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Purpose: We report our experience with transperitoneal laparoscopic nephrectomy (LN) for giant hydronephrosis (GH) and compare the outcome data with open nephrectomy (ON). Patients and methods: The retrospective data of 88 patients (52 males and 36 females) who underwent LN or ON for treatment of GH in the period between October 2015 and December 2019 were investigated. LN was performed in 38 patients, while 50 patients underwent ON. We compared the two groups for success, operative time, and intraoperative and postoperative complications. Results: The mean age of the patients in the LN group was 45.8 ± 11.4 years, and it was 44.7 ± 10.8 years in the ON group. The mean operative time in the LN group was statistically significantly longer when compared with the ON group195 ± 18 min versus 127 ± 22 min (p = 0.01).The estimated blood loss was significantly greater in the ON group (p = 0.01). However, no patients required blood transfusions in either group. The visual analog pain (VAP) scores were significantly higher on both day 1 and day 2 in the ON group 3.6 ± 0.9 and 2 ± 0.7 versus 2.7 ± 0.6 and 1.4 ± 0.5 in LN group, (p = 0.01). Conclusion: LN for GH is feasible, safe, and efficacious. Compared to open surgery, the laparoscopic approach resulted in significantly shorter hospital stays, decreased morbidity, and quicker recovery. Some tips and tricks could help to do it in an easier way and reduce the operative time. [ABSTRACT FROM AUTHOR]

Objectives: To present the first prospective randomized comparison between laparoendoscopic single-site surgery (LESS) and minilaparoscopy (ML) for treatment of upper urinary tract pathologies. Patients and Methods: Between January 2013 and June 2015, patients with different upper urinary pathologies were blindly randomized to both LESS and ML. All procedures were done by single experienced surgeon. Both cohorts were compared regarding demographic data, peri and postoperative characteristics, and visual analog pain scale (VAS). Cosmetic outcome was assessed after 12 months using patient scar assessment scale (PSAS) and observer scar assessment scale (OSAS). Results: Sixty patients were randomized into two equal groups with comparable demographic and preoperative characteristics. Indications included nephrectomy, pyeloplasty, cyst marsupialization, adrenalectomy, and repair of retrocaval ureter. Operative time was 167 ± 24 and 145 ± 39 minutes in LESS and ML groups, respectively ( p = 0.09). Estimated blood loss was 59 ± 34 and 43 ± 42 mL in both groups, respectively ( p = 0.2). VAS was 1.7 ± 0.6 and 2.8 ± 0.5 in both groups, respectively ( p = 0.02). PSAS and OSAS were 5.9 ± 0.85 and 10.6 ± 1.98 vs 8.9 ± 0.9 and 13.5 ± 6.3 in both groups, respectively ( p > 0.05). There were no intraoperative complications, conversions to open surgery, or conventional laparoscopy in both groups. Mean postoperative Diclofenac Na was 151.7 ± 35.6 and 169.7 ± 47.3 mg in both groups, respectively ( p = 0.04). Postoperative complications rate and hospital stay were comparable between both groups. Conclusion: Both LESS and ML have comparable operative time, blood loss, complication rate, and hospital stay in treatment of upper urinary tract pathologies. However, LESS is associated with less analgesic requirement and better cosmetic outcome. [ABSTRACT FROM AUTHOR]

What's known on the subject? and What does the study add? LESS-NU may be an alternative minimally-invasive treatment option for patients eligible to undergo laparoscopic surgery for upper urinary tract urothelial carcinoma., The true benefits of LESS-NU remain to be determined and require randomized control trials in the future. Despite encouraging early findings, clinical trials still are warranted before this procedure is adopted widely, and longer follow-up is needed to determine its oncological durability., Objective To report a large multi-institutional series of laparoendoscopic single-site ( LESS) nephroureterectomy ( NU)., Materials and Methods Data on all cases of LESS-NU performed between 2008 and 2012 at 15 institutions were retrospectively gathered., The main demographic data and perioperative outcomes were analysed., Results The study included 101 patients whose mean ( sd) age was 66.4 (9.9) years and mean ( sd) body mass index was 24.8 (4) kg/m2, and of whom 29.7% had undergone previous abdominal/pelvic surgery., The mean ( sd) operating time was 221.4 (73.7) min, estimated blood loss 231.7 (348.0) mL., A robot-assisted LESS technique was applied in 25.7% of cases. An extra trocar was inserted in 28.7% of cases to complete the procedure. Conversion to open surgery was necessary in three cases (3.0%). There was no bladder cuff excision in 20.8% of cases, and excision was carried out using a variety of techniques in the remaining cases., Six intra-operative complications occurred (5.9%). The mean ( sd) length of hospital stay was 6.3 (3.5) days. The overall postoperative complication rate was 10.0%, and most of the complications were low grade ( Clavien grades 1 and 2)., The mean tumour size was 3.1 (1.9) cm. Pathological staging was pTis in two patients, pTa in 12 patients, pT1 in 42 patients, pT2 in 20 patients, pT3 in 23 patients and pT4 in two patients. Pathological grade was high in 71 and low in 30 patients., At a mean follow-up of 14 months, six patients (5.9%) had died. Disease recurrence (including distant and bladder recurrence) was detected in 22.8% of patients, with a mean time to recurrence of 11.5 months., Conclusions This study reports the largest multi-institutional experience of LESS-NU to date., Peri-operative outcomes mirror those of published standard laparoscopy series., Despite encouraging early findings, longer follow-up is needed to determine the oncological efficacy of the procedure. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Laparoscopic repair of vesicovaginal fistula (VVF) has been recently reported. We present our experience of laparoscopic transperitoneal extravesical repair of VVF. Methods: Fifteen females with supratrigonal VVF were included. Patients with malignant radiation and recurrent fistulas were excluded. Laparoscopic transperitoneal extravesical repair was done using four to five ports. The bladder was closed longitudinally, while the vagina was closed transversally with interposition of omentum in between. Bladder was drained by a urethral catheter for 3 weeks. Results: Mean operative time was 171.6 ± 19.5 min. There was no conversion to open in all patients. Mean blood loss was 110 ± 17 cc. No intraoperative or postoperative complications. Mean hospital stay was 3 ± 1 days. At a mean follow-up of 18.9 ± 8.6 months all patients were cured. Conclusions: Laparoscopic transperitoneal extravesical repair of VVF is a safe and effective minimally invasive procedure for treatment of VVF. [ABSTRACT FROM AUTHOR]

Vesicovaginal fistula (VVF) is a distressing urologic disorder. We describe a new technique that adds a third layer of closure during vaginal repair of VVF. Twenty female patients with low VVF were included. A circumferential incision was made around the fistula that was completely excised. A rectangular vaginal flap was created just proximal to the site of the fistula. After closure of the urinary bladder, the distal edges of the vaginal flap were dissected and it was mobilized and interposed between the bladder and the vagina. Then the vagina was closed. The mean follow-up was 16 ± 9 months. All of the patients are dry. None of them had any added morbidity due to the procedure. There are no postoperative complications. Vaginal flap reinforcement during vaginal repair of VVF is a simple and effective technique with high success rate and no added complications. [ABSTRACT FROM AUTHOR]

We evaluated the effect of a somatostatin analog (octreotide) on clitoral and vaginal blood flow following suprasacral spinal cord injury (SCI) in rats. Twenty-four spinalized female Sprague-Dawley rats were randomized into 4 equal groups. The first group served as control paraplegics. The other three groups received octreotide (60µg/day/4weeks) immediately, 2 weeks, and 4 weeks following SCI. At the end of the experiment, a laser Doppler was used to measure blood flow changes following clitoral and pelvic nerve plexus stimulations. Marked decreases in both clitoral and vaginal blood flow in the control paraplegics were recorded. Significant increases (p < 0.05) in both clitoral and vaginal blood flow were recorded in animals that received octreotide; however, the increase was marked in the animals that received the drug immediately following SCI. Improvement in the clitoral and vaginal blood flow of spinalized rats using octreotide indicates that octreotide may be helpful for patients with SCI. [ABSTRACT FROM AUTHOR]

We evaluated the effect of a somatostatin analog (octreotide) on clitoral and vaginal blood flow following suprasacral spinal cord injury (SCI) in rats. Twenty-four spinalized female Sprague-Dawley rats were randomized into 4 equal groups. The first group served as control paraplegics. The other three groups received octreotide (60 micrograms/day/4 weeks) immediately, 2 weeks, and 4 weeks following SCI. At the end of the experiment, a laser Dopper was used to measure blood flow changes following clitoral and pelvic nerve plexus stimulations. Marked decreases in both clitoral and vaginal blood flow in the control paraplegics were recorded. Significant increases (p < 0.05) in both clitoral and vaginal blood flow were recorded in animals that received octreotide; however, the increase was marked in the animals that received the drug immediately following SCI. Improvement in the clitoral and vaginal blood flow of spinalized rats using octreotide indicates that octreotide may be helpful for patients with SCI. [ABSTRACT FROM AUTHOR]