VIDEOUROLOGY ABSTRACTS
2023; Mary Ann Liebert, Inc.; Volume: 37; Issue: 11 Linguagem: Inglês
10.1089/end.2023.29141.vid
ISSN1557-900X
Tópico(s)Urinary Bladder and Prostate Research
ResumoJournal of EndourologyVol. 37, No. 11 AbstractsFree AccessVIDEOUROLOGY ABSTRACTSPublished Online:8 Nov 2023https://doi.org/10.1089/end.2023.29141.vidAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail The Vortex Effect in Minimally Invasive Percutaneous NephrolithotomyWillian E. Ito, MD1, Dillon J. Prokop, BS2, Crystal Valadon, MD1, Bristol B. Whiles, MD1, Donald A. Neff, MD1, David A. Duchene, MD1, and Wilson R. Molina, MD11Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA.2School of Medicine, University of Kansas, Kansas City, Kansas, USA.Introduction: Minimally invasive percutaneous (MIP) nephrolithotomy was initially discredited with assumptions of difficult stone fragment retrieval because of the equipment's smaller size. However, in 2008 Nagele et al. described a hydrodynamic phenomenon that allowed stone retrieval without the aid of endoscopic tools.1–3 This study aims to describe the physical principles of the “vortex effect” to better understand its applicability in MIP procedures.Methods: Two acrylic phantom models were built based on the cross-sectional area (CSA) ratio of an MIP nephroscope and access sheaths (15/16F and 21/22F MIP-M™, Karl Storz®). The nephroscope–phantom was 10 mm in diameter. The access sheaths had diameters of 14 mm (CSA ratio: 0.69) and 20 mm (CSA ratio: 0.30). The models were adapted to generate hydrolysis, and hydrogen bubbles enhanced flow observation on a green laser background. After calibration, the experimental flow rate was set to 12.0 mL/sec. Three 30-second trials assessing the flow were performed with each model. Computational fluid dynamic simulations were completed to determine the speed and pressure profiles.Results: In both models, as the incoming fluid from the nephroscope–phantom attempted to move toward the collecting system, a stagnation point (SP) was demonstrated. No fluid entered the collecting system phantom. Utilizing the 14 mm sheath, we observed a random generation of several vortices and a pressure gradient (PG) of 114.4 Pa between the nephroscope's tip and SP. When the 20 mm sheath was examined, a significantly smaller PG (19.4 Pa) and no noticeable vortices were noted.Conclusions: The speed of the fluid and equipment geometry regulate the PG and the vortices field, which are responsible for the production of the vortex effect. Considering the same flow rate, a higher ratio between the CSA of the nephroscope and access sheath results in improved efficacy of the vortex.Patient Consent Statement: This is a bench study. No patients were involved in this study. Consent statements are not applicable to this type of study.http://online.liebertpub.com/doi/full/10.1089/vid.2023.0035Laparoscopic Heminephrectomy in Crossed Fused Renal Ectopia with Complex CystMoacir Cavalcante de Albuquerque Neto, MD, Thomé Décio Pinheiro Barros Júnior, MD, Nayrton Kalys Cruz dos Anjos, MD, Heron Oliveira Schots, MD, Guilherme Bastos Palitot de Brito, MD, and Fabio de Oliveira Vilar, MDUrology Clinic, Department of Surgery, Clinics Hospital, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.Introduction: Crossed fused renal ectopia (CFRE) is a rare congenital malformation, which presents when the kidney is located in the midline fused with the contralateral kidney.1,2 Clear cell renal carcinoma, although rare, is a condition that can be found in patients with CFRE.3 The vascular anatomy of the kidney is atypical and preoperative radiologic evaluation is important to surgical planning.4 Herein, we present a laparoscopic heminephrectomy in a patient with a complex cystic lesion in a CFRE.Materials and Methods: The patient is a 40 years old woman complaining of dysuria for 2 months. Urinalysis identified microscopic hematuria and ultrasonography showed a 3.9 × 3.5 cm cyst in the right kidney. Contrast-enhanced computed tomography showed CFRE to the right and a Bosniak IV cystic lesion in the right kidney, measuring 7.7 × 6.1 × 5.0 cm. The width of the fused portion of the parenchyma was 3.4 cm. Tc-99m dimercaptosuccinic acid scintigraphy showed mildly decreased relative tubular function in the left kidney. The preoperative estimated glomerular filtration rate (eGFR) was 53 mL/min per 1.73 m2. Right laparoscopic heminephrectomy was indicated. To better study the renal and vascular anatomy, an angiotomography was performed. The patient was positioned in the left lateral decubitus. The renal artery and renal vein were clipped using Hem-o-lok® and then divided. The isthmus was isolated and sectioned with an Echelon® vascular stapler. An abdominal drain was placed.Results: The operative time was 130 minutes, with no intraoperative complications. The patient was discharged with preserved renal function. Six months after surgery and with nephrologic follow-up, the eGFR was 63 mL/min per 1.73 m2. The histopathologic study showed cystic nephroma.Conclusion: Laparoscopic heminephrectomy in CFRE is an unusual procedure. Preoperative study of renal and vascular anatomy is recommended. The use of the vascular stapler is an option for sectioning the isthmus.Ethics Committee: The authors received and filed ethics committee consent for recording/publishing the video.Patient Consent Statement: The authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.http://online.liebertpub.com/doi/full/10.1089/vid.2023.0040Robot-Assisted Revision of Bilateral Ureteroenteric Anastomotic StricturesNirupama Ancha, BBA1, Safiya-Hana Belbina, MD1, Sofia Gereta, BA1, and Aaron Laviana, MD, MBA21Dell Medical School at The University of Texas at Austin, Austin, Texas, USA.2Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA.Background: The incidence of ureteroenteric stricture (UES) after radical cystectomy is approximately 8%.1–4 UES is often managed with long-term indwelling ureteral stents or nephrostomy tubes, both of which can have a negative impact on quality of life and require frequent exchange. In this video, we are the first to describe bilateral robotic-assisted revision of UES in a neobladder with the assistance of Firefly and Indocyanine Green (ICG).Clinical History: A 66-year-old male underwent an open cystoprostatectomy and open neobladder construction in 2016 due to bladder cancer. Seven years later, he presented with back pain and serum creatinine elevated to 3.5 mg/dL. He had no prior history of radiation.Physical Exam: Physical exam was significant for an intact midline incision from previous procedures.Diagnosis: Imaging revealed stable bilateral hydronephrosis from bilateral UES.Intervention: On presentation, the patient was managed with indwelling nephroureteral stents connected to external drainage. The patient strongly preferred definitive revision to avoid continuous nephroureteral stent exchange. As such, we proceeded with a robotic-assisted revision of bilateral ureteroenteric anastomoses in a neobladder. The surgery began with laparoscopic lysis of adhesions from the previous open procedures. ICG was given through the bilateral nephrostomy tubes to facilitate ureteral and neobladder identification and highlight healthy ureteral tissue. The right ureter was mobilized and resected sharply, and the old ureteral stent was exchanged. The right ureter was then spatulated sharply at the anterior roof, and a cystostomy was made into the afferent limb. A running anastomosis was performed with 4-0 polydioxanone suture and reinforced with 4-0 vicryl suture. The same technique was repeated on the left ureter. Due to the shortened length of the left ureter, it was reimplanted into the top of the afferent chimney, the portion of the neobladder having the most mobility. Bilateral nephrostomy tubes were removed intraoperatively.Follow-Up/Outcomes: The patient's postoperative course was uncomplicated. His serum creatinine normalized to 2.0 mg/dL. He was discharged home on postoperative day 5 with a foley catheter which was removed 10 days later. Both ureteral stents were removed cystoscopically and at 6 months postoperatively, he remains drain and stent free with a stable creatinine of 2.0 mg/dL. His hydronephrosis has also resolved. Overall, bilateral ureteroenteric anastomotic strictures are a significant complication of radical cystectomy and urinary diversion that are rarely documented. In this video, we are the first to validate the usefulness of a conventional robot-assisted system for simultaneous repair of bilateral UES in a neobladder.http://online.liebertpub.com/doi/full/10.1089/vid.2023.0031Donor-Gifted Allograft Staghorn Calculus Managed via Percutaneous NephrolithotomyMaria Veronica Rodriguez, MD1, Octavio Herrera, MD1, Brett Friedman, MD, MPH1, Mario Moya, MD2, andGaudencio Olgin, MD11Department of Urology, University of Texas at Rio Grande Valley, Doctors Hospital at Renaissance, Edinburg, Texas, USA.2Department of Interventional Radiology, Doctors Hospital at Renaissance, Edinburg, Texas, USA.Donor-gifted lithiasis presents in <1%. Presentation is asymptomatic given allograft denervation, but it can be associated with infections, hydronephrosis, or creatinine (Cr) elevations. Ultrasonography (US) offers the possibility to detect calculi that can be managed during transplantation. However, its use has remained controversial due to the infrequent occurrence of these events, making the benefits of imaging cadaveric kidneys unclear. Historically, the management can be achieved through medical expulsion therapy or any percutaneous procedures. For those stones 100 mL) and very large prostates (>150 mL) as it has favorable outcomes including low perioperative morbidity rates, blood loss, transfusion rates, and short recovery time.2–4 The learning curve is significantly shorter with RASP compared to LEP.4,5 RASP can also be utilized with same-day discharge pathway reducing the cost of care and healthcare burden.Here we describe our bladder-neck sparing technique for RASP with emphasis on intraoperative technical aspects to hasten the recovery and avoid the use of continuous bladder irrigation.Methods: Data were prospectively recorded from 24 patients who underwent outpatient RASP from September 2021 to March 2023 following the IRB approval. Patient demographics, preoperative, perioperative, and postoperative outcomes were collected. All patients followed an enhanced recovery after surgery protocol.Results: The mean age was 71.5 ± 7.8 years, mean body mass index was 28.8 ± 4.5 kg/m2, median preoperative Prostate Specific Antigen (PSA) was 5.9 (3.1–11) ng/mL, median preoperative AUA score was 20 (13.5–28.25), and 9 patients (37.5%) were in retention, median prostate size was 135 (101.5–158) mL, mean operative time was 138.3 ± 39.8 minutes, mean console time was 78 ± 20.1 minutes, estimated blood loss was 100 (50–100) mL, median weight of the removed specimen was 72.4 (47.1–95.1) mL, median hospital stay was 157 (116.5–180) minutes, median length of catheterization was 7-days. There were no perioperative complications, blood transfusions, conversions to open, or need for continuous bladder irrigation. Twenty-one (87.5%) patients were discharged home on the day of surgery. The median pain score at discharge time reported by 15 patients was 3 (0–5). Only 3 (25%) of 12 patients reporting on pain management needed to use opioids.All patients were able to urinate after the catheter removal. One patient was readmitted for blood clot retention due to strenuous exercise at 3-weeks postoperatively (Clavien Dindo class II).Incidental cancer (Gleason Score 3+3) was found in one patient (4.2%) who is now managed by monitoring the PSA levels every 3 months. The median postoperative 3-month PSA was 0.8 (0.48–1.65) ng/mL. Twenty patients reported their postoperative 3-month urinary continence status, and all of them were continent. The median postoperative 3-month AUA score reported by 15 patients was 5 (3–11). Only one patient needed reintervention postoperatively due to slowing of the urinary stream as he had a urethral mucosal flap from preoperative catheter injury.Conclusions: Outpatient RASP is safe with the described technique and is an excellent option for men with enlarged prostates while also eliminating routine hospital stays.Patient Consent Statement: Author(s) have received and archived patient consent for video recording/publication in advance of the video recording of the procedure.http://online.liebertpub.com/doi/full/10.1089/vid.2023.0051References1. Nagele U, Nicklas A. Vacuum cleaner effect, purging effect, active and passive wash out: A new terminology in hydrodynamic stone retrival is arising—Does it affect our endourologic routine? World J Urol 2016;34(1):143–144. Crossref, Medline, Google Scholar2. Nagele U, Schilling D, Anastasiadis AG, et al. [Minimally invasive percutaneous nephrolitholapaxy (MIP)]. Urologe A 2008;47(9):1066, 8–73. Crossref, Google Scholar3. 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Crossref, Medline, Google ScholarFiguresReferencesRelatedDetails Volume 37Issue 11Nov 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:VIDEOUROLOGY ABSTRACTS.Journal of Endourology.Nov 2023.1236-1240.http://doi.org/10.1089/end.2023.29141.vidPublished in Volume: 37 Issue 11: November 8, 2023PDF download
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