ahead of print

One-sided anterior Urethroplasty for panurethral stricture: step-by-step

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

doi: 10.1590/S1677-5538.IBJU.2018.0174


VIDEO SECTION

Willian Eduardo Ito 1, Marco Aurélio Rodrigues 1, Silvio Henrique Maia de Almeida 1
1 Disciplina de Urologia, Universidade Estadual de Londrina Centro de Ciencias da Saude, Londrina, PR, Brasil

ABSTRACT

Not available

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180174_Ito_et_al

[Full Text]


 

New technologies for old procedures: when Firefly improves robotic bladder diverticulectomy

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

doi: 10.1590/S1677-5538.IBJU.2018.0495


VIDEO SECTION

Francesca Vedovo 1, Bernardino de Concilio 2, Guglielmo Zeccolini 2, Tommaso Silvestri 1, Antonio Celia 2
1 Department of Urology, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy; 2 Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy

ABSTRACT

Introduction: Several techniques have been described to aid in the intra-operative identifi cation of the bladder diverticula.
The video shows the peculiar advantage of using Firefl y Fluorescence Imaging da Vinci System® (FFIS) during bladder diverticula detection and dissection (BD).
Material and Methods: Patient is placed in the lithotomic position. A transperitoneal access to the bladder is preferred. A flexible cystoscopy with the FFIS is performed. This procedure facilitates the diverticulum detection. This near-infrared technology can be usefully utilized to facilitate the diverticulum dissection. Using sharp and blunt dissection, the diverticulum is totally resected. Bladder is sutured in two absorbable layers. Drainage is placed in the Retzius space and a peritoneum reconstruction is performed.
Results: Between 2016 and 2017, 4 BDs with intraoperative FFIS were performed in our Center. Median operative time was 110 minutes. Mean time of postoperative catheterization was 11 days and mean length of stay was 4 days. No significant post void residual neither urine extravasation after catheter removal occurred. No Clavien-Dindo post-operative complications ≥2 have been reported. Several approaches have been described for intra-operative diverticulum identification and its dissection: Parra used a cystoscopic transillumination of diverticulum; Das proposed the use of a Foley 50 mL balloon inserted in the diverticulum, while Nadler used a balloon catheter, placed in the...

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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...

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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...

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Outcomes of endovascular treatment of renal arterial stenosis in transplanted kidneys

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

doi: 10.1590/S1677-5538.IBJU.2018.0737


ORIGINAL ARTICLE

Alexandre Sallum Bull 1, Affonso Celso Piovesan 1, Giovanni Scala Marchini 1, Kleiton Gabriel Ribeiro Yamaçake 1, Ioannis Michel Antonopoulos 1, Renato Falci 1, Hideki Kanashiro 1, Gustavo Ebaid 1, Francisco César Carnevale 2, Gustavo Messi 1, William Carlos Nahas 1
1 Divisão de Urologia, Unidade de Transplante Renal, Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil; 2 Unidade de Radiologia Intervencionista da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil

ABSTRACT

Objective: To evaluate the effectiveness and outcomes of endovascular treatment of TRAS with PTA.

Materials and Methods: We searched our prospectively collected database looking at cases of TRAS between January 2005-December 2011. CCT was the gold-standart for diagnosis of TRAS. Parameters analysed comprised technical aspects, arterial blood pressure variation, and renal function. A minimum follow-up of 24 months was considered.

Results: Of the 2221 renal transplants performed in the selected period, 22 (0.9%) patients were identifi ed with TRAS. Fourteen (63.6%) were male and mean age was 377±14.8years (12-69). Kidney graft was from deceased donnors in 20 (80%) cases.

On doppler evaluation, mean blood fl ow speed after transplantation, at TRAS diagnosis and after TAP was 210.6±99.5, 417±122.7 and 182.5±81.6mL/sec, respectively (p<0.001). For SBP and DBP, there was a signifi cant difference between between preintervention and all post-treatment time points (p<0.001). After 1 month of the procedure, there was stabilization of the Cr level with a signifi cant difference between mean Cr levels along time (p<0.001). After a mean follow-up of 16±4.2 (3-24) months, overall success rate was...

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Portable model for vasectomy reversal training

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

doi: 10.1590/S1677-5538.IBJU.2019.0092


ORIGINAL ARTICLE

Luis Otávio Amaral Duarte Pinto 1, Charles Alberto Villacorta de Barros 1, Anderson Bentes de Lima 1, Deivid Ramos dos Santos 1, Herick Pampolha Huet de Bacelar 1
1 Programa de Mestrado Profissional em Cirurgia e Pesquisa Experimental, Universidade do Estado do Pará – Uepa, Belém, PA, Brasil

ABSTRACT

Objectives: to validate an experimental non-animal model for training of vasectomy reversal.

Materials and Methods: The model consisted of two artificial vas deferens, made with silicon tubes, covered by a white resin, measuring 10 cm (length) and internal and external diameters of 0.5 and 1.5 mm, respectively. The holder of the ducts is made by a small box developed with polylactic acid, using a 3D print. The objective of the invention is to simulate the surgical fi eld of vasovasostomy, when the vas deferens are isolated from other cord structures. For validation, it was verifi ed the acquisition of microsurgical skills during its use, in a capacitation course with 5 urology residents from a Hospital of the region. Along the training sessions, it was analyzed the time (speed) of microsurgical sutures, and quantifi cation of the performance using a checklist. Collected data were analyzed using de BioEstat®5.4 software.

Results: Medium time for the completion of microsurgical sutures improved considerably during the course, and reached a plateau after the third day of training (p=0.0365). In relation to the checklist, it was verified that during capacitation, there was significant improvement of the scores of each participant, that reached a plateau after the fourth day of training with the model (p=0.0035).

Conclusion: The developed model was able to allow the students that attended the course to gain skills in microsurgery, being considered...

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