Learning Curve for Robotic-Assisted Laparoscopic Retroperitoneal Lymph Node Dissection.

Robotic retroperitoneal lymph node dissection (R-RPLND) is a challenging procedure. We hypothesized that surgical times and operative complications would decrease as surgeons became more facile with R-RPLND. We retrospectively reviewed 121 consecutive R-RPLNDs performed at Naval Medical Center San Diego and Mayo Clinic Arizona by 4 fellowship trained robotic surgeons between 2008 and 2018.

Primary robotic RLPND for nonseminomatous germ cell testicular cancer: a two-center analysis of intermediate oncologic and safety outcomes.

Objective: To evaluate the intermediate-term oncologic outcomes and safety profile of the largest case series of primary robotic retroperitoneal lymphadenectomy for low-clinical-stage non-seminomatous germ cell testicular cancer.

Methods: This was a two-center retrospective analysis of robotic RPLND cases for low-clinical-stage (stage I-IIB) non-seminomatous germ cell testicular cancer in the primary setting. Demographic, perioperative, operative and oncologic variables were collected between March 2008 and May 2019.

Comparison of retroperitoneal and transperitoneal robotic partial nephrectomy for Pentafecta perioperative and renal functional outcomes.

Background: We compared quality outcomes between transperitoneal (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN).

Methods: Two-center retrospective analysis of TRPN and RRPN from 10/2009 to 10/2015. Perioperative/renal function outcomes were analyzed.

A 10-Year Retrospective Review of Nephrolithiasis in the Navy and Navy Pilots.

Purpose: Little is known about the incidence of nephrolithiasis in the United States Navy. Navy pilots must be kidney stone-free and are often referred for treatment of small asymptomatic stones. The primary objectives of this study were to determine the incidence of nephrolithiasis and computerized tomography, proportion undergoing treatment and incidence of stone related mishaps in Navy pilots compared with other Navy personnel.

Prospective Quality of Life in Men Choosing Active Surveillance Compared to Those Biopsied but not Diagnosed with Prostate Cancer.

Purpose: Active surveillance is an important alternative to definitive therapy for men with low risk prostate cancer. However, the impact of active surveillance on health related quality of life compared to that in men without cancer remains unknown. In this study we evaluated health related quality of life outcomes in men on active surveillance compared to men followed after negative prostate needle biopsy.

Robot-assisted retroperitoneal lymph node dissection in testicular cancer.

Robotic surgical techniques are now being applied in the setting of retroperitoneal lymphadenectomy (RPLND) for testicular cancer. While laparoscopic RPLND has not been widely accepted, reports of robot assisted RPLND (RARPLND) are emerging. This manuscript will review the application of RPLND for testicular cancer, evolution of minimally invasive techniques, the controversies, and current status of RARPLND.

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.

Prospective quality-of-life outcomes for low-risk prostate cancer: Active surveillance versus radical prostatectomy.

Background: For patients with low-risk prostate cancer (PCa), active surveillance (AS) may produce oncologic outcomes comparable to those achieved with radical prostatectomy (RP). Health-related quality-of-life (HRQoL) outcomes are important to consider, yet few studies have examined HRQoL among patients with PCa who were managed with AS. In this study, the authors compared longitudinal HRQoL in a prospective, racially diverse, and contemporary cohort of patients who underwent RP or AS for low-risk PCa.

Dyslipidemia is associated with an increased risk of nephrolithiasis.

The pathophysiology of nephrolithiasis is multifactorial. Obesity, diabetes mellitus and hypertension are implicated in its formation. Dyslipidemia (DLD) recently has received attention as well.

Operating characteristics of follicle-stimulating hormone in azoospermic men.

Objective: To validate factors predictive of nonobstructive azoospermia (NOA) and to determine the operating characteristics of FSH for predicting NOA.

Design: Retrospective cohort study.

Setting: Tertiary care military treatment facility.

Determinants of renal functional decline after open partial nephrectomy: a comparison of warm, cold, and non-ischemic modalities.

Introduction: Renal functional decline after partial nephrectomy (PN) may be related to a variety of nonmodifiable and modifiable factors, including ischemia time (IT) and modality. We sought to determine the impact of these factors on renal functional degeneration after PN.

Materials And Methods: Multicenter retrospective analysis (n = 347) was performed, identifying patients who underwent open PN using warm, cold, and non-ischemic techniques.

Impact of tumour morphology on renal function decline after partial nephrectomy.

Objective: To examine the association of renal morphology with renal function after partial nephrectomy (PN).

Patients And Methods: We conducted a multi-institutional retrospective analysis of 322 PNs performed between 2003 and 2011. The RENAL nephrometry score for each lesion was determined and the estimated glomerular filtration rate (eGFR) was calculated preoperatively and at last follow-up.

RENAL nephrometry score is associated with complications after renal cryoablation: a multicenter analysis.

Objective: To analyze outcomes and complications of percutaneous (PRC) and laparoscopic renal cryoablation (LRC) using the radius, endophytic, nearness to collecting system, anterior/posterior, and location (RENAL) nephrometry system.

Methods: Retrospective multicenter analysis of 154 consecutive patients who underwent either ultrasound-guided LRC (n = 88) or computed tomography (CT)-guided PRC (n = 66) from March 2003 to December 2011. RENAL score and demographics were compared to postoperative complications (Clavien).

Telementoring in robotic surgery.

Purpose Of Review: To provide an overview of the current concepts regarding telementoring with robotic surgery highlighting recent advances with respect to urological minimally invasive surgery (MIS).

Recent Findings: As robotic surgery continues to evolve, telementoring will become a viable alternative to traditional on-site surgical proctoring.

Summary: MIS represents one of the most important breakthroughs in medicine over the past few decades.

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.

RENAL nephrometry score is associated with operative approach for partial nephrectomy and urine leak.

Objective: To identify whether RENAL nephrometry score is associated with partial nephrectomy (PN) technique. RENAL nephrometry score quantifies anatomic characteristics of renal tumors. Data are limited regarding clinical utility for surgical planning.

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.

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.

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.