Robotics in urologic surgery.

Robotic surgery is becoming rapidly integrated in urology. Nearly every open or laparoscopic procedure has been described with robotic assistance. While the da Vinci robot is recently applied to the upper urinary tract, it has become widely adopted for performing radical prostatectomy.

Awake endotracheal intubation and prone patient self-positioning: anesthetic and positioning considerations during percutaneous nephrolithotomy in obese patients.

Background And Purpose: Obesity is associated with adverse outcomes with certain urologic procedures and may make patient positioning more difficult. We describe our technique of awake intubation and prone patient self-positioning before percutaneous nephrolithotomy (PCNL), and review the literature regarding prone positioning in obese patients and the impact of obesity on PCNL.

Methods: Patient preparation begins with detailed preoperative counseling regarding the procedure.

Outcomes of locally advanced (T3 or greater) prostate cancer in men undergoing robot-assisted laparoscopic prostatectomy.

Objectives: Despite nearly equivalent outcomes between open and robot-assisted laparoscopic prostatectomy (RALP) for organ-confined prostate cancer (PCa), the role of primary treatment with RALP in men with locally advanced (T3 or greater) PCa has not been described in detail. We report our experience with RALP for pathologically advanced disease.

Patients And Methods: From October 2005 to November 2008, 220 RALPs were performed by a single surgeon (R.

Stricture recurrence after urethroplasty: a systematic review.

Purpose: Urethroplasty remains the gold standard for the management of urethral stricture disease with acceptable long-term success. However, the standard by which stricture recurrence is defined and evaluated after urethral reconstruction remains widely variable. We conducted a systematic review of the urological literature to determine how stricture recurrence is defined and evaluated.

Robot-assisted radical prostatectomy in men aged > or =70 years.

Objectives: To assess the outcomes of elderly men with prostate cancer treated with robot-assisted radical prostatectomy (RARP), because more healthy elderly men will present with localized prostate cancer and many will seek surgical treatment as the population ages.

Patients And Methods: Between 2005 and 2008, 203 men had RARP performed by one surgeon; patients were categorized into two groups based on their age (> or =70 vs <70 years). All data were recorded prospectively in an institutional approved database.

Bladder neck contracture after retropubic radical prostatectomy: incidence and risk factors from a large single-surgeon experience.

Objective: To examine a large, single-surgeon series of patients with prostate cancer who underwent retropubic radical prostatectomy (RRP) for men with postoperative bladder neck contractures (BNCs).

Patients And Methods: From 1983 to 2007, 4132 men underwent RRP for prostate cancer by one surgeon. All patients had BN reconstruction with mucosal eversion.

Common variants in 8q24 are associated with risk for prostate cancer and tumor aggressiveness in men of European ancestry.

Background: Recent whole genome association studies have independently identified multiple prostate cancer (PC) risk variants on 8q24. We have evaluated association of common variants in this region with PC susceptibility and tumor aggressiveness in a sample of European American men.

Methods: Forty-nine tagging SNPs including three previously reported significant variants (rs1447295, rs6983267, rs16901979) and seven variants in the 5' upstream region of the MYC proto-oncogene were tested for association with susceptibility to PC and tumor aggressiveness in 596 histologically verified PC cases and 567 ethnically matched controls.

Pathological outcomes associated with the 17q prostate cancer risk variants.

Purpose: Recent studies have identified 2 distinct genetic variants along chromosome 17, including allele T of single nucleotide polymorphism rs4430796 on 17q12 and allele G of single nucleotide polymorphism rs1859962 on 17q24, that have been linked to prostate cancer risk. Less is known about tumor pathological features in carriers of these variants.

Materials And Methods: Genotypes for regions 17q12 and 17q24 were determined in 759 white men with prostate cancer and compared to those in 790 healthy control volunteers using logistic regression.

Characteristics of prostate cancers detected at prostate specific antigen levels less than 2.5 ng/ml.

Purpose: The Prostate Cancer Prevention Trial reported that 15% of men with a prostate specific antigen less than 4 ng/ml and a normal digital rectal examination have biopsy detectable prostate cancer. However, limited published data describe the tumor features of prostate cancer detected at low prostate specific antigen levels (less than 2.5 ng/ml).

The valence of event-based prospective memory cues or the context in which they occur affects their detection.

Event-based prospective memory tasks entail detecting cues or reminders in our environment related to previously established intentions. If they are detected at an opportune time, then the intention can be fulfilled. In Experiments 1a-1c, we gave people 3 different nonfocal intentions (e.

Bulbar urethral ligation for managing persistent urinary incontinence in young men with myelomeningocele.

Objective: To report our experience with ligation of the bulbar urethra for treating refractory stress incontinence in a selected group of young men with neuropathic bladders secondary to myelomeningocele (MM), in whom primary anti-incontinence procedures had failed.

Patients And Methods: Persistent urethral incontinence leading to chronic perineal skin ulceration can occur in these patients, despite aggressive medical and surgical efforts to decrease wetting by increasing bladder capacity, compliance and outlet resistance. Four young men with MM had bulbar urethral ligation; all had undergone a previous ileocystoplasty and functioning continent catheterizable channels (CCC, three appendicovesicostomies, one Monti procedure).

Outcomes of radical prostatectomy for patients with clinical stage T1a and T1b disease.

Objective: To compare the outcomes between patients with stage T1a/b with those of patients with T1c cancer of the prostate treated with radical retropubic prostatectomy (RRP), as the appropriate management of clinical stage T1a/b prostate cancer is subject to debate; although many patients are managed expectantly, some have adverse pathological features suggesting that more active treatment might be beneficial.

Patients And Methods: From 1983 to 2003, 3478 men had RRP by one surgeon. From this group, we retrospectively identified 29 men with clinical stage T1a and 83 with clinical stage T1b disease.

Implementation intentions about nonfocal event-based prospective memory tasks.

Implementation intentions are detailed and systematic plans that are developed during intention formation. We compared two different implementation intentions to standard event-based prospective memory instructions using three different kinds of intentions. Two of these intentions involved nonfocal cues whereas the remaining intention was about specific, focal cues.

Staged reconstruction of long segment urethral strictures in men with previous pediatric hypospadias repair.

Purpose: Reconstruction of long segment urethral stricture disease in adults with a history of pediatric hypospadias repair remains complex secondary to poor urethral blood supply, extensive penile scarring and the need for significant amounts of graft or flap tissue. We describe our experience with staged urethroplasty in this cohort of men.

Materials And Methods: A total of 15 males underwent staged urethroplasty for urethral stricture disease following previous hypospadias repair in childhood.

An ex vivo preparation of the intact mouse vomeronasal organ and accessory olfactory bulb.

The accessory olfactory system (AOS) in mammals detects and processes information from liquid-phase environmental odorants, including pheromones. The AOS carries out tasks such as individual recognition, learning, and decision-making with relatively few stages of neural processing; it thus represents an attractive system for investigating the neural circuits that carry out these functions. Progress in understanding the AOS has long been impeded by its relative inaccessibility to standard physiological approaches.

Impact of prostate median lobe anatomy on robotic-assisted laparoscopic prostatectomy.

Objectives: Robotic-assisted laparoscopic prostatectomy (RALP) is becoming widely used for the management of prostate cancer. Although prostate size does not affect operative times for RALP, the effect of a large median prostate lobe has not been described.

Methods: One hundred fifty-four men underwent RALP by one surgeon between 2005 and 2007.

Full-thickness abdominal skin graft for long-segment urethral stricture reconstruction.

Multiple tissue sources have been used for urethral reconstruction in adults. Patients with lichen sclerosis (LS), long segment strictures, or prior oral graft use have less available tissue for urethroplasty. We describe a technique for the use of a full-thickness skin graft of hairless abdominal skin for long segment urethroplasty.

Risk factors and management of urine leaks after partial nephrectomy.

Purpose: As nephron sparing surgery is used more frequently for select renal tumors, the incidence of urine leaks will likely increase. To our knowledge the risk factors of and management strategies for urine leaks have not been studied. We report our experience with the risk factors of and management for urine leaks after open and laparoscopic partial nephrectomy.

Pediatric robotic-assisted laparoscopic diverticulectomy.

Congenital bladder diverticula are rare anomalies of the bladder. Patients present with infection, hematuria, and/or urinary obstruction. We report on the case of a 12-year-old boy who developed gross hematuria and recurrent infection owing to a 12-cm bladder diverticulum.

DNA microarray comparisons of plant factor- and nitrogen deprivation-induced Hormogonia reveal decision-making transcriptional regulation patterns in Nostoc punctiforme.

Hormogonia are nongrowing filaments, motile by means of a gliding mechanism, that are produced by certain cyanobacteria. Their differentiation is induced by positive and negative factors for growth, such as deprivation of combined nitrogen (nitrogen stress induction [NSI]). In Nostoc punctiforme, they are also induced by the exudate (hormogonium-inducing factor [HIF]) of a symbiotic plant partner.

Reconstruction of urethral erosion in men with a neurogenic bladder.

Objective: To describe the surgical outcomes and operative technique for reconstructing catheter-induced urethral erosion in men with a neurogenic bladder.

Patients And Methods: This was a prospective study of 11 men (median age 45 years, range 26-52) who had elective urethroplasty for urethral erosion between 2004 and 2007 by one surgeon (C.M.

Urethroplasty in patients with kidney and pancreas transplants.

Purpose: In patients with solid organ transplants urethral strictures may develop from repeat catheterization, recurrent urinary tract infection or chronic irritation of the urethral mucosa secondary to contact with pancreatic enzymes. We describe surgical outcomes in patients with kidney and kidney-pancreas transplants after urethral reconstruction for stricture or fistula disease.

Materials And Methods: Ten males underwent urethroplasty for urethral stricture (9) or urethral fistula (1) disease after kidney or kidney-pancreas transplantation.

Orthotopic neobladder for bladder cancer and neurogenic bladder dysfunction.

Patients with neurogenic bladder (NGB) from spinal cord injury (SCI) are at increased risk for developing bladder cancer. The choice of urinary diversion in patients with NGB and bladder cancer remains controversial and is dependent on patient preference, manual dexterity, social support, and renal function. We describe the outcome of a man with NGB from SCI who developed bladder cancer, underwent cystectomy with creation of an orthotopic neobladder, and now voids by Valsalva.