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BackgroundRobotic-assisted laparoscopic surgery is being applied to a growing number of procedures.Patient and MethodsA 32-year-old woman with ureteropelvic obstruction underwent a robotic-assisted laparoscopic ureterocalicostomy in 2005. She had an uncomplicated surgery with minimal blood loss and post-operative course.ResultsImaging done serially after surgery remained stable. She became pregnant about 2 years later and ultimately required percutaneous nephrostomy for flank pain and worsening hydronephrosis in the third trimester. Nephrostogram after delivery showed a patent anastomosis, and the nephrostomy tube was removed.ConclusionsRobotic-assisted laparoscopy is an option for patients who require ureterocalicostomy. Long-term outcome at 3 years is favorable. [ABSTRACT FROM AUTHOR]

PurposeThe Adjustable Continence Therapy (ACT®) device has been developed for the treatment of recurrent stress urinary incontinence resulting from intrinsic sphincter deficiency (ISD) by increasing urethral coaptation. We critically evaluated the technique and its results.MethodsThe ACT device consists of two balloons each attached to an injectable port placed in the labia majora. The port enables postoperative adjustment in balloon coaptation pressure. All 49 patients had previously failed anti-incontinence surgery. Each patient was implanted with the ACT device and assessed by preoperative and postoperative overall impression, incontinence quality of life questionnaire, and visual analog scale; 38 of the 49 subjects had a minimum of 1 year of data collected, including pad use, number of adjustments needed, and complications.ResultsMean operative time was 20.3 minutes (range 10–30 minutes), with 88 of implantations performed using local or regional anesthesia. Balloon adjustments were needed in 62; 68 of patients reported being dry and 16 improved. Complications included migration (12), balloon failure (3.6), and erosion (4).ConclusionThe ACT device provided significant improvement in at last 70 of patients with recurrent stress urinary incontinence. [ABSTRACT FROM AUTHOR]

AbstractPurpose:To evaluate the feasibility and safety of bilateral simultaneous tubeless percutaneous nephrolithotomy (PCNL).Patients and Methods:From August 2007 to January 2008, six patients underwent bilateral simultaneous totally tubeless PCNL. Patients who needed more than one access, who had significant intraoperative bleeding, and who had pelvicaliceal system perforations or a residual stone were excluded from the study group. Preliminary results were analyzed in six patients.Results:Five men and one woman patient with a mean age of 50.1 years underwent a bilateral totally tubeless procedure. The mean stone burden was 524.5 mm2(range 100 mm2–1800 mm2). The mean drop in hemoglobin was 1.55 g/dL (range 0.6–2.6 g/dL). No blood transfusion was necessary in any patient. The mean hospitalization time was 1.8 days (range 1–4 d). A complications was encountered in one patient; the patient had anuria postoperatively for 16 hours, which resolved after the insertion of bilateral Double-J stents.Conclusions:Bilateral simultaneous tubeless PCNL procedure should be kept in mind for selected patients. Prospective randomized studies with large series are necessary for further evaluation of the procedure. [ABSTRACT FROM AUTHOR]

Background and PurposeIn patients with a percutaneous nephrostomy tube (PCN) inserted for symptomatic stone disease, antegrade pyelography is an accepted modality to assess the collecting system and residual stone status prior to PCN removal. Recently, unenhanced multidetector CT (UMDCT) has shown its superiority for the assessment of urinary-tract stones. Comparison of UMDCT with antegrade pyelography has never been done; hence, our aim was to compare the two methods for the assessment of urinary stones in patients with a PCN.Patients and MethodsBetween July 2004 and July 2005, we prospectively imaged 49 consecutive patients with known urinary-tract stone disease who had PCN (27 men and 22 women; average age 57 ± 20 years; range 4–88 years). All patients underwent UMDCT and antegrade pyelography within 24 hours. Both examinations were prospectively and blindly evaluated by two attending radiologists for the presence, location, and size of urinary-tract stones.ResultsAccording to the findings of both imaging modalities, 18 patients were stone free, and 31 patients had urinary stones. In 20 of the latter 31 patients (64.5), the urinary stones were diagnosed only by UMDCT. Antegrade pyelography missed renal as well as ureteral stones, with a significant mean size (5.1 × 6.2 mm, and 6 × 5.3 mm, respectively). Antegrade pyelography missed radiolucent (820) as well as radiopaque (1220) stones. In 11 of the 31 patients (35.5), urinary stones were diagnosed by both UMDCT and antegrade pyelography. The average size of these renal stones was 6 × 11 mm, and the mean ureteral stone size was 11 × 13 mm. In 64 (711), the stones were radiolucent and in 36 (411) radiopaque. There was no patient in whom urinary stones were diagnosed by antegrade pyelography but missed by UMDCT.ConclusionsUnenhanced multidetector CT is more accurate than antegrade pyelography via a PCN for the assessment of urinary-tract stones, with the advantage of reducing the risks of contrast injection side effects. [ABSTRACT FROM AUTHOR]