A Randomized, Single-Blind Clinical Trial Comparing Robotic-Assisted Fluoroscopic-Guided with Ultrasound-Guided Renal Access for Percutaneous Nephrolithotomy.

Purpose: We conducted a randomized, single-blind clinical trial comparing the surgical outcomes of robotic-assisted fluoroscopic-guided (RAF group) and ultrasound-guided (US group) renal access in mini-percutaneous nephrolithotomy (PCNL).

Materials And Methods: We recruited patients who underwent mini-PCNL with ureteroscopic assistance for large renal stones between January 2020 and May 2021. Block randomization was performed using online software.

A Rare Case of Acute Urinary Bladder Diverticulitis Mimicking Acute Appendicitis.

BACKGROUND Urinary bladder diverticula are common. They are typically asymptomatic and usually discovered incidentally. Urinary bladder diverticulitis, in contrast to colonic diverticulitis, is an extremely rare occurrence.

Automated Needle Targeting with X-ray (ANT-X) - Robot-assisted device for percutaneous nephrolithotomy (PCNL) with its first successful use in human.

Introduction: To make percutaneous access easier in PCNL, we developed Automated Needle Targeting with X-ray (ANT-X).

Method: ANT-X uses an image registration software with a closed loop feedback system to autoalign the puncture needle to the desired calyx using the bullseye technique. We tried percutaneous punctures on a live pig model and compared the results with free-hand technique.

Which is best method for instillation of topical therapy to the upper urinary tract? An in vivo porcine study to evaluate three delivery methods.

Purpose: To compare the staining intensity of the upper urinary tract (UUT) urothelium among three UUT delivery methods in an in vivo porcine model.

Materials And Methods: A fluorescent dye solution (indigo carmine) was delivered to the UUT via three different methods: antegrade perfusion, vesico-ureteral reflux via indwelling ureteric stent and retrograde perfusion via a 5F open-ended ureteral catheter. Twelve renal units were tested with 4 in each method.

MRI Fusion-Targeted Transrectal Prostate Biopsy and the Role of Prostate-Specific Antigen Density and Prostate Health Index for the Detection of Clinically Significant Prostate Cancer in Southeast Asian Men.

Objective: To test the hypothesis that targeted biopsy has a higher detection rate for clinically significant prostate cancer (csPCa) than systematic biopsy. We defined csPCa as any Gleason sum ≥7 cancer. In patients with Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions, to determine if factors, such as prostate-specific antigen density (PSAD) and prostate health index (PHI), can predict csPCa and help select patients for biopsy.

Malakoplakia of the Prostate as a Mimicker of Prostate Cancer on Prostate Health Index and Magnetic Resonance Imaging-Fusion Prostate Biopsy: A Case Report.

Isolated malakoplakia of the prostate is a rare inflammatory condition that has been clinically mistaken for prostatic malignancies. The development of Prostate Imaging Reporting and Data System (PI-RADS) classifications, and Prostate Health Index (PHI) has led to more accurate diagnosis of clinically significant disease and stratification of patients that may be at risk of prostate cancer. We present a case of a 75-year-old male who was on follow-up with our hospital for elevated prostate specific antigen (PSA).

Prospective validation of %p2PSA and the Prostate Health Index, in prostate cancer detection in initial prostate biopsies of Asian men, with total PSA 4-10 ng ml-1.

Despite its widespread use for prostate cancer screening, low specificity makes PSA a suboptimal biomarker, especially in the diagnostic "gray zone" of 4-10 ng ml-1 . False-positives lead to unnecessary biopsies with attendant morbidities. This is the first prospective validation study of %p2PSA and the Prostate Health Index (PHI) in Asian men presenting with a total PSA between 4.

Minimally invasive percutaneous management of large bladder stones with a laparoscopic entrapment bag.

Introduction: The treatment of large volume bladder stones is a management conundrum. Transurethral methods are plagued by long operative times, trauma to the bladder mucosa, and the need for a postoperative urethral catheter. Open cystolithotomy has higher morbidity.

A comparison of long term renal functional outcomes following partial nephrectomy and radiofrequency ablation.

Introduction: To compare long term glomerular filtration rate (GFR) outcomes of partial nephrectomy and radiofrequency ablation performed for renal malignancy.

Materials And Methods: Renal function of 347 patients undergoing radiofrequency ablation (n = 142) or partial nephrectomy (n = 205) for renal malignancy between 1994 and 2011 were compared from a retrospective database at a single tertiary care center. Minimum 1 year of follow up was required, resulting in a mean follow up of 48.

Minimally invasive pyeloplasty in horseshoe kidneys with ureteropelvic junction obstruction: a case series.

Background And Purpose: Horseshoe kidney is an uncommon renal anomaly often associated with ureteropelvic junction (UPJ) obstruction. Advanced minimally invasive surgical (MIS) reconstructive techniques including laparoscopic and robotic surgery are now being utilized in this population. However, fewer than 30 cases of MIS UPJ reconstruction in horseshoe kidneys have been reported.

Evaluation of anatomic and morphologic nomogram to predict malignant and high-grade disease in a cohort of patients with small renal masses.

Objective: To evaluate a nomogram using the RENAL Nephrometry Score (RENAL-NS) that was developed to characterize masses as benign vs. malignant and high vs. low grade in our patients with small renal masses treated with partial nephrectomy (PN).

Irreversible electroporation: evaluation of nonthermal and thermal ablative capabilities in the porcine kidney.

Objective: To compare the renal ablative capabilities of nonthermal irreversible electroporation (NT-IRE) with those of thermal irreversible electroporation (T-IRE) in a porcine model.

Materials And Methods: A total of 24 laparoscopic renal ablations were performed in 12 pigs using a novel generator capable of alternately delivering NT-IRE and T-IRE. Each pig underwent unilateral interpolar ablation straddling the renal pelvis and lower pole ablation, using a single modality.

Management of stones in abnormal situations.

Stones in abnormal situations present a management conundrum to the urologist. Many of these situations are relatively rare and literature is scanty on the appropriate management. We review the current literature on the management of stones in the setting of pregnancy, calyceal diverticulum, urinary diversions, pelvic kidneys, transplant kidneys, autosomal dominant polycystic kidney disease, horseshoe kidneys, and other renal anomalies.

Laparoendoscopic single site (LESS) in vivo suturing using a magnetic anchoring and guidance system (MAGS) camera in a porcine model: impact on ergonomics and workload.

Objective: To compare the ergonomics and workload of the surgeon during single-site suturing while using the magnetic anchoring and guidance system (MAGS) camera vs a conventional laparoscope.

Methods: Seven urologic surgeons were enrolled and divided into an expert group (n=2) and a novice group (n=5) according to their laparoendoscopic single-site (LESS) experience. Each surgeon performed 2 conventional LESS and 2 MAGS camera-assisted LESS vesicostomy closures in a porcine model.

Comparison between magnetic anchoring and guidance system camera-assisted laparoendoscopic single-site surgery nephrectomy and conventional laparoendoscopic single-site surgery nephrectomy in a porcine model: focus on ergonomics and workload profiles.

Purpose: To compare surgeon-assessed ergonomic and workload demands of magnetic anchoring and guidance system (MAGS) laparoendoscopic single-site surgery (LESS) nephrectomy with conventional LESS nephrectomy in a porcine model.

Methods: Participants included two expert and five novice surgeons who each performed bilateral LESS nephrectomy in two nonsurvival animals using either the MAGS camera or conventional laparoscope. Task difficulty and workload demands of the surgeon and camera driver were assessed using the validated National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire.

Novel iron oxide microparticles used to render stone fragments paramagnetic: assessment of toxicity in a murine model.

Purpose: We developed novel peptide coated iron oxide supraparamagnetic microparticles that bind to calcium stones, allowing for extraction of these stones with magnetic tools. Urothelial and fibroblast cell lines show minimal to no toxicity when exposed to the particles. Before clinical evaluation, assessment of the in vivo systemic toxicity of the microparticles was required.

Renal oxygenation during robot-assisted laparoscopic partial nephrectomy: characterization using laparoscopic digital light processing hyperspectral imaging.

Unlabelled: Abstract Background and Purpose: Digital light processing-based hyperspectral imaging (DLP(®)-HSI) was adapted for use during laparoscopic surgery by coupling the spectral illumination source with a conventional laparoscopic light guide and incorporating a customized digital charge-coupled device camera for image acquisition. The system was used to characterize renal oxygenation during robot-assisted laparoscopic partial nephrectomy (RALPN) in humans.

Patients And Methods: After Institutional Review Board approval, laparoscopic DLP-HSI was performed in consecutive patients undergoing RALPN at our institution.

Laparoendoscopic single-site (LESS) pyeloplasty for horseshoe ureteropelvic junction obstruction.

Background And Objective: Pyeloplasty in horseshoe kidneys can be challenging due to aberrant vasculature, renal malrotation, and ectopic location. Fewer than 20 cases of minimally invasive (MIS) pyeloplasty in horseshoe kidneys have been reported in the literature to date. We herein report the first 2 cases of laparoendoscopic single-site (LESS) pyeloplasty for UPJ obstruction in horseshoe kidneys.

In vitro comparison of prototype magnetic tool with conventional nitinol basket for ureteroscopic retrieval of stone fragments rendered paramagnetic with iron oxide microparticles.

Purpose: We developed a prototype magnetic tool for ureteroscopic extraction of magnetized stone particles. We compared its efficiency for retrieving magnetized calcium oxalate monohydrate stone particles with that of a conventional nitinol basket from the pelvi-collecting system of a bench top ureteroscopic simulator.

Materials And Methods: Iron oxide microparticles were successfully bound to 1 to 1.

Tadalafil for prevention of renal dysfunction secondary to renal ischemia.

Introduction: Growing evidence suggests that phosphodiesterase-5 inhibitors may mitigate ischemia-related renal damage through multiple mechanisms. We evaluated the role of tadalafil in renal function preservation during experimentally induced ischemia/reperfusion injury (IRI) in a solitary kidney porcine model.

Materials And Methods: Ten adult female pigs underwent left laparoscopic nephrectomy followed by a 1 week recovery period.

Prediction of perioperative outcomes following minimally invasive partial nephrectomy: role of the R.E.N.A.L nephrometry score.

Objectives: Objective characterization of renal mass anatomy facilitates treatment selection and prediction of surgical outcomes. We investigated R.E.

Determining a performance envelope for capture of kidney stones functionalized with superparamagnetic microparticles.

Background And Purpose: Complete stone removal is important in upper tract stone surgery. Unfortunately, even with the latest technologic advances, current methods only achieve 50% to 80% complete clearance of upper tract stones at the time of primary treatment. Our group has explored the novel use of peptide-coated iron oxide superparamagnetic microparticles that bind to calcium stones, allowing for extraction of these stones with magnetic tools.

Long-term outcomes of renal tumor radio frequency ablation stratified by tumor diameter: size matters.

Purpose: Renal tumor size influences the efficacy of radio frequency ablation but identification of confident size cutoffs has been limited by small numbers and short followup. We evaluated tumor size related outcomes after radio frequency ablation for patients with adequate (greater than 3 years) followup.

Materials And Methods: We identified 159 tumors treated with radio frequency ablation as primary treatment.

Radiofrequency ablation of incidental benign small renal mass: outcomes and follow-up protocol.

Objective: To review our 10-year experience with radiofrequency ablation, focusing on the outcomes for the incidental benign renal tumor. Tumor ablation is an alternative minimally invasive approach for the treatment of small renal masses (SRMs), with published series appropriately emphasizing the outcomes for the renal cell carcinoma subset of treated tumors. However, just as with partial nephrectomy, approximately 20% of SRMs are benign.

Robot-assisted laparoendoscopic single-site pyeloplasty: technique using the da Vinci Si robotic platform.

Conventional laparoscopic dismembered pyeloplasty (LP) is an established alternative to open pyeloplasty given equivalent intermediate-term outcomes and decreased morbidity. Laparoendoscopic single-site (LESS) pyeloplasty has the potential to further decrease the morbidity of LP, while yielding superior cosmesis. It is, however, technically very challenging even with the use of an accessory port, largely because of the difficulty of intracorporeal suturing through a single umbilical incision.