Outcomes of Alternative Reservoir Placement in the Lateral Retroperitoneum During Inflatable Penile Prosthesis Placement.

Objectives: To describe outcomes of reservoir placement, exchange, and extraction from the lateral retroperitoneum (LR) in complex patients with a three-piece inflatable penile prosthesis (IPP).

Methods: A retrospective chart review was performed on all patients that underwent placement of an IPP from 2009 to 2019. Patients with placement of the reservoir in the LR were identified.

Three-Piece Inflatable Penile Prosthesis Placement Following Pelvic Radiation: Technical Considerations and Contemporary Outcomes.

Background: Pelvic radiation is a known risk factor for the development and progression of erectile dysfunction. When medical therapy fails, the 3-piece inflatable penile prosthesis (IPP) can offer patients a definitive treatment option. Because of radiation-induced vascular changes and tissue fibrosis, a careful surgical approach is necessary to avoid intraoperative complications and attain successful outcomes.

3-Piece Inflatable Penile Prosthesis Placement Following Radical Cystoprostatectomy and Urinary Diversion: Technique and Outcomes.

Background: After radical cystoprostatectomy (RC), postoperative erectile dysfunction (ED) is a common consequence with multiple contributing etiologies. The inflatable penile prosthesis (IPP) offers patients a definitive treatment option when ED is refractory to medical therapies. Because of the hostile postoperative anatomy of these patients, a careful surgical approach is necessary for successful outcomes and to avoid adjacent organ injury.

Vena Cavoscopy in the Assessment of Intraluminal Vena Caval Tumor Involvement.

Objective: To improve confirmation of complete tumor thrombus removal in advanced malignancy, we report on our experience using intraoperative vena cavoscopy using a flexible cystoscope to confirm complete thrombus resection. Patients with renal cell carcinoma or testicular cancer associated with inferior vena caval tumor involvement benefit from surgical resection of the primary tumor and the tumor thrombus. Intraoperative assessment of the vena cava represents a technical challenge, particularly when the thrombus is friable and involves the hepatic veins, or there is caudal extension of thrombus toward the bifurcation.

Critical Appraisal and Review of Management Strategies for Severe Fibrosis During Penile Implant Surgery.

Introduction: Penile corporal fibrosis represents a challenging clinical scenario for surgeons placing penile prostheses (PP). Because of its rarity, a small number of series with limited follow-up have reported outcomes in this cohort.

Aim: The aim of this study was to perform a critical appraisal of the corporal excavation technique, discuss its relevance to contemporary practice, and review alternative surgical methods and outcomes.

Total bladder and posterior urethral reconstruction: salvage technique for defunctionalized bladder with recalcitrant posterior urethral stenosis.

Purpose: Recalcitrant posterior urethral stenosis is a challenging disease. When combined with a defunctionalized bladder, cutaneous urinary diversion is the most common surgical option. We present a novel technique of total lower urinary tract reconstruction, combining salvage cystectomy, ileal neobladder formation and urethral pull-through, as an orthotopic alternative in patients with a defunctionalized bladder and recalcitrant posterior urethral stenosis.

Level III-IV inferior vena caval thrombectomy without cardiopulmonary bypass: long-term experience with intrapericardial control.

Purpose: Inferior vena cava tumor thrombectomy requires experienced surgical teams due to complex hemodynamic considerations. The teams often use vascular bypass techniques that introduce additional risk. Inferior vena caval control in the pericardium obviates the need for cardiopulmonary bypass.

Validation of a novel robotic-assisted partial nephrectomy surgical training model.

Unlabelled: What's known on the subject? and What does the study add? One area of particular growth for robotic surgery has been partial nephrectomy. Despite a perceived notion that robotic-assisted partial nephrectomy is more easily adaptable compared to laparoscopic partial nephrectomy, there is nonetheless an associated learning curve. Validated training models with a corresponding assessment method for robotic-assisted partial nephrectomy were previously unavailable.

Zero ischemia anatomical partial nephrectomy: a novel approach.

Purpose: We present a novel concept of zero ischemia anatomical robotic and laparoscopic partial nephrectomy.

Materials And Methods: Our technique primarily involves anatomical vascular microdissection and preemptive control of tumor specific, tertiary or higher order renal arterial branch(es) using neurosurgical aneurysm micro-bulldog clamps. In 58 consecutive patients the majority (70%) had anatomically complex tumors including central (67%), hilar (26%), completely intrarenal (23%), pT1b (18%) and solitary kidney (7%).

Eliminating global renal ischemia during partial nephrectomy: an anatomical approach.

Purpose Of Review: Partial nephrectomy surgery typically requires clamping the main renal artery. This creates the bloodless field necessary for precise tumor excision and reconstruction. However, hilar clamping also renders the entire kidney ischemic, an undesirable albeit unavoidable consequence.

Concurrent and predictive validation of a novel robotic surgery simulator: a prospective, randomized study.

Purpose: We evaluated the concurrent and predictive validity of a novel robotic surgery simulator in a prospective, randomized study.

Materials And Methods: A total of 24 robotic surgery trainees performed virtual reality exercises on the da Vinci® Skills Simulator using the da Vinci Si™ surgeon console. Baseline simulator performance was captured.

Anatomic renal artery branch microdissection to facilitate zero-ischemia partial nephrectomy.

Background: Robot-assisted and laparoscopic partial nephrectomies (PNs) for medial tumors are technically challenging even with the hilum clamped and, until now, were impossible to perform with the hilum unclamped.

Objective: Evaluate whether targeted vascular microdissection (VMD) of renal artery branches allows zero-ischemia PN to be performed even for challenging medial tumors.

Design, Setting, And Participants: A prospective cohort evaluation of 44 patients with renal masses who underwent robot-assisted or laparoscopic zero-ischemia PN either with anatomic VMD (group 1; n=22) or without anatomic VMD (group 2; n=22) performed by a single surgeon from April 2010 to January 2011.

Early comparison of nephrectomy options in children (open, transperitoneal laparoscopic, laparo-endoscopic single site (LESS), and robotic surgery).

Objective: To compare the perioperative parameters of paediatric patients who underwent nephrectomy via laparo-endoscopic single site (LESS) surgery (also known as single incision laparoscopic surgery or SILS) with those who underwent nephrectomy via conventional laparoscopy (LAP), robotic-assisted laparoscopy (RALN), and open surgery (OPEN).

Patients And Methods: The medical records of 69 paediatric patients at a single institution who underwent nephrectomies for non-functioning kidneys in 72 renal units (39 OPEN, 11 LAP, 11 RALN and 11 LESS) were reviewed for patient demographics and perioperative clinical parameters.

Results: The minimally invasive modalities in children, including LESS nephrectomy, were associated with shorter lengths of hospital stay (P < 0.

Face, content and construct validity of a novel robotic surgery simulator.

Purpose: We evaluated the face, content and construct validity of the novel da Vinci® Skills Simulator™ using the da Vinci Si™ Surgeon Console as the surgeon interface.

Materials And Methods: We evaluated a novel robotic surgical simulator for robotic surgery using the da Vinci Si Surgeon Console and Mimic™ virtual reality. Subjects were categorized as novice-no surgical training, intermediate-surgical training with fewer than 100 robotic cases or expert-100 or more primary surgeon robotic cases.

Renal cell carcinoma with inferior vena cava tumor thrombus and metastatic caval wall invasion.

We present a case of renal cell carcinoma with inferior vena caval tumor thrombus and metastatic involvement of the distal inferior vena cava.

Innovations in laparoscopic and robotic partial nephrectomy: a novel 'zero ischemia' technique.

Purpose Of Review: To describe a novel 'zero ischemia' technique for laparoscopic and robotic partial nephrectomy.

Recent Findings: Laparoscopic partial nephrectomy has been performed in 15 patients without the need for warm ischemia by utilizing pharmalogically induced hypotension. This consecutive series includes complex tumors in patients with multiple comorbidities.

"Zero ischemia" partial nephrectomy: novel laparoscopic and robotic technique.

Background: Ischemic injury impacts renal function outcomes following partial nephrectomy. Efforts to minimize, better yet, eliminate renal ischemia are imperative.

Objective: Describe a novel technique of "zero ischemia" laparoscopic (LPN) and robotic-assisted (RAPN) partial nephrectomy.

Laparoendoscopic single-site nephrectomy in pediatric patients: initial clinical series of infants to adolescents.

Objectives: To present our initial clinical series of laparoendoscopic single-site (LESS) nephrectomy using an umbilical incision in children ranging from infants to adolescents. Laparoscopic surgery in pediatric urology is increasingly being performed for many intra-abdominal ablative procedures, such as nephrectomy for poorly functioning kidneys. We have previously reported our initial experience with LESS surgery in the adult population.

Productivity and cost implications of implementing electronic medical records into an ambulatory surgical subspecialty clinic.

Objectives: Electronic medical records (EMRs) have been proposed as technology through which the quality of healthcare could be improved. We present an analysis of the cost and productivity implications associated with the transition from transcription to an EMR system in an ambulatory setting.

Methods: Data were collected from eight consecutive fiscal years from 1998 to 2005.

A prospective, randomized trial evaluating the use of hydrogel coated latex versus all silicone urethral catheters after urethral reconstructive surgery.

Purpose: The superiority of silicone over latex based catheters following urethral reconstructive surgery for stricture disease has been theorized, and yet data comparing their use in this group of patients are lacking. We present our findings from a prospective, randomized trial comparing silicone to hydrogel coated latex catheters in patients following urethral reconstructive surgery.

Materials And Methods: From February 2004 to August 2006 men undergoing urethral reconstructive surgeries were randomized to receive an all-silicone or a hydrogel coated latex urethral catheter for postoperative bladder drainage.