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Objectives To study high‐frequency 29 MHz transrectal side‐fire micro‐ultrasound (micro‐US) for the detection of clinically significant prostate cancer (csPCa) on prostate biopsy, and validate an image interpretation protocol for micro‐US imaging of the prostate. Materials and methods A prospective randomized clinical trial was performed where 1676 men with indications for prostate biopsy and without known prostate cancer were randomized 1:1 to micro‐US vs conventional end‐fire ultrasound (conv‐US) transrectal‐guided prostate biopsy across five sites in North America. The trial was split into two phases, before and after training on a micro‐US image interpretation protocol that was developed during the trial using data from the pre‐training micro‐US arm. Investigators received a standardized training program mid‐trial, and the post‐training micro‐US data were used to examine the training effect. Results Detection of csPCa (the primary outcome) was no better with the first‐generation micro‐US system than with conv‐US in the overall population (34.6% vs 36.6%, respectively, P = .21). Data from the first portion of the trial were, however, used to develop an image interpretation protocol termed PRI‐MUS in order to address the lack of understanding of the appearance of cancer under micro‐US. Micro‐US sensitivity in the post‐training group improved to 60.8% from 24.6% (P

Introduction: During the first regional COVID-19 lockdown in March 2020, we conducted a study aimed at evaluating completeness of telemedicine consultation in urology. Of 1679 consultations, 67% were considered completely managed by phone. The aim of the present study was to assess patients’ experience and satisfaction with telemedicine and to compare them with urologists’ perceptions about quality and completeness of the telemedicine consultation. Methods: We contacted a randomly selected sample of patients (n=356) from our previous study to enquire about their experience. We used a home patient experience questionnaire, inspired by the Patient Experiences Questionnaire for Out-of-Hours Care (PEQ-OHC) and the Consumer Assessment Health Profile Survey (CAHPS). Results: Of 356 patients contacted, 315 agreed to complete the questionnaire. Urological consultations were for non-oncological (104), oncological (121), cancer suspicion (41), and pediatric (49) indications. Mean patient satisfaction score after telemedicine consultation was 8.8/10 (median 9/10) and 86.3% of patients rated the quality of the consultation as either excellent (54.6%) or very good (31.7%). Consultations regarding cancer suspicion had the lowest score (8.3/10). Overall, 46.7% of all patients would have preferred an in-person visit outside of the pandemic situation. Among patients whose consultations were rated suboptimal by urologists, almost a third more (31.2%) would have preferred an in-person visit (p=0.03). Conclusions: Despite high reported patient satisfaction rates with telemedicine, it is noteworthy that nearly half of the patients would have preferred an in-person visit. Post-pandemic, it will be important to incorporate telemedicine as an alternative, while retaining and offering in-person visits.

Prostate cancer (PCa) and associated treatments incur symptoms that may impact patients’ quality of life. Studies have shown beneficial relationships between diet, especially omega-3 fatty acids, and these symptoms. Unfortunately, only few data describing the relationship between long-chain omega-3 fatty acids (LCn3) and PCa-related symptoms in patients are available. The purpose of this study was to evaluate the effects of LCn3 supplementation on PCa-specific quality of life in 130 men treated by radical prostatectomy. Men were randomized to receive a daily dose of either 3.75 g of fish oil or a placebo starting 7 weeks before surgery and for up to one-year post-surgery. Quality of life was assessed using the validated EPIC-26 and IPSS questionnaires at randomization, at surgery, and every 3 months following surgery. Between-group differences were assessed using linear mixed models. Intention-to-treat analyses showed no significant difference between the two groups. However, at 12-month follow-up, per-protocol analyses showed a significantly greater increase in the urinary irritation function score (better urinary function) (MD = 5.5, p = 0.03) for the LCn3 group compared to placebo. These results suggest that LCn3 supplementation may improve the urinary irritation function in men with PCa treated by radical prostatectomy and support to conduct of larger-scale studies.

CONTEXT: Team-based learning (TBL) is a flipped-classroom approach requiring students to study before class. Fully flipped curricula usually have fewer in-class hours. However, for practical reasons, several programs implement a few weeks of TBL without adjusting the semester timetable. Students fear that they will be overloaded by the individual and collaborative study hours needed to prepare for TBL. METHODS: We implemented three consecutive weeks of TBL in a 15-week lecture-based course on the renal system. In-class time and assessments were unchanged for all courses. Four hundred fifty-nine first-year undergraduate medical students (229 in 2018; 230 in 2019) were invited to complete weekly logs of their individual and collaborative study hours during lectures and TBL, along with questionnaires on cognitive load and perception of the course. Our program changed from A to E grading in 2018 to pass-fail grading in 2019 RESULTS: Participants (n = 324) spent a similar number of hours studying for TBL vs. lectures with a mean of 3.1 h/week. Collaborative study was minimal outside class (median 0.1 h/week). Results remained similar with pass-fail grading. If in-class time were reduced, 18% of participants said they would have used freed-up time to study for TBL. Studying for TBL generated similar extraneous cognitive load and lower intrinsic load compared to studying for lectures; students were less stressed, and maintained high levels of motivation and self-perceived learning. CONCLUSIONS: Three weeks of lectures were replaced by TBL without reducing in-class time. Students did not report overload in study hours or in cognitive load. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01314-x.

Introduction The COVID-19 pandemic has accelerated the development of telemedicine due to confinement measures. However, the percentage of outpatient urological cases that could be managed completely by telemedicine outside of the COVID-19 pandemic remains to be determined. We conducted a prospective, multisite study involving all urologists working in the region of Quebec City. Methods During the first four weeks of the regional confinement, 18 pediatric and adult urologists were asked to determine, after each telemedicine appointment, if it translated into a complete (CCM), incomplete (ICM), or suboptimal case management (SCM, adequate only in the context of the pandemic). Results A total of 1679 appointments representing all urological areas were registered. Overall, 67.6% (95% confidence interval [CI] 65.3; 69.8), 27.1% (25.0; 29.3), and 4.3% (3.5; 5.4) were reported as CCM, SCM, and ICM, respectively. The CCM ratio varied according to the reason for consultation, with cancer suspicion (52.9% [42.9; 62.8]) and pediatric reasons (38.0% [30.0; 46.6]) showing the lowest CCM percentages. CCM percentages also varied significantly based on the setting where it was performed, ranging from 61.1% (private clinic) to 86.8% (endourology and general hospital). Conclusions We show that two-thirds of all urological outpatient cases could be completely managed by telemedicine outside of the pandemic. After the pandemic, it will be important to incorporate telemedicine as an alternative for a patient's first or followup visit, especially those with geographical, pathological, and socioeconomic considerations.

BACKGROUND Transplant glomerulopathy (TG) is a diagnostic criterion for chronic active antibody-mediated rejection (CAABMR), with C4d, donor-specific antibodies (DSA) and other lesions of chronic tissue injury. However, TG often presents without C4d or DSA. Until recently, such cases were termed suspicious for CAABMR, and their prognosis remains unclear. METHODS To better understand the contribution of TG, C4d, and DSA on outcomes, we retrospectively studied 61 patients with late TG for the composite endpoint of death-censored graft failure or doubling of serum creatinine. Cases were matched to controls based on age, year and number of transplant, type of donor, and the availability of an indication biopsy during the same time after transplantation. Analyses were performed using proportional hazards models. RESULTS Compared to matched controls, patients with TG had a more than fivefold increased risk of reaching the endpoint (adjusted hazard ratio (aHR), 5.3; 95% confidence interval (95% CI), 1.5-18.4). The proportion of patients with isolated TG, TG suspicious for CAABMR (C4+/DSA- or C4d-/DSA+) and TG with definite CAABMR (C4d+/DSA+) were 63%, 20%, and 17%, respectively. Suspicious and definite CAABMR showed a similar prognosis, significantly worse than isolated TG (aHR, 4.5; 95% CI, 1.1-18.9 and aHR, 5.9, 95% CI, 1.1-31.3 respectively). CONCLUSION Transplant glomerulopathy is associated with poor prognosis, independent of the level of graft dysfunction and other chronic histologic changes. This prognosis is similar whether there is evidence of tissue or peripheral alloantibody reactivity. These findings are relevant to the development of clinically meaningful criteria for CAABMR, for its clinical management, and in the future selection of population for clinical trials.

Background Third kidney retransplants have technical and immunologic hurdles that may preclude success, which is of particular importance in the contemporary context of discrepancy between organ supply and demand. Methods The outcomes of third renal transplant recipients (TRTR) were compared with those receiving a first transplant from paired donor kidneys to assess transplant success and complication rates. The Ontario-based Trillium Gift of Life Network database was used to identify deceased donors (n=28) who donated one kidney to a TRTR and the mate kidney to a primary renal transplant recipient (PRTR) from June 1977 to August 2006. Results As anticipated, TRTR were sensitized versus PRTR based on % panel reactive antibodies (24%+/-34% vs. 7%+/-14%, P=0.03). Delayed graft function (46% vs. 22%, P=0.05) and biopsy-proven rejection episodes (50% vs. 29%, P=0.01) occurred more frequently with TRTR despite greater frequency of induction therapy (74% vs. 35%, P=0.004). However, 1- and 5-year patient survival were similar at 93%, 83% and 96%, 87% for TRTR and PRTR, respectively. Accordingly, 1- and 5-year allograft survival censored for mortality, were comparable at 78%, 66% and 78%, 75%. Renal function was similar in both groups. Bacterial infections (43% vs. 18%, P=0.001) and wound problems (28% vs. 11%, P=0.09) were the only postoperative complications to occur more frequently in the TRTR. Conclusion We conclude that third renal transplantation should not be discouraged based on functional outcomes alone.

The effect of adding a calcium channel antagonist to kidney allograft perfusate solution was assessed. All renal transplants in which both kidneys from the same donor used for transplantation were studied between November, 2003 and August, 2005 (n=46). The first renal allograft was perfused on the backtable with 1 L of histidine-tryptophan-ketoglurate solution and the second with 1 L of histidine-tryptophan-ketoglurate with 5 mg/L of verapamil. Both organs were transplanted in the usual manner. Baseline demographic parameters were similar between first and second kidney recipients other than BMI and cold ischemic time. At 6 and 12 months, renal function was significantly improved in the verapamil versus control cohort (creatinine clearance 73.8+/-23.5 mL/min vs. 55.8+/-17.0 mL/min, P

Objectives To evaluate the functional outcomes and quality of life of adult patients with neurogenic bladders who had undergone Casale Spiral Monti vesicostomy. Methods Twelve patients who underwent Casale Spiral Monti vesicostomy from May 1999 to December 2004 were evaluated with the Medical Outcomes Study 36-item short-form health survey to assess for postoperative quality of life. Complications and patient reported continence were also documented. Results The 12 patients (mean age 27.4 years) were followed up for a mean of 2.8 years. All 12 reported excellent urinary continence after the procedure, with only 7 patients who had the capacity to self-catheterize. Two patients reported wearing one light pad per day over the stoma. Two patients required one endoscopic dilation each for stomal stenosis, and one patient was readmitted 3 weeks postoperatively for the management of paralytic ileus. Eight patients reported no urinary tract infection since the operation. All 12 patients reported being very satisfied with the procedure. Conclusions The results of this study have demonstrated that Casale Spiral Monti vesicostomy can have dramatic positive effects on the quality of life in adults with a neurogenic bladder by granting them social independence, convenient bladder management, and excellent continence rates.

Laparoscopic living donor nephrectomy (LLDN) is a minimally invasive technique for kidney procurement and was developed with the hope of reducing the disincentives associated with live renal donation. Compared with open donor nephrectomy (ODN), this alternative has many advantages including less postoperative pain and earlier return to work. Unfortunately, these benefits are sometimes negated by postoperative complications. Among these, chylous ascites (CA) is a rare but serious problem that is usually managed conservatively. We report the case of a living donor who developed CA refractory to initial conservative management and surgical treatment. We also discuss the role of surgery in the treatment of CA following LLDN.

Introduction and Objectives The ImmuKnow assay measures cell-mediated immunity by quantifying ATP release from CD4+ T-cells in peripheral blood. Herein, we hypothesized that this assay could predict complications associated with over-/under-immunosuppression in patients with kidney transplant (KT). Methods Sixty-seven patients undergoing KT were recruited prospectively and had ATP levels measured preoperatively, and at specified intervals over two months. Clinicians were blinded to ATP levels. Clinical events including rejection and infection/cancer were documented with a median follow-up of 21 months. Parameters including absolute ATP levels and changes in ATP patterns (slopes, delta) were analyzed. Association between ATP parameters and clinical outcomes was compared using the likelihood-ratio test and Kaplan–Meier curves. Results Absolute ATP values postoperatively had poor predictive value with regard to rejection or infection/malignancy. As well, changes in ATP values were poorly associated with complications. Importantly, patients with pre-transplant ATP values 300 ng/mL (p

We describe laparoscopic partial nephrectomy in a patient with autosomal dominant polycystic kidney disease. Reconstruction was accomplished despite the abnormal quality of the renal tissue. In this patient, with borderline renal function, the warm-ischemia time (50 minutes) was longer than the normally accepted time and was poorly tolerated. In order to avoid the damaging effects of warm ischemia, alternatives to hilar clamping should be employed, and open partial nephrectomy should be considered.

Delayed graft function (DGF) has a negative impact on graft survival in donation after brain death (DBD) but not for donation after cardiac death (DCD) kidneys. However, older donor age is associated with graft loss in DCD transplants. We sought to examine the interaction between donor age and DGF in DBD kidneys. This is a single-center, retrospective review of 657 consecutive DBD recipients transplanted between 1990 and 2005. We stratified the cohort by decades of donor age and studied the association between DGF and graft failure using Cox models. The risk of graft loss associated with DGF was not significantly increased for donor age below 60 years (adjusted hazard ratio [aHR] 1.12, 1.51, and 0.90, respectively, for age

INTRODUCTION AND OBJECTIVES: We prospectively assessed the impact of multiple factors affecting early, intermediate and late renal function after LPN. METHODS: Between 2004–2009, sixty-eight patients with 2 functioning renal units undergoing LPN were prospectively analysed. MDRD and Cockcroft Gault-calculated glomerular filtration rates (GFR), MAG-3 renograms with GFR and differential function were obtained at 1) preoperatively 2) immediately post-op ( 3 days) 3) intermediate post-op (6–12wks) and late post-op (one year). The impact of patient demographics, tumour characteristics and surgical factors on functional renal outcomes were assessed. Correlation analysis was first performed using Spearman correlation to elucidate factors correlated with GFR decline. Subsequent multivariate analysis was performed at each of the postop periods. Paired t-test was used to compare baseline GFR and renograms to these outcomes at each of the postoperative time periods. RESULTS: Spearman correlation determined that age, weight, pre-operative GFR, piece size and warm ischemia time (WIT) were correlated with early decline in GFR. However, multivariate analysis showed that in the immediate time period, only tumor weight and WIT were predictive of decreased renal function (p 0.01). As well, in the late post-op period, only the degree of early/intermediate reduction in renal function was predictive of persistent impaired renal function (p 0.00001). Paired t-test analysis showed that there was significant decline in renal function in the immediate and intermediate time points (p 0.001); this decline did not persist at one year, indicating capacity for late renal recovery (p NS). However, paired t-test using nuclear renogram studies showed that there was persistent dysfunction of the affected kidney at one year postop (41.7% vs 49.4% preop; p 0.001). Taken together, this indicates that late renal recovery may occur as a result of compensation from the contralateral renal unit. CONCLUSIONS: This study confirms the negative impact of warm ishemic time upon early renal function post-LPN. Importantly, this is the first study to show that the degree of initial renal functional loss is a key determinant to renal recovery at one year. Additionally, the function of the affected kidney remains compromised at one year, and recovery of renal function is primarily by compensation from the contralateral kidney.

Carbon monoxide (CO) can provide beneficial antiapoptotic and anti-inflammatory effects in the context of ischemia-reperfusion injury (IRI). Here we tested the ability of pretreating the kidney donor with carbon monoxide-releasing molecules (CORM) to prevent IRI in a transplant model. Isogeneic Brown Norway donor rats were pretreated with CORM-2 18 h before kidney retrieval. The kidneys were then cold-preserved for 26 h and transplanted into Lewis rat recipients that had undergone bilateral nephrectomy. Allografts from Brown Norway to Lewis rats were also performed after 6 h of cold ischemic time with low-dose tacrolimus treatment. All recipients receiving CORM-2-treated isografts survived the transplant process and had near-normal serum creatinine levels, whereas all control animals died of uremia by the third post-operative day. This beneficial effect was also seen in isografted Lewis recipients receiving kidneys perfused with CORM-3, indicating that CORMs have direct effects on the kidney. Pretreatment of human umbilical vein endothelial cells in culture with CORM-2 for 1 h significantly reduced cytokine-induced nicotinamide adenine dinucleotide phosphate-dependent production of superoxide, activation of the inflammation-relevant transcription factor nuclear factor-κB, upregulated expression of E-selectin and intercellular adhesion molecule-1 adhesion proteins, and leukocyte adhesion to the endothelial cells. Thus, CORM-2-derived CO protects renal transplants from IRI by modulating inflammation.

Background Organ shortage has led to the use of dual-kidney transplant (DKT) of very marginal donors into a single recipient to increase the use of marginal organs. To date, few data are available about the long-term outcome of DKT and its usefulness to increase the pool of available organ. Methods We conducted a single-center cohort study of DKTs with longitudinal follow-up over an 8-year period. Between 1999 and 2007, 63 DKTs were performed. All kidneys from donors younger than 75 years refused by all centers for single transplantation, and kidneys from donors aged 75 years or older were routinely evaluated based on preimplantation glomerulosclerosis. Renal function, patient or graft survival, and perioperative complications were compared with 66 single kidneys from expanded criteria donors (ECD) and 63 ideal kidney donors. Results After a median follow-up of 56 months, patient or graft survival was similar between the three groups. Twelve-, 36-, and 84-month creatinine clearance were similar for DKT and ECD (12 months: 58 and 59 mL/min; 36 months: 54 and 60 mL/min; and 84 months: 62 and 51 mL/min, respectively). For the study period, the routine evaluation of very marginal kidneys for DKT in our center has led to an increase of 47% in the transplants from donors aged 50 years or older, which represent 12% at the level of our organ procurement organization. Conclusions DKT patients can expect long-term results comparable with single kidney ECD. The implementation of a DKT program in our unit safely increased the pool of organs from marginal donors.

Robot-assisted pyeloplasty (RAP) has been established recently as an option in the management of ureteropelvic junction obstruction (UPJO). We present the first Canadian experience with RAP with respect to operative results and outcomes. We compare the surgical outcomes between experienced and trainee surgeons, with respect to operating room times and success rates.Eighty-eight patients underwent transperitoneal RAP for UPJO using the da Vinci robotic platform. Two surgeons performed Anderson-Hynes dismembered pyeloplasty in 85 cases and YV-plasty in 5 cases. Five patients had RAP for secondary UPJO after failure of other treatments. Diuretic renography was performed at 6 weeks, and 6, 12, 18, 24, and 36 months postpyeloplasty. The mean follow-up was 14.1 ± 8.5 months.The mean operative time was 167.7 ± 43.2 minutes, and the mean anastomotic time was 41.9 ± 14.1 minutes. The mean operative duration significantly decreased with time (P0.05). Ten patients needed simultaneous nephroscopic stone management via the pyelotomy incision. The mean blood loss was 56.6 ± 55.4 mL, and the mean hospital stay was 2.5 ± 0.5 days. There were five major postoperative (stent migration, urinoma) and three minor complications that were associated with the RAP procedures. Postoperative renal scintigraphy demonstrated only four cases with persistent obstruction. Eighty-three (94.3%) patients experienced improvement of symptoms whereas 5 continued to be symptomatic. Two patients needed secondary procedures to relieve persisting obstruction. There were no statistical differences in outcomes between the experienced surgeons and trainees (P = 0.28).In the first large case series of RAP from Canada, we demonstrate that RAP can be performed with relatively short operative times and is safe and effective, achieving similar long-term results with standard open repair. We show that robot-assisted surgery can be safely transitioned to surgical trainees. With its cost and availability, its role in the Canadian system needs further study.

The development, advancement and clinical integration of robotictechnology in surgery continue at a staggering pace. In no otherdiscipline has this rapid evolution occurred to a greater degreethan in urology. Although radical prostatectomy has grown tobecome the prototypical application for the robot, the role of therobot in renal surgery remains controversial. Herein we reviewthe literature on robotic renal surgery. A comprehensive PubMedliterature search was performed to identify all published reportsrelating to robotic renal surgery. All clinically related articlesinvolving human participants were critically appraised in thisreview. Fifty-one clinical articles were included, encompassingrobot-assisted pyeloplasty, nephrectomy, nephroureterectomy,living-donor nephrectomy and partial nephrectomy. Feasibilityhas been shown for each of these procedures. Robot-assisted techniqueshave been described for almost all renal-related procedures.However, the intersect between feasibility and necessityas it pertains to robotic renal surgery has yet to be defined. Also,the high cost of surgical robotic technology mandates criticalappraisal before adoption, especially in a publicly funded healthcare system, such as the one present in Canada.Le développement, le perfectionnement et l’intégration en milieuclinique de la technologie robotique en contexte opératoire sepoursuit à un rythme stupéfiant. Aucune autre discipline n’a vucette évolution rapide à un niveau aussi élevé que l’urologie.Alors que la prostatectomie radicale en est devenue l’applicationprototype, le rôle de la robotique en chirurgie rénale demeurecontroversé. Dans l’article qui suit, nous passons en revue lalittérature portant sur l’emploi de la robotique en chirurgie rénale.Une recherche exhaustive dans la base de données PubMed aété effectuée afin de cerner les rapports sur le sujet. Tous les rapportscliniques portant sur des sujets humains ont été évalués.Cinquante et un articles cliniques ont été inclus dans notreanalyse, incluant des cas, tous assistés par robot, de pyéloplastie,de néphrectomie, de néphro-urétérectomie, de néphrectomiechez des donneurs vivants et de néphrectomie partielle. Pour chacunede ces interventions, la faisabilité a été démontrée. Des techniquesassistées par robot ont été décrites pour pratiquement tousles types d’interventions rénales. Néanmoins, le point d’intersectionentre faisabilité et nécessité concernant l’utilisation de larobotique reste à définir. Par ailleurs, le coût élevé de la robotiquechirurgicale justifie une évaluation critique avant l’adoptionde cette technologie, en particulier dans un système de santépublic comme celui du Canada.

The acute Page kidney phenomenon occurs as a consequence of external compression of the renal parenchyma leading to renal ischemia and hypertension. Between January 2000 and September 2007, 550 kidney transplants and 518 ultrasound-guided kidney biopsies were performed. During that time, four recipients developed acute oligo-anuria following ultrasound-guided allograft biopsy. Emergent doppler-ultrasounds were performed demonstrating absence of diastolic flow as well as a sub-capsular hematoma of the kidney. Prompt surgical exploration with allograft capsulotomy was performed in all cases. Immediately after capsulotomy, intraoperative Doppler study demonstrated robust return of diastolic flow. Three patients maintained good graft function, and one kidney was lost due to acute antibody-mediated rejection. We conclude that postbiopsy anuria associated with a subcapsular hematoma and acute absence of diastolic flow on doppler ultrasound should be considered pathognomonic of APK. All renal transplant specialists should be able to recognize this complication, because immediate surgical decompression can salvage the allograft.

The worldwide evolution of robotic surgery continues to advance at a staggering pace. In less than 20 years, the technology has grown exponentially from theoretical military application to daily use in operating rooms around the globe. In fact, the overwhelming success of robotic surgery with regards to invention, innovation, and adaptation is an excellent example of collaboration between surgeons, industry, and government. While the first robotic device to be used clinically dates back to computerized tomography-guided stereotactic neurosurgery by Kwoh et al in 1988 1, the first urological application in a human was not described until Davies et al2 used a modified industrial robotic arm to perform a transurethral resection of the prostate three years later. The first commercial application in laparoscopy did not come until the Automated Endoscopic System for Optimal Positioning (AESOPTM) was FDA approved in the United States in 19937. Originally designed by the U.S. military, the table-mounted device could precisely guide a laparoscope and was later put into production by Computer Motion Inc. (Santa Barbara, California).3 Computer Motion Inc. would later introduce the ZEUSTM robotic system onto the U.S. market in 1998, just months after the unveiling of another surgical robot, the da Vinci® (Intuitive Surgical, Sunnyvale, California). The da Vinci® system was born out of technology designed by NASA, also originally intended for use by the U.S. military, but quickly adopted for civilian use. In 2003, Intuitive Surgical took over Computer Motion Inc., thereby paving the way for the da Vinci® robot, along with it’s newly FDA approved EndoWristTM, to dominate surgical robotic use worldwide.3 Today, the vast majority of published literature on robotic-assisted renal surgery has employed the use of the da Vinci® system, and it is the only commercially available master-slave robotic system in production today. Few studies have addressed the comparative performance and efficiency between the three most cited robotic platforms, namely AESOP, ZEUS and da Vinci®. Sung et al4 initially looked at this question in a porcine model, and we later compared our results in a cohort of patients undergoing pyeloplasty for ureteropelvic junction obstruction (UPJO).5 Both groups concluded that the da Vinci® system was superior in terms of shorter operative time, quicker anastomotic time, and flatter learning curve. We also found the majority of technical manoeuvering inherently more intuitive with the da Vinci® system compared to the ZEUS system. There does exist some earlier reports of experience with the ZEUS O pe n A cc es s D at ab as e w w w .ite ch on lin e. co m

We describe the case of a 23 year-old man with high-flow priapism following blunt perineal trauma. He was treated successfully with super-selective embolization with a resorbable material (gel foam). We will review the pathophysiology, etiology, and diagnosis and treatment approaches of high-flow priapism based on a review of the medical literature.

Postoperative chylous ascites is a rare complication after retroperitoneal surgery. It is a complex problem associated with nutritionnal and immunological consequences. Urologists should be able to manage this complication linked to many urological procedures. Incidence of chylous ascites seems to increase with time probably because more complex surgical interventions. Diagnosis is usually suspected based on clinical abdominal symptoms. Diagnostic paracentesis shows milky fluid with high triglyceride and lymphocyte content. Treatment is classicaly based on dietary interventions with the goal to decrease fistula's lymph flow. Somatostatin analog is a very efficient adjuvant therapy and should be used early in the course of treatment. Surgery is usually attempted in patients who have failed conservative modalities. Because chylous ascites is rare, no clear management guidelines exist. Treatment should be individualized and tailored according to severity of lymphatic leakage, its consequences and the patient health status.

Introduction and Objectives : Mortality due to AKI has not changed significantly over the past 50 years. This is due in part to failure to detect early AKI and to initiate appropriate therapeutic measures. There is therefore a need to identify biomarkers that would improve the early detection of AKI. The objective of this study was to assess whether cystatin C levels obtained at specific timepoints during laparoscopic partial nephrectomy (PN) could be early predictors of AKI. Materials and Methods: Twenty-five patients underwent laparoscopic PN for organ-confined tumors. All procedures were performed by two surgeons in a single institution. Plasma samples were collected preoperatively, and post-unclamping at 5, 20, 120 min and on the day following surgery. Plasma cystatin C was measured by enzyme-linked immunosorbent assay. Correlation between levels of cystatin C and other parameters of interest were assessed in order to define cystatin C ability to predict AKI and loss of renal function following laparoscopic PN. Results: The mean baseline eGFR was 93 ml/min/1.73 m 2 . Warm ischemia time varied between 16 and 44 min. Post-operative day 1 (POD1) cystatin C levels compared to baseline were increased in 13 (52%) of the patients. There was a high correlation between the difference of POD 1 and baseline value, and eGFR in the immediate postoperative period (r = −0.681; P = 0.0002) and at 12-month follow-up (r = −0.460, P = 0.048). However, the variation in cystatin C levels at earlier timepoints were not associated to AKI nor renal function. Conclusions: High increase in POD 1 cystatin C levels from baseline may help identify patients with AKI and those at higher risk of chronic kidney disease, following laparoscopic PN.

Background: Abraham Groves worked as a general practitioner and surgeon in the small town of Fergus, Ontario, Canada. Several priority claims have been attributed to Groves’ life in surgery, including aseptic surgery (1874), appendectomy (1883) and the use of surgical gloves (1885). He was also an early practitioner of urological surgery. Objective: The purpose of this paper is to describe and objectively assess his contributions as a pioneer in urological surgery. Methods: A systematic search of contemporary journals was made for articles by or about Groves. These articles and his 1934 autobiography were reviewed. The information was assessed not only for priority, but also for the development of organized surgical principles and thought. Results: Groves published frequently throughout his career; up to this point, 36 papers have been identified. Groves’ claims are verifiable for aseptic surgery, which were the result of logical surgical thought and was practiced throughout his career. Contemporary publications support his early use of suprapubic lithotomy (1875), prostatotomy (1887), bladder repair (1892), urethral repair (1903), renal decapsulation (1905) and prostatectomy (1911). Conclusions: Despite his isolation, Abraham Groves independently developed a full range of surgical techniques and principles relevant to modern-day urology. His impact was reduced by the nature of the environment in which he worked and by the limited circulation of the journals in which he chose to publish. Contexte : Abraham Groves etait omnipraticien et chirurgien dans la petite ville de Fergus, en Ontario. Plusieurs percees importantes lui ont ete attribuees, comme la chirurgie en asepsie (1874), l’appendicectomie (1883) et l’emploi de gants chirurgicaux (1885). Il a aussi ete un pionnier de la chirurgie urologique. Objectif : Le present article vise a decrire et evaluer de facon objective les contributions d’Abraham Groves dans l’evolution de la chirurgie urologique. Methodologie : Une recherche systematique des revues medicales de l’epoque a permis de degager des articles signes par Groves ou portant sur ses travaux. On a ensuite passe en revue ces articles et son autobiographie, datant de 1934. On cherchait dans ces documents non seulement des preuves de ses percees sur le plan scientifique mais aussi l’elaboration de principes et theories structures en chirurgie. Resultats : Groves a publie de nombreux articles; jusqu’a present, nous en avons trouve 36. Il a ete possible de confirmer les decouvertes de Groves concernant la chirurgie en asepsie, technique decoulant de la logique scientifique et qu’il a pratiquee durant toute sa carriere. Des articles de l’epoque confirment son utilisation de la lithotomie sus-pubienne (1875), de la prostatotomie (1887), de la reparation vesicale (1892), de la reparation uretrale (1903), de la decapsulation renale (1905) et de la prostatectomie (1911). Conclusions : En depit de son isolement, Abraham Groves a elabore de facon independante une gamme de techniques chirurgicales et de principes toujours pertinents en urologie de nos jours. Son influence a ete limitee par la nature de son environnement professionnel et par la circulation limitee des periodiques dans lesquels il a choisi de publier.

Introduction: Our objective was to compare the impact of extracapsular (ECAN) versus intracapsular allograft nephrectomy (ICAN) on allosensitization and surgical outcomes. Methods: Between 1990 and 2004, 96 allograft nephrectomies were performed at our institution. Of these, 29 procedures were performed within 1 month of the transplant and were therefore omitted from analysis. Overall, the results of 44 ECAN and 23 ICAN were reviewed. Results: The mean operative times were 110.9 versus 130.4 min for ICAN versus ECAN (p = 0.02) and the estimated blood loss was 226 mL for ICAN versus 483 mL for ECAN (p = 0.004). Intraoperative and postoperative complications were low using either technique and differences were not statistically significant. Overall, the preoperative to postoperative change in the percentage of panel reactive antibody was +2.1% for ICAN versus +1.2% for ECAN (NS) at 3 to 12 months postoperatively, respectively (NS). The percentage of patients relisted was 33.3% versus 54.3% (NS), and the percentage of patients re-transplanted once relisted was also very similar: 63.2% for ECAN versus 66.7% for ICAN (NS), after a mean follow-up of 4.5 and 8.4 years, respectively. Conclusions: ICAN can be performed with shorter operative times and less blood loss versus the extracapsular approach. As well, this operative approach does not appear to affect allosensitization and the ability to re-transplant patients.