Transretroperitoneal Pedicled Omental Flap for Coverage of Traumatic Sacral Defect: A Case Report.

The greater omentum is a reliable choice for salvage soft-tissue reconstruction. Benefits include consistent anatomy, long pedicle length, and a high concentration of lymphatic tissue that is resistant to infection. We report the case of a 46-year-old man with a complex traumatic sacral wound resulting in severe limitation of reconstructive options.

Cost Analysis of Metallic Stents for Chronic Ureteral Obstruction: A Multicenter Study.

Introduction: Metallic and polymer ureteral stents are used to manage chronic ureteral obstruction. In general, metallic stents are more costly than polymer stents but they are changed less frequently. We examined the overall costs of using these stent types at 2 institutions.

Primary Renal Lymphoma Identified in a Robot-Assisted Laparoscopic Nephroureterectomy Specimen.

Background: Although renal involvement is often present in non-Hodgkin's lymphoma (NHL), primary renal NHL is a rare diagnosis.

Case Presentation: We present a case report of a 72-year-old asymptomatic male who underwent a robot-assisted laparoscopic radical nephroureterectomy on an atrophic left kidney with evidence of an infiltrating mass. Pathology report demonstrated a grade 1 follicular lymphoma.

Three-Dimensional Numerical Simulations of Peristaltic Contractions in Obstructed Ureter Flows.

Ureteral peristalsis can be considered as a series of waves on the ureteral wall, which transfers the urine along the ureter toward the bladder. The stones that form in the kidney and migrate to the ureter can create a substantial health problem due to the pain caused by interaction of the ureteral walls and stones during the peristaltic motion. Three-dimensional (3D) computational fluid dynamics (CFD) simulations were carried out using the commercial code ansys fluent to solve for the peristaltic movement of the ureter, with and without stones.

Crowd-Sourced Assessment of Technical Skills for Validation of Basic Laparoscopic Urologic Skills Tasks.

Purpose: The BLUS (Basic Laparoscopic Urologic Skills) consortium sought to address the construct validity of BLUS tasks and the wider problem of accurate, scalable and affordable skill evaluation by investigating the concordance of 2 novel candidate methods with faculty panel scores, those of automated motion metrics and crowdsourcing.

Materials And Methods: A faculty panel of surgeons (5) and anonymous crowdworkers blindly reviewed a randomized sequence of a representative sample of 24 videos (12 pegboard and 12 suturing) extracted from the BLUS validation study (454) using the GOALS (Global Objective Assessment of Laparoscopic Skills) survey tool with appended pass-fail anchors via the same web based user interface. Pre-recorded motion metrics (tool path length, jerk cost etc) were available for each video.

Validation of the AUA BLUS Tasks.

Purpose: Standardized assessment of laparoscopic skill in urology is lacking. We investigated whether the AUA (American Urological Association) BLUS (Basic Laparoscopic Urologic Skills) skill tasks are valid to address this need.

Materials And Methods: This institutional review board approved study included 27 medical students, 42 urology residents, 18 fellows and 37 faculty urologists across 8 sites.

Significance of Extraction Forces in Kidney Stone Basketing.

Introduction: Ureteroscopic stone extraction devices are effective tools in the management of urolithiasis, but on occasion, their improper use can cause injury to the ureter. Avulsion and perforation of the ureter as a result of excessive forces on the extraction device are some of the more serious complications of this treatment.

Materials And Methods: In this article, avulsion and perforation forces were measured by two different test setups.

Two Unexpected Tumors in a Laparoscopic Nephrectomy Specimen, Including a Rare Tubulocystic Renal-Cell Carcinoma: A Case Report.

We present a case of a 52-year-old Caucasian male who underwent a laparoscopic nephrectomy for an atrophic kidney and was found to have two unexpected, synchronous kidney cancers. He had a remote history of testicular cancer complicated by lymphadenopathy and external ureteral compression. Over time, he developed an atrophic left kidney from obstructive uropathy.

Low enhancing papillary renal cell carcinoma diagnosed by using dual energy computerized tomography: a case report and review of literature.

Background: Papillary renal cell carcinoma (pRCC) is a mixed group of tumors that constitutes about 15-20% of all renal cortical cancers. Strong enhancement on computerized tomography (CT) is a feature of clear cell, but not of pRCC making the differentiation of papillary tumors from benign cysts a diagnostic problem in some cases.

Case Presentation: We report here a case of a female patient with pRCC that was initially diagnosed as a benign renal cyst.

The use of internal stents in chronic ureteral obstruction.

Purpose: Despite the lack of a well delineated definition, chronic ureteral obstruction imposes significant quality of life loss, increased pathological morbidity and risk of mortality as well as substantial economic burden. Ureteral stenting serves as an important therapeutic option to alleviate obstruction. Thus, we assessed the recently published literature on chronic ureteral obstruction; treatment options; types, benefits and shortcomings of current ureteral stents; as well as outcomes and complications of chronic ureteral stenting, with the goal of providing concise management guidelines.

A case of a metanephric adenoma of the kidney surgically treated with robot-assisted laparoscopic partial nephrectomy.

Metanephric adenomas are a rare neoplasm of the kidney with less than 200 cases reported. We report a case of a metanephric adenoma incidentally found on imaging in a 52-year-old Hispanic female and treated with robot-assisted laparoscopic partial nephrectomy. A brief review of the literature is also included.

Human-relevant levels of added sugar consumption increase female mortality and lower male fitness in mice.

Consumption of added sugar has increased over recent decades and is correlated with numerous diseases. Rodent models have elucidated mechanisms of toxicity, but only at concentrations beyond typical human exposure. Here we show that comparatively low levels of added sugar consumption have substantial negative effects on mouse survival, competitive ability, and reproduction.

Ocular radiation exposure in modern urological practice.

Purpose: The human eye is a highly radiosensitive portion of the body and repeat radiation exposure can lead to cataract. The minimum fractionated long-term dose to initiate cataract formation is about 2,500 mSv. We determined whether further radiation related precautions are necessary to protect the eyes of the surgeon.

Cost analysis of metallic ureteral stents with 12 months of follow-up.

Background And Purpose: The metallic ureteral stent was first developed for patients with ureteral obstruction related to malignant disease, but it can be used in all patients needing chronic indwelling ureteral stents, including those with benign disease. The traditional method of polymer stent management often necessitates multiple exchanges per year depending on patient and logistical factors. This has significant direct financial cost and likely a negative effect on patients' overall health.

Supracervical robotic-assisted laparoscopic sacrocolpopexy for pelvic organ prolapse.

Background: Supracervical robotic-assisted laparoscopic sacrocolpopexy (SRALS) is a new surgical treatment for pelvic organ prolapse that secures the cervical remnant to the sacral promontory. We present our initial experience with SRALS in the same setting as supracervical robotic-assisted hysterectomy (SRAH).

Methods: Women with vaginal vault prolapse and significant apical defects as defined by a Baden-Walker score of greater than or equal to 3 who had not undergone hysterectomy were offered SRALS in combination with SRAH.

Metal ureteral stent for benign and malignant ureteral obstruction.

Purpose: Metal ureteral stents are a relatively new version of a device with a long history of relieving ureteral obstruction. Metal stents are effective for relieving ureteral obstruction but success regarding patient tolerability has been variable. We present our single institution experience with long-term metal ureteral stent placement.

Robot-assisted laparoscopic sacrouteropexy for pelvic organ prolapse in classical bladder exstrophy.

Classical bladder exstrophy is a rare congenital anomaly with male predominance. When occurring in women, the accompanying anatomical and functional abnormalities, including pelvic organ prolapse (POP), may cause significant problems in both pediatric and adult patients. The robotic surgical approach to POP has not been described for bladder exstrophy as it has been in otherwise normal women.

Robot-assisted laparoscopic skills development: formal versus informal training.

Introduction: The learning curve for robotic surgery is not completely defined, and ideal training components have not yet been identified. We attempted to determine whether skill development would be accelerated with formal, organized instruction in robotic surgical techniques versus informal practice alone.

Materials And Methods: Forty-three medical students naive to robotic surgery were randomized into two groups and tested on three tasks using the robotic platform.

Large bladder diverticulum presenting as an inguinal hernia.

We present the case of a 76-year-old man with a large bladder diverticulum presenting as an inguinal hernia with small bowel incarceration. Bladder herniation is extremely rare and when clinically suspected, computed tomography can be an important adjunct to diagnosis.

Renal insufficiency is not a contraindication for cryoablation of small renal masses.

Objective: Small, incidental renal masses are increasingly discovered in elderly patients with comorbid disease, such as chronic renal insufficiency (CRI). Observation of these masses or nephron-sparing surgery is the standard of care for these patients if possible. Laparoscopic renal cryotherapy (LRC) has been shown to be equivalent to laparoscopic partial nephrectomy in short-term follow-up for management of these masses.

Primary Hodgkin lymphoma of the adrenal gland: a unique case presentation.

Adrenal "incidentalomas" are commonly found on body imaging, and treatment of these lesions 4 cm-6 cm in size is controversial. Most of these lesions are benign adrenal cortical adenomas. Lymphoma is a rare disease manifestation in the adrenal gland, and the overwhelming majority are metastatic lesions.