The Role of Experience: How Case Volume and Endourology-Fellowship Training Impact Surgical Outcomes for Ureteroscopy.

Surgical experience is associated with superior outcomes in complex urologic cases, such as prostatectomy, nephrectomy, and cystectomy. The question remains whether experience is predictive of outcomes for less complex procedures, such as ureteroscopy (URS). Our study examined how case volume and endourology-fellowship training impacts URS outcomes.

Outcomes over 20 years performing robot-assisted laparoscopic prostatectomy: a single-surgeon experience.

Objective: To evaluate a single surgeon's 20-year experience with robotic radical prostatectomy.

Methods: Patients who had undergone robot-assisted laparoscopic prostatectomy by a single surgeon were identified via an IRB approved prospectively maintained prostate cancer database. Patients were divided into 5-year cohorts (cohort A 2001-2005; cohort B 2006-2010; cohort C 2011-2015; cohort D 2016-2021) for analysis.

Use of a preoperative checklist reduces risk of penile prosthesis infection.

Purpose: Infection of a penile prosthesis is a devastating complication that necessitates the removal of all device components. Many aspects of preoperative and intraoperative infection prophylaxis practices have been examined but the specific relevant factors remain unknown. We determined whether use of a mandatory checklist of perioperative practices believed to reduce the risk of prosthesis infection would impact patient safety.

Monthly variations in urolithiasis presentations and their association with meteorologic factors in New York City.

Introduction: Nephrolithiasis in the United States has been on the rise during the past several decades. Temperature has been shown to directly correlate with increased stone disease. We examine the association between climactic factors and monthly urolithiasis presentation rates for 6 years at a single institution in New York City.

What is the "true" incidence of active surveillance and brachytherapy candidates in men undergoing robot-assisted radical prostatectomy?

Purpose: To correlate clinical low-risk prostate cancers with pathologic outcomes in men who are considered for active surveillance (AS), interstitial radiation therapy, or radical prostatectomy (RP).

Patients And Methods: Clinical and pathologic data of 76 consecutive patients who underwent RP by a single surgeon between October 2001 and July 2008 were reviewed. The retrospective review identified men with clinical low-risk disease--defined as a prostate-specific antigen (PSA) level <10 ng/mL, no Gleason pattern >3, no >2 cores positive, and no core >50%--who would also have been considered for AS and/or brachytherapy based on these features.

Resume fraud: unverifiable publications of urology training program applicants.

Purpose: We examined the incidence of resume fraud among urology residency applicants by determining the rate of misrepresented publications listed in applications to a urology residency program.

Materials And Methods: Applications from all 147 urology residency applicants to a program from the 2007 application cycle were analyzed. Verification of listed publications was attempted by querying PubMed, Google Scholar and MEDLINE.

Robot-assisted laparoscopic dismembered pyeloplasty.

Objective: Advanced laparoscopic skills limit the implementation of laparoscopic pyeloplasty to centers with extensive experience. The introduction of robotic technology into the field of minimally invasive surgery has facilitated complex surgical dissection and genitourinary reconstruction. We report our experience with robot-assisted laparoscopic pyeloplasty using the da Vinci Robotic Surgical System at 3 New York City medical centers.

Laparoscopic retrieval of retroperitoneal vas deferens in vasovasostomy for postinguinal herniorrhaphy obstructive azoospermia.

Objective: Iatrogenic injury to the vas deferens is a well-documented complication of inguinal hernia repair. Recently obstruction related to the use of polypropylene mesh for hernia repair has been reported. We describe a case using laparoscopy to mobilize the retroperitoneal vas and deliver it to the healthy vas proximal to the vas trapped in the cicatrix induced by mesh thus allowing a tension-free microsurgical repair.

Robot-assisted laparoscopic dismembered pyeloplasty: a combined experience.

Background And Purpose: The need for advanced laparoscopic skills limits the implementation of laparoscopic pyeloplasty to centers with extensive experience. The introduction of robotic technology into the field of minimally invasive surgery has facilitated complex surgical dissection and genitourinary reconstruction. We report our experience with robot-assisted laparoscopic pyeloplasty using the daVinci Surgical System at three New York City medical centers.

Laparoscopic adrenalectomy for isolated adrenal metastasis.

Background: Laparoscopic adrenalectomy is accepted by many as the standard of care for the majority of adrenal masses less than 8 cm. The question exists whether laparoscopic removal of metastatic lesions to the adrenal is more difficult than laparoscopic removal of primary adrenal lesions.

Methods: We performed a retrospective analysis of all laparoscopic adrenalectomies performed at a single institution from 1998 to 2001, comparing laparoscopic adrenalectomies for primary lesions of the adrenal gland versus isolated metastatic lesions to the adrenal gland.

Laparoscopic heminephrectomy for benign disease of the horseshoe kidney.

Background And Objective: Minimally invasive surgery plays a definitive role in the management of complications associated with the horseshoe kidney (HK). Aberrant vessels, the renal isthmus, and renal ectopia are all unique features of this anomaly that make the laparoscopic approach a challenge. We report our experience with this technique in 2 patients.

Ureteral ischemia model: an explanation of ureteral dysfunction after chronic obstruction.

Background And Purpose: Many models of smooth muscle ischemia have been developed to explain organ insufficiency or failure. Ureteral decompensation may also be described in these terms. We anticipate that ureteral ischemia will result from overdistention brought about by obstruction.

Tail stent versus re-entry tube: a randomized comparison after percutaneous stone extraction.

Objectives: To evaluate the efficacy of a 7F tail stent with an 18F Councill nephrostomy tube and compare it to a 24F re-entry Malecot nephrostomy tube after percutaneous nephrolithotomy.

Methods: Forty patients were prospectively randomized to receive either a 24F re-entry Malecot nephrostomy tube (group A, n = 20) or a 7F tail stent with an 18F Councill nephrostomy tube (group B, n = 20) for postoperative drainage. Patients were evaluated with an analogue scale questionnaire 15 days after percutaneous nephrolithotomy at the routine office follow-up visit asking them to rate the flank pain on a 0 to 10 scale, urinary urgency on a 0 to 10 scale, and quality of life, while the external drainage tubes were still in place.

Efficiency and efficacy of different intracorporeal ultrasonic lithotripsy units on a synthetic stone model.

Purpose: The efficiency and efficacy of the available intracorporeal ultrasonic lithotripters were compared in a stone model experiment.

Materials And Methods: Plaster of Paris (POP) stone phantoms having ratios of 1:1, 1.5:1, and 2:1 with water were fabricated into cubes of various hardnesses weighing an average of 24.

Endopyelotomy failure is associated with reduced urinary transforming growth factor-beta1 levels in patients with upper urinary tract obstruction.

Background And Purpose: We previously demonstrated that obstructed ureteropelvic junction (UPJ) segments from patients who had secondary pyeloplasty after endopyelotomy failure expressed transforming growth factor-beta1 (TGF-beta1) at levels significantly lower than patients who had primary pyeloplasty. In order to determine whether these differences in secreted TGF-beta1 are detectable preoperatively in the urine, the TGF-beta1 concentration of urine from patients undergoing endopyelotomy was determined and compared with that from subjects without urologic disease.

Materials And Methods: Bladder and renal pelvic urine from the obstructed side was obtained from patients (N = 34) undergoing primary endopyelotomy for UPJ obstruction.

[Endourologic treatment of transitional cell carcinoma of the upper urinary tract].

Nephrourete-rectomy with excision of a bladder cuff has been the standard treatment of the upper urinary tract transitional cell carcinoma. The very indolent behavior (GI, II, Ta, T1) of more than 50% and up to 82% of the upper urinary tract tumors treated with nephroureterectomy in different series in conjunction with the advent of sophisticated endourological techniques have permitted in certain cases alternative treatments using a conservative approach with either ureteropyeloscopy or percutaneous access. Ureteroscopy is reserved for ureteral tumors and small, simple tumors of the renal pelvis (< 1.

The laparoscopic Boari flap.

Purpose: Laparoscopic management of ureteral pathologies, such as ureteropelvic junction obstruction, ureteral calculi and retroperitoneal fibrosis, has proved to be highly effective. We present our initial experience with the laparoscopic Boari flap in regard to feasibility, safety and short-term results.

Materials And Methods: Three patients who presented with distal ureteral obstruction underwent preoperative radiographic evaluation, including excretory urography, computerized tomography and retrograde pyelography, that showed upper urinary tract dilatation at the site of obstruction.

Transitional-cell carcinoma of the renal pelvis: ureteroscopic and percutaneous approach.

There are a variety of publications advocating the ureteroscopic or the percutaneous approach for the treatment of transitional cell carcinoma of the renal pelvis. The diagnostic tool of choice for the upper urinary tract and collecting system is the flexible ureteroscope. One of the major concerns about ureteroscopic management of renal disease initially was the lack of flexibility of the instruments and therefore the inability to deal with demanding sites.

Ureteral reconstruction: small intestine submucosa for the management of strictures and defects of the upper third of the ureter.

Purpose: We evaluated the effectiveness of small intestine submucosa in ureteral reconstruction.

Materials And Methods: We report an experimental study in 6 female pigs weighing between 50 and 60 pounds. The animals were anesthetized, midline laparotomy was performed and two-thirds of the diameter of the upper third of the left ureter were incised parallel to the ureteral axis, leaving intact only a third of the ureteral wall for a segment of 7 cm.

In vitro bactericidal effect of a modified thermal Nitinol electrode.

Purpose: A standard electrode surgical generator connected to a Nitinol coil was used in vitro to evaluate whether the generated electromagnetic energy had any bactericidal effect on Escherichia coli.

Materials And Methods: The ATCC 259222 E. coli strain was used.

Comparison of symptoms related to positioning of double-pigtail stent in upper pole versus renal pelvis.

Purpose: This study was a comparison of the symptomatology associated with placement of the upper coil of a double-pigtail stent in the upper pole or the renal pelvis.

Patients And Methods: A prospective study with 40 patients was performed. In 20 patients, the stent was placed in the upper pole (Group A) and in another 20 patients (Group B) in the renal pelvis.

Laparoscopic ureteral reconstruction with small intestinal submucosa.

Purpose: To evaluate the feasibility of laparoscopic ureteral reconstruction with small intestinal submucosa (SIS) in the pig ureter.

Materials And Methods: Eight female pigs weighing between 25 and 30 kg were enrolled. After anesthesia was administered, a double-pigtail stent was inserted, the animals were moved to a lateral decubitus position, pneumoperitoneum was established, and three 10-mm ports were positioned.

Ureteral ischemia model: an explanation of ureteral dysfunction after chronic obstruction.

Background And Purpose: Many models of smooth muscle ischemia have been developed to explain organ insufficiency or failure. Ureteral decompensation may also be described in these terms. We anticipate that ureteral ischemia will result from overdistention brought about by obstruction.