.2 years suffering from ureteropelvic junction obstruction were treated with percutaneous endopyelotomy or laparoscopic dismembered pyeloplasty and followed for 47 to 61 months (mean 53.8) and 47 to 62 months (mean 52.5), respectively. Diagnosis was based on findings of ultrasound, excretory urography, furosemide washout renogram and retrograde ureteropyelography. In cases of ureteral kinking color duplex sonography and spiral computerized tomography were performed. In 14 patients with intrinsic stenosis percutaneous endopyelotomy was performed, while the remaining 8 patients (5 with crossing vessels, 2 with an extremely distended pelvis and 1 with a 2.5 cm. stricture) were treated with a laparoscopic dismembered Anderson-Hynes pyeloplasty.Results: In the endopyelotomy group (success rate 92.8%), mean operation time was 1.2 hours, estimated blood loss was 152 ml., unit doses of analgesics were 5.4 tablets, days of hospitalization were 4.2 and time to return to normal activities was 15.7 days. In the laparoscopic group (success rate of 100%) the aforementioned variables were 3.5 hours (p <0.05), 150 ml., 6.3 tablets, 5 and 17.8 days, respectively. Long-term followup excretory urography and/or diuretic renal scan demonstrated improvement in all patients.Conclusions: Percutaneous endopyelotomy should be the treatment of choice for intrinsic ureteropelvic junction obstruction. Laparoscopic dismembered pyeloplasty, although technically challenging, provides excellent results for extrinsic or complicated ureteropelvic junction stenosis.

We report two cases of acute polyarthritis secondary to intravesical BCG therapy for superficial bladder cancer. This extremely rare complication requires high clinical suspicion and responds well to non-steroidal anti-inflammatory drugs and conservative management.

BACKGROUND The lower third is the location of the great majority of ureteral stones. Treatment of these stones remains controversial: in situ extracorporeal shockwave lithotripsy (SWL) vs. ureteroscopy (URS). METHODS During the last decade, 633 distal ureteral calculi were treated at our institution using in situ SWL (Siemens Lithostar electromagnetic lithotripter) in 395 patients and URS (with 11.5F instrument and ultrasonic lithotripsy) in 228 patients. The patients' age and stone size were similar in the two groups. All SWL therapies were performed on an outpatient basis. RESULTS The overall success rate was 99% for SWL, and the efficiency quotient (EQ) was 92.4%. The treatment was more effective for <10 mm calculi. In the URS group, there was a 92% overall success rate with an EQ at 91.2%. Compared with SWL, URS was more time consuming, at least for the initial cases; often required intravenous sedation; entailed routine placement of a ureteral stent; and more often led to hospitalization. On the other hand, stone clearance was rapid after URS, although most of the SWL patients were stone free at the end of 6 weeks. The cost was similar in the two groups. CONCLUSION We believe that multiple factors should be considered when deciding the most appropriate approach to distal ureteral calculi. In situ SWL provides optimal first-line treatment for calculi < 10 mm, whereas URS is better reserved for stones >10 mm.