International Braz J Urol最新文献

Objective: To compare the outcomes of robotic-assisted partial nephrectomy (RALPN) and selective arterial embolization (SAE) for the treatment of sporadic renal angiomyolipoma (AML).

Patients and methods: The outcomes of patients who were managed by RALPN (n = 191) or SAE (n = 51) for sporadic renal AML were matched (2:1) using a propensity score for analyses. The primary endpoint was therapeutic success defined as the absence of secondary treatment. Secondary endpoints were post-operative complications and renal function preservation (loss of eGFR at 6 months). Univariate and multivariate logistic regression analyses were used to predict factors associated with re-intervention.

Results: Patients baseline characteristics in the matched population (RALP, n=96 vs. SAE, n=48) were balanced. LOS was shorter (mean: 4.2 vs. 3.1 days; p = 0.004) and EBL was lower (327 mL vs. 0 mL, p < 0.0001) in the SAE group. Overall (PN: 15.2% vs. AES: 11.7% p = 0.09) and Clavien-Dindo stratified (p = 0.62) complications were similar in both groups. After a comparable mean follow-up time (33 vs. 40 months, p = 0.63), there was an overall mean loss of eGFR of 7.7±26 mL/min/1.73m2 (p = 0.001). This loss was similar between the two groups (PN: 6.87±26 vs. AES: 11.56±23, p = 0.36). After adjusting for identified confounding factors including tumor size, type of primary intervention (RALPN vs SAE) was the only predictive factor for secondary intervention.

Conclusion: RALPN was associated with decreased need for secondary treatment with no increase in morbidity compared with SAE.

Purpose: Ureterocalicostomy refers to the anastomosis of the lower pole calyces with the ureter after excision of the hydronephrotic lower renal pole (1, 2). Indications for ureterocalicostomy include previous failed pyeloplasty, ureteropelvic junction obstruction (UPJO) with anatomical abnormalities, such as intrarenal pelvis or short ureter (3) and proximal ureteral strictures (4). The purpose of this video is to demonstrate the technique of Robotic-Assisted Laparoscopic Ureterocalicostomy (RALUC) in a patient with UPJO and intrarenal pelvis.

Materials and methods: Preoperatively, a retrograde ureteropyelography was performed. A transperitoneal approach with the Hassan technique was used, followed by the introduction of four additional DaVinci® trocars. The first step of the procedure is dissection of the retroperitoneum, the proximal ureter and lower part of the kidney including the renal hilum. The proximal ureter is dissected below the stricture. The lower pole artery is selectively bulldogged, and the lower pole of the kidney is resected in a circular manner to get broad based access to the lowest calix. The "Garland" suture technique is used to control hemostasis of the lower pole of the kidney. Therefore, a running, "low tension", circular suture is performed along the whole renal defect. This provides sufficient parenchymal hemostasis without narrowing the access to the lower calix. The ureter is then spatulated and sutured to the lower calix. The video shows step by step the ureterocalical anastomosis in single knot technique and explains tips and tricks.

Results: Total operative time was 114 minutes, while estimated blood loss was 25 mL. The JJ catheter was removed at 40 days postoperatively, while an ultrasound was performed after the JJ removal, showing no hydronephrosis. No intraoperative or postoperative complications were reported. The creatinine count and GFR after JJ removal were 92 μmoL/L and 70 ml/min, respectively. During the last follow-up the patient remained asymptomatic and had a mild chronical dilatation of the caliceal system but no hydronephrosis.

Conclusions: This video demonstrates the effectiveness and repeatability of RALUC for reconstructing UPJO in patients with very narrow or intrarenal pelvis. RALUC is a feasible, safe and efficient approach for selected patients requiring reconstruction of the upper urinary tract.

Leukocytospermia, defined as ≥1×10⁶ white blood cells (WBC)/ml of semen, is a condition frequently observed in infertile men. While symptomatic leukocytospermia is often associated with genital tract infections and managed accordingly, the clinical significance of asymptomatic leukocytospermia remains uncertain-particularly in the setting of Assisted Reproductive Technology (ART). Seminal leukocytes, primarily neutrophils, play a physiological role in immune surveillance and tissue homeostasis. However, when excessively activated, they may generate high levels of reactive oxygen species (ROS), contributing to oxidative stress, sperm dysfunction, and DNA damage. This narrative review critically examines whether asymptomatic leukocytospermia adversely affects ART outcomes, including fertilization, embryo development, clinical pregnancy, and live birth rates. A synthesis of current evidence-including meta-analyses and large retrospective studies-suggests that asymptomatic leukocytospermia does not negatively impact these outcomes. Moreover, standard sperm preparation techniques and the widespread use of ICSI appear to neutralize any potential deleterious effects from seminal leukocytes. Given the absence of compelling evidence supporting its harmful impact on ART success, routine treatment of asymptomatic leukocytospermia-particularly with empiric antibiotics-is not recommended. Such interventions may disturb the natural immune balance, promote antibiotic resistance, and increase healthcare burdens without demonstrable benefit. Nonetheless, selective treatment may be justified in specific scenarios, such as recurrent implantation failure or early pregnancy loss. Further research is warranted to standardize leukocyte detection methods and to clarify the role of adjunctive therapies. Until more definitive data emerge, an individualized, evidence-based approach remains the most appropriate strategy for managing asymptomatic leukocytospermia in infertile men pursuing ART.

Purpose: This meta-analysis compares the efficacy and safety of the Bricker and Wallace techniques, focusing on updating previously unassessed clinical outcomes to inform surgical decision-making.

Material and methods: A systematic review and meta-analysis followed PRISMA and Cochrane guidelines, with the protocol in PROSPERO (CRD42024621076). Searches in MEDLINE/PubMed, EMBASE, and Cochrane Library included Randomized Clinical Trials and cohort studies comparing both anastomosis techniques. Analyses used Odds Ratio (OR) and mean differences with a random-effects model.

Results: Fourteen studies with 1,903 patients (980 Bricker; 923 Wallace) were included. No significant difference was found in overall stricture rates. However, the Bricker technique had more unilateral strictures (OR 0.47; 95% CI 0.30-0.75; p < 0.01), while the Wallace technique had lower stricture rates in patients who underwent ileal-conduit urinary diversion (OR 0.35; 95% CI 0.19-0.64; p < 0.001), and patients without prior radiotherapy (OR 0.29; 95% CI 0.14-0.61; p < 0.001). Wallace also presented reduced hydronephrosis (OR 0.37; 95% CI 0.17-0.79; p < 0.05). No significant differences were observed in patients undergoing neobladder diversion or those with bladder cancer.

Conclusion: No difference in main analyses of stricture rates was found, supporting that technique choice should rely on surgeon preference and expertise. Therefore, beyond surgeon preference, the choice of technique should consider the patient's history of radiotherapy, and the type of urinary diversion planned, aiming to optimize postoperative outcomes and minimize the risk of specific complications.

Introduction: The 2001 Lindbergh operation provided evidence for the feasibility of transatlantic telesurgery.(1-3) However, technological and economic challenges have limited the implementation of this technique.(4-6) This video illustrates details of a telesurgery connection over a 13,000 km distance between Orlando (USA) and Shanghai (China). Surgeons at both locations operated simultaneously on the same animals using telesurgery consoles (MicroPort® MedBot™) for teleproctoring, allowing for a robust evaluation of connectivity and robotic system performance across vast distances.

Methods: On July 23rd and 24th, 2024, we conducted a prospective telesurgery study using live animal models (porcine) connecting Orlando to Shanghai. We reproduced a real-life telesurgery scenario where both ends of the connection had control over the robot. Four surgeons were in Orlando and one in Shanghai. We illustrated the communication between surgeons and highlighted the potential of telesurgery to improve outcomes and teaching robotic surgery.

Results: Connectivity and robotic technology performed optimally for several hours without troubleshooting or malfunctions. Median delay was 139 milliseconds (137-216) on the first day and 139 milliseconds (137-185) on the second day. The surgeons were able to switch the console control multiple times during the procedures. They could communicate, discuss cases in real-time, and seamlessly transfer control in critical steps of the surgery.

Conclusions: This video underscores the practical potential of Telesurgery use in teleproctoring, particularly when an experienced remote surgeon steps in to assist another surgeon during complex or challenging procedures. It highlights Telesurgery's potential for training and improving outcomes in robotic surgery.

Purpose: The use of patient prioritization tools is one of several methods to enhance the management of waiting times for elective surgeries. Developing these tools specifically for urinary stones in the Brazilian context may enhance queue management and increase patient satisfaction. This study aims to adapt two previously published scores, the WCWL (Western Canada Waiting List - general criteria) and the SCQ-score (specific to urinary stone criteria), into Brazilian Portuguese.

Materials and methods: Our study adhered to established protocols for the cross-cultural adaptation and translation of health-related questionnaires. The process for translating both original scores involved four steps: initial translation, back-translation, committee review, and pre-testing. The translations were conducted by professionals proficient in the relevant languages. The pre-test phase engaged eight endourologists who applied the translated versions of the scores to twelve hypothetical patient cases.

Results: Our study successfully produced Brazilian Portuguese versions of the SCQ and WCWL scores. During the pre-testing, these scores were found to be quick to perform (with an average completion time of 1 minute and 35 seconds) and were deemed easy to understand and use by the endourologists. However, there was a concern regarding the practical utility and interpretability of the WCWL score due to its more generalized criteria.

Conclusion: We successfully developed the Brazilian Portuguese version of the Western Canada Waiting List and SCQ-score. This development will allow further studies to evaluate the impact of their use within the Brazilian healthcare environment.