Minerva Urology and Nephrology最新文献

Background: The aim of this study was to describe the technique and initial outcomes of robot-assisted T-plasty for recalcitrant bladder neck stenosis.

Methods: Patients who underwent robot-assisted T-plasty for recalcitrant bladder neck stenosis in a single center were included. Presence of bladder neck stenosis was preoperatively confirmed by the combination of retrograde urethrography with voiding cysto-urethrography and flexible urethroscopy. Follow-up visits were performed with history taking, uroflowmetry and echographic residual urine measurement. Complications were graded according to the Clavien-Dindo classification. Patients without urinary symptoms and with a maximum uroflow of no less than 15mL/s were considered as successfully treated. Otherwise, cystoscopy would be performed, and recurrence was defined as the inability to pass a 14 French cystoscope through the bladder neck.

Results: Since 2018, seven patients were treated. The etiologies were transurethral resection of the prostate and simple prostatectomy in respectively 6 patients and 1 patient. Cystoscopy was able to diagnose bladder neck stenosis in all cases whereas urethrography was equivocal in 3 out of 7 cases. Median (range) age at surgery was 60 (54-75) years, and median number of prior endoscopic treatment for bladder neck stenosis was 3 (1-16). The median operative time was 123 (110-159) minutes. No intraoperative complications were reported. Three patients suffered a grade 2 complication. After a median follow-up of 27 (4-74) months, the recurrence-free rate was 100% with no evidence of de-novo incontinence or erectile dysfunction.

Conclusions: In our series, robot-assisted T-plasty suggests positive and safe outcomes in treating recalcitrant bladder neck stenosis with a good patency rate and low incontinence rate. Additionally, cystoscopy is reliable in the diagnosis of patients with inconclusive urethrography results.

Background: Urethral stricture is an abnormal narrowing of the urethra and occurs in anterior urethra for 92% of cases. Although open surgery is considered the gold standard for this type of disease, endoscopic procedures are the most commonly used. The Optilume^® Drug Coated Balloon (DCB) (Urotronic, Inc., Plymouth, MN, USA) is the first DCB intended for the treatment of male urethral strictures. Here we report the results of a multicenter Italian real-life study.

Methods: We collected data from nine Italian centers. Patients with urethral strictures or bladder neck stricture were treated with the Optilume^© DCB. We evaluated variation in IPSS, QoL and IIEF5 score, QMax, PVR, and freedom from repeat intervention.

Results: Overall, 130 subjects were treated; median follow-up was six months. Mean age and prostate volume were 64 and 45 mL. Total median operative time was 15 minutes whereas the median time of Optilume application was 7 minutes. IPSS and QoL changed from a mean of 24 and 4 points at baseline to 10 and 1 points respectively at the last follow-up (P<0.001). We have also recorded a significant improvement in Qmax and PVR from 8 mL/s and 100 mL at baseline to 17.8 mL/s and 0 mL at the last follow-up (P<0.001). Intra and post operative not serious complications occurred in 3 and 10 patients, respectively. Six patients underwent reoperation during follow-up.

Conclusions: In our experience, the Optilume^© represents a valid option in the management of patients with urethral stricture, with or without previous surgery.

Background: We present our step-by-step experience regarding the feasibility and surgical setup for a case series of robotic pyeloplasty using the new Hugo^™ RAS System.

Methods: Five consecutives robotic pyeloplasties have been performed, through a trans-peritoneal route. Three robotic ports were placed under direct vision, including an optical 11-mm robotic trocar, and two 8-mm operative robotic ports. Two laparoscopic ports for bed-assistant were placed between robotic ports and below the camera port to avoid clashes. Only three arm carts were used and located behind the back of the patient to leave more working space to the bed-assistant space and avoid internal or external clashes between robotic arms. After docking and paracolic gutter incision, kidney lower pole identification, UPJ stenosis excision, and spatulation of the ureter with double J ureteral catheter placement were key steps of our procedure.

Results: Median Docking and Console time were 4 minutes (IQR: 4-5) and 115 minutes (IQR:105-120), respectively. No intraoperative complications occurred. No additional ports placement was necessary. No robotic instrument clashed, nor clashes between the robotic arms and the bed-assistant were observed. Estimated blood loss was negligible. The patients were discharged on postoperative day 3 after bladder catheter and abdominal drain removal. No complications were recorded within the first 30 postoperative days. Finally, a median follow-up of 4 (IQR: 3-8) reported satisfactory outcomes.

Conclusions: In the setting of robotic pyeloplasty, this novel platform showed a user-friendly docking system, providing satisfactory perioperative outcomes with a simple three-arms configuration.

Background: This paper aimed to compare laparoscopic (LEVUR) vs. robot-assisted (REVUR) Lich Gregoir extravesical ureteral reimplantation (UR) in children with vesicoureteral reflux (VUR).

Methods: The charts of all patients with moderate to high-grade VUR (3 to 5), who received LEVUR or REVUR over a 10-year period (2014-2024), were retrospectively reviewed.

Results: Seventy-six patients (40 girls and 36 boys), with median age of 5.7 years (range 2-11) and moderate to high-grade VUR, were enrolled. VUR was unilateral in 55/76 (72.3%) and bilateral in 21/76 (27.7%). Patients were grouped according to the MIS approach and pathology side. The median operative time (OT) of unilateral non-dismembered UR was similar in LEVUR (65 min) and REVUR (50 min) (P=0.56). REVUR was faster than LEVUR in unilateral dismembered (90 vs. 120 min) (P=0.001) and bilateral UR (105 vs. 160 min) (P=0.001). The radiographic VUR resolution rate was similar between REVUR and LEVUR (97.8% vs. 96.7%) (P=0.89). Two patients (2.6%) reported low-grade persistent reflux without need for additional treatments. Mild bladder dysfunction developed in 2/21 (9.5%) undergoing bilateral UR (Clavien-Dindo 2).

Conclusions: REVUR is technically easier, faster and provides better ergonomics compared to LEVUR. The postoperative outcomes are excellent in both techniques, with success rates higher than 95%. Complications developed after bilateral reimplantation in patients who had previous history of bladder dysfunction. Given the robot availability, we believe that the best indication for LEVUR remains unilateral reflux without need for ureteral tapering. In unilateral refluxing megaureter, para-ureteral diverticulum or bilateral cases, REVUR represents the best choice.