Laparoscopic pyeloplasty: our experience

==inizio abstract==

in this video we show our experience with laparoscopic pyeloplasty in the treatment of pyeloureteral junction obstruction.
We describe the technique of laparoscopic dismembered Anderson-Hynes type pyeloplasty
Our technique always involves a trans peritoneal approach with 3 trocars. a mono J stent is always placed before surgery.
Laparoscopic pyeloplasty has become the operation of choice in cases of hydronephrosis secondary to crossing vessel, when there is great pyelic dilation, and for the treatment of failures of previous endopyelotomy.

==fine abstract==

robotic kidney transplationretroperitoneal graft placement, indocyanine green imaging

==inizio abstract==

The aim of this video is to report the first preliminary experience with intraoperative indocyanine green (ICG) fluorescence videography (IFV) to assess graft and ureteral reperfusion during robot-assisted kidney transplantation (RAKT). We prospectively collected data from consecutive patients undergoing RAKT and IFV from living-donors at our Institution. ICG was injected intravenously after vascular anastomoses to quantitate graft and ureteral fluorescence signal. The signal intensity within selected intraoperative snapshots was evaluated for renal parenchyma, ureter and vascular anastomoses. Three patients were included. Neither conversions to open surgery nor major intra- or postoperative complications were recorded. At a median follow-up of 9 months median estimated glomerular filtration rate was 61.2 mL/min/1.73 m2. Intraoperative quantitative assessment of ICG fluorescence was successful in all patients. IFV during RAKT is feasible and safe and provides a reliable assessment of graft reperfusion. Larger studies are needed to standardize the technique and to evaluate the association between fluorescence signal, ultrasound parameters and postoperative kidney function.

==fine abstract==

Does laparoscopic surgery still play a role in urology?

==inizio abstract==

In this video we show some complex urological procedures treated with laparoscopic approach: radical prostatectomy in patients already undergoing major abdominal surgery, ureteral replantation, removal of large retroperitoneal masses, complex partial nephrectomies. Our goal is to demonstrate the effectiveness and safety of this method in the age of robotic surgery.

==fine abstract==

MEGAPENE ACQUISITO: corporoplastica riduttiva con rinforzo in pericardio bovino

==inizio abstract==

Si descrive correzione chirurgica di raro caso di cedimento strutturale dell’albuginea di entrambi i corpi cavernosi, esteso per pressochè tutta l’asta con risparmio di pochi centimetri alla base, con risultante incremento circumfereziale del pene tale da rendere fortemente disagevole l’ attività sessuale penetrativa.
Caso clinico: paziente di 55 anni con sviluppo senza causa apparente di deformazione simil-aneurismatica del pene con circonferenza massima di 21 cm. Rigidità conservata. Iter diagnostico: cavernosometria/-grafia dinamica e RNM basale e dinamica, con conferma di dilatazione aneurismatica di entrambi i corpi cavernosi.
Tecnica chirurgica: incisione circumferenziale e degloving dell’asta, estrusione dell’asta tramite incisione scrotale. Bilateralmente incisioni parauretrali a tutta lunghezza della fascia di Buck e completo scollamento della stessa – con nel suo contesto il fascio neurovascolare dorsale – dai corpi cavernosi. Erezione indotta: albuginea assottigliata nell’area di cedimento strutturale. Misurazioni circumferenziali seriate e calcolo della riduzione circumferenziale da ottenere. Conseguente asportazione bilaterale di losanghe di albuginea. Punti di ancoraggio introflettenti in Biosyn rinforzati da continua incavigliata in PDS. Confezionamento di patch in pericardio bovino (Supple Peri-Guard, Synovis) a coprire l’intera circonferenza dell’albuginea denudata, ad eccezione del corpo spongioso uretrale, fissata con punti di ancoraggio all’albuginea.
Ricostruzione di fascia di Buck. Reinserimento dell’asta nel proprio involucro cutaneo.
Circoncisione formale.

==fine abstract==

THE USE OF AUTOEXPANDABLE URETERAL PROSTHESYS ALLIUM FOR THE POST URETERORENOSCOPIC URETERAL STRICTURES TREATMENT

==inizio objective==

Ureteral strictures are severe and difficult to treat disorders and significantly affects the quality of life of patients. Usually the definitive resolution required laser incision or surgical reconstructive procedures or ureteral stent replacement. In our experience we evaluate the use of new expandable ureteral stent (ALLIUM®) in the post endourological ureteral strictures as alternative to standard ureteral stent or reconstructive surgery.

==fine objective==

==inizio methodsresults==

From September 2013 to May 2019, 118 patients were enrolled in the study and underwent to endoscopic positioning of the urinary tract autoexpandable prosthesys Allium® for different ureteral disorders. We selected 54 out of 118 patients with ureteral strictures ost-ureterolithotripsy. In this group the location and the lenght of the stenosys were evaluated , such as , the presence and the grade of hydroneprosys. In these patients an ureteral balloon dilatation was always performed and the positioning of the Allium was obtaining by both endoscopic and Xray control. The lenght and the design of the Allium depended on the location and the lenght of the strictures. All the patients were followed up by ultrasound adn KUB after 30 , 90 and 180 days. At 6 months the Allium system was removed and patients re-evaluated.

==fine methodsresults==

==inizio results==

In 46 out of 54 patients we removed the Allium at 6 months and 8 patients are still in evaluation . In 36 out of 46 patients (78.2%) we obtained the absence of hydronephosis at 6 months. 10 patients required reconstructive surgery for the persistence of the strictures. We reported 3 cases of stent migration and no infective complications were reported.

==fine results==

==inizio discussions==

==fine discussions==

==inizio conclusion==

The autoexpandablre ureteral prosthesys Allium® can be considered an option in the treatment of postoperative ureteral strictures with a succes rate of 78.2%. It requires, as usually, a learning curve, it has minimal post-operative complications and lower negative impact on the quality of life of patients. In our experience all the failures and complications were reported in the first period of learning curve.

==fine conclusion==

==inizio reference==

==fine reference==

Occasional finding of a giant renal artery aneurysm: case report

==inizio objective==

The renal artery aneurysms (RAA) was mentioned for the first time in 1770 by Rouppe, who described the death of a sailor due to rupture of a large false aneurysm. Renal artery aneurysms are often diagnosed by ultrasound examination for the screening of hypertension. Many small aneurysms are repairable, in other large aneurysms nephrectomy may be required for the increased wall shear stress and the destruction of renal parenchyma. In recent years, coil embolization or stent-graft with the coil embolization was successful for treating RAAs This paper will deal with the accidental diagnosis and treatment of one giant asymptomatic renal artery aneurysm.

==fine objective==

==inizio methodsresults==

A 73-year-old female patient presented at the emergency department due to accidental fall. Left lombar pain was present since a week. The patient had general good health and BMI was 23. At the arrival, left thighbone fracture was diagnosed, the patient was stable and the routine blood tests were normal, with creatinine 0.83 mg/dL and Hb 13.5 g/dL.

==fine methodsresults==

==inizio results==

FAST Ultrasonography (US) revealed a left abdominal mass with a big surrounding haematoma. A computed tomography (CT) revealed a pseudo-cystic lesion of the left kidney with enhanchement during the arterial phase.
Renal angiography showed a swirling flow of the pseudo-cystic formation which turned out to be a left renal artery giant aneurism. The aneurism was not susceptible of percutaneous endovascular treatment due to the high angle and dimensions. So the patient underwent an laparotomy resection of the aneurysm and a left nephrectomy.
She had an uneventful recovery and a healthy status.
Histological examination revealed a large aneurysm of the renal artery size of 9 cm, with compression of the renal parenchyma, with diffuse glomerulosclerosis, interstitial inflammation and diffuse atrophy.

==fine results==

==inizio discussions==

There are a lot of studies about renal artery aneurysms, but little exists on treatment plans for giant renal artery aneurysm. It seems that most Giant RAAs are discovered when they are close to 10 cm in diameter and are usually part of the renal parenchyma and simptomatics. Arterial reconstruction or arterial embolization are not always an option since the dimensions and because these patients may be elderly and have significant comorbidities.

==fine discussions==

==inizio conclusion==

This report confirms that nephrectomy could be mandatory in some case of RAA not suitable for conservative management.

==fine conclusion==

==inizio reference==

1. Rouppe DL. Renalarteryaneurys. NovaActaPhysico-Medica Academiae Caesareae Leopoldino-Carolinae Naturae Curiosorum. 1770; 4:76.
2. Hageman JH, Smith RF, Szilagyi E, Elliott JP. Aneurysms of the renal artery: problems of prognosis and surgical management. Surgery. 1978; 84:563-72.
3. Jibiki M, Inoue Y, Kudo T, Toyofuku T. Surgical Procedures for Renal Artery Aneurysms. Annals of Vascular Diseases. 2012; 5:157-160.

==fine reference==

Laparoscopic management of complex ureteropelvic junction obstruction

==inizio abstract==

This video shows the management of some complex cases of ureteropelvic junction obstruction performed at the “Urology Department” of A.Cardarelli Hospital (Naples). We present a minimally invasive approach with laparoscopic access. Open access technique is used for primary trocar. All procedures were performed with transperitoneal approach using three operative trocars. We used these laparoscopic instruments: 1 bipolar grasp, 1 scissor, 2 needle drivers,1 grasp and 1 suction device. In some cases a fourth trocar was placed for a grasp to elevate the liver. The patients were placed in lateral position. We present a pyeloplasty in ptosic kidney, in ectopic kidney and the ureteropelvic junction reconstruction in a horseshoe kidney. Moreover we show the pyeloplasty in a double incomplete collecting system and a case of repyeloplasty after failed laparoscopic repair of UPJ obstruction by crossing vessels. A double J stent was placed intraoperative with a laparoscopic-endoscopic procedure in all cases. The remodelling of the junction was performed using 5/0 Vicryl suture. No patients experienced compications and no failure of the procedures were seen at post-operative follow-up. Mini-invasive treatment of complex ureteropelvic junction obstruction is a feasible and safe procedure if performed in highly experienced laparoscopic centres.

==fine abstract==

Transvaginal Vesicovaginal fistula (VVF) repair using a Martius Flap

==inizio abstract==

Vesicovaginal fistula (VVF) are among the most distressing complications of gynecologic and obstetric procedures and it is still a major cause for concern in many developing countries. The diagnosis of the condition has traditionally been based on clinical methods and dye testing but CT or MRI of the pelvis are have also been proposed to depict the fistolous tract.

The best chance of a successful repair is at the first attempt. The arguments about the most appropriate route for repair continue and are not clarified by the publications so far.

In the video we show a VVF repair technique using a Martius flap.
This technique represents our consolidated experience in 19 cases.
17 patients developed a VVF after gynecologic surgery and 5 out of 17 were recurrent fistula after previous transvaginal attempt of repair. One patient developed a fistula following a radical cystectomy with a continent ortotopic urinary diversion and one patients had a VVF after previous multiple surgery for recurrent uretrahral diverticula.
Successful surgical repair was obtained in 18 out of 19 patient while in one patient was necessary to perform a urinary diversion.

==fine abstract==

URETRAL- RECTUM FISTULA REPAIR. OUR EXPERIENCE

==inizio abstract==

MALE PATIENT 57 YEARS OLD, PREVIOUS SURGERY VIDEOLAPAROSCOPIC RADICAL PROSTATECTOMY. HE CAME TO OUR CENTER WITH RECCURENT UTI AND URINARY SPILLAGE FROM THE RECTUM. WE PERFORMED A CISTOGRAPHY THAT SHOWED URETHRAL-RECTUM FISTULA AT THE ANASTOMOSIS LEVEL. IN OPERATORY ROOM WE PERFORMED A STANDARD CYSTOSCOPY WITH CYSTOSCOPE 17 CH 30 DEGREE OPTICS: THE ANTERIOR URETHRA WAS REGOLAR. THERE WAS A FISTOLOSE CONNECTION AT SEVEN O’CLOCK AT THE LEVEL OF THE URETHRAL BLADDER ANASTOMOSIS. URETERAL ORIFICE WERE IN SITE AND COMPETENT. POSITIONING OF URETERAL CATHETERINE 5CH IN THE FISTULOUS VIA. FOLEY CATHETER 16 CH IN BLADDER. PERINEAL INCISION. EXPOSURE OF THE BULBOSPONGIUS MUSCLE. ISOLATION OF THE SAME WITH SECTION OF THE CENTRAL TENDON OF PERINEUM, IDENTIFICATION AND OPENING OF THE FISTULA WITH EXPOSURE OF THE URETERAL CATHETER PREVIOUSLY POSITIONED. REGULARIZATION OF THE FISTULA MARGINS BOTH ON THE RECTUM AND ON THE BLADDER. CLOSURE OF THE VESICAL OPENING WITH TWO SEMICONTINUOS SUTURES IN VYCRIL 4-0. LEAK TEST UP TO 120 ML OF NACL SOLUTION IN THE BLADDER. CLOSURE OF THE INTESTINAL OPENING WITH DETACHED SUTURE IN VYCRIL 3-0. SEAL CONTROL WITH AIR IN THE RECTUM. CONTROL OF HEMOSTASIS. ABUNDANT WASHING WITH NACL SOLUTION. APPOSITION OF EVICEAL ON THE SUTURES. LAYERED SYNTHESIS OF THE WALL. RECTAL PROBE.

==fine abstract==

Neovescica ileale robotica: un intervento cucito su misura

==inizio abstract==

L’approccio mininvasico, laparoscopico o robotico, alla cistectomia radicale offre indubbi vantaggi nel recupero clinico nel post operatorio, basti pensare alla riduzione delle perdite ematiche intraoperatorie e alla conseguente riduzione di emotrasfusioni, alla riduzione del dolore da ferita chirurgica quindi alla precoce mobilizzazione e alla precoce canalizzazione intestinale soprattutto se viene eseguita la resezione ileale per il confezionamento di una derivazione ortotopica o eterotopica. L’approccio mininvasivo associato al fast track chirurgico permette la canalizzazione fin dal POD#3. Il sondino nasogastrico viene rimosso la mattina successiva all’intervento e il pz inizia a sorseggiare acqua e mangiare del gelato mattina e sera fin dal post operatorio. Non viene somministrata nutrizione parenterale. La mobilizzazione è in prima giornata post operatoria.
Il video mostra le fasi salienti della fase ricostruttiva, isolamento dell’ansa mediante suturatrici meccaniche laparoscopiche , riconfigurazione dell’ansa ileale, anastomosi ileouretrale e anastomosi degli ureteri.
Il vantaggio dell’approccio robotico sta nella semplificazione della riconfigurazione con sutura continua della neovescica ortotopica e nella maggior facilità di esecuzione della anastomosi neovescicouretrale. I risultati clinici nel post operatorio ci incoraggiano a perseguire questo approccio.

==fine abstract==