Background: Chronic scrotal content pain (CSCP) is a devastating condition characterized by localized scrotal pain that persists for ≥ 3 months and interferes with daily activities. Approximately 2.5% of all urology outpatient visits are associated with CSCP. General urologists may have difficulty treating these patients because of uncertainties regarding the etiology and pathophysiology of CSCP. Therefore, we aimed to provide a simplified diagnostic and treatment approach for CSCP by subdividing it into distinct categories.
Materials and methods: We systematically reviewed the published literature in the PubMed, MEDLINE, and Cochrane databases for all reports on CSCP diagnosis and treatment using the keywords “chronic scrotal content pain,” “testicular pain,” “orchialgia,” “testicular pain syndrome,” “microdenervation of the spermatic cord,” “post-vasectomy pain syndrome,” “post-inguinal hernia repair pain,” “testialgia,” and “pudendal neuralgia.” This review included only CSCP-related articles published in English language.
Results: We subdivided CSCP syndrome into 5 clinical presentation types, including hyperactive cremasteric reflex, pain localized in the testicles, pain in the testis, spermatic cord, and groin, pain localized in the testicles, spermatic cord, groin, and pubis, and pain in the testicles, spermatic cord/groin, and penis/pelvis. Treatments were adjusted stepwise for each type and section. We included more information regarding the role of pudendal neuroglia in CSCP syndrome and discussed more options for nerve blocks for CSCP. For microsurgical spermatic cord denervation failure, we included treatment options for salvage ultrasound-guided targeted cryoablation, Botox injections, and posterior-inferior scrotal denervation.
Conclusions: Different CSCP subtypes could help general urologists assess the appropriate diagnostic and treatment approaches for scrotal pain management in daily practice.
The holmium:yttrium aluminum garnet laser, the gold standard for lithotripsy, is widely used in various endourological fields. Their physical characteristics contribute to the Moses effect. This narrative review aimed to analyze the current knowledge of the Moses effect and its applications in endourology. The Moses effect involves the rapid formation of a vapor bubble that allows the remaining energy to reach the target with less attenuation. Lumenis® developed pulse modulation technology, the MOSES™ technology, that harnesses the Moses effect to optimize holmium energy. Preclinical studies concluded that the new technology improves stone retropulsion, allowing for reduced lithotripsy duration. However, the heterogeneity of clinical studies and the lack of randomized controlled trials do not allow definitive conclusions. The MOSES™ technology has also been applied in holmium laser enucleation of the prostate, reducing enucleation and hemostasis times, leading to improved enucleation efficiency. However, minimal changes occurred in hemoglobin or hematocrit levels and no significant differences were noted in complications or functional outcomes. Further research is needed to fully evaluate the benefits and limitations of MOSES™ technology in clinical practice.
With advancements in laser technology and urological techniques, flexible ureterorenoscopy has emerged as a vital surgical approach for managing stone disease. Various techniques can be employed to customize endourological stone treatments. Despite the continuous evolution of equipment, it remains crucial to comprehend the fundamental steps of the procedure. This paper offers a comprehensive step-by-step guide that integrates the latest advancements in both scopes and lasers. Additionally, it outlines potential pitfalls and strategies to circumvent them, aiming to achieve optimal stone clearance and deliver individualized patient care safely and efficiently.
Background: There is limited published evidence regarding the incidence of intraoperative and postoperative events and the effect of percutaneous nephrolithotomy (PCNL) in supine and prone positions and laparoscopic pyelolithotomy on kidney function in patients with large and complex calculi.
Materials and methods: We evaluated the surgical outcomes of 97 patients with large and complex kidney stones. The patients were divided into 3 groups: those who underwent PCNL in the prone position, PCNL in the supine position, and pyelolithotomy by laparoscopy and retroperitoneoscopy. General surgical outcomes, size of residual stones, stone-free rate, glomerular filtration rate (GFR), and split GFR obtained from Tc-99m renal dynamic scintigrams were analyzed.
Results: Percutaneous nephrolithotomy in the prone position was correlated with improved function of the affected kidney. In the supine PCNL group, none of the analyzed indicators demonstrated a significant difference. Dynamic nephroscintigrams revealed negative changes in terms of accumulation and secretion of the affected kidney. A slight decrease in creatinine clearance was noted. However, positive dynamics in split GFR and secretory index were seen in this group. The laparoscopic group showed positive results in all analyzed parameters. However, full assessment of the function of the affected kidney in this group was limited due to restricted use of laparoscopic pyelolithotomy for complex stones.
Conclusions: Percutaneous nephrolithotomy in the prone position resulted in the most favorable renal functional outcomes for patients with high-grade renal calculi, whereas a laparoscopic approach may be preferred for patients with stones of lower grades. The most significant factors that adversely affected renal function were intraoperative bleeding volume, kidney stone size and density, and body mass index.
Background: Flexible ureterorenoscopy (fURS) and mini-percutaneous nephrolithotomy (mPCNL) have been increasingly used for the treatment of renal stones. However, current guidelines do not recommend one modality over the other. The aim of this study is to compare the safety and efficacy of treatment with fURS versus mPCNL for renal stones sized 2 cm or less.
Materials and methods: A prospective, randomized, comparative study was conducted between January 2019 and July 2021 at 3 tertiary care urology centers. Inclusion criteria were adult patients with renal stone(s) ≤ 2 cm with inappropriateness or failure of extracorporeal shock-wave lithotripsy. Subjects were assigned to 1 of 2 treatment groups, either mPCNL or fURS. Two primary outcomes were assessed: (1) initial success rate, defined as the absence of clinically significant residual fragments (>2 mm) on kidney ureter bladder X-ray and ultrasound on the first postoperative day; and (2) complications, which were reported according to the Modified Clavien-Dindo classification system. Secondary outcomes included final success rate, defined as the absence of clinically significant residual fragments on noncontrast computed tomography on the 90th postoperative day; operative time; auxiliary procedures and blood transfusion rates; hemoglobin drop; and length of hospital stay.
Results: One hundred and eighteen procedures were analyzed (59 in each group). The initial success rate of the mPCNL group (93%) was significantly higher than that of the fURS group (70%). Complications occurred more frequently with mPCNL than fURS (44.1% vs. 18.6%, respectively). Final success rate, operative time, and length of hospital stay were comparable between the 2 groups.
Conclusions: Mini-percutaneous nephrolithotomy is more effective than fURS as a single-step treatment for renal stones <2 cm because of its higher initial success rate and lower auxiliary procedure rate. However, mPCNL results in significantly higher complication rates than fURS.
Background: The lifetime occurrence of urinary stones is approximately 1%-15%, and the peak age of occurrence is 30 years. Approximately one fifths of urinary tract stones are found in the ureter, of which two thirds are in the distal ureter. Many drugs, including phosphodiesterase-5 inhibitors (PDE5Is) and α-blockers, are used to relax the smooth muscles in medical expulsive therapy (MET). We aimed to compare the combination of tadalafil and tamsulosin versus tadalafil alone as MET for stones in the L1/3 ureter of 10 mm or less.
Materials and methods: A total of 150 patients with L1/3 ureteric stones measuring 10 mm or less were enrolled in the study and randomly assigned to one of 3 equal groups using a computer-generated random number. Patients in group A prescribed tadalafil 10 mg/d. However, those in group B were prescribed tamsulosin 0.4 mg and tadalafil 10 mg/d, whereas those in group C received a placebo once daily. Stone expulsion rate and pain recurrence were evaluated after 14 days.
Results: The stone expulsion rate was significantly higher in the tadalafil and tamsulosin groups and the tamsulosin group than in the placebo group in the current study by 68% in the combination group, 64% in the tadalafil alone group, and 42% in the placebo group (p = 0.019). In the current study, a combination was associated with lower pain recurrence than tadalafil alone or placebo, with means of 1.06, 1.9, 2.98 (with a p value of 0.001). Stone size was not effective in any group.
Conclusions: The combination of PDE5Is and α-blockers effectively increases the expulsion of lower ureteric stones (5-10 mm), but with the same effect as PDE5Is alone, with the advantage of decreasing pain recurrence. Stone size did not affect the expulsion rate in patients who received MET for stones less than 1 cm in size.
Objective: The objective of this study is to assess the effectiveness and safety of ureteroscopic lithotripsy and flexible ureteroscopy (fURS) for treating patients on anticoagulant (AC) or antiplatelet (AP) medications.
Patients and Methods: The study included 213 patients with urinary stones who underwent ureteroscopic lithotripsy or fURS between January 2019 and October 2022 at the Shanghai Municipal Hospital Urology Specialist Alliance. Among these patients, 15 received AC therapy, 193 received AP therapy, and 5 received both AC and AP therapy. Patients were divided into 3 groups based on the real-world management of antithrombotic drugs: the continuation group (n = 62), the discontinuation group (n = 91), and the discontinuation and bridge heparin group (n = 60). Intraoperative and postoperative outcomes were compared among the 3 groups.
Results: Age, sex, body mass index, stone location, stone size, stone side, and residual fragments were not different among the groups. None of the patients received blood transfusions or had thromboembolic events, emergencies for gross hematuria, significant bleeding-related complications, or unplanned secondary ureteroscopic surgery. The mean duration of hospital stay of the continuation group (3.97 days) was significantly lower than that of the discontinuation group (5.99 days) and the discontinuation and bridge heparin group (5.75 days) (p < 0.001).
Conclusions: Ureteroscopic lithotripsy and fURS can be performed safely and effectively in patients on AC or AP drugs, resulting in reduced duration of hospital stay.
Objectives: This study aimed to ascertain the relevance of the Guy's stone score in the evaluation and outcome of percutaneous nephrolithotomy (PCNL).
Materials and methods: This 2-year hospital-based, prospective clinical study enrolled 100 patients who were indicated for PCNL. All patients were allocated into groups according to the Guy's stone score and were compared for factors associated with stone-free rate (SFR) and complication risk. The data were statistically analyzed using SPSS version 20.
Results: The median patient age was 40 years (range, 5-70 years). A greater portion of the patients were aged 31-40 years. A majority of the stones were solitary, found in 83% of the kidneys. Overall, 49% were grouped as Guy's stone score 1, 26% as 2, 11% as 3, and 14% as 4. The overall SFR was 97%. Furthermore, SFR was found to be 100% for Guy's stone score 1, 100% for 2, 90.91% for 3, and 85.7% for 4. Intraoperative and postoperative complication rates were found in 6% and 38% of the patients, respectively. Among postoperative complications, pain (26%) was the most frequent, followed by fever (8%), bleeding (3%), and puncture site abscess (1%).
Conclusions: Based on the study findings, Guy's stone score was efficient in predicting PCNL outcomes.
Objective: The aim of this study was to develop and evaluate two deep-learning (DL) models for predicting spontaneous ureteral stone passage (SSP).
Materials and methods: A total of 1217 patients with thin-layer computed tomography-confirmed ureteral stones in our hospital from January 2019 to December 2022 were retrospectively examined. These patients were grouped into 3 data sets: the training set (n = 1000), the validation set (n = 100), and the test set (n = 117). Two DL models based on residual neural network (ResNet)—2-dimensional (2D) ResNet29 and 3-dimensional (3D) ResNet29—were separately developed, trained, and assessed. The predictive ability of a conventional approach using a stone diameter of <5 mm on computed tomography was investigated, and the results were compared with those of the two DL models.
Results: Of the 1217 patients, SSP was reported in 446 (36.6%). The total accuracy, sensitivity, and specificity were 76.9%, 56.1%, and 90.8% for the stone diameter approach; 87.1%, 84.2%, and 92.7% for the 2D ResNet29 model; and 90.6%, 88.2%, and 95.1% for the 3D ResNet29 model, respectively. Both the 2D and 3D ResNet29 models showed significantly higher accuracy than the stone diameter approach. Receiver operating characteristic curve analysis showed that both DL models had a significantly higher area under the curve than the stone diameter-based classification.
Conclusions: The DL models, particularly the 3D model, are novel and effective methods for predicting SSP rates. Using such models may help determine whether a patient should receive surgical intervention or expect a long interval before stone passage.
Background: The use of visual aids to enhance patient learning is becoming increasingly common in medicine. Patients with a better understanding of surgical procedures tend to have better long-term outcomes due to the active seeking of help when complications occur postsurgery. We hypothesized that showing patients an animation of ureteroscopy with instructions on how to address potential complications would increase their understanding of the perioperative nature of ureteroscopy.
Methods and materials: Fifty patients were selected between May and August 2019. The group consisted of patients who had recently undergone ureteroscopy for nephrolithiasis or who would undergo ureteroscopy in the near future. Patients were given a prevideo assessment, followed by video and postvideo assessments. The prevideo and postvideo assessments were multiple choice and identical, except for 3 additional questions at the end of the postvideo assessment asking about patient opinions regarding the video. Patients were unaware that they would be completing a postvideo assessment until they had finished watching the video.
Results: When asked about the symptoms of a urinary tract infection postprocedure, 72% of patients answered incorrectly, with 58% choosing “go to the emergency department immediately,” in the prevideo assessment versus 6% in the postvideo assessment (p < 0.05). If bleeding was a possible side effect of the procedure, 20% versus 0% answered incorrectly (p < 0.05). When asked about stent placement after surgery, 6% versus 0% answered incorrectly. One hundred percent of patients in both assessments answered correctly that stones would be removed and a scope was inserted into the urethra. Ninety-four percent of patients noted the video was presented in a very clear way, 80% noted that the video increased their understanding of the procedure “a lot,” and 82% noted the video increased the quality of their visit “a lot.”
Conclusions: Using an animated video to explain ureteroscopy and laser lithotripsy is beneficial.
Background: The coronavirus disease (COVID-19) pandemic has posed challenges to the global health care community, affecting the management of upper urinary tract stones.
Materials and methods: This retrospective study involved 9 Italian centers. We compared the 12-month period prior to COVID-19 (March 1, 2019, to February 28, 2020; Period A) with the COVID-19 period (March 1, 2020, to February 28, 2021, Period B). This study aimed to compare outcomes during Periods A and B, specifically focusing on the overall number of treatments, rate of urgent/elective cases, and operational complexity.
Results: A total of 4018 procedures were collected, comprising 2176 procedures during Period A and 1842 during Period B, indicating a loss of 15.35% (p < 0.001). In the elective cases, 1622 procedures were conducted in Period A, compared with 1280 in Period B, representing a 21.09% reduction in cases (p = 0.001). All types of stone treatments were affected: extracorporeal shock wave lithotripsy (−29.37%, p = 0.001), percutaneous nephrolithotomy (−26.47%, p = 0.008), retrograde surgeries for renal stones (−10.63%, p = 0.008), and semirigid ureterolithotripsy (−24.86%, p = 0.008). Waiting lists experienced significant delays during Period B. The waiting time (WT) for elective procedures increased during Period B (p < 0.001). For ureteral stones, the mean WT in Period A was 61.44 days compared with 86.56 days in Period B (p = 0.008). The WT for renal stones increased from 64.96 days in Period A to 85.66 days in Period B for retrograde intrarenal surgery (p = 0.008) and from 96.9 days to 1103.9 days (p = 0.035) for percutaneous nephrolithotomy procedures.
Conclusions: Our study demonstrates that COVID-19 significantly disrupted endourological services across the country. Our data underline how patients received treatment over a prolonged period, potentially increasing the risk of stone-related complications and patient discomfort.
Objectives: To evaluate the pubourethral stump angle (PUA) to determine the site of urethral transection during transperineal anastomotic urethroplasty (TAU).
Patients and methods: Patients diagnosed with pelvic fracture urethral distraction defect who underwent preoperative magnetic resonance (MR) urethrography and were treated with TAU between June 2019 and December 2021 were retrospectively reviewed. According to the site of urethral transection during TAU, patients were classified into proximal and distal groups receiving TAU with proximal and distal transection, respectively. The demographic and clinical data were recorded. The PUA was measured on sagittal T2-weighted MR urethrography. The relationship between the site of urethral transection and PUA was analyzed.
Results: Sixty-seven patients were included. Forty-one and 26 patients were included in the proximal and distal groups, respectively. Finally, the success rates in the proximal and distal groups were 95.1% and 92.3%, respectively. The PUAs were 123.7° ± 14.6° and 86.5° ± 9.8° (p = 0.005), respectively. The curves for the 2 groups intersected between 90° and 110°. The scribing effects at 90°, 100°, and 110° in the 2 groups were compared in detail. Compared with 90° and 110°, 100° had the highest sensitivity as the demarcation line.
Conclusions: In the treatment of pelvic fracture urethral distraction defect, the PUA on MR urethrography is an objective and valid parameter for evaluating the site of urethral transection during TAU. A PUA >100° indicates that proximal transection should be preferentially attempted.
Objectives: To evaluate the urinary kidney injury molecule-1 (KIM-1) as a predictor for early detection of acute kidney injury in cases with obstructive nephropathy in an animal model and to correlate urinary KIM-1 with the progress of obstructive nephropathy on a histopathological basis.
Materials and methods: Three models of obstruction were induced in 90 male rats: unilateral partial ureteral obstruction with a normal contra-lateral kidney, with nephrectomy of a contralateral kidney (solitary kidney), and bilateral partial ureteral obstruction. Each group was further divided into 2 subgroups; the sham-group (10 rats) and the disease group (20 rats). Serum creatinine, blood urea nitrogen, and urinary KIM-1 were collected on days 0, 7, and 14. Rats were sacrificed on the 7th and 14th day for histopathological examination of the obstructed kidney.
Results: By the end of first week, there was a significant rise of all biomarker levels in all groups when compared with basal levels. Similarly, biomarker levels at the 14th day were significantly higher than those obtained at the 7th day. The urinary KIM-1 level was not detected in the baseline condition. Expression of urinary KIM-1 showed a significant rise in all models ranging from 22 to 85 fold at the 7th day and even higher levels at the 14th day. Histopathological examination confirmed the presence of different forms of tubular injury.
Conclusions: Urinary KIM-1 is significantly elevated in obstructive uropathy. Such an elevation might be advantageous in the early diagnosis and subsequent early intervention of cases with partial ureteral obstruction.
Background: Sacral neuromodulation (SNM) treatment of refractory urinary symptoms is associated with quality of life improvements using disease-specific instruments. There is a paucity of information relating universal health outcomes to effective treatment of urinary symptoms. The objective was to analyze changes in Patient-Reported Outcomes Measurement Information System (PROMIS) item-bank scores following SNM for treating refractory lower urinary tract symptoms (LUTS).
Materials and methods: This is a sub-analysis collected from an institutional review board approved, retrospective chart review evaluating changes between pre- and post-procedure PROMIS scores in subjects undergoing successful SNM implantation for refractory LUTS at a multidisciplinary adult continence clinic. The difference between pre- and post-procedure PROMIS scores was compared via two-sided Wilcoxon signed-rank test, with p <0.05 considered statistically significant.
Results: Of the 29 subjects, most were female (89.66%), Caucasian (68.97%), nonsmokers (89.66%) with public insurance (62.07%). The median age was 63years and body mass index was 33.2kg/m2. Procedure indications included urinary urge incontinence (83%), mixed urinary incontinence (10%), retention (17.24%), and overactive bladder (3%). Pain Interference and Depression scores had a nonsignificant improvement from 64.2 (ranging 58.9-67.5) to 60.75 (ranging 55.2-67.2), p = 0.21, and 55.2 (ranging 51.5-59.9) to 53.4 (ranging 49.5-61.1), p = 0.33, respectively. Median Physical Function scores demonstrated nonsignificant worsening following implantation from 38.0 (ranging 34.7-40.9) to 36.1 (ranging 33.1-40.8) (p = 0.25). Twenty-one subjects (72%) reported an improvement in at least 1 PROMIS item-bank with 6 subjects (21%) reporting no improvement in any of the item-banks.
Conclusions: Treatment of refractory LUTS with SNM resulted in no statistically significant changes in the PROMIS item-banks of Physical Function, Pain Interference, or Depression. Further prospective investigation is necessary to delineate the relationship of the self-reported universal-health outcomes in the treatment of LUTS.
Background: Partial nephrectomy (PN) is considered the gold standard surgical treatment for renal masses < 7cm in size (T1 tumors). Since the introduction of the robotic-assisted laparoscopic PN (raPN) in high-volume centers, it has been increasingly adapted and standardized by urologists worldwide. There is growing evidence that the robot-assisted laparoscopic technique is associated with superior outcomes compared to those of open and conventional laparoscopic techniques. This study aimed to summarize the contemporary outcome data of raPN for renal tumors with varying degrees of complexity and to assess whether the outcomes reported from high-volume centers are reproducible in a limited caseload setting.
Materials and methods: This was a retrospective study of a single surgeon's experience, including 123 consecutive patients undergoing raPN at our institution. Ultimately, 110 patients were included in the analysis. Basic characteristics, tumor complexity as described by the RENAL score, complications described by the Clavien-Dindo classification system, and functional and oncological outcomes were assessed and analyzed statistically.
Results: Of the 110 patients, 27 (24%), 61 (55%), and 23 (21%) had low, intermediate, and high degrees of complexity, respectively, according to the RENAL score. A cancer-negative surgical margin was achieved in 108 (97%) patients. A total of 70 (64%) patients had no loss of renal function, while 20 (27%) had minimal loss of renal function. Complications of > 3 Clavien-Dindo classification during the first 30 postoperative days occurred in 5 (5%) patients. The 3 complexity groups were found to have significantly different ischemia time: Low, 8 minutes (interquartile range [IQR], 8-9.5); Intermediate, 12 minutes (IQR, 10-13); and High, 15.5 minutes (IQR, 11.25-18.75) (p < 0.001). There were no significant differences between the groups.
Conclusions: Contemporary standards for raPN are safe and reproducible. Adherence to the technique reported by centers of excellence yielded comparable results with regard to tumor control, preservation of renal function, and complication rates in lower-volume settings.
Objectives: This study compared the long-term efficacy and prognostic factors of partial nephrectomy (PN) and radical nephrectomy (RN) for T1bN0M0 renal cell carcinoma (RCC) using data from the Surveillance, Epidemiology, and End Results database.
Materials and methods: We retrospectively analyzed the clinical data of 12,471 patients diagnosed with T1bN0M0 RCC from the Surveillance, Epidemiology, and End Results database between 2010 and 2019. Patients were divided into the PN and RN groups, and propensity score matching was conducted to balance the differences between the groups. We compared overall survival (OS), RCC cancer-specific mortality (CSM), and noncancer-specific mortality (NCSM) between the 2 groups. The risk factors for all-cause and RCC-related mortality were analyzed.
Results: After propensity score matching, there were 3817 patients in each group. After matching, OS and NCSM were significantly longer in the PN group (p < 0.001); however, there was no significant between-group difference in the RCC-CSM. The hazard ratio (HR) for all-cause mortality was significantly lower in the PN group (HR, 0.671; 95% confidence interval [CI], 0.579-0.778, p < 0.001), but PN was not associated with lower RCC-related mortality. Subgroup analysis showed that PN reduced the HR of all-cause mortality by 35% (HR, 0.647; 95% CI, 0.536-0.781; p < 0.001) in patients with 4.0- to 5.5-cm tumors compared with RN and by 29% (HR, 0.709; 95% CI, 0.559-0.899; p = 0.004) in those with larger tumors (5.6-7.0 cm). Multifactorial analysis showed that PN was an independent predictor of OS (HR, 0.671; 95% CI, 0.579-0.778; p < 0.001). In addition, multivariate analysis validated that age at diagnosis, sex, pathological grade, and tumor size were associated with outcomes.
Conclusions: In patients with T1b RCC, PN resulted in better OS and NCSM outcomes than RN. The benefit of PN in all-cause mortality was pronounced in patients with 4.0-5.5 cm tumor loads. Therefore, individualized treatment schemes should prioritize PN, when technically feasible.
Background: This study is aimed to determine the impact of living donor (LD) versus deceased donor (DD) kidney transplantation on renal graft survival and patient overall survival rates within Johannesburg, South Africa.
Materials and methods: A retrospective assessment was conducted of all 1685 adult first kidney-alone kidney transplant recipients transplanted between the years 1966 and 2013 in a single center. The patients were divided according to the source of the transplant: LD versus DD. Demographics and post-transplantation follow-up data were determined and tabulated. Graft and overall survival plots were generated.
Results: Of the recipients enrolled, 84.1% were DD recipients and 15.9% were LD recipients. Living donor recipient status was significantly associated with younger age (p ≤ 0.0001), a higher proportion of white, Asian, or mixed race compared to black race (p ≤ 000.1), a higher proportion of urologic etiology of disease (p = 0.015), and a lower proportion with hypertension (p ≤ 0.0001) as the cause of end stage kidney disease. Results showed a decreased risk of graft failure (hazard ratio, 0.55; 95% confidence interval, 0.45-0.66) and a decreased risk of death (hazard ratio, 0.47; 95% confidence interval, 0.36-0.61) among LD graft recipients as compared to DD graft recipients.
Conclusions: In keeping with internationally reported trends, LD recipients continue to have enhanced patient and graft survival outcomes as compared to DD recipients within our local experience. This Johannesburg experience will serve as a foundation for future related studies in this region of the world.
Ileocystoplasty is one of the treatment options in the armamentarium for the management of adults with neurogenic bladder dysfunction, after failure of less invasive treatment alternatives, such as intravesical onabotulinum toxin A injection therapy and sacral neuromodulation. It has traditionally been performed as open surgery and can be associated with significant morbidity, especially in the early postoperative period.[1] Complications associated with open ileocystoplasty include prolonged postoperative ileus, wound infections, and pain. Performing robot-assisted ileocystoplasty can reduce the morbidity associated with open surgery[2] and has been shown to be safe and feasible in experienced hands,[3] although it may be associated with increased operative duration because of its learning curve. Our technique of robot-assisted ileocystoplasty and early postoperative outcomes is demonstrated in this video (Supplemental Digital Content, https://links.lww.com/CURRUROL/A47).
Robotic console time was 180 minutes, with minimal blood loss. Eight-hourly catheter aspiration and flushes were performed to manage the mucus in the urine. There were no metabolic acidosis or electrolyte derangements postoperatively. The patient was discharged on postoperative day 5. Postoperative cystogram at week 2 showed no leak and the patient is doing well at 1 year postoperatively. Robotic ileocystoplasty is safe and feasible and can reduce the morbidity associated with open surgery with good outcomes.
The disorder of sex development is a rare disorder that usually occurs in early childhood. As adults, those with disorder of sexual development present with gynecomastia, primary amenorrhea, and primary infertility, which often causes great psychological impact. We report a unique case of a male adult hermaphrodite presenting with hematometra and hematosalpinx. Early management including psychiatry counseling, gender reassignment, and surgery is essential. Our patient underwent müllerian tissue removal with phallus reconstruction.
Ureterosigmoidostomy was commonly utilized as a procedure for continent urinary diversion. However, ureterosigmoidostomy is associated with complications such as infection, electrolyte disturbances, and neoplasia development. A 40-year-old Caucasian male presented with acute left flank pain. Past medical history was significant for bladder exstrophy for which ureterosigmoidostomy urinary diversion was performed during childhood. On physical exam, multiple circular erythematous patches were scattered across the forearms that had been presented for 2 years. Cross-sectional imaging demonnttated an ill-defined mass at the site of ureteral implantation with associated severe left hydroureteronephrosis. Endoscopy revealed a mass at the site of ureteral implantation and biopsy demonstrated invasive, poorly differentiated adenocarcinoma. The dermatosis was diagnosed as interstitial granulomatous dermatitis, a rare inflammatory skin condition associated with underlying autoimmune disease or malignancy. Patient elected operative management with left nephrectomy, sigmoidectomy, and ileal conduit diversion. Ihis case demonnttates a rare presentation of cutaneous paraneoplastic syndrome after development of colon cancer after ureterosigmoidostomy. Ureterooolonic urinary diversion has a demonnttaaie risk of neoplasia development at the anastomotic site, requiring routine endoscopic surveillance.