Flexible peritoneal windows for quantitative fluorescence and bioluminescence preclinical imaging.

At present, there is considerable interest in the use of in vivo fluorescence and bioluminescence imaging to track the onset and progression of pathologic processes in preclinical models of human disease. Optical quantitation of such phenomena, however, is often problematic, frequently complicated by the overlying tissue's scattering and absorption of light, as well as the presence of endogenous cutaneous and subcutaneous fluorophores. To partially circumvent this information loss, we report here the development of flexible, surgically implanted, transparent windows that enhance quantitative in vivo fluorescence and bioluminescence imaging of optical reporters.

Laparoscopic nephron-sparing surgery in the management of angiomyolipoma: a single center experience.

Background And Purpose: Angioembolization is often the first-line treatment for patients with renal angiomyolipoma (AML). Regrowth and repeated hemorrhage after embolization, however, remain a concern. Laparoscopic partial nephrectomy (LPN) is the definitive, minimally invasive treatment alternative.

Recutting prostate needle core biopsies with high grade prostatic intraepithelial neoplasia increases detection of adenocarcinoma.

Objectives: We sought to evaluate the ability of biopsy core recutting to increase cancer detection in patients with high grade prostatic intraepithelial neoplasia (HGPIN).

Methods: This prospective study encompasses all patients undergoing 12 core TRUS guided prostate biopsy between February 2004 and January 2007. In patients with HGPIN on initial biopsy, the paraffin blocks were resampled for cancer by additional deeper levels per core.

An update on experience with the single-instrument port laparoscopic nephrectomy.

Objective: To describe a modification of the posterior prone retroperitoneoscopic nephrectomy, which allows the entire operation to be performed through a single instrument port.

Patients And Methods: With the patient prone, a retroperitoneal working space is created using a custom-made balloon lateral to the sacrospinalis muscle. One instrument port is placed at the tip of the 11th rib under direct vision.

Artery-only occlusion may provide superior renal preservation during laparoscopic partial nephrectomy.

Objectives: Artery-only occlusion (AO) has been used during nephron-sparing surgery to reduce ischemic damage. However, this has not been demonstrated in laparoscopic partial nephrectomy (LPN). We compared our experience with AO and both artery and vein occlusion (AV) in LPN to optimize the method of ischemia.

The predictive value of multi-targeted fluorescent in-situ hybridization in patients with history of bladder cancer.

Objectives: UroVysion (Abbott Molecular Inc., Des Plaines, IL) is a multi-target fluorescent in-situ hybridization (FISH) assay that detects aneuploidy of chromosomes 3, 7, and 17, and loss of the 9p21 locus in exfoliated cells in urine. In this study, we evaluated if UroVysion can predict tumor recurrence in patients with negative cystoscopy and urinary cytology at the time of (FISH) assay.

Hemostatic agents and instruments in laparoscopic renal surgery.

Control of bleeding is one of the most technically challenging steps in laparoscopic renal surgery, especially partial nephrectomy. Although there is no consensus on how best to approach hemostasis, the options continue to expand. The original method of sutured renorrhaphy is, perhaps, the most effective; however, great skill is needed to avoid prolonged warm ischemia.

Bladder neck contracture after robot-assisted laparoscopic radical prostatectomy: evaluation of incidence and risk factors and impact on urinary function.

Background And Purpose: Bladder neck contracture (BNC) after radical prostatectomy has been reported to occur in 5% to 32% of men after open retropubic prostatectomy (RRP) and in 0% to 3% after laparoscopic RRP. Optimal anastomotic closure involves creating a watertight, tension-free anastomosis with well-vascularized, mucosal apposition and correct realignment of the urethra. The cause of BNC is poorly understood; however, it is likely related to multiple factors, including excessive luminal narrowing at the site of reconstruction, local tissue ischemia, failed mucosal apposition, and urinary leakage.

Open surgical repair of ureteral strictures and fistulas following radical cystectomy and urinary diversion.

Purpose: Open surgery after cystectomy can be a challenge. We report the incidence of postoperative urinary diversion-enteric fistula and ureteral strictures in patients undergoing radical cystectomy, and discuss the diagnosis and management of these complications, including our surgical approach to these patients.

Materials And Methods: We preformed a retrospective review of 553 patients undergoing radical cystectomy and urinary diversion for bladder cancer between April 1999 and January 2007.

Case report: conservative management of a large capnothorax following laparoscopic renal surgery.

As indications for laparoscopy surgery continue to grow for management of upper urinary tract pathology, knowledge of the potential complications that may be encountered and their respective management are essential. Pneumothorax during laparoscopic renal surgery is typically related to a diaphragmatic injury that allows pressurized CO(2) to enter the thoracic cavity. The placement of a chest tube is usually required for large defects and symptomatic patients.

Bladder neck contracture after robot-assisted laparoscopic radical prostatectomy: evaluation of incidence and risk factors and impact on urinary function.

Purpose: Bladder neck contracture (BNC) after radical prostatectomy has been reported to occur in 5% to 32% of men after open radical retropubic prostatectomy (RRP) and 0% to 3% after laparoscopic RRP. Optimal anastomotic closure involves creating a watertight, tension-free anastomosis with well-vascularized, mucosal apposition and correct realignment of the urethra. The cause of BNC is poorly understood; however, it is likely related to multiple factors, including excessive luminal narrowing at the site of reconstruction, local tissue ischemia, failed mucosal apposition, and urinary leakage.

Prostate weight: an independent predictor for positive surgical margins during robotic-assisted laparoscopic radical prostatectomy.

Introduction: Pre-operative prediction of pathological stage represents the cornerstone of prostate cancer management. Patient counseling is routinely based on pre-operative PSA, Gleason score and clinical stage. In this study, we evaluated whether prostate weight (PW) is an independent predictor of extracapsular extension (ECE) and positive surgical margin (PSM).

Cystectomy in the ninth decade: operative results and long-term survival outcomes.

Introduction: Radical cystectomy (RC) with urinary diversion remains as one of the more complex urological procedures despite considerable progress in surgical technique. Increasing patient age, along with associated age-related comorbidities, may portend a poor outcome in those undergoing such complicated surgical procedures. Herein, we report our experience with radical cystectomy in the elderly population.

Comparison of laparoscopic radical and partial nephrectomy: effects on long-term serum creatinine.

Objectives: Laparoscopic partial nephrectomy (LPN) and radical nephrectomy (LRN) have been shown to be safe and effective treatment options for renal tumors. However, limited data are available regarding the long-term effect on postoperative renal function in patients undergoing LPN and LRN who have a normal preoperative serum creatinine (sCr) less than 1.5 mg/dL and a two-kidney system.

Current use of artificial urinary sphincters in the United States.

Purpose: Significant improvement and high patient satisfaction are seen after artificial urinary sphincter implantation for male stress urinary incontinence. However, only a small percent of men are treated with an artificial urinary sphincter nationally. We defined trends in current artificial urinary sphincter use in the United States, specifically focusing on regional differences in use.

Splenic cyst presenting as severe hydronephrosis in a pediatric patient.

Large cystic abdominal masses can represent a diagnostic dilemma despite advanced diagnostic and imaging techniques. We report a case of a large cystic mass initially managed as a giant ureteropelvic junction obstruction, but ultimately found to be a congenital splenic cyst. Focus is placed on the diagnostic evaluation of large cystic abdominal masses.