The natural history of renal stone fragments following ureteroscopy.

Objectives: To describe the natural history of postureteroscopic renal stone fragments ≤4 mm based on computed tomography (CT) follow-up. The goal of ureteroscopy is to fragment stones, actively basket and remove fragments larger than 1 mm, and allow the remaining fragments to pass spontaneously. The reality is that smaller fragments may be difficult to extract or may be missed.

Is the transition from open to robotic prostatectomy fair to your patients? A single-surgeon comparison with 2-year follow-up.

Robot-assisted radical prostatectomy (RARP) is a procedure thought to require experience with a significant number of cases before mastering. Most RARP series examine outcomes after the learning curve or by combining results from multiple surgeons. We review a single surgeon's experience during the transition from open radical retropubic prostatectomy (RRP) to RARP using a matched case-control model.

Computed tomography-determined stone-free rates for ureteroscopy of upper-tract stones.

Background And Purpose: Most series on ureteroscopy for urolithiasis use postoperative plain radiography of the kidneys, ureters, and bladder (KUB) or intravenous urography (IVU) to determine outcomes. These imaging modalities, however, are not very sensitive and may overestimate stone-free rates (SFRs). The aim of our study was to assess SFRs after ureteroscopy for urolithiasis using CT follow-up.

Chronic prostatitis: management strategies.

The National Institutes of Health (NIH) has redefined prostatitis into four distinct entities. Category I is acute bacterial prostatitis. It is an acute prostatic infection with a uropathogen, often with systemic symptoms of fever, chills and hypotension.

Laparoscopic nephroureterectomy and management of the distal ureter: a review of current techniques and outcomes.

Laparoscopic nephroureterectomy (LNU) is becoming an increasingly common alternative treatment for transitional cell carcinoma (TCC) of the renal pelvis and ureter due to decreased perioperative morbidity, shorter hospitalization, and comparable oncologic control with open nephroureterectomy (ONU). Mobilization of the kidney and proximal ureter may be performed through a transperitoneal, retroperitoneal, or hand-assisted approach. Each technique is associated with its own benefits and limitations, and the optimal approach is often dictated by surgeon preference.

Impact of prostate median lobe anatomy on robotic-assisted laparoscopic prostatectomy.

Objectives: Robotic-assisted laparoscopic prostatectomy (RALP) is becoming widely used for the management of prostate cancer. Although prostate size does not affect operative times for RALP, the effect of a large median prostate lobe has not been described.

Methods: One hundred fifty-four men underwent RALP by one surgeon between 2005 and 2007.

Cystoscope- and robot-assisted bladder diverticulectomy.

Background And Purpose: Minimally invasive approaches to manage bladder diverticula have become increasingly popular; however, intracorporeal identification of bladder diverticula may be challenging. We report a novel technique for diverticular illumination using flexible cystoscopy.

Patients And Methods: After management of bladder neck obstruction, two patients with bladder diverticula and persistent lower urinary tract symptoms underwent robot-assisted bladder diverticulectomy.

A new computer enhanced visual learning method to train urology residents in pediatric orchiopexy: a prototype for Accreditation Council for Graduate Medical Education documentation.

Purpose: Residency programs must continue to restructure teaching and assessment of surgical skills to improve the documentation of Accreditation Council for Graduate Medical Education competencies. To improve teaching and documenting resident performance we developed a computer enhanced visual learning method that includes a curriculum and administrative reports. The curriculum consists of 1) study of a step-by-step surgical tutorial of computer enhanced visuals that show specific surgical skills, 2) a checklist tool to objectively assess resident performance and 3) a log of postoperative feedback that is used to structure deliberate practice.

Percutaneous radiofrequency ablation-induced perinephric hematoma with acute renal failure in a solitary kidney.

Iatrogenic occurrences (including radiologically guided renal biopsy, shockwave lithotripsy, and minimally invasive ablative procedures) of subcapsular hematoma that lead to acute renal failure are rare but serious. The advancement of minimally invasive procedures has led to an increase in this complication, especially in patients with a solitary kidney. Fortunately, prompt surgical evacuation of the hematoma in these patients allows decompression of the renal parenchyma and recovery of renal function.

Management of distal ureter in laparoscopic nephroureterectomy--a comprehensive review of techniques.

Approximately 5% of all urothelial tumors in adults arise from the upper tracts. While the gold standard treatment is open nephroureterectomy, laparoscopic nephroureterectomy is becoming increasingly popular. Oncologic principles dictate that complete excision of the transmural ureter and bladder cuff and avoidance of urine spillage are paramount.

Radiographic parameters on noncontrast computerized tomography predictive of shock wave lithotripsy success.

Purpose: Accurate prediction of shock wave lithotripsy success for given patient and radiographic parameters will lead to improved selection of patients for shock wave lithotripsy vs more invasive treatment. In this study we determined which radiographic parameters are the most predictive of shock wave lithotripsy success, and present a method to incorporate these into current and future models based on nonradiographic parameters.

Materials And Methods: A retrospective case-control study was performed to determine average, maximum and standard deviation of stone attenuation values, stone size and skin-to-stone distance on preoperative noncontrast computerized tomography for 220 patients successfully treated with shock wave lithotripsy and 105 patients in whom shock wave lithotripsy failed.

Clinical urological outcomes following primary tethered cord release in children younger than 3 years.

Purpose: Current practice at our institution is to recommend tethered cord release at diagnosis to prevent the onset or worsening of symptoms. Tethered cord release is frequently performed in children younger than 3 years who often have no urological manifestations. To our knowledge there are currently no long-term data on urological outcomes in this age group.

Asymptomatic bacteriuria and symptomatic urinary tract infections during pregnancy.

Urinary tract infections are common complications of pregnancy; upper tract infections in particular may lead to significant morbidity for both the mother and fetus. Bacteriuria is a significant risk factor for developing pyelonephritis in pregnant women. Therefore, proper screening and treatment of bacteriuria during pregnancy is necessary to prevent complications.