Uro, Volume 1, Issue 4 (December 2021) – 10 articles

Background. To provide optimal nephron mass, two adult kidneys with suboptimal function can be transplanted into one single recipient. All techniques described to date are based on the lengthy sequential transplantation of one allograft after the other, in each iliac fossa, or through one long incision in the right iliac quadrant. Material and Methods. We report on a novel shorter and simpler operative technique allowing the en-bloc transplantation of seven dual adult kidneys with multiple vessels into a single iliac fossa, with revascularization through the donor aorta and vena cava. A proposal for the identification, allocation, procurement, and placement of the dual adult kidneys is presented. Results. There was no primary non-function, no thrombosis, and no urinary leakage. No urosepsis and hydronephrosis were noted during the follow-up. The operative time was 180 min. At 36 months, serum creatinine levels averaged 1.8 mg/dL (range 1.4–1.9 mg/dL). Conclusions. The procedure described permits converting two complex vascular kidneys into one en-bloc graft, which then can be transplanted into a single iliac incision, using only one arterial and one venous anastomoses. It avoids extensive dissection, shortens the operative time, and reduces the complications rate for the elderly recipients. It is applicable to the transplantation of dual kidneys with single or multiple arteries. Full article

Some prognostic markers have been shown to determine the course and survival of Urothelial Cancer. A cross-sectional retrospective study, specifically looking at the role that various indices related to platelets—namely Mean Platelet Volume (MPV), platelet count and MPV/Platelet ratio—play in the diagnosis and prognosis of urinary bladder cancer, was conducted at the Department of Pathology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan (India) between January 2016 and August 2021 and included 76 patients who underwent multicore TURBT biopsy. Complete Blood Count (CBC) was used to determine platelet count, MPV and MPV/Platelet ratio. Platelet count was found to be more elevated in patients with high grade urothelial carcinoma and muscle invasive urothelial carcinoma as compared to patients with low grade urothelial carcinoma and non-muscle invasive urothelial carcinoma (p < 0.05). The median MPV and MPV/PLT ratio was found to be significantly lower in patients with high grade urothelial carcinoma and muscle invasive urothelial carcinoma as compared to patients with low grade urothelial carcinoma and non-muscle invasive urothelial carcinoma (p < 0.05). Thus, platelet indices can be useful supportive prognostic and diagnostic indicators in the determination of the clinical outcome of urothelial carcinoma. Full article

Robotic surgery saw unprecedented success throughout the world, with urology as a key discipline. Robotic-assisted radical prostatectomy (RARP) and partial nephrectomy (RAPN) were the frontline procedures. Many other urologic procedures have since been standardized over time. However, there is no universal consensus in current research on the recognition of robotics as the standard of care. Although better operative outcomes have been reported for most robotic procedures compared to open and laparoscopic surgery, no superiority has been proven as far as oncologic outcomes are concerned. This review aims to describe current research on robotic surgery concerning each urologic procedure, showing its applications and limits. The non-classic parameters in part responsible for the planetary success of robotics, such as the shorter learning curve, improved ergonomics, and surgeon’s comfort, as well immersive three-dimensional vision, are further areas of focus. Full article

Despite technological progress in instrumental diagnostic investigations of the last decade, prostate cancer remains one of the most frequent malignant tumors and the second leading cause of cancer death among men. Although prostate biopsy remains the reference among all diagnosis procedures, it still exposes patients to the risk of developing complications. In this paper, the authors present a novel robotic system for prostate cancer diagnosis aimed at improving the current diagnostic procedures and reducing their undesired effects. The purpose of this work is to validate the proposed methodology by considering experimental analysis on both phantom and ex-vivo prostate tissues. Full article

Urolithiasis is a common condition, and it represents a large number of hospital visits. Under the term infundibulopelvic dysgenesis, many conditions amongst a spectrum of congenital disorders of the pelvicalyceal system are described. Retrograde intrarenal surgery (RIRS) is an effective and safe treatment modality in the management of urinary system stone disease. Fluoroscopic imaging is a cornerstone in endourology. Herein, we present a case where we diagnosed an obstructed calyx during RIRS for renal calculi and operated on it. In this extraordinary case, contrast agent was trapped in the calyx mimicking a renal stone and that was the reason that we discovered the infundibular stenosis. The patient, 24 h after the operation, left the hospital without any complications reported. Full article

Background: Phytotherapeutic agents aroused an increasing interest either as alternative or in addition to conventional therapy in the management of BPH. The aim of the article was to evaluate the clinical and functional changes after add-on treatment with Serenoa repens associated with Solanum lycopersicum, lycopene and bromelain in patients with BPH presenting with mild to moderate LUTS and previously treated only with Alfuzosin over a 6–12 months period. Materials and methods: Between January and July 2019, patients with symptomatic BPH already on treatment with Alfuzosin (Al) 10 mg for at least 6–12-month were enrolled at three academic referral centres, included in a prospective treatment group, and managed with a combination treatment of Al and 6-month daily oral single-tablet supplementation of Serenoa repens and Solanum lycopersicum + lycopene + bromelain (SeR + SL + Ly + Br). A retrospective control group with comparable baseline characteristics was obtained by performing a propensity score matching from a database of 434 patients managed with Alfuzosin 10 mg/day only over a 6–12 months period between March 2015 and December 2018. IPSS, QoL questionnaires, voiding diary assessment, postvoid residual volume (PVR), maximal (Qmax) and average (Qave) urinary flow rates were evaluated at baseline in the treatment group at the moment of patient accrual, in the control group after 6-month of treatment with alfuzosin, and thereafter at 3 and 6 months in both groups. Results: Overall, 250 patients entered the study (n = 125 treatment group; n = 125 control group). Total IPSS score significantly decreased at 6-month assessment from baseline in the treatment vs control group (17 [IQR: 12–20] vs 12 [IQR: 9–14], p = 0.02) with a significative storage symptoms improvement detected both at 3- (p = 0.03) and 6-month evaluation (p = 0.001). PVR significantly improved at each follow-up visit with the most relevant reduction at 6-month assessment (125 cc vs. 102 cc; p = 0.02). Moreover, a significative improvement in LUTS-related quality of life (QoL) was recorded at 3- and 6-month assessment with a median decrease of −1 and −2 (p = 0.05 and p = 0.001 respectively) from baseline. Conclusions: Combination treatment with AB and SeR + SL + Ly + Br led to meaningful improvements in LUTS severity compared to AB as monotherapy, after a 6-month treatment period in men with mild to moderate LUTS/BPH. Full article

Tacrolimus is the cornerstone component of all immunosuppressive regimens. Despite its long record of use, very little is known about its acute toxicity syndrome. We describe five patients with acute organ failure, involving both native and transplanted organs, which was reversed by inducing the cytochrome P450-3A system. In all patients, the causative drug was stopped and phenytoin was given intravenously to accelerate tacrolimus metabolism. Within 24 h, tacrolimus trough levels fell daily at a significant level (p < 0.05) and all failed organs recovered their normal function within 48–72 h. Therefore, phenytoin metabolic induction appears to be a safe therapeutic option for patients with acute tacrolimus toxicity. Full article

Background: Vasculitides are specific inflammations of the blood vessel wall that can take place in any organ system of the human body. They may occur as a primary process (primary systemic vasculitides, PSV) or may be secondary to another underlying disease. In general, in association with the specific type of vasculitis, affected vessels vary in size, type, and location. In the following scoping review, we present clinical characteristics and manifestations of PSV with reference to the genitourinary system. Materials and methods: A non-systematic search of the relevant literature was conducted using three electronic databases (PubMed, Embase, and Web of Science) up to 29 October 2021. Results: Urogenital manifestations of PSV are infrequent, with the most commonly reported findings as prostatic or testicular involvements. However, almost all other organs of the genitourinary system can be affected. Conclusions: Because of the clinical heterogeneity and non-specific symptoms, the proper diagnosis of PSV is often delayed and constricted. Fast identification of urological manifestations of vasculitides is essential in implementing appropriate therapy and avoiding unnecessary, harmful, and invasive surgery. Full article

Holmium laser enucleation of the prostate (HoLEP) is one of only two AUA guideline-recommended prostate size-independent surgeries for benign prostate hyperplasia (BPH). The significant variation in gland size treated results in a wide range of enucleation and morcellation times. We sought to understand the effect of prostate size on HoLEP efficiency to better educate patients and improve operative room utilization. After IRB approval, we identified patients from 1 July 2016 to 1 January 2020 who underwent HoLEP by two endourologists. Our primary objectives were to assess the effects of increasing increments (25 g) of mean enucleated prostate tissue weight on enucleation and morcellation efficiency (g/min). One-way Kruskal–Wallis ANOVA with Dunn’s post hoc test was used, with significant p < 0.05. We included 675 HoLEPs with all comers mean tissue weight resected of 72.1 g (Range 1–448 g), energy used 110.00 kJ (10.73–340 kJ), enucleation time 48.6 min (5–151 min), and morcellation time 10.1 min (0.5–113 min). Average enucleation efficiency increased with increasing prostate size categories (e.g., <25 g–0.48 g/min, >325 g–3.91 g/min) (K-W ANOVA p = 0.004, Dunn’s post hoc p = 0.004). The combined average enucleation and morcellation efficiency was ≥5 g/min between 55 and 271 g. Inefficiency for cases <55 g was driven by enucleation, while >271 g case inefficiency was driven by morcellation. Increasing tissue weight at the time of HoLEP is associated with a linear relationship of increasing enucleation and decreasing morcellation efficiencies. Full article

Escherichia coli (E. coli)-related urosepsis associated with a ureteric stone has been shown to cause a systemic bacteraemia that can spread to other parts of the body. Hematogenous spread of infection is the most common cause of pyogenic spondylodiscitis. A 74-year-old female presented with acute left-sided flank pain and was found to have an obstructing 9 mm distal ureteric stone. After initial management involving ureteric stent insertion, the patient deteriorated and developed an E. coli associated bacteraemia, which proved difficult to treat. Further investigations revealed a subsequent spondylodiscitis, which required a 6-week course of antibiotics and no additional intervention. This case presents the likely association of stone-related bacteraemia, complicated by urinary tract instrumentation leading to spondylodiscitis, and demonstrates the importance of clinicians’ awareness of other causes of unresolving sepsis in an elderly patient. Full article