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Analysis of surgeon biometrics during open and robotic radical cystectomy with electromyography and motion capture analysis

Vol. 45 (x): 2019 June 6.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2019.0163


VIDEO SECTION

Adam Baumgarten 1, Joon Kim 1, Jeff Robison 1, John Mayer 2, Dustin Hardwick 2, Trushar Patel 1
1 Department of Urology, University of South Florida, CA, United States; 2 Department of Physical Therapy, University of South Florida, CA, United States

ABSTRACT

Purpose: To determine feasibility of measuring surgeon physical stress during both open radical cystectomy (ORC) and robotic radical cystectomy (RRC).
Materials and Methods: One patient underwent ORC, while the other underwent RRC by a single surgeon. The diversion was excluded from this study. Noraxon® myoMOTION™ kinematics sensors were used to quantify the amount of joint and segmental motion of the spine, shoulders, and head. myoMUSCLE™ EMG sensors were used to measure activation levels, patterns, and fa­tigue characteristics of key muscle groups. The Prone Static Plank Test (PSPT) and Modified Biering-Sorensen Test (MBST) were used to assess surgeon strength and endurance of core musculature.
Results: The surgeries were represented in five stages. During ORC, the percentage of time spent in cervical flexion was 98%, 91.8%, 87.5%, 100%, and 97.1%, respectively. During RRC, 100% of the time was spent in cervical flexion. Activation of key muscle groups was examined across all stages and expressed as a percentage of peak activation. MBST times were both 25 sec­ond pre-and post-surgery ORC and 25.1 seconds pre-surgery and 32.4 seconds post-surgery for RRC. PSPT times were 68 second pre-surgery and 48 seconds post-surgery for ORC, and 59 second pre-surgery and 51 seconds post-surgery for RRC.
Conclusion: We were able to identify meaningful data using kinematic and EMG analysis during ORC and RRC. We were able to identify target muscle groups that will be used to conduct a larger study with multiple surgeons to help determine if there is an ergonomic advantage to RRC over traditional ORC.
 

Available at: https://www.intbrazjurol.com.br/video-section/20190163_ Baumgarten_et_al

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Apical sling for laparoscopic sacrohisteropexy in a young virgin patient with joint hypermobility syndrome

Vol. 45 (x): 2019 June 6.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0746


VIDEO SECTION

Alcidézio Farias Santana 1, Raquel Doria Ramos Richetti 2, Susane Mey Hwang 3, Tatenda Nzenza 4, Luis Gustavo M. Toledo 5
1 Departamento de Cirurgia, Hospital Irmandade da Santa Casa de Misericórdia de São Paulo, SP, Brasil; 2 Departamento de Ginecologia, Hospital Maternidade Vila Nova Cachoeirinha, São Paulo, SP, Brasil; 3 Departamento de Uroginecologia, Hospital Maternidade Vila Nova Cachoeirinha, São Paulo, SP, Brasil; 4 Austin Health, Urology Heidelberg, Victoria, Australia; 5 Departamento de Urologia, Faculdade de Medicina da Santa Casa de São Paulo, SP, Brasil

ABSTRACT

Introduction: We are faced with a young patient with uterine prolapse and urinary difficulties due to Joint Hypermobil­ity Syndrome, a congenital collagen disease that predisposes woman to the development of pelvic organ prolapse. The patient had urinary difficulty requiring standing and bowing to reduce prolapse and then start urination. This video demonstrates that videolaparoscopic technique is feasible for the treatment of uterine prolapse in young and sexually virgin woman.
Materials and Methods: We separated the bladder from vagina and opened the peritoneum anterior to the uterus. Next, we attached the sigmoid colon to the left abdominal wall in order to better expose the promontory. We then opened the peri­toneum posterior to the uterus and medially tunnelled the right uterosacral ligament, transfixing the broad ligament and passing the end of a polypropylene mesh through this tunnel to the posterior region of the uterus. The same maneuver was performed on the other side so that the mesh surrounded the anterior portion of the cervix while its two extremities were posterior to the uterus. The mesh was fixed on the anterior surface of the uterine cervix and its two extremities were fixed to the promontory in the anterior longitudinal ligament of the spine. Finally, we closed the peritoneum.
Results: Uterine prolapse was corrected, with good recovery.
Conclusions: Videolaparoscopic technique is feasible for correction of uterine prolapse, being effective and safe in virgin woman.

Available at: https://www.intbrazjurol.com.br/video-section/20180746_Santana_et_al

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Multiple renal tumorectomy in a Von Hipple Lindau patient. Combined retro/transperitoneal approach with intracorporeal hypotermia

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0803


VIDEO SECTION

Valentí Tubau 1, Jose Luis Bauza 1, Enrique Pieras 1, Xavier Brugarolas 1, Pedro Pizà 1
1 Department of Urology, Hospital Universitario Son Espases, Palma de Mallorca, Illes Balears, Spain

ABSTRACT

Objective & Introduction: To show the feasibility of a combined transperitoneal (TP) and retroperitoneal (RP) laparoscopic approach in a Von Hipple-Lindau (VHL) patient with multiple kidney tumors. VHL is an autosomal dominant inherited syndrome characterized by a high incidence of benign and malignant tumors and cysts in many organs. Renal cell carcinoma is one of the most common and a leading cause of mortality (1). Surgical approach is usually complex because of its multiplicity and the need of maximum kidney function preservation due to the risk of future recurrences (2, 3).
Intracorporeal renal hypothermia may be useful in these cases to prevent permanent renal function loss (4).
Materials and Methods: A 40 years old male was being monitored for multiple bilateral renal masses. Family history included a VHL syndrome affecting his mother and sister.
Past medical history included a VHL syndrome with multiple cerebellar and medular hemangioblastomas, a pancreatic cystoadenoma and bilateral kidney tumors which had significantly grown up during follow-up.
The patient was scheduled for laparoscopic multiple partial nephrectomy. A combined TP and RP approach with intracorporeal hypothermia was chosen.
Results: A total of six right kidney tumors were removed. Operative time was 240 min. Cold ischemia time was 50 min.
Average kidney temperature was 23.7ºC. Blood losses were negligible. The patient was discharged after 72 hours. No major changes in serum creatinine were found during the follow-up. Final pathology revealed a clear cell renal cell carcinoma, pT1a, ISUP grade 2 in most of the tumors but one ISUP grade 3. Surgical margins were negative.
Conclusions: Combined TP and RP is a feasible alternative for the treatment of multiple renal tumors. It’s safe and effective, allowing the use of intracorporeal hypothermia which may improve postoperative renal function. Consistent experience is needed before embarking on this surgery.

Available at: https://www.intbrazjurol.com.br/video-section/20180803_Tubau_et_al

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3D Reconstruction and physical renal model to improve percutaneous punture during PNL

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0799


VIDEO SECTION

Lorenzo Bianchi 1, 2, Riccardo Schiavina 1, 2, Umberto Barbaresi 1, Andrea Angiolini 1, Cristian V. Pultrone 1, 2, Fabio Manferrari 1, 2, Barbara Bortolani 3, Laura Cercenelli 3, Marco Borghesi 1, 2, Francesco Chessa 1, 2, Elisa Sessagesimi 4, Caterina Gaudiano 4, Emanuela Marcelli 3, Eugenio Brunocilla 1, 2
1 Department of Urology, University of Bologna, Bologna, Italy; 2 Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy; 3 Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy; 4 Department of Radiology, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

ABSTRACT

Introduction and Objectives: We aim to present the use of 3D digital and physical renal model (1-5) to guide the percutaneous access during percutaneous nephrolithotripsy (PNL).
Materials and Methods: We present the clinical case of a 30 years old man with left renal stone (25×15 mm). A virtual 3D reconstruction of the anatomical model including the stone, the renal parenchyma, the urinary collecting system (UCS) and the skeletal landmarks (lumbar spine and ribs) was elaborated. Finally, a physical 3D model was created with a 3D printer including the renal parenchyma, UCS and the stone. The surgeon evaluated the 3D virtual reconstruction and manipulated the printed model before surgery to improve the anatomical knowledge and to facilitate the percutaneous access. In prone position, combining ultrasound and fl uoroscopy implemented by the preoperative anatomical planning based on the 3D virtual and printed model, an easy and safe access of the inferior calyx was achieved. Then, the patient underwent PNL using a 30 Fr Amplatz sheet with semi-rigid nephroscope and ultrasound energy to achieve a complete lithotripsy of the pelvic stone.
Results: The procedure was safely completed with 1 single percutaneous puncture (time of puncture 2 minutes). Overall surgical time was 90 min. No intra and postoperative complications were reported. The CT scan performed before discharge confi rmed a complete stone free state.
Conclusion: The 3D-guided approach to PNL facilitates the preoperative planning of the puncture with better knowledge of the renal anatomy and may be helpful to reduce operative time and improve the learning curve.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180799_Bianchi_et_al

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A new Surgical Technique: Transvesical Prostate Resection

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0488


VIDEO SECTION

Hakan Türk 1, Erkan Arslan 2
1 Department of Urology, Evliya Celebi Training and Research Hospital, Kutahya, Turkey; 2 Department of Urology, Harran University Medical School, Sanliurfa, Turkey

ABSTRACT

Objectives: Surgical treatment is indicated in patients where medical therapy fails to prove benefi cial or in patients who develop complications related with bladder outlet obstruction. In our study, we developed a new surgical technique which can be defi ned as Transvesical Resection of Prostate (TVRP) without using the urethra. This method was previously described in our articles (1).
Materials and Methods: A 62-years-old male patient, using an alpha blocker agent for 5 years, reported increased discomfort with urination. His fi ndings were as follows: PSA: 1.2 ng/dL, prostate volume: 45 cc, digital rectal examination: benign, IPSS: 30, QoL: 5, Qmax: 6, urine volume: 225 cc, post-mictional residue: 65 cc. Eventually the patient was informed and prostate resection decision was made.
Results: Suprapubic catheter was removed 1 day after surgery and the patient was discharged. Urethral catheter was removed 4 days after urine output became clear. No complications developed after the operation. At postoperative 1st month, Qmax was 22, urine volume was 260 cc, post-mictional residue was 40 cc, IPSS was 8, QoL was 1, and the pathology was benign prostate tissue.
Conclusions: Urethral stricture is one of the most important postoperative complications of TURP. The incidence of urethral stricture is reported between 2.2% and 9.8% in different series (2-5). In this technique which we developed, urethra is not used and prostate is removed through the bladder, similar to open prostatectomies. For this reason, we suggest that it has an advantage over TURP, regarding urethral stricture development.

ARTICLE INFO
Available at: https://www.intbrazjurol.com.br/video-section/20180488_Turk_et_al

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Robot-assisted repair for ureteroileal anastomosis stricture after cystectomy: technical points

Vol. 45 (x): 2019 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0794


VIDEO SECTION

Juan Garisto 1, Riccardo Bertolo 1, Mohamed Eltemamy 1, Rebecca Campbell 1, Jihad Kaouk 1
1 Department of Urology, Cleveland Clinic, Cleveland, Ohio, United States

ABSTRACT

AIM: Uretero-ileal anastomosis strictures (UAS) occur in 3 to 11% of patients who undergo ileal conduit urinary diversion after cystectomy. We aimed to demonstrate our surgical technique for robotic repair of UAS after cystectomy, focusing on the technical points.
MATERIALS AND METHODS: We present the case of a 75 year-old male with right hydronephrosis status post cystectomy with ileal conduit urinary diversion. Da Vinci Si® surgical system (Intuitive Surgical, Sunnyvale, CA) was docked and access into the abdominal cavity was gained. Uretero-ileal anastomosis was identified followed by ureteral stent visualization guiding the dissection. Stent was cut and further ureteral dissection was performed to maximize the length. Ureter was spatulated and specimen was sent for frozen section. Ileal conduit was incised at the site of the planned ureteral reimplantation. A new ureteral stent was inserted and the uretero-ileal anastomosis was performed. Thereafter, the previous site of the right ureteral anastomosis was closed.
RESULTS: Operative time was 120 minutes. Blood loss was 60mL. No perioperative complications occurred. Patient was discharged on postoperative day 1. Technical points for outcomes optimization during UAS robotic repair: 1) Preoperative placement of a ureteral stent is required for guidance and urinary diversion, 2) Port placement should be tailored according to the previous surgical site, 3) Maximal ureteral dissection facilitates reimplantation, 4) Frozen section from the stricture is mandatory to rule out malignancy.
CONCLUSIONS: In our experience, UAS repair is feasible and reproducible using a minimally invasive robotic approach. Comparative studies with open surgical approach are warranted.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180794_Garisto_et_al

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Step-by-Step: Fusion-guided prostate biopsy in the diagnosis and surveillance of prostate cancer

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0886


VIDEO SECTION

Nima Nassiri 1, Lauren Beeder 1, Azadeh Nazemi 1, Kian Asanad 1, John Um 1, Inderbir Gill 1, Masakatsu Oishi 1, 2, Suzanne L. Palmer 3, Manju Aron 4, Osamu Ukimura 1, 2, Andre Luis de Castro Abreu 1
1 Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; 2 Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; 3 Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; 4 Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

ABSTRACT

Objective: To provide a step-by-step technique for fusion-guided biopsy for prostate cancer diagnosis and surveillance.
Materials and Methods: All men with clinical indications for image-guided biopsy undergo 3-Tesla multiparametric magnetic resonance imaging (mpMRI) first. Lesions identified on mpMRI are graded using the Prostate Imaging-Reporting and Data System version 2.0 (PI-RADS v2) grading system. At the time of biopsy, real-time 3-dimensional (3D) transrectal ultrasound (TRUS) imaging is acquired and elastically fused with the mpMRI. Both targeted biopsies of MRI-derived suspicious lesions (PI-RADS 3-5) and systematic 12-core biopsies are performed. Patients without suspicious lesion on mpMRI undergo 3D TRUS-guided biopsy in standard templated fashion. In men placed on active surveillance (AS), prior positive sites are revisited using the trajectory and tracking functions of the fusion biopsy software.
Results: The advantages of MRI/TRUS fusion biopsy for prostate cancer diagnosis and surveillance are numerous. The 3D model created by elastic fusion of real-time TRUS imaging to mpMRI provides excellent visualization of prostate anatomy. Suspicious lesions on mpMRI can be accurately targeted, increasing detection of clinically significant prostate cancer. Biopsy trajectory visualization provides spatial localization of the trajectory of the cores within the prostate. Systematic biopsies are also taken in addition to targeted cores to minimize the effect of the mpMRI-invisible lesion. Prior positive biopsy sites can be tracked in men on AS.
Conclusions: Combined, the added benefits of prior lesion identification, adequate mapping of prostate anatomy and suspicious lesions, biopsy-trajectory visualization, tracking of prior positive biopsy sites, and combined targeted and systematic cores may offer the most effective method for prostate cancer diagnosis and surveillance.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180886_Nassiri_et_al

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Biological roles of filamin a in prostate cancer cells

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0535


ORIGINAL ARTICLE

Xue-Chao Li 1, Chuan-Xi Huang 2, Shi-Kui Wu 1, Lan Yu 3, Guang-Jian Zhou 3, Li-Jun Chen 1
1 Department of Urology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China; 2 College of Life Science, Hebei University, Hebei, China; 3 Laboratory of Medical Molecular Biology, Beijing Institute of Biotechnology, Beijing, China

ABSTRACT

Objective: This study aims to investigate the association of filamin A with the function and morphology of prostate cancer (PCa) cells, and explore the role of filamin A in the development of PCa, in order to analyze its significance in the evolvement of PCa.

Materials and Methods: A stably transfected cell line, in which filamin A expression was suppressed by RNA interference, was first established. Then, the effects of the sup­pression of filamin A gene expression on the biological characteristics of human PCa LNCaP cells were observed through cell morphology, in vitro cell growth curve, soft agar cloning assay, and scratch test.

Results: A cell line model with a low expression of filamin A was successfully con­structed on the basis of LNCaP cells. The morphology of cells transfected with plasmid pSilencer-filamin A was the following: Cells were loosely arranged, had less connec­tion with each other, had fewer tentacles, and presented a fibrous look. The growth rate of LNCap cells was faster than cells transfected with plasmid pSilencer-filamin A (P <0.05). The clones of LNCap cells in the soft agar cloning assay was significantly fewer than that of cells stably transfected with plasmid pSilencer-filamin A (P <0.05). Cells stably transfected with plasmid pSilencer-filamin A presented with a stronger healing and migration ability compared to LNCap cells (healing rate was 32.2% and 12.1%, respectively; P <0.05).

Conclusion: The expression of the filamin A gene inhibited the malignant development of LNCap cells. Therefore, the filamin A gene may be a tumor suppressor gene.

Keywords: Prostatic Neoplasms; Filamins; RNAi Therapeutics

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WITHDRAWN: Comparison of vacuum-assisted closure therapy and debridement with primer surgical closure for fournier’s gangrene treatment: 10 years’ experience of a single centre

Vol. 43 (x): 2017 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0052


ORIGINAL ARTICLE

Mustafa Ozan Horsanali 1, Utku Eser 2, Burcu O. Horsanali 3, Omer Altaş 3, Huseyin Eren 4
1 Department of Urology, Izmir Katip Celebi University Ataturk Training and Research Hos-pital, Izmir, Turkey; 2 Department of Family Medicine, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey; 3 Department of Anesthesiology and Reanimation, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey; 4 Department of Urology, Recep Tayyip Erdogan University, Rize, Turkey.

ABSTRACT

The International Brazilian Journal of Urology will retract this article because the authors were not authorized to publish the data according to the Department of Urology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey, where the paper was done.