K. Zougkas, G. Kotakidis, A. Petas, K. Marantidis, Katerina Aleksandridi
INTRODUCTION: The aim of the study is to evaluate the result of bladder neck sparing technique associated with positive surgical margins in patients operated with laparoscopic radical prostatectomy. MATERIAL AND METHOD: We analyze data from 17 patients with localized PCa patients treated with laparoscopic radical prostatectomy while preserve the bladder neck. In all patients, an intra-operative biopsy was performed from the bladder neck while topographic histological findings, potential positive margins and urinary continence after 3.6 and 12 months were presented. RESULTS: The mean age of the patients was 65.17 (range 56 to 70). The mean PSA was 6.14 ng/ml (range 3.2 to 10.1), and the most common Gleason Score was 6 (range 6 to 8). In all cases the biopsy from the bladder neck was negative. Sixteen men (94.1%) had clinical stage pT2 and 1 (5.9%) were pT3a. Positive surgical margins were found at the top of the prostate in only 1 case whereas 11, 13 and 15 patients were normalized at 3.6.12 months, respectively. CONCLUSIONS: It seems in our patients, that the bladder neck sparing technique is not associated with the increase incidence of positive surgical margins and can also be performed
{"title":"Positive surgical margins and bladder neck sparing during laparoscopic radical prostatectomy","authors":"K. Zougkas, G. Kotakidis, A. Petas, K. Marantidis, Katerina Aleksandridi","doi":"10.19264/HJ.V31I2.265","DOIUrl":"https://doi.org/10.19264/HJ.V31I2.265","url":null,"abstract":"INTRODUCTION: The aim of the study is to evaluate the result of bladder neck sparing technique associated with positive surgical margins in patients operated with laparoscopic radical prostatectomy. MATERIAL AND METHOD: We analyze data from 17 patients with localized PCa patients treated with laparoscopic radical prostatectomy while preserve the bladder neck. In all patients, an intra-operative biopsy was performed from the bladder neck while topographic histological findings, potential positive margins and urinary continence after 3.6 and 12 months were presented. RESULTS: The mean age of the patients was 65.17 (range 56 to 70). The mean PSA was 6.14 ng/ml (range 3.2 to 10.1), and the most common Gleason Score was 6 (range 6 to 8). In all cases the biopsy from the bladder neck was negative. Sixteen men (94.1%) had clinical stage pT2 and 1 (5.9%) were pT3a. Positive surgical margins were found at the top of the prostate in only 1 case whereas 11, 13 and 15 patients were normalized at 3.6.12 months, respectively. CONCLUSIONS: It seems in our patients, that the bladder neck sparing technique is not associated with the increase incidence of positive surgical margins and can also be performed","PeriodicalId":185530,"journal":{"name":"Hellenic Urology","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123225040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Stamatiou, G. Perletti, V. Magri, A. Trinchieri
Chronic bacterial prostatitis (CBP, NIH category II) is a difficult- to-eradicate, recurring, chronic infection of the prostate, often characterized by disabling symptoms, significantly reducing the quality of life of patients. Fluoroquinolones have been for many years first-line agents for treatment of this condition. However, mounting pathogen resistance trends (especially in Mediterranean countries like Greece and Italy) are progressively restricting the usage of fluoroquinolones for treating many Gram-positive or Gram-negative infections in the urological field, and clinicians are increasingly treating bacterial prostatitis by empirically administering agents which have not been adequately tested in the frame of clinical trials. In recent years, reports on the efficacy of the bactericidal antibiotic fosfomycin on CBP have been published. Most articles published so far are case reports, and only few case series or cohort studies are available. The aim of this article is to review the information published so far concerning the usage and dosage of fosfomycin for treatment of chronic bacterial prostatitis.
{"title":"Usage and Dosage of Fosfomycin for NIH Category II Chronic Bacterial Prostatitis","authors":"K. Stamatiou, G. Perletti, V. Magri, A. Trinchieri","doi":"10.19264/HJ.V31I2.268","DOIUrl":"https://doi.org/10.19264/HJ.V31I2.268","url":null,"abstract":"Chronic bacterial prostatitis (CBP, NIH category II) is a difficult- to-eradicate, recurring, chronic infection of the prostate, often characterized by disabling symptoms, significantly reducing the quality of life of patients. Fluoroquinolones have been for many years first-line agents for treatment of this condition. However, mounting pathogen resistance trends (especially in Mediterranean countries like Greece and Italy) are progressively restricting the usage of fluoroquinolones for treating many Gram-positive or Gram-negative infections in the urological field, and clinicians are increasingly treating bacterial prostatitis by empirically administering agents which have not been adequately tested in the frame of clinical trials. In recent years, reports on the efficacy of the bactericidal antibiotic fosfomycin on CBP have been published. Most articles published so far are case reports, and only few case series or cohort studies are available. The aim of this article is to review the information published so far concerning the usage and dosage of fosfomycin for treatment of chronic bacterial prostatitis.","PeriodicalId":185530,"journal":{"name":"Hellenic Urology","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126632974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Mourmouris, L. Lazarou, L. Tzelves, A. Skolarikos
Flexible instrumentation is the mainstay of minimal invasive stone surgery and this led to the invention of smaller and safer instruments which performed remarkable good to a variety of procedures. Further developments like digital technology and single use ureteroscopes which along with similar technological advances in lasers and disposables transformed flexible surgery in a tool of paramount importance in the intrarenal surgery of various clinical entities. This is the second part of our review of the literature concerning the advances
{"title":"Retrograde Intrarenal Surgery: Scopes, lasers and disposables (part 2)","authors":"P. Mourmouris, L. Lazarou, L. Tzelves, A. Skolarikos","doi":"10.19264/HJ.V31I2.267","DOIUrl":"https://doi.org/10.19264/HJ.V31I2.267","url":null,"abstract":"Flexible instrumentation is the mainstay of minimal invasive stone surgery and this led to the invention of smaller and safer instruments which performed remarkable good to a variety of procedures. Further developments like digital technology and single use ureteroscopes which along with similar technological advances in lasers and disposables transformed flexible surgery in a tool of paramount importance in the intrarenal surgery of various clinical entities. This is the second part of our review of the literature concerning the advances","PeriodicalId":185530,"journal":{"name":"Hellenic Urology","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131043520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Flexible instrumentation is the mainstay of minimal invasive stone surgery and this led to the invention of smaller and safer instruments which performed remarkable good to a variety of procedures. Further developments like digital technology and single use ureteroscopes which along with similar technological advances in lasers transformed flexible surgery in a tool of paramount importance in the intrarenal surgery of various clinical entities. We review the literature concerning the advances in the field of scopes and lasers for retrograde intrarenal surgery in an effort to find the optimal combination, if any, that potentially produces the best surgical outcomes.
{"title":"Contemporary retrograde intrarenal surgery: Scopes and Lasers","authors":"P. Mourmouris","doi":"10.19264/HJ.V31I1.258","DOIUrl":"https://doi.org/10.19264/HJ.V31I1.258","url":null,"abstract":"Flexible instrumentation is the mainstay of minimal invasive stone surgery and this led to the invention of smaller and safer instruments which performed remarkable good to a variety of procedures. Further developments like digital technology and single use ureteroscopes which along with similar technological advances in lasers transformed flexible surgery in a tool of paramount importance in the intrarenal surgery of various clinical entities. We review the literature concerning the advances in the field of scopes and lasers for retrograde intrarenal surgery in an effort to find the optimal combination, if any, that potentially produces the best surgical outcomes.","PeriodicalId":185530,"journal":{"name":"Hellenic Urology","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128577708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Stamatiou, V. Magri, G. Perletti, Nektaria Rekleiti, R. Lacroix, H. Moschouris
Introduction/Aim: Chronic bacterial prostatitis (CBP) is an inflammatory condition of the prostate that is characterized by pain in the genital or the pelvic area which may accompany urinary disorders and may cause sexual dysfunction. It caused by a variety of uropathogens such as Gram-negative and Gram-positive microorganisms. The pathogenicity of most Gram-positive microorganisms has been questioned, since most leading experts restrict the list of CBP pathogens to the sole Enterobacteriaceae plus Enterococcus spp. In order to clarify the role of Gram-positive microorganisms on CBP and investigate the treatment options we reviewed our database of CBP cases from 2008 onwards. Material: The material of this retrospective study consisted in Gram-positive bacterial isolates from urine and/or prostatic secretions or sperm cultures (total ejaculate) obtained from individuals with reported chronic pelvic discomfort and genital pain, with or without lower urinary tract symptoms and sexual dysfunction, and from patients with febrile relapses of CBP, visiting the Urology Department of the Tzaneio Prefecture General Hospital of Piraeus, Greece, from 03/2008 to 11/2018. Demographic, microbiological and clinical history of each assessed patient were reviewed. Results/Conclusions: In total, 188 out of 314 Gram-positive bacterial isolates were monomicrobial and the remaining 126 polymicrobial. A vast variety of Gram-positive bacteria was found in positive cultures, with coagulase negative Staphylococci (CoNS, mainly S. haemoliticus, S. hominis, S. epidermidis and rarely S. lugdunensis) being the most frequent pathogens (85 monomicrobial and 43 polymicrobial isolates). As far as the outcomes of follow-up visits are concerned, bacterial eradication was achieved in 213 cases though 135 were completely clinically cured. In the remaining 78 cases bacterial elimination was not accompanied by clinical improvement. Bacterial persistence occurred in 70 cases. 41 out of these were superinfections and the remaining 29 were true persistences. In conclusion, the data from the present study suggest that Gram-positive pathogens can be responsible for prostatic infection. Multidrug resistance for CoNS and Enterococci is an emerging medical problem that may cause important threats to public health in the future.
{"title":"Gram-positive microorganisms isolated during Chronic Bacterial Prostatitis investigation. A retrospective study","authors":"K. Stamatiou, V. Magri, G. Perletti, Nektaria Rekleiti, R. Lacroix, H. Moschouris","doi":"10.19264/HJ.V30I4.249","DOIUrl":"https://doi.org/10.19264/HJ.V30I4.249","url":null,"abstract":"Introduction/Aim: Chronic bacterial prostatitis (CBP) is an inflammatory condition of the prostate that is characterized by pain in the genital or the pelvic area which may accompany urinary disorders and may cause sexual dysfunction. It caused by a variety of uropathogens such as Gram-negative and Gram-positive microorganisms. The pathogenicity of most Gram-positive microorganisms has been questioned, since most leading experts restrict the list of CBP pathogens to the sole Enterobacteriaceae plus Enterococcus spp. In order to clarify the role of Gram-positive microorganisms on CBP and investigate the treatment options we reviewed our database of CBP cases from 2008 onwards. Material: The material of this retrospective study consisted in Gram-positive bacterial isolates from urine and/or prostatic secretions or sperm cultures (total ejaculate) obtained from individuals with reported chronic pelvic discomfort and genital pain, with or without lower urinary tract symptoms and sexual dysfunction, and from patients with febrile relapses of CBP, visiting the Urology Department of the Tzaneio Prefecture General Hospital of Piraeus, Greece, from 03/2008 to 11/2018. Demographic, microbiological and clinical history of each assessed patient were reviewed. Results/Conclusions: In total, 188 out of 314 Gram-positive bacterial isolates were monomicrobial and the remaining 126 polymicrobial. A vast variety of Gram-positive bacteria was found in positive cultures, with coagulase negative Staphylococci (CoNS, mainly S. haemoliticus, S. hominis, S. epidermidis and rarely S. lugdunensis) being the most frequent pathogens (85 monomicrobial and 43 polymicrobial isolates). As far as the outcomes of follow-up visits are concerned, bacterial eradication was achieved in 213 cases though 135 were completely clinically cured. In the remaining 78 cases bacterial elimination was not accompanied by clinical improvement. Bacterial persistence occurred in 70 cases. 41 out of these were superinfections and the remaining 29 were true persistences. In conclusion, the data from the present study suggest that Gram-positive pathogens can be responsible for prostatic infection. Multidrug resistance for CoNS and Enterococci is an emerging medical problem that may cause important threats to public health in the future.","PeriodicalId":185530,"journal":{"name":"Hellenic Urology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134282955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Mourmouris, M. Berdempes, Titos Markopoulos, L. Lazarou, L. Tzelves, A. Skolarikos
Percutaneous nephrolithotomy (PNL) is the gold standard procedure for large stones and complex kidney anatomy, but in the same time its morbidity remains the highest among stone treatment procedures. In pursuit of minimizing complication rates surgeons have developed different variations of the classic prone position but in the same time and with the same goal, supine position was introduced. In our study, we review the literature about all available evidence on different variations in positioning during PCNL, in an effort to clarify if there is a position that makes the difference in terms of minimizing the morbidity of this procedure.
{"title":"Patient positioning during percutaneous nephrolithotomy (PCNL): is there an optimal position?","authors":"P. Mourmouris, M. Berdempes, Titos Markopoulos, L. Lazarou, L. Tzelves, A. Skolarikos","doi":"10.19264/HJ.V30I4.246","DOIUrl":"https://doi.org/10.19264/HJ.V30I4.246","url":null,"abstract":"Percutaneous nephrolithotomy (PNL) is the gold standard procedure for large stones and complex kidney anatomy, but in the same time its morbidity remains the highest among stone treatment procedures. In pursuit of minimizing complication rates surgeons have developed different variations of the classic prone position but in the same time and with the same goal, supine position was introduced. In our study, we review the literature about all available evidence on different variations in positioning during PCNL, in an effort to clarify if there is a position that makes the difference in terms of minimizing the morbidity of this procedure.","PeriodicalId":185530,"journal":{"name":"Hellenic Urology","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123681069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Moschouris, K. Stamatiou, S. Tzamarias, Dimitrios Zavradinos, K. Fokas, Konstantinos Zioutos, Vasilis Politis
Introduction/Purpose: Among its many applications, contrast- enhanced ultrasonography (CEUS) is used with very good results in oncology imaging to evaluate the effect of several therapeutic interventional radiology techniques. The aim of this study is to evaluate the efficacy of CEUS in postoperative renal tumor imaging. Material and Method: The study group consisted of 17 consecutive patients (11 males and 6 females, aged between 71 and 87) who underwent palliative embolization or chemoembolization of renal tumors between January 2008 and December 2017. All patients underwent preoperative imaging with CEUS and CT scan and they were followed postoperatively with CEUS and CT scan for up to 24 months after initial intervention. The ultrasound and CT operators were blind to each other’s findings. Results: CEUS proved to be an effective means of monitoring both arterial embolism and RFA of renal tumors with comparable findings with CT and could be an alternative technique to CT and MRI.
{"title":"Can contrast-enhanced ultrasonography r substitute CT scan in postoperative renal tumor imaging?","authors":"H. Moschouris, K. Stamatiou, S. Tzamarias, Dimitrios Zavradinos, K. Fokas, Konstantinos Zioutos, Vasilis Politis","doi":"10.19264/HJ.V30I4.248","DOIUrl":"https://doi.org/10.19264/HJ.V30I4.248","url":null,"abstract":"Introduction/Purpose: Among its many applications, contrast- enhanced ultrasonography (CEUS) is used with very good results in oncology imaging to evaluate the effect of several therapeutic interventional radiology techniques. The aim of this study is to evaluate the efficacy of CEUS in postoperative renal tumor imaging. Material and Method: The study group consisted of 17 consecutive patients (11 males and 6 females, aged between 71 and 87) who underwent palliative embolization or chemoembolization of renal tumors between January 2008 and December 2017. All patients underwent preoperative imaging with CEUS and CT scan and they were followed postoperatively with CEUS and CT scan for up to 24 months after initial intervention. The ultrasound and CT operators were blind to each other’s findings. Results: CEUS proved to be an effective means of monitoring both arterial embolism and RFA of renal tumors with comparable findings with CT and could be an alternative technique to CT and MRI.","PeriodicalId":185530,"journal":{"name":"Hellenic Urology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124330812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Tzelves, G. Raptidis, Marinos Mperdembes, Titos Markopoulos, G. Dellis, I. Siafakas, A. Skolarikos
Introduction: Ureterorenoscopy is a common procedure for treatment of stone disease. LithoVue is a relatively new entry in urologist armamentarium and offers digital image as well as single use nature when compared with traditional fiber-optic, reusable ureteroscopes. We aim to compare periprocedural outcomes for stone disease when using these two types of ureteroscopes. Patients and Methods: Baseline demographic data, perioperative( procedural time, surgical equipment, complication and stone-free rates) and postoperative(complication rate, length of stay) variables were recorded for two groups of patients: one managed with LithoVue and another with fiber-optic flexible ureteroscope. Chi-square and Fisher's exact test was used to compare qualitative data and unpaired t-test for continuous data, with a statistical significance set at a=0.05. Results: LithoVue was utilized in 40 and fiber-optic ureteroscope in 37 patients. The two groups were balanced regarding their baseline characteristics. Mean operative time for LithoVue cases was 49.36 ± 14.48 minutes and 62.46 ± 16.60 minutes for fiber-optic ureteroscope (p<0.001), while intraoperative stone-free rate for LithoVue was 70% and 43% for fiber-optic ureteroscope(p<0.005). This difference was also detected 24 hours postoperatively. Conclusions: Our study indicates that LithoVue can be used safely as an alternative for flexible fiber-optic ureteroscopes when managing patients with stone disease. These results should be confirmed with randomized trials.
导读:输尿管镜检查是治疗结石疾病的常用方法。与传统的光纤输尿管镜和可重复使用输尿管镜相比，LithoVue输尿管镜是泌尿科设备中一个相对较新的条目，它提供了数字图像和一次性使用的特性。我们的目的是比较使用这两种输尿管镜治疗结石疾病的围手术期结果。患者和方法:记录两组患者的基线人口统计学数据、围手术期(手术时间、手术设备、并发症和无结石率)和术后(并发症率、住院时间)变量:一组使用LithoVue，另一组使用光纤输尿管软镜。定性资料采用卡方检验和Fisher精确检验，连续资料采用非配对t检验，差异有统计学意义，差异设为a=0.05。结果:40例患者采用LithoVue输尿管镜，37例患者采用光纤输尿管镜。两组的基线特征是平衡的。LithoVue组平均手术时间为49.36±14.48 min，光纤输尿管镜组平均手术时间为62.46±16.60 min (p<0.001)，术中结石清除率为70%，光纤输尿管镜组为43% (p<0.005)。这种差异也在术后24小时检测到。结论:我们的研究表明，在治疗结石患者时，LithoVue可以安全地作为柔性光纤输尿管镜的替代方案。这些结果应该通过随机试验来证实。
{"title":"Comparison of a Single Use Digital Ureteroscope to a Fiberoptic Ureteroscope During Retrograde Renolithotripsy","authors":"L. Tzelves, G. Raptidis, Marinos Mperdembes, Titos Markopoulos, G. Dellis, I. Siafakas, A. Skolarikos","doi":"10.19264/HJ.V30I4.250","DOIUrl":"https://doi.org/10.19264/HJ.V30I4.250","url":null,"abstract":"Introduction: Ureterorenoscopy is a common procedure for treatment of stone disease. LithoVue is a relatively new entry in urologist armamentarium and offers digital image as well as single use nature when compared with traditional fiber-optic, reusable ureteroscopes. We aim to compare periprocedural outcomes for stone disease when using these two types of ureteroscopes. Patients and Methods: Baseline demographic data, perioperative( procedural time, surgical equipment, complication and stone-free rates) and postoperative(complication rate, length of stay) variables were recorded for two groups of patients: one managed with LithoVue and another with fiber-optic flexible ureteroscope. Chi-square and Fisher's exact test was used to compare qualitative data and unpaired t-test for continuous data, with a statistical significance set at a=0.05. Results: LithoVue was utilized in 40 and fiber-optic ureteroscope in 37 patients. The two groups were balanced regarding their baseline characteristics. Mean operative time for LithoVue cases was 49.36 ± 14.48 minutes and 62.46 ± 16.60 minutes for fiber-optic ureteroscope (p<0.001), while intraoperative stone-free rate for LithoVue was 70% and 43% for fiber-optic ureteroscope(p<0.005). This difference was also detected 24 hours postoperatively. Conclusions: Our study indicates that LithoVue can be used safely as an alternative for flexible fiber-optic ureteroscopes when managing patients with stone disease. These results should be confirmed with randomized trials.","PeriodicalId":185530,"journal":{"name":"Hellenic Urology","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115015860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To evaluate the intra- and post-operative outcomes of percutaneous renal access using either ECIRS (Endoscopic Combined Intrarenal Surgery) or fluoroscopic-guided renal access for supine percutaneous nephrolithotomy (PCNL). Methods: In our institute, over a 24-month period (April 2012 to March 2014), two surgeons performed a total of 68 PCNLs (not consecutive staghorn stone cases); 33 ECIRS and 35 fluoroscopically- guided access (FGA). All patient and calculi demographics were recorded, as well as intra-operative parameters and complication/secondary procedure rates. Results: We demonstrate that ECIRS offers rapid operating time (total procedure time 113 vs. 142 min, p<0.05), low complication rates (sepsis (0% vs. 5.8%), transfusion (0% vs. 8.6%) or bowel injury (0%)), with reduced in-patient stay (2 vs. 4 days, p<0.05) and high rates of stone clearance/residual fragments <4mm (3% vs. 25.7%, p<0.05) and low rate of secondary procedure (6.1% vs. 31.4%, p<0.05). Conclusion: ECIRS offers shorter operating times, with low complication rates, higher rates of stone clearance and a reduced requirement for secondary procedures in comparison to purely FGA. We envisage that this is due to a combination of quicker and more accurate needle placement, as well as the ability to perform concomitant FURS and laser stone fragmentation.
{"title":"ECIRS (Endoscopic Combined Intrarenal Surgery) Versus Fluoroscopic-guided Renal Access during supine Percutaneous Nephrolithotomy (PCNL): A Comparative Study","authors":"S. Kontos, A. Papatsoris, S. Nalagatla","doi":"10.19264/hj.v30i3.241","DOIUrl":"https://doi.org/10.19264/hj.v30i3.241","url":null,"abstract":"Objective: To evaluate the intra- and post-operative outcomes of percutaneous renal access using either ECIRS (Endoscopic Combined Intrarenal Surgery) or fluoroscopic-guided renal access for supine percutaneous nephrolithotomy (PCNL). Methods: In our institute, over a 24-month period (April 2012 to March 2014), two surgeons performed a total of 68 PCNLs (not consecutive staghorn stone cases); 33 ECIRS and 35 fluoroscopically- guided access (FGA). All patient and calculi demographics were recorded, as well as intra-operative parameters and complication/secondary procedure rates. Results: We demonstrate that ECIRS offers rapid operating time (total procedure time 113 vs. 142 min, p<0.05), low complication rates (sepsis (0% vs. 5.8%), transfusion (0% vs. 8.6%) or bowel injury (0%)), with reduced in-patient stay (2 vs. 4 days, p<0.05) and high rates of stone clearance/residual fragments <4mm (3% vs. 25.7%, p<0.05) and low rate of secondary procedure (6.1% vs. 31.4%, p<0.05). Conclusion: ECIRS offers shorter operating times, with low complication rates, higher rates of stone clearance and a reduced requirement for secondary procedures in comparison to purely FGA. We envisage that this is due to a combination of quicker and more accurate needle placement, as well as the ability to perform concomitant FURS and laser stone fragmentation.","PeriodicalId":185530,"journal":{"name":"Hellenic Urology","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121069603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Kyriazis, D. Dimitriou, M. Karavitakis, E. Liatsikos, A. Thanos
Aim of the study: To report the prospectively collected outcomes of our initial experience with laparoscopic radical prostatectomy in a secondary hospital of Greece. Materials and methods: In total 15 cases with localized prostate cancer (3x low risk, 5x intermediate risk and 7x high risk) and a mean age of 70 years (range 58-79) were operated during a 9 month period in our department. All operations were performed by a single laparoscopic surgeon under the supervision of two senior experienced open surgeons and the assistance of an assistant experienced in laparoscopic prostatectomy. Results: No case was converted into open surgery. Mean operating time (OT) dropped gradually from 5.5 hours in the beginning of our experience to up to 2 hours with a mean OT of 3.2 hours including 6 cases where a pelvic lymph node dissection was deemed necessary. Blood loss was minimum in all cases and no transfusion was required. All but 3 cases (80%) were discharged on the first postoperative day and catheter was removed 5 days later under cystographic verification of anastomotic water tightness in the vast majority of cases. Positive surgical margins (PSMs) were present in 5 patients (33%). Immediate continence after catheter removal was evident in 53% of our cases and early continence (continent within 2weeks from catheter removal) in 60%. Out of 10 patients having completed a 3month follow-up, 80% (8/10) were pad free. Both two incontinent patients still use 1 pad per day and include one case with immediate continence which started leaking after salvage radiotherapy initiation. PSA failure (>0.2ng/ dL) at 3 months was evident in 3 (30%) of patients including one patient operated with a PSA of 136ng/dL and two patients without PSMs. All these cases were included in the first 6 operated cases and were scheduled for salvage radiation treatment. At a mean of 56 days post prostatectomy, potency was restored in 3 patients following a penile rehabilitation protocol after surgery while none of the rest of patients requested further treatment for impotency. Conclusions: In the hands of a well-trained surgical group, perioperative morbidity of laparoscopic radical prostatectomy during the initial phases of learning curve is minimum. Early continence outcomes can reach comparative levels with the high volume center literature after the very first cases. Initial oncological outcomes were inferior to the published literature yet they were most likely due to case selection (older patients with adverse pathology) than due to limitations of the operative technique.
{"title":"Initial experience with extraperitoneal monopolarless laparoscopic radical prostatectomy in a secondary hospital of Greece","authors":"I. Kyriazis, D. Dimitriou, M. Karavitakis, E. Liatsikos, A. Thanos","doi":"10.19264/HJ.V30I3.243","DOIUrl":"https://doi.org/10.19264/HJ.V30I3.243","url":null,"abstract":"Aim of the study: To report the prospectively collected outcomes of our initial experience with laparoscopic radical prostatectomy in a secondary hospital of Greece. Materials and methods: In total 15 cases with localized prostate cancer (3x low risk, 5x intermediate risk and 7x high risk) and a mean age of 70 years (range 58-79) were operated during a 9 month period in our department. All operations were performed by a single laparoscopic surgeon under the supervision of two senior experienced open surgeons and the assistance of an assistant experienced in laparoscopic prostatectomy. Results: No case was converted into open surgery. Mean operating time (OT) dropped gradually from 5.5 hours in the beginning of our experience to up to 2 hours with a mean OT of 3.2 hours including 6 cases where a pelvic lymph node dissection was deemed necessary. Blood loss was minimum in all cases and no transfusion was required. All but 3 cases (80%) were discharged on the first postoperative day and catheter was removed 5 days later under cystographic verification of anastomotic water tightness in the vast majority of cases. Positive surgical margins (PSMs) were present in 5 patients (33%). Immediate continence after catheter removal was evident in 53% of our cases and early continence (continent within 2weeks from catheter removal) in 60%. Out of 10 patients having completed a 3month follow-up, 80% (8/10) were pad free. Both two incontinent patients still use 1 pad per day and include one case with immediate continence which started leaking after salvage radiotherapy initiation. PSA failure (>0.2ng/ dL) at 3 months was evident in 3 (30%) of patients including one patient operated with a PSA of 136ng/dL and two patients without PSMs. All these cases were included in the first 6 operated cases and were scheduled for salvage radiation treatment. At a mean of 56 days post prostatectomy, potency was restored in 3 patients following a penile rehabilitation protocol after surgery while none of the rest of patients requested further treatment for impotency. Conclusions: In the hands of a well-trained surgical group, perioperative morbidity of laparoscopic radical prostatectomy during the initial phases of learning curve is minimum. Early continence outcomes can reach comparative levels with the high volume center literature after the very first cases. Initial oncological outcomes were inferior to the published literature yet they were most likely due to case selection (older patients with adverse pathology) than due to limitations of the operative technique.","PeriodicalId":185530,"journal":{"name":"Hellenic Urology","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133692042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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