Robot-assisted vasovasostomy using a single layer anastomosis.

Of all patients who have vasectomies performed in the United States, upwards of 6% will pursue a vasectomy reversal. Currently, the gold-standard reversal procedure is a microscopic vasovasostomy utilizing either a one or two-layer vasal anastomosis. Unfortunately, most urologists do not perform these procedures as they require extensive training and experience in microsurgery.

Intraocular Pressure During Robotic-assisted Laparoscopic Procedures Utilizing Steep Trendelenburg Positioning.

Purpose: To determine the effect of steep Trendelenburg (sTBURG) surgical positioning on intraocular pressure (IOP) during robotic-assisted laparoscopy (RAL) in subjects without previously identified ocular disease.

Design: Prospective cohort study.

Participants And Controls: Eighteen patients undergoing RAL with sTBURG and 21 controls undergoing open and laparoscopic cases in horizontal positioning.

Impact of statins on nephrolithiasis in hyperlipidemic patients: a 10-year review of an equal access health care system.

Aim: To investigate the impact of statin medications on urinary stone formation in hyperlipidemic patients.

Material And Methods: We searched outpatient military electronic health records from the Southwestern United States to identify adult patients with hyperlipidemia and urolithiasis. Military facilities serve active duty members, retirees, and their immediate family members.

Changes in urine parameters after desert exposure: assessment of stone risk in United States Marines transiently exposed to a desert environment.

Purpose: Living in a desert environment has been associated with a higher incidence of kidney stone formation, likely because of concentrated urine output, higher production of vitamin D and genetic predisposition. We determined the changes in urinary parameters after a group of United States Marines temporarily transitioned from a temperate environment to a desert environment.

Materials And Methods: A total of 50 Marines completed a questionnaire and performed 3, 24-hour urine collections before mobilization to the desert, after 30 days in the desert and 2 weeks after returning from the desert.

Percutaneous stone surgery using a tubeless technique with fibrin sealant: report of our first 107 cases.

Unlabelled: Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Small case series support the safety and efficacy of tubeless PCNL with fibrin sealant. However, there is a paucity of data from larger case series supporting this approach.

Robotic vasovasostomy: description of technique and review of initial results.

Vasovasostomy (VV) for iatrogenic infertility is commonly employed for patients with obstructive intervals of less than 15 years, with the microsurgical technique gaining favor over use of loupe magnification due to precision suture placement. We present our technique of a robot-assisted VV and compare surgical times of staff to resident. Twenty patients with iatrogenic infertility and obstructed intervals of less than 10 years underwent robot-assisted VV, 17 utilizing a single-layer reapproximation and 3 using a double-layer reapproximation.

Retroperitoneal robotic-assisted laparoscopic reimplantation of a ureter into an ileal conduit.

A novel technique for managing ureteroenteric strictures is robotic-assisted retroperitoneal laparoscopic reimplantation. A 63-year-old morbidly obese male underwent a left nephroureterectomy and cystoprostatectomy after neoadjuvant chemotherapy for transitional cell carcinoma of both the bladder and left kidney. His single right ureter was anastomosed to the ileal conduit.

Rectal cultures before transrectal ultrasound-guided prostate biopsy reduce post-prostatic biopsy infection rates.

Objective: To test our hypothesis that a targeted rectal screening protocol before transrectal ultrasound (TRUS)-guided biopsy would potentiate streamlined prophylaxis, thereby reducing postbiopsy infectious rates while minimizing unnecessary broad-spectrum antibiotic use. To this end, we instituted preprocedure rectal cultures in an effort to identify fluoroquinolone (FQ)- resistant flora using selective media to optimally direct targeted prophylactic antibiotic administration. The inexorably increasing prevalence of multidrug-resistant microorganisms, notably extended spectrum beta lactamase (ESBL)-producing and FQ-resistant Enterobacteriaceae has increased the post-TRUS prostatic biopsy infection rates, including life-threatening sepsis.

Genitourinary abnormalities in an asymptomatic screening population: findings on virtual colonoscopy.

Introduction: The true incidences of genitourinary conditions in the modern era are not completely known. We sought to determine the incidence of genitourinary abnormalities in a group of asymptomatic adult patients undergoing axial imaging with virtual colonoscopy.

Methods: We performed a post-hoc analysis of imaging results from a prospective, IRB-approved study that randomized patients to screening "virtual" CT colonography (CTC) followed by standard endoscopic colonoscopy.

Castleman's disease in the left suprarenal region, mimicking an adrenal neoplasm.

We present a rare case of a 16-year-old male patient with Castleman's disease (CD) manifest by a suspicious mass within the left suprarenal region abutting the left adrenal gland, mimicking an adrenal neoplasm. CD is an uncommon and poorly understood lymphoproliferative disorder that, when observed, typically occurs as a mediastinal mass. Two percent of cases reportedly occur in the pararenal region.

Practice patterns of primary care providers and urologists for use of medical expulsion therapy.

Purpose: Alpha-blockers and calcium channel blockers have shown promise for medical expulsion therapy (MET) of distal ureteral calculi < 1 cm in size. Although MET has been discussed in urology for some time, little has been written about MET in the emergency medicine and primary care literature. We sought to evaluate current practice patterns of MET among urologists, emergency medicine physicians, other primary care providers, and frontline military care providers.

The use of adjunctive hemostatic agents for tubeless percutaneous nephrolithotomy.

Tubeless percutaneous nephrolithotomy (PCNL) is a viable option for selected patients, particularly those with solitary calculi, multiple stones located in a single location, or those that can be accessed using one access tract. Benefits over the standard PCNL include reduced hospital stay, decreased pain, and decreased urine leak from the access site that would typically occur from around the nephrostomy tube. Hemostatic agents in the form of fibrin "glue" or gelatin matrix substances have been demonstrated to be safe and effective to augment the tubeless procedure.

Analysis of ureteric stent kinking forces: the role of curvature in stent failure.

Objective: To further characterize the kinking forces and degree of curvature that result in failure of various stents, as malignant obstruction of the ureter causes failure of about half of ureteric stents.

Materials And Methods: Several stents (Silhouette 4.6 F and 6 F, Applied Medical, Rancho Santa Margarita, CA; Sof-Curl Tecoflex 6 F, Gyrus ACMI, Southborough, MA; Polaris Ultra 6 and 7 F, and Percuflex 6, 7 and 8 F stents, Boston Scientific, Natick, MA, USA) were tested.

Do nonspecific deep corticomedullary sutures performed during partial nephrectomy adequately control major vascular and collecting system injury?

Objective: To critically evaluate the effectiveness of placing nonspecific deep corticomedullary sutures in the setting of major vascular and collecting system injury during laparoscopic partial nephrectomy (LPN). We also aimed to evaluate the incidence of ischaemic injury to the remaining renal remnant because of these sutures, as many laparoscopic centres have adopted this practice.

Materials And Methods: We performed open PN on eight porcine kidneys.

Analysis of ureteral stent compression force and its role in malignant obstruction.

Purpose: Extrinsic ureteral obstruction can be a challenging entity for the urologist since half of the ureteral stents placed for malignant obstruction fail. We evaluated the resistance to radial compression of various stents.

Materials And Methods: Silhouette(R) 4.

Myeloid (granulocytic) sarcoma of epididymis as rare manifestation of recurrent acute myelogenous leukemia.

Myeloid sarcoma involving the genitourinary system is a rare complication associated with acute myelogenous leukemia or other myeloproliferative disorders. The diagnosis is made by pathologic findings of diffuse infiltration of intermediate-size neoplastic cells and fibrosis of the affected organ. Immunohistochemically, the cells stain positive for myeloperoxidase, CD45, and CD117 but negative for CD34.

Testis cancer: a 20-year epidemiological review of the experience at a regional military medical facility.

Purpose: Testis cancer is the most common solid malignancy in the young adult population and the incidence in this population is increasing. We present a 20-year epidemiological review of testis cancers treated at our institution.

Materials And Methods: The records of testis cancer cases diagnosed between January 1988 and June 2007 were reviewed.

Important military role for medical expulsion therapy of urolithiasis.

Kidney stones are a major problem affecting military personnel and may lead to decreases in individual and unit readiness. Various medications, including steroids, calcium channel blockers, and alpha-adrenergic antagonists have been shown to aid in the spontaneous passage of ureteral calculi. Several recent randomized clinical trials have shown that selective alpha blockers improve stone passage rates.

Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less.

Purpose: The optimal management of lower pole renal calculi is controversial. We compared shock wave lithotripsy (SWL) and ureteroscopy (URS) for the treatment of patients with small lower pole stones in a prospective, randomized, multicenter trial.

Materials And Methods: A total of 78 patients with 1 cm or less isolated lower pole stones were randomized to SWL or URS.

Practice patterns of ureteral stenting after routine ureteroscopic stone surgery: a survey of practicing urologists.

Background: Controversy exists regarding the need for ureteral stent insertion after routine ureteroscopic stone surgery. We designed a questionnaire to assess and better understand the practice patterns of urologists for stent applications.

Materials And Methods: A 26-question survey was distributed to 570 community and academic urologists.

Retroperitoneoscopic radical nephrectomy for renal-cell carcinoma during twin pregnancy.

Renal-cell carcinoma (RCC) is rarely reported during pregnancy. Both the open and the laparoscopic approach to nephrectomy have been used effectively and safely in pregnant patients with RCC. We report a unique case of a 52-year-old woman found to have RCC during twin gestation who was treated with retroperitoneoscopic radical nephrectomy, one of the first such cases managed by this approach.

Effect of obesity on prostate-specific antigen recurrence after radiation therapy for localized prostate cancer as measured by the 2006 Radiation Therapy Oncology Group-American Society for Therapeutic Radiation and Oncology (RTOG-ASTRO) Phoenix consensus definition.

Background: Given the limited data regarding the impact of obesity on treatment outcomes after external beam radiation therapy (EBRT) for the definitive treatment of prostate cancer, the authors sought to evaluate the effect of obesity as measured by body mass index (BMI) on biochemical disease recurrence (BCR) using the most current 2006 Radiation Therapy Oncology Group-American Society for Therapeutic Radiation and Oncology (RTOG-ASTRO) Phoenix consensus definition (prostate-specific antigen [PSA] nadir + 2 ng/mL).

Methods: A retrospective cohort study identified men who underwent primary EBRT for localized prostate cancer between 1989 and 2003 using the Center for Prostate Disease Research (CPDR) Multi-center National Database. BMI was calculated (in kg/m(2)) and the data were analyzed.

Effect of freeze time during renal cryoablation: a swine model.

Background And Purpose: Cryotherapy provides a minimally invasive treatment for small renal tumors via an open, percutaneous, or laparoscopic approach. We sought to determine the most appropriate duration of freezing and the number of probes necessary to produce cell death without concomitant morbidity.

Materials And Methods: Nine domestic female pigs were divided into three groups of three animals each.

Metabolic abnormalities associated with calyceal diverticular stones.

Objective: To review the metabolic analyses of patients with calyceal diverticular stones who had surgical treatment of their calculi and to examine the effect of selective medical therapy on stone recurrence, as recent reports suggest that metabolic abnormalities contribute to stone development.

Patients And Methods: In all, 37 patients who had endoscopic treatment of symptomatic calyceal diverticular calculi were retrospectively reviewed. Stone composition and initial 24-h urine collections (24-h urinary volumes, pH, calcium, sodium, uric acid, oxalate, citrate, and the number of abnormalities/patient per collection) were compared with 20 randomly selected stone-forming patients (controls) with no known anatomical abnormalities.