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Background: Rates of persistent urine leak after partial nephrectomy are reported in the range of 2-13%, of which many are technically preventable by intraoperative identification and repair of collective system injuries. We describe our technique and institutional experience utilizing intravenous sodium fluorescein, a xanthene die with rapid urinary excretion, at the time of tumor resection during partial nephrectomy for identification of collecting system injury., Methods: Here, we present a video illustrating the utilization of sodium fluorescein for the intra-operative identification of collecting system injury. We retrospectively reviewed all patients who underwent robot-assisted partial nephrectomy with sodium fluorescein between October 2017 and May 2019 by a single surgeon (KC), and report clinicodemographic and tumor characteristics, as well as rates of post-operative urine leak., Results: Over the study period, 48 patients underwent robot-assisted partial nephrectomy with intraoperative sodium fluorescein, of which 44 had follow-up data (Table 1). Patients were 66.7% male, had a median age of 65 (interquartile range [IQR] 54-72) years and median body mass index of 27.5 (IQR 24.4-35.5) kg/m 2 . Mean tumor nephrometry score was 7.8 (±1.45), with a mean distance of 3.3 mm (±4.0) from the collecting system. In cases performed with arterial clamping, 5 mL of sodium fluorescein (100 mg/mL) was injected intravenously by anesthesia as the clamp was removed following tumor resection. In cases performed off-clamp, sodium fluorescein was delivered after tumor resection. The video demonstrates three cases where sodium fluorescein aided in the identification and repair of a collecting system leak. There were no recorded urine leaks at time of final follow-up (median 198.6, IQR 20-289 days)., Conclusion: Sodium fluorescein is a simple technique for identification of collecting system injuries at time of partial nephrectomy. With the aid of sodium fluorescein, intra-operative collecting system leaks can be identified and repaired, potentially mitigating postoperative urine leaks and urinomas., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To test the feasibility of ureteral stent placement without image guidance after uncomplicated ureteral stone removal and to compare the outcomes of fluoro-less and conventional ureteral stent placement., Methods: A technique was devised to allow placement of a ureteral stent without image guidance by substituting fluoroscopy with visual and tactile cues. A retrospective review of 25 patients using fluoro-less stent placement was compared with 25 consecutive patients who underwent conventional stent placement with fluoroscopy. Stent placement was graded on a 6-point scale to assess coil symmetry and location. Comparisons between the fluoro-less stent placements and controls were performed with the Mann-Whitney U test. All hypotheses were 2-sided and conducted at an alpha level of 0.05., Results: All 25 ureteral stent placements were performed successfully without the use of fluoroscopy for image guidance. There was no significant difference in age, gender, body mass index, stone size, or complication rates when fluoro-less and conventional stent placements were compared. In addition, grade 1 placement was achieved in 76% of the fluoro-less group and in 64% of the conventional group. Although placement accuracy was higher in the fluoro-less group this was not statistically significant (P = .13)., Conclusion: Ureteral stent placement without fluoroscopic guidance is feasible. It maintains comparable efficacy and complication rates with conventional ureteral stent placement. This technique allows reduced radiation exposure in patients requiring ureteral stent placement., (Copyright © 2012 Elsevier Inc. All rights reserved.)