Surgical decompression is associated with decreased mortality in patients with sepsis and ureteral calculi.

Purpose: The combination of sepsis and ureteral calculus is a urological emergency. Traditional teaching advocates urgent decompression with nephrostomy tube or ureteral stent placement, although published outcomes validating this treatment are lacking. National practice patterns for such scenarios are currently undefined.

BioGlue surgical adhesive as a thermal reflector during laparoscopic cryoablation: effect on iceball size and ablation zone diameter.

Background And Objectives: Cryoablation represents an alternative for treating small renal cortical neoplasms (RCN). Previously, we demonstrated that applying BioGlue during cryoablation diminished bleeding and incidentally noted that the iceballs seemed larger than those in controls. We examined the effects of BioGlue as a thermal insulator of cryoablated tissue to determine its effect on iceball size.

Clinical, pathologic, and functional outcomes after nephron-sparing surgery in patients with a solitary kidney: a multicenter experience.

Background And Purpose: Surgical management of a renal neoplasm in a solitary kidney is a balance between oncologic control and preservation of renal function. We analyzed patients with a renal mass in a solitary kidney undergoing nephron-sparing procedures to determine perioperative, oncologic, and renal functional outcomes.

Patients And Methods: A multicenter study was performed from 12 institutions.

Comparison of two core biopsy techniques before and after laparoscopic cryoablation of small renal cortical neoplasms.

Introduction: Cryoablation is an acceptable treatment option for small renal cortical neoplasms (RCN). Unlike extirpative interventions, intraoperative needle biopsy is the only pathologic data for ablated tumors. It is imperative that sampled tissue accurately captures pathology.

Evaluation of perirenal fat as a predictor of cT 1a renal cortical neoplasm histopathology and surgical outcomes.

Background And Purpose: With the increasing detection of small renal cortical neoplasms (RCNs), the preoperative prediction of histopathology has become increasingly important. Because perirenal fat (PF) is known to be metabolically active, we evaluated PF as a predictor of renal tumor histopathology.

Patients And Methods: We retrospectively evaluated patients who underwent laparoscopic nephron-sparing procedures for cT(1a) RCN at two institutions.

The effect of extralumenal safety wires on ureteral injury and insertion force of ureteral access sheaths: evaluation using an ex vivo porcine model.

Objective: To evaluate the effect that a safety wire (SW) had on insertion force and direct ureteral trauma using ureteral access sheaths (UAS) in an ex vivo porcine model.

Material And Methods: UASs were advance into 20 fresh ex vivo porcine kidney-ureters, either with or without SWs. The average and max force of insertion were recorded.

Retrospective comparison of laparoscopic partial nephrectomy versus laparoscopic renal cryoablation for small (<3.5 cm) cortical renal masses.

Objective: We compared perioperative and short-term outcomes of renal laparoscopic partial nephrectomy (LPN) and laparoscopic cryoablation (LCA) in patients with small (<3.5 cm) renal cortical neoplasms.

Methods: A retrospective analysis from our prospectively established database was performed.

Nonischemic laparoscopic partial nephrectomy using a novel wet monopolar device in a porcine model.

Background And Purpose: Laparoscopic partial nephrectomy (LPN) is the minimally invasive standard of care for the management of a cT(1a) renal mass. We evaluated a novel saline enhanced electrosurgical resection (SEER) device for performance of a nonischemic LPN.

Materials And Methods: Six pigs were used in a nonsurvival pilot study.

Validating the use of the Mimic dV-trainer for robotic surgery skill acquisition among urology residents.

Objective: To compare robotic surgery skill acquisition of residents trained with Mimic dVTrainer (MdVT) and da Vinci Surgical System (dVSS) console. No standardized curriculum currently exists for robotic surgical education. The MdVT is a compact hardware platform that closely reproduces the experience of the dVSS.

Prospective randomized evaluation of gel mat foot pads in the endoscopic suite.

Background And Purpose: Several studies that compare open and laparoscopic procedures have demonstrated that the minimally invasive surgeon has greater musculoskeletal pain when compared with open surgeons. The purpose of our study was to demonstrate whether the use of the gel mat in the endoscopic setting offered any ergonomic benefit to the surgeon.

Materials And Methods: One hundred endoscopic procedures, by 11 different surgeons, were randomized intostudy (use of a gel mat) and control groups.

Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures.

Purpose: Prior studies suggest that renal pelvic urine culture is a more accurate predictor of urosepsis. We prospectively determined the correlation between preoperative bladder urine cultures, intraoperative renal pelvis cultures and stone cultures in patients undergoing percutaneous nephrolithotomy. We also examined post-procedure risk factors for systemic inflammatory response syndrome.

Independent diagnostic and post-treatment prognostic models for prostate cancer demonstrate significant correlation with disease progression end points.

Background And Purpose: A major advance in the standard practice of tissue-based pathology is the new discipline of systems pathology (SP) that uses computational modeling to combine clinical, pathologic, and molecular measurements to predict biologic activity. Recently, a SP-based prostate cancer (PCa) predictive model for both preoperative (Px+) and postoperative (Px) prostatectomy has been developed. The purpose of this study is to calculate the percent agreement and the concordance between the Px+ and Px end points.

Pilot study evaluation of standard laparoscopic suturing and a novel parenchymal apposition mechanism for minimally invasive renal reconstruction.

Objectives: The most technically demanding portion of a laparoscopic partial nephrectomy is the renorrhaphy. The purpose of this study was to determine whether a parenchymal apposition mechanism (PAM) device would be as effective as standard laparoscopic technique (SLT) with respect to efficiency, capability, and safety of renal defect closure.

Materials And Methods: In this pilot study, participants were recruited to perform surgical reconstruction of a standardized renal parenchymal defect with both SLT and the PAM.

Polyglyconate unidirectional barbed suture for posterior reconstruction and anastomosis during robot-assisted prostatectomy: effect on procedure time, efficacy, and minimum 6-month follow-up.

Background And Purpose: With widespread implementation of posterior rhabdosphincter reconstruction (RSR) followed by urethrovesical anastomosis (UVA), reconstruction has become a significant portion of robot-assisted laparoscopic prostatectomy (RALP). Successful anastomosis can be measured by time for reconstruction and the absence of urinary leak. We prospectively evaluated the experience of a single surgeon (KKB) in using the V-Loc™ wound closure device for the posterior RSR and UVA, and compared it with a standard reconstruction and anastomosis.

BioGlue iceball stabilization to minimize the risk of hemorrhage during laparoscopic renal cryoablation.

Objective: To evaluate the application of a BioGlue adhesive shell to minimize iceball fracture. Iceball fracture and hemorrhage is common with laparoscopic cryoablation (LCA) of larger (>4 cm) renal tumors.

Methods: Twenty large iceballs were created in porcine kidneys using 3 cryoablation probes in a nonsurvival study.

Evaluation of bioimpedance as novel predictor of extracorporeal shockwave lithotripsy success.

Background And Purpose: Obesity has been identified as a limitation of extracorporeal shockwave lithotripsy (SWL). The obesity metrics of body mass index (BMI) and skin-to-stone distance (SSD) have been evaluated as predictors of SWL success. While SSD has demonstrated a strong correlation with success, BMI has not.

Comparison of distal ureteral management strategies during laparoscopic nephroureterectomy.

Background And Purpose: The optimal approach for management of the distal ureter and bladder cuff (DUBC) during laparoscopic nephroureterectomy (LNU) for upper-tract transitional-cell carcinoma (TCC) is controversial. We describe our contemporary experience with LNU and compare several approaches to the DUBC.

Patients And Methods: A retrospective analysis was performed on 36 patients undergoing LNU.

Contemporary experience with laparoscopic partial nephrectomy.

Introduction: We evaluated our contemporary outcomes with laparoscopic partial nephrectomy (LPN) for renal cortical neoplasms (RCN) by an experienced single surgeon in our last 100 consecutive patients.

Methods: We reviewed a prospectively established database and identified 378 patients who underwent LPN for RCN. Data from the most recent 100 consecutive patients (June 2007 to August 2009) were evaluated for oncologic, functional, and recovery outcomes, and tumors were stratified by size.

Minimally invasive percutaneous ablation of parapelvic renal cysts and caliceal diverticula using bipolar energy.

Background And Purpose: The use of bipolar electrocautery has proven advantages over monopolar energy during transurethral surgery by limiting hyponatremia and its clinical sequelae. Percutaneous ablation of caliceal diverticula and parapelvic renal cysts has been shown to be an effective surgical approach for the management of these conditions when clinically indicated. We present single center results of percutaneous ablation of renal cysts and caliceal diverticula using a bipolar energy technique and compare the results with a cohort of patients undergoing the procedure using monopolar energy.

Active surveillance of renal cortical neoplasms: a contemporary review.

Introduction: Over the past 2 decades, there has been a significant increase in the number of incidentally found small renal cortical neoplasms (RCNs). As more RCNs are being discovered in the elderly and infirmed patient populations, there has been a growing interest in the role of active surveillance (AS). Active surveillance is recommended for high surgical-risk patients and those with a reduced life expectancy.

Laparoscopic ablation of renal neoplasms.

As a result of the widespread application of cross sectional imaging, there has been a significant rise in the incidence of small renal cortical neoplasms. The current standard of care in the management of these lesions is nephron-sparing extirpative surgery. In the last decade, however, image-guided or ablative therapies have garnered significant attention as nephron-sparing alternatives to partial nephrectomy.

Natural history of renal cortical neoplasms during active surveillance with follow-up longer than 5 years.

Objectives: To present our experience with patients who elected active surveillance for renal cortical neoplasms (RCNs) with ≥5 years of follow-up. Few data are available regarding the long-term natural history of RCNs during surveillance.

Methods: We retrospectively reviewed our urologic oncology database and identified 44 patients with 51 RCNs who had received active surveillance for >5 years of follow-up.

Contemporary experience with laparoscopic radical nephrectomy.

Introduction: We present our single-center contemporary experience with laparoscopic radical nephrectomy (LRN). LRN is an established minimally invasive approach comparable to open radical nephrectomy for the treatment of renal cortical neoplasms. Technical advancements and surgical experience with LRN mandate a re-evaluation of contemporary outcomes.

Prospective randomized single-blinded in vitro and ex vivo evaluation of new and reprocessed laparoscopic trocars.

Background: Reprocessing of single-use medical instruments has been proposed as a mechanism for managing the rising costs of health care. We compared the performance of new and reprocessed laparoscopic trocars.

Study Design: New and reprocessed laparoscopic trocars were evaluated.

Contemporary experience in the management of angiomyolipoma.

Purpose: We review our single center experience in the management of renal angiomyolipoma (AML) in patients who were treated with active surveillance (AS) or invasive treatment protocols.

Patients And Methods: A prospectively evaluated database was reviewed, and we identified 91 patients with the diagnosis of renal AML who presented between June 1985 and February 2009. Patient characteristics, clinical presentation, treatment modalities, and patient outcomes were evaluated.