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Removal of intramural trapped intrauterine device by cystoscopic incision of bladder wall

Vol. 44 (x): 2018 September 9.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0056


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Abbas Basiri 1, Behnam Shakiba 1, Niloufar Rostaminejad 1
1 Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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Removal of intramural trapped intrauterine device by cystoscopic incision of bladder wall

Vol. 44 (x): 2018 September 9.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0056


VIDEO SECTION

Abbas Basiri 1, Behnam Shakiba 1, Niloufar Rostaminejad 1
1 Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

ABSTRACT

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A healthy 37 – year – old woman referred to our clinic with one – year history of recurrent urinary tract infection, dy­suria and frequency. Her past medical history informed us that an IUD (Copper TCu380A) had been inserted 11 years ago. Eleven months after the IUD insertion she had become pregnant, unexpectedly. At that time, she had undergone gynecological examination and abdominal ultrasound study. However, the IUD had not been found, and the gynecologist had made the diagnosis of spontaneous fall out of the IUD. She had experienced normal pregnancy and caesarian section with no complications.

On physical examination, pelvic examination was normal and no other abnormalities were noted. Urinalysis revealed microhematuria and pyuria. Urine culture was positive for Escherichia coli. Ultrasound study revealed a calculus of about 10 mm in the bladder with a hyperdense lesion. A plain abdominal radiograph was requested which showed a metallic foreign body in the pelvis. We failed to remove the IUD by cystoscopic forceps because it had strongly invaded into the uterine and bladder wall. Despite previous papers suggesting open or laparoscopic surgeries in this situation (1, 2), we performed a modified cystoscopic extraction technique. We made a superficial cut in the bladder mucosa and muscle with J – hook monopolar electrocautery and extracted it completely with gentle traction.

This technique can decrease the indication of open or laparoscopic surgery for extraction of intravesical IUDs. In the other side of the coin, this technique may increase the risk of uterovesical fistula. Therefore, the depth of incision is important and the surgeon should cut the bladder wall superficially with caution. Although present study is a case report which is normally classified as with low level of evidence, it seems that our modified cystoscopic extraction technique is a safe and useful method for extraction of partially intravesical IUDs.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20180056_Basiri_et_al
Int Braz J Urol. 2018; 44 (Video #X): XXX-X

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Anterograde irrigation – assisted ureteroscopic lithotripsy in patients with percutaneous nephrostomy

Vol. 44 (x): 2018 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0238


VIDEO SECTION

Jemo Yoo 1, Seung-Ju Lee 1, Hyun-Sop Choe 1, Hee Youn Kim 1, Joon Ho Lee 1, Dong Sup Lee 1
1 St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea

ABSTRACT

In complicated urinary tract infection with ureteral calculi, urinary diversion is inevitable. So, stenting or percutaneous drainage can be an option. In hemodynamically unstable patients, percutaneous drainage is superior to ureteral stenting (1). Once acute infection is controlled, definite treatment of the stone is necessary. According to a guideline, semirigid ureteroscopy is recommended for lower and mid – ureter stone and flexible ureteroscopy for upper ureter stone (2). Semi – rigid ureteroscopy can migrate stone to kidney, especially in upper ureter stone, lowering stone free rate (3). Not only flexible ureteroscopy creates additional costs but also is barely available in developing countries (4, 5). So, the authors would like to introduce anterograde irrigation – assisted ureteroscopic lithotripsy in patients with percutaneous nephrostomy.

Retrograde irrigation was connected and flowed minimally enough to secure visual field. Once stone is noted, another saline irrigation, which is placed above 40 cm over the patient is connected to nephrostomy. Retrograde irrigation is disconnected from ureteroscope and the previous connected channel on ureteroscope is opened. Actual pressure detected by barometer from the opened channel of ureteroscope is usually about 30 cmH2O while anterograde irrigation is administered in maximal flow, which means fully opened anterograde irrigation is not hazardous to kidney. There was no complication in 17 patients submitted to this method.

Video shows advantages of our practice: clear visual field; reduced risk of stone migration into kidney; induced spontaneous passage of fragments without using instrumentation; and decreased operation time. In short, most of surgeons, even unexperienced, can perform an excellent procedure with less time consuming using our method.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20180238_Yoo_et_al

Int Braz J Urol. 2018; 44 (Video #X): XXX-X

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Anterograde irrigation – assisted ureteroscopic lithotripsy in patients with percutaneous nephrostomy

Vol. 44 (x): 2018 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0238


VIDEO SECTION

Jemo Yoo 1, Seung-Ju Lee 1, Hyun-Sop Choe 1, Hee Youn Kim 1, Joon Ho Lee 1, Dong Sup Lee 1
1 St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea

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Vascular injuries during laparoscopic donor nephrectomy and proposed risk reduction strategies

Vol. 44 (x): 2018 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0281


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Parag Sonawane 1, Arvind Ganpule 1, Abhishek Singh 1, Ravindra Sabnis 1, Mahesh R. Desai 1
1 Department of Urology, Division of Laparoscopic and Robotic Surgery, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India

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Vascular injuries during laparoscopic donor nephrectomy and proposed risk reduction strategies

Vol. 44 (x): 2018 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0281


VIDEO SECTION

Parag Sonawane 1, Arvind Ganpule 1, Abhishek Singh 1, Ravindra Sabnis 1, Mahesh R. Desai 1
1 Department of Urology, Division of Laparoscopic and Robotic Surgery, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India

ABSTRACT

 Introduction: Laparoscopic donor nephrectomy (LDN) has become the standard of care and popular among most of the transplant centres across the globe.

Objective of this video is to report different vascular injuries, their management during LDNs and propose risk reduction strategies.

Patient and methods: This was a retrospective analysis of all the LDNs performed between January 2011 and March 2016. All donor nephrectomies were performed laparoscopically by transperitoneal route, under ideal operative conditions by expert laparoscopic surgeons and by novice surgeons.

Results: 858 LDNs (left, n = 797; right, n = 61) were performed during the study period with 5 cases of vascular injuries. Mean (SD) donor age was 45.5 (± 10.76) years and the operative time was 165 (± 44.4) min. Of these five cases, two had renal vein injury, while the three others had renal artery, inferior vena cava and aortic injury (one each). Four injuries occurred during left LDN and only one during a right LDN. Vascular injuries were managed using the Rescue stitch or metallic clips as indicated. Risk reduction strategy was developed to avoid vascular injuries during LDN, which include – meticulous attention to port placement, addition of fourth port, complete dissection of upper pole and pedicle before clipping, and judicious use of ultrasonic diathermy.

Conclusions: Careful evaluation of computed tomography angiography just before surgery will act like a global position­ing system (GPS) for the operating surgeon. Rescue stitch is a saviour. Not to panic and being well versed with the risk reduction strategies of laparoscopy and rescue measures is of paramount importance.

 ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20180281_Sonawane_et_al

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Robot – assisted laparoscopic local recurrence resection after radical prostatectomy

Vol. 44 (x): 2018 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0503


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Fabio C. M. Torricelli 1, Paulo Afonso de Carvalho 1, 2, Giuliano B. Guglielmetti 1,2, William C. Nahas 1, 2, Rafael F. Coelho 1, 2, 3
1 Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil; 2 Instituto do Cancer do Estado de Sao Paulo (ICESP), São Paulo, SP, Brasil; 3 Hospital Israelita Albert Einstein, São Paulo, SP, Brasil

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Robot – assisted laparoscopic local recurrence resection after radical prostatectomy

Vol. 44 (x): 2018 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0503


VIDEO SECTION

Fabio C. M. Torricelli 1, Paulo Afonso de Carvalho 1, 2, Giuliano B. Guglielmetti 1,2, William C. Nahas 1, 2, Rafael F. Coelho 1, 2, 3
1 Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil; 2 Instituto do Cancer do Estado de Sao Paulo (ICESP), São Paulo, SP, Brasil; 3 Hospital Israelita Albert Einstein, São Paulo, SP, Brasil

ABSTRACT

Introduction and objective: Local prostate cancer recurrence is usually treated with salvage radiation (sRDT) with or with­out adjuvant therapy. However, surgical resection could be an option. We aim to present the surgical technique for robot – assisted laparoscopic resection prostate cancer local recurrence after radical prostatectomy (RP) and sRDT in 2 cases.

Patients and method: First case depicts a 70 year – old man who underwent RP in 2001 and sRDT in 2004. Following ad­juvant therapy, patient had biochemical recurrence. MRI showed a solid mass in the prostatic fossa close to vesicourethral anastomosis, measuring 2.1 cm and PET / CT revealed hyper caption significant uptake in the prostatic fossa. Second case is a 59 year – old man who underwent RP in 2010 and sRDT in 2011. Again, patient presented with biochemical recur­rence. PET / CT showed hyper caption in the prostatic fossa. Biopsy conformed a prostate adenocarcinoma. Both patients underwent robot – assisted extended pelvic lymph nodes dissection and local recurrence resection. A standard 4 robotic arms port placement was utilized.

Results: Both procedures were uneventfully performed in less than 3 hours and there were no complications. Pathologi­cal examination showed a prostate adenocarcinoma Gleason 7 and 8 in the first and second case, respectively; surgical margins and lymph nodes were negative. After 6 months of follow-up, continence was not affected and both patients presented with PSA < 0.15 ng / mL.

Conclusion: Robot – assisted laparoscopic resection of prostate cancer local recurrence after RP and sRDT detected by PSMA PET / CT seems to be safe in experienced hands. It may postpone adjuvant therapy in selected cases.

Available at: http://www.intbrazjurol.com.br/video-section/20170503_Torricelli_et_al

Int Braz J Urol. 2018; 44 (Video #X): XXX-X

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A novel “six stitches” procedures for pediatric and adult buried penis

Vol. 44 (x): 2018 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0688


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Junhao Lei 1, Chunhua Luo 1, Xinghuan Wang 1,2, Xinjun Su 1
1 Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China; 2 Center for Evidence-based and Translational Medicine, Wuhan University, Wuhan, China
”[evp_embed_video

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A novel “six stitches” procedures for pediatric and adult buried penis

Vol. 44 (x): 2018 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0688


VIDEO SECTION

Junhao Lei 1, Chunhua Luo 1, Xinghuan Wang 1,2, Xinjun Su 1
1 Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China; 2 Center for Evidence-based and Translational Medicine, Wuhan University, Wuhan, China

ABSTRACT

Introduction: The buried penis, if not treated before adolescence, will lead to psychological and physical disorders in adulthood. Therefore, early surgical intervention is necessary. At present, the common surgical methods include the penile corpus fixation, the Johnson’s operation, the Devine’s method, the modified Devine’s method, Shiraki’s method, etc. However, we found that these traditional surgeries showed various postoperative complications, such as long-term prepuce edema, avascular necrosis of skin flaps, stenotic prepuce, scarring, and poor appearance. This video shows the main technical steps of our innovative surgical procedure “Six Stitch” (SS) method for the buried penis.
Materials and Methods: The designation of the so-called SS method was based on the total knots made (six knots were made for the SS procedure).
After the crura penis was fully exposed via a longitudinal incision at the penoscrotal junction, at the 2 o’clock position (around the penis), the superficial layer of albuginea of the crura penis was sutured to the prepubic ligament with 2-0 non-absorbable sutures to prevent the retraction of the penis (the 1st knot). The same procedure was used for the 10 o’clock position (the 2nd knot); At the 2 o’clock position, the skin and subcutaneous tissue at the pubic mound were sutured to the prepubic ligament to reconstruct the appearance of dorsum penis (the 3rd knot). The same procedures were used for the 10 o’clock position (the 4th knot). At the 5 o’clock position, the ventral albuginea was sutured to the tunica dartos and subcutaneous tissue at the penoscrotal junction to reconstruct the penoscrotal angle (the 5th knot). The same procedures were used for the 4 o’clock position (the 6th knot). Finally, the gloved prepuce was reset and circumcision was conducted if the redundant prepuce existed.
Results: We have done a total of 64 cases of SS procedures for concealed penis; mean length improvement was 3.8 ± 0.5 cm, with a satisfying 95 percent (61 / 64), which was much longer than the outcome of the above-mentioned methods.
Mean operative time was 62.3 ± 12.1 minutes, and there was no serious intraoperative or postoperative complication (only 2 presented scar hyperplasia at the incision site).
Conclusions: In conclusion, after the SS procedure, patients with buried penis can acquire an almost 4 cm improvement of penile length and covert incision at the midline of the scrotum, with an acceptable and low incidence of adverse events.
This safe and effective procedure may be a viable option for the surgical management of pediatric and adult buried penis.

ARTICLE INFO
Available at: http://www.intbrazjurol.com.br/video-section/20170688_ Lei_et_al
Int Braz J Urol. 2018; 44 (Video #X): XXX-X

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