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Purpose: Iatrogenic ureteral strictures (US) after endoscopic treatment for urolithiasis represent a significant healthcare concern. However, high-quality evidence on the risk factors associated with US is currently lacking. We aimed to develop a consensus statement addressing the definition, risk factors, and follow-up management of iatrogenic US after endoscopic treatment for urolithiasis. Methods: Utilizing a modified Delphi method, a steering committee developed survey statements based on a systematic literature review. Then, a two-round online survey was submitted to 25 experts, offering voting options to assess agreement levels. A consensus panel meeting was held for unresolved statements. The predetermined consensus threshold was set at 70%. Results: The steering committee formulated 73 statements. In the initial survey, consensus was reached on 56 (77%) statements. Following in-depth discussions and refinement of 17 (23%) statements in a consensus meeting, the second survey achieved consensus on 63 (86%) statements. This process underscored agreement on pivotal factors influencing US in endoscopic urolithiasis treatments. Conclusions: This study provides a comprehensive list of categorized risk factors for US following endoscopic urolithiasis treatments. The objectives include enhancing uniformity in research, minimizing redundancy in outcome assessments, and effectively addressing risk factors associated with US. These findings are crucial for designing future clinical trials and guiding endoscopic surgeons in mitigating the risk of US. [ABSTRACT FROM AUTHOR]

To evaluate the performance of a mathematical model to drive preoperative planning between RIRS and MiniPerc (MP) for the treatment of renal stones between 10 and 20 mm. Patients with a renal stone between 10 and 20 mm were enrolled. A mathematical model named Stone Management According to Size-Hardness (SMASH) score was calculated: hounsfield units (HU) χ stone maximum size (cm)/100. Patients were divided into 4 groups: RIRS with score < 15 (Group A), RIRS with score ≥ 15 (Group B), MP with score < 15 (Group C), MP with score ≥ 15 (Group D). Cyber Ho device was always used. Stone free rate (SFR) was assessed after 3 months. Complication rate and need for auxiliary procedures were evaluated. Between January 2019 and December 2021, 350 patients were enrolled (87, 88, 82 and 93 in Groups A, B, C and D). Mean stone size was 13.1 vs 13.3 mm in Group A vs B (p = 0.18) and 16.2 vs 18.1 mm in Group C vs D (p = 0.12). SFR was 82%, 61%, 75% and 85% for Groups A, B, C and D. SFR was comparable between Groups C and D (p = 0.32) and Groups A and C (p = 0.22). SFR was significantly higher in Group A over B (p = 0.03) and in Group D over B (p = 0.02). Complication rate was 2.2%, 3.4%, 12.1%, 12.9% for Groups A, B, C, D. RIRS and MP are both safe and effective. The mathematical model with the proposed cut-off allowed a proper allocation of patients between endoscopic and percutaneous approaches. Registration number of the study ISRCTN55546280. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. Methods: We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). Results: A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years’ studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively. Conclusions: The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment. [ABSTRACT FROM AUTHOR]

Context: Large and complex renal stones are usually treated with percutaneous nephrolithotomy (PCNL). One of the crucial steps in this procedure is the access to the collecting system with the percutaneous puncture and this maneuver leads to a risk of vascular and neighboring organs' injury. In the last years, the application of virtual image-guided surgery has gained wide diffusion even in this specific field. Objectives: To provide a short overview of the most recent evidence on current applications of virtual imaging guidance for PCNL. Evidence acquisition: A non-systematic review of the literature was performed. Medline, PubMed, the Cochrane Database and Embase were screened for studies regarding the use virtual imaging guidance for PCNL. Evidence synthesis: 3D virtual navigation technology for PCNL was first used in urology with the purpose of surgical training and surgical planning; subsequently, the field of surgical navigation with different modalities (from cognitive to augmented reality or mixed reality) had been explored. Finally, anecdotal preliminary experiences explored the potential application of artificial intelligence guidance for percutaneous puncture. Conclusion: Nowadays, many experiences proved the potential benefit of virtual guidance for surgical simulation and training. Focusing on surgery, this tool revealed to be useful both for surgical planning, allowed to achieve a better surgical performance, and for surgical navigation by using augmented reality and mixed reality systems aimed to assist the surgeon in real time during the intervention. [ABSTRACT FROM AUTHOR]

Purpose: PCNL requires a lithotrite to efficiently break stones, and some devices include active suction to remove the fragments. We set out to determine the efficacy and safety of the Swiss LithoClast® Trilogy, in a prospective European multicentre evaluation and compared it to published stone clearance rates for Trilogy based on surface area (68.9 mm2/min) and using the 3D calculated stone volume (526.7 mm3/min). Methods: Ten European centres participated in this prospective non-randomized study of Trilogy for PCNL. Objective measures of stone clearance rate, device malfunction, complications and stone-free rates were assessed. Each surgeon subjectively evaluated ergonomic and device effectiveness, on a 1–10 scale (10 = extremely ergonomic/effective) and compared to their usual lithotrite on a 1–10 scale (10 = extremely effective). Results: One hundred and fifty seven PCNLs using Trilogy were included (53% male, 47% female; mean age 55 years, range 13–84 years). Mean stone clearance rate was 65.55 mm2/min or 945 mm3/min based on calculated 3D volume. Stone-free rate on fluoroscopy screening at the end of the procedure was 83%. Feedback for suction effectiveness was 9.0 with 9.1 for combination and 9.0 for overall effectiveness compared to lithotrite used previously. Ergonomic score was 8.1, the least satisfactory element. Complications included 13 (8.2%) Clavien–Dindo Grade II and 2 (1.3%) Grade III. Probe breakage was seen in 9 (5.7%), none required using a different lithotrite. Conclusions: We have demonstrated that Trilogy is highly effective at stone removal. From a user perspective, the device was perceived by surgeons to be highly effective overall and compared to the most commonly used previous lithotrite, with an excellent safety profile. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the non-papillary puncture for mini-PCNL in terms of safety and efficacy. Methods: A total number of 32 patients were subjected to mini-PCNL by the performance of non-papillary punctures over 6 months. One-step track dilation to 22 Fr took place in all cases. An 18 Fr nephroscope (Slender, Karl Storz GmbH, Germany) and an ultrasound lithotripter (Lithoclast Master, EMS S.A, Switzerland) with 9.9 Fr probe was used. Demographics and perioperative data are prospectively collected from an institutional board-approved database and the presented data were retrospectively collected. Results: The average cumulative stone size was 23.53 ± 6.6 mm. Mean operative time was 44.6 ± 13.44 min and primary stone-free rate after PCNL was 96% and 85.7% for single and multiple access, respectively. Second access was performed in seven cases, all of which had multiple stones. Mean hemoglobin drop was 1.23 ± 0.88 gr/dL. The patients stayed 2.56 ± 0.98 days in the hospital. Overall complication rate was 9.37%, without encountering any severe bleeding complication. Conclusion: Using non-papillary access for mini-PCNL did not result in significant blood loss and need for transfusions. The respective data were directly comparable to contemporary literature and the safety of mini-PCNL by a non-papillary approach could be advocated. [ABSTRACT FROM AUTHOR]

Purpose: Fluoroscopy is valuable in modern endourology. We present the results of a survey where compliance to radiation safety measures was tested according to surgical exposure, and level of understanding of the radiation rules and risks associated with it. Methods: A 52-item, anonymous questionnaire, structured by 6 ESUT/EULIS experts was distributed at 3 different endourological meetings during 2017–2018. Main aim was to evaluate level of knowledge on radiation physics and the protective measures taken against radiation exposure by participants. Fisher's exact test, Kruskal–Wallis test and ROC curve were used for statistical analysis. Results: 211 responses were evaluated. Number of correct answers (median 7.00) differed significantly according to age (p = 0.001), working position (p = 0.005), working field (p < 0.001), number of semirigid (p < 0.001)/flexible URS (p < 0.001) and PNL (p < 0.001) performed per year. Physicians aged 50–60 years, consultants, academics and those who performed more procedures achieved higher scores. In our study 51.7% of responders used shields in the operating room, 89.6% wore lead aprons, 84.4% thyroid shields, while glasses and gloves were used by 14.7% and 8.1%, respectively. Age, working field and number of correct answers did not affect significantly the use of protection in contrast with endourology fellowship training, working position and lessons on radiation. Interestingly, residents, untrained endourologists and those who were provided with lessons on radiation were more compliant. Conclusions: Our study revealed that majority of modern urologists advocate radiation protection during endourology practice. Senior consultants and academic urologists performing a high volume of procedures seem to understand physics and rules of radiation use. [ABSTRACT FROM AUTHOR]

Purpose: Aquablation of the prostate using the AquaBeam™ system promises equivalent functional outcomes, reduced learning curve, and improved sexual function compared to transurethral prostate resection as shown in prospective randomized trials. This prospective cohort study aims to evaluate if published results can be transferred into the clinical routine in a non-selected patient collective. Methods: This study includes all patients treated between September 2017 and June 2018 with Aquablation of the prostate. Patients have been evaluated prospectively for the perioperative course and early follow-up. Besides voiding parameter and symptom score, TRUS-volume change, ejaculatory function, and adverse events have been recorded. Results: 118 consecutive patients have been treated in the given time. Aquablation could be carried out successfully in all patients. IPSS, QoL, Qmax, and PVR improved significantly after the procedure and continued to improve during 3-month follow-up. Mean OR time was 20 min, TRUS volume decreased by 65%, and 73% of the patients retained antegrade ejaculation. Thirteen adverse events (> Clavien-Dindo I) occurred in 10 patients. Conclusion: The surgical ablation of the prostate using Aquablation achieved significant and immediate improvement of functional voiding parameters Qmax and PVR as well as symptomatic improvement of IPSS and QoL. Aquablation seems to be safe and effective with a low perioperative complication profile even in a non-selected group of patients. [ABSTRACT FROM AUTHOR]

Copyright of Der Urologe A is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Live surgery (LS) is considered a useful teaching opportunity. The benefits must be balanced with patient safety concerns. To evaluate the rate of complications of a series of urologic LS performed by experts during the Congress Challenge in Laparoscopy and Robotics (CILR).Methods: We present a large, multi-institution, multi-surgeon database that derives from 12 CILR events, from 2004 to 2015 with a total of 224 cases. Radical prostatectomy (RP) was the most common procedure and a selection of complex cases was noted. The primary measure was postoperative complications and use of a Postoperative Morbidity Index (PMI) to allow quantitative weighing of postoperative complications.Results: From 12 events, the number of cases increased from 11 in 2004 to 27 in 2015 and a total of 27 surgeons. Of 224 cases (164 laparoscopic and 60 robotic), there were 26 (11.6%) complications: 5 grade I, 5 grade II, 3 grade IIIa, 12 grade IIIb and 1 grade V, the latter from laparoscopic cystectomy. Analysis of PMI was 23 times higher from cystectomy compared to RP.Conclusions: In the setting of live surgery, the overall rate of complications is low considering the complexity of surgeries. The PMI is not higher in more complex procedures, whereas RP seems very safe. [ABSTRACT FROM AUTHOR]

Recent publications have failed to demonstrate significant differences in perioperative oncological and functional outcomes between laparoscopic radical prostatectomy (LRPE) and R-LRPE. Reports suggesting better functional results, in particular better potency rates for R-LRPE, are rare. However, to date no large prospective, randomized, multicenter studies have compared the two methods. With an experienced operator both methods produce comparably good results. The monopoly of the intuitive system with extremely high cost of purchase and maintenance are the major disadvantages of R-LRPE. [ABSTRACT FROM AUTHOR]

A lot of interest has been recently attracted to miniaturized Percutaneous Nephrolithotomy (PCNL). Smaller diameter tracts and instruments, in comparison to standard PCNL are utilized to decrease the morbidity of PCNL. However, a debate is ongoing regarding the safety and efficacy of these methods. The growing enthusiasm toward miniaturized PCNL led to different techniques and instruments, and eventually generated confusion in the terminology of PCNL. In this review, we highlight the different modalities of miniaturized PCNL, their indication, their safety and efficacy, and the appropriate terminology is suggested. A comprehensive review of current literature was performed using PubMed. Publications relevant to the subject were retrieved and critically appraised. Miniaturized PCNL was introduced with the desire to reduce access-related complications and bleeding. Miniaturized PCNL has yet to prove clear advantage over the standard PCNL. Nevertheless, the current experience proves the safety of the miniaturized techniques. Advantages of the miniaturized PCNL suggested in the literature are the lower bleeding rate and decreased hospital stay. In addition, the miniaturized PCNL has been proven a safe and effective modality of renal stone treatment in pediatric population. [ABSTRACT FROM AUTHOR]

Treatment of renal stones using flexible ureteroscopy (fURS) is increasingly common despite the poor evidence in literature supporting its use and indications. With this study, we wanted to investigate the current use and indication of fURS for the treatment of renal stones in the clinical practice across the European countries. A survey was conducted using an emailed questionnaire consisting of 21 items; 2,894 recipients were selected via the EAU membership database. The questionnaires were collected through the SurveyMonkey system and the data were processed with the SPSS statistical package. Frequencies, cross tabs and Pearson correlation coefficients were applied as appropriate. 1,168 questionnaires were collected (response rate 40.4 %). fURS was performed in 72.9 % of the respondents' institutions, and 54.2 % of the respondents were performing the procedure. For 95 % of the users, fURS was considered first-line treatment, for stone of lower pole stone (45.9 %) and <1 cm (44.2 %) and 2 cm (43.8 %) in size. The ureteral access sheaths were used routinely by more than 70 % of the respondents. Lower pole stone repositioning technique was routinely performed by 45.9 % of the surgeons. After fragmentation, 47.2 % of the responders preferred to retrieve only the bigger fragments. At the end of fURS, lower volume surgeons were more likely to place routinely a double-J stent ( p = 0.001). Higher volume surgeons estimated a higher durability of devices, both optical and digital ones ( p < 0.001), and were more prone to consider fURS cost-effective when compared to other treatment modalities ( p < 0.001). fURS is widely used for the treatment of renal stones and its use and indication can vary according to the age and surgeons' case volume. Higher volume surgeons are more prompt to extend international guidelines indications and to consider the technology cost-effective. [ABSTRACT FROM AUTHOR]

Optical coherence tomography (OCT) images and histology images of metal stents (MSs) inserted in animal ureters were compared, and the reliability of an OCT-based automated method for the performance of quantitative evaluation of ureteral MSs was evaluated. A zotarolimus-eluting metal stent (ZES) and a bare metal stent (BMS) were inserted in each ureter of ten pigs and six rabbits. OCT was performed in unobstructed stented ureters. Histopathologic examination of the stented ureters embedded in glycol-methacrylate took place. Quadrants of OCT images were compared to their respective histologic images by employing two independent observers who delineated different layers in the quadrants of OCT images and correlated them to the respective histologic quadrants. Manual (integrated OCT device software) and automated measurements of the OCT images using an automated strut detection method were compared. The observers highly agreed on the delineation of urothelium from the lamina propria and the lamina propria from the muscle layer of the ureteral wall. The algorithm measurements were similar to the manual measurements, and the algorithm proved to be reliable in the evaluation of ureteral MSs. Significantly higher endothelial hyperplasia of the BMSs in comparison to the ZESs was also quantitatively demonstrated by the strut detection method. OCT proved to be a reliable method for the evaluation of ureteral MSs. OCT provided images of the stented ureteral lumen similar to light microscopy quality. Measurements of the stented ureter are reliably performed by the automated strut detection method. [ABSTRACT FROM AUTHOR]

Introduction: Natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) are the next steps in the evolution of laparoscopic surgery, promising reduced morbidity and improved cosmetic result. The inconsistent terminology initially used led to confusion. Understanding the technical evolution, the current status and a unified and simplified terminology are key issues for further acceptance of both approaches. Objective: To present LESS and NOTES in its historical context and to clarify the associated terminology. Method: Extensive literature search took place using the PubMed. Several hundred publications in general surgery and urology regarding LESS are present including the expert opinion of members the European Society of Uro-technology (ESUT). Results: The increasing interest on NOTES and LESS is reflected by a raising number of publications during the last 4 years. The initial confusion with the terminology of single-incision surgery represented a significant issue for further evolution of the technique. Thus, consortiums of experts searched a universally acceptable name for single-incision surgery. They determined that 'laparoendoscopic single-site surgery' (LESS) was both scientifically accurate and colloquially appropriate, the term being also ratified by the NOTES working group (Endourological Society) and the ESUT. For additional use of instruments, the terms hybrid NOTES and hybrid LESS should be used. Any single use of miniaturized instruments for laparoscopy should be called mini-laparoscopy. Discussion: The evolution of LESS and most likely NOTES to a new standard of minimally invasive surgery could represent an evolutionary step even greater than the one performed by the establishment of laparoscopy over open surgery. [ABSTRACT FROM AUTHOR]

Copyright of Der Urologe A is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of this study was to investigate the patterns of renal function recovery during partial nephrectomy (PN) on an experimental solitary kidney rabbit model and establish the upper tolerable time limits of applied ischemia. Forty-eight New Zealand rabbits underwent an open right nephrectomy and after 30 days, the animals were clustered into five groups (A, B, C, D, E). The first four groups received an open left PN, under different types of ischemia. Groups A ( n = 8) and B ( n = 10) were subjected to 90 and 60 min of warm ischemia (WI), respectively, while groups C ( n = 10) and D ( n = 10) received 90 and 120 min of cold ischemia (CI) with ice-slush cooling. Group E ( n = 10) served as sham group. Serum determinations of creatinine (SCr) and BUN were recorded preoperatively and on postoperative days (POD) 1, 3, 6 and 15. The animals were euthanized and the remaining kidneys were harvested and evaluated microscopically. The type and duration of ischemia were statistically significant parameters ( P < 0.001). Groups B, C and D exhibited a similar pattern of recovery from trial initiation to the 15th POD ( P = 0.788 and P = 0.068, respectively). Group A was extremely differentiated, with 100% mortality caused by uremia. The microscopic findings were consistent to the serum biochemistry. In our solitary kidney rabbit model, the upper limits of tolerable WI seem to be set on 60 min. CI can safely preserve the model’s renal function—even up to 120 min. [ABSTRACT FROM AUTHOR]

The treatment of prostate cancer has undergone a fundamental change in the last decade. New surgical and nonsurgical minimal invasive methods have evolved. As the methodology of the different treatments is commonly known to urologists, this article focuses on oncological and functional outcome of open retropubic (ORP), trans- or extraperitoneal endoscopical (LRP), and robot-assisted radical prostatectomy (RALP), based on personal experience and review of the literature. A MEDLINE search was performed to review the literature on LRP and RALP between 1982 and 2007 with special emphasis on oncological and functional results, technical considerations, comparison of LRP and RALP to ORP, laparoscopic training, historical aspects, and cost-efficiency of the techniques. Based on diligent training and proctoring programs, a continuous dissemination of laparoscopic techniques takes place. There is a trend towards the extraperitoneal access in most of the minimal invasive programs at least in the European community. Mid-term outcomes of LRP and short-term outcomes of RALP achieved equivalence to open surgery with regards to complications, oncologic and functional results. Distinct advantages of LRP include less postoperative pain, lower transfusion rates, shorter convalescence, and better cosmetics. In contrast to RALP, LRP reaches cost-equivalence with open surgery in selected centers. LRP and RALP reproduce the short-term results of open surgery while providing the advantages of a minimal access. Video-assisted teaching improves the transfer of anatomical knowledge and technical knowhow, but the discussion about the longer learning curve for laparoscopy handling remains. The future will show if European centers adopt the use of robots comparable to the United States. [ABSTRACT FROM AUTHOR]

Relatively long learning curves and, therefore, initially longer operating times compared to conventional procedures are still a matter of debate. Today, there are numerous possibilities for learning laparoscopic techniques and establishing one's own laparoscopic programs, including various pelvitrainers and virtual reality computer programs. One useful and realistic way involves "wet lab" training programs for ablative and reconstructive procedures using the pig model. Today, laparoscopic urological surgery includes procedures with low (e.g. laparoscopy for undescended testicles), intermediate (laparoscopic pyeloplasty) and high level (laparoscopic/endoscopic prostatectomy) complexity. Therefore, laparoscopy should be an integral part of training in urology. A defined number of possibly multi-institutional training centers with well structured educational programs are needed. The main goal should be the standardization of surgical procedures as well as educational training programs in order to shorten individual learning curves and generate common quality standards. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess the relationship between the length of perineal body, the anal position index, the total fourchette-coccyx distance and the anal-coccyx length and female urodynamic stress urinary incontinence (USUI). Patients and methods: The study included 57 women with USUI (group A) and 45 women without USUI as control (group B). All patients underwent a urodynamic evaluation and measurement of the length of perineal body (PB) and the distance between the fourchette and the inferior margin of coccyx (FC). PB is the distance between the fourchette and the center of anal orifice. The ratio PB/FC is the anal position index. Subtracting the PB length from FC distance equals the anal-coccyx (AC) length. Results: The student’s t-test showed no significant statistical difference between any of the measured lengths in the two groups. Moreover, in the USUI group, ANOVA did not show any significant relationship between the urodynamic parameters and the measured lengths. Regarding to the investigated urodynamic parameters only the maximum urethral pressure (Pura max) presented a significant statistical difference between the two groups ( P = 0.009). Conclusion: Theoretically, a differentiation of perineal distances probably brings to the surface a laxity of the pelvic floor, a factor predisposing to USUI. Furthermore, the anterior position of anus can be a cause of constipation which also contributes to USUI. However, our study did not reveal any relationship between the perineal length measurements and USUI. Further investigation with longer series of patients is needed to show if this simple, inexpensive and non-invasive test could be added in the armamentarium of the diagnostic and prognostic investigation of USUI. Regarding to the urodynamic parameters, our results emphasize the importance of the Pura max parameter in the urodynamic evaluation of USUI. [ABSTRACT FROM AUTHOR]

We have evaluated 21 patients, ranging in age from 44 to 71 years (mean: 55 years), who presented to our department with the radiologic characteristics of retroperitoneal fibrosis. Ureterolysis was performed in all cases. Intraperitoneal placement of the ureter was performed in 9, and placement of the ureter in a lateral extraperitoneal position in 12 cases. We found no difference in the postoperative course and radiological and clinical improvement to favour the first or the second method, and therefore we consider the intraperitoneal approach as an unnecessary manoeuvre. [ABSTRACT FROM AUTHOR]

We herein report a case of a female embryo who died in utero and at autopsy she was found to have bilateral renal agenesis with the extrarenal manifestations of Potter's syndrome together with mermaid syndrome which is a rare combination. From all the anomalies of the upper urinary tract bilateral renal agenesis seems to have a cardinal role in the survival of the embryo afflicted with the spectrum of associated anomalies. [ABSTRACT FROM AUTHOR]

A group of 42 hypercalciuric patients (24 males and 18 females) aged 23 to 61 years (mean 45.57±12.27) with recurrent stone disease was studied. We applied for a period of 10 days a normocalcium, moderately low protein diet. We found statistically significant variations of azotaemia, venous pH, and vitamin D 1–25. In the 24 h urine collection we found a statistically significant decrease of nitrogen, uric acid, sodium, chloride, calcium, phosphates, oxalate, and hydroxyproline. In conclusion, the present study suggests that the restricted consumption of animal protein can produce a limited effect in urinary biochemistry. The actual efficiency of this dietary restriction on stone formation remains to be evaluated by a prospective long-term study of a larger population. Whether this has an effect on the future incidence of stone formation has to be further verified. [ABSTRACT FROM AUTHOR]

An unusual case of a 15-year-old male who presented with a characteristic clinical syndrome of testicular torsion one week prior to our observation, is reported. During our intervention the testicle was not removed but, on the contrary, restoration of a satisfactory testicular albugineal appearance was achieved. [ABSTRACT FROM AUTHOR]

Fifty-three patients with BPH have been evaluated and treated with TMT with a follow-up at 7 months. The prostate was heated transcrectally to 42-43°C and the treatment consisted of 5 to 6 sessions. The duration of each session was 60 minutes. The urodynamic parameters studied revealed an increase of the maximum flow rate and a decrease of the detrusor opening pressure as well as the detrusor pressure at maximum flow. A significant improvement in the amount of residual urine was seen in all patients. Based on the above, we propose TMT as a viable alternative to open surgical or transurethral removal of the prostate. Futhermore, TMT may serve as a preferred treatment option in patients with indwelling urethral catheters and highly increased surgical risk. [ABSTRACT FROM AUTHOR]

The authors prospectively evaluated 24 consecutive female patients with type III stress urinary incontinence, ranging in age from 36 to 70 years (mean 55 years). All patients were operated upon and had a vesicourethral suspension by a Gore-Tex suburethral sling. All were evaluated urodynamically 6 and 30 months after surgery. In this group of patients clinical cure of incontinence was observed in 83.3% (20) and in the remaining 4 patients it was significantly improved. In 2 patients there was an erosion of the urethra and the sling had to be removed 3.5 years later. Five other women remained dry but complained of occasional irritative symptoms, and several urinary tract infections were recorded (2–3 per year), which were documented by positive urine cultures. In the remaining 17 patients no erosion was observed and no irritative symptoms were reported. The urodynamic evaluation revealed an excellent postoperative result both 6 months and 30 months after surgery. [ABSTRACT FROM AUTHOR]

We report 2 cases of penile lipomas. although the simultaneous sexual dysfunction proved to be phsychogenic their surgical excision improved their sexual life. [ABSTRACT FROM AUTHOR]