Andrey Vinarov

The potential role of tissue-engineered urethral substitution: clinical and preclinical studies.

Urethral strictures and anomalies remain among the difficult problems in urology, with urethroplasty procedures being the most effective treatment options. The two major types of urethroplasty are anastomotic urethroplasty and widening the urethral lumen using flaps or grafts (i.e. substitution urethroplasty). However, no ideal material for the latter has been found so far. Designing and selecting such a material is a necessary and challenging endeavour, driving the need for further bioengineered urethral tissue research. This article reviews currently available studies on the potentialities of tissue engineering in urethral reconstruction, in particular those describing the use of both acellular and recellularized tissue‐engineered constructs in animal and human models. Possible future developments in this field are also discussed. Copyright

Biomarkers of Renal Tumors: the Current State and Clinical Perspectives

Renal cell carcinoma (RCC) ranks the first death rate among the urogenital tumors, whereas its incidence follows the incidences of prostate and bladder cancer. The diagnosis of RCC at early stages allows immediately undertaking appropriate treatment, which significantly increases patients’ survival rate. Early and accurate diagnosis avoids inadequate treatment, provides the disease progression forecast, and permits to apply more efficient therapy. Unfortunately, the small renal tumors are usually asymptomatic resulting in the late diagnosis and, therefore, low efficacy of treatment. Thus, sensible and preventive biomarkers are essential for early RCC detection and monitoring of its progression. So far, many attempts were performed aimed at recognizing novel informative kidney tumor biomarkers applicable for early detection of the disease and possessing prognostic and predictive capabilities. This review summarizes recent advances in renal tumor biomarkers recognition, their diagnostic and prognostic values, and clinical feasibility.

V11-11 THULIUM LITHOTRIPSY: FROM EXPERIMENT TO CLINICAL PRACTICE

INTRODUCTION AND OBJECTIVES: Mini-percutaneous nephrolithotomy (mini-PCNL) was initially described in the late 1990s. Many variations on the technique have been described since that time focusing on differing access sizes. Lithotripsy through a mini-PCNL tract has traditionally been accomplished through laser or electro-hydraulic/ pneumaticenergy.Wesought toexplore the feasibility of lithotripsy through a mini-PCNL tract with the Olympus ShockPulse-SE Lithotripter which combines both ultrasonic and mechanical energy to optimize lithotripsy. METHODS: A 58 year male patient with a 2.5 cm left lower pole stone was identified as the initial candidate for our technique. He was positioned in the standard prone position and access was obtained into his lower pole with an 18-gauge Cook LS access needle. We proceeded to dilate a 16-French tract using a one-step dilator with the Storz Modular Minimally Invasive PCNL (MIP) System. With the Storz MIP M nephroscope and a 1.5 mm Olympus ShockPulse-SE probe, we then broke the stone into minute fragments which were initially suctioned and collected with the StoneCatcher (Boston Scientific) system. Remaining fragments were removed with an endoscopic grasper and a nitinol stone basket. The procedure was performed tubeless with a stent. After five days, a follow-up plain film was obtained and the stent removed. RESULTS: The dual modality lithotripter was efficient with stone fragmentation and extraction through suction. The total operative time was 110 minutes. The patient was discharged on post-operative day one after an uncomplicated stay of 30 hours total duration. Postoperatively, his hemoglobin declined 2.3 g/dl and his creatinine rose 0.2 mg/dl. On return, his large 2.5 cm stone showed good clearance on KUB though dust like fragments (< 2 mm) remained in his lower pole. CONCLUSIONS: This is the first report of using integrated ultrasonic and mechanical energy lithotripsy in a mini-PCNL. The combination of the Olympus ShockPulse-SE Lithotripter with the Storz MIP system proved efficient in terms of operative duration and stone breakdown. It was also effective at clearing a large stone burden through a small 16-French tract. This method is feasible and provides an alternative to laser or pneumatic lithotripsy and offers the benefits of suction.

PD42-07 COMPARATIVE IN VITRO STUDY OF HO:YAG AND TM FIBER LASER LITHOTRIPTERS IN DUSTING MODE OF OPERATION

presented as an interval scale ranging from 0 to 5 with 5 being the best response possible. We tested the instrument at our institution by administering it after routine upper tract stone cases utilizing a flexible ureteroscope. Three flexible ureteroscope categories were evaluated including: fiberoptic (Olympus URF-P5/P6), reusable digital (Storz Flex Xc), and the LithoVue disposable digital (Boston Scientific). Any urologist or trainee who used the ureteroscope during the procedure was allowed to evaluate the ureteroscope. The instrument was completed independently of each other and opinions about the ureteroscope were not discussed during the procedure. Internal consistency was assessed with Cronbach’s alpha and Pearson correlation coefficients were calculated to describe the linear relationship between items. Multivariate analyses were done to assess responses. RESULTS: A total of 34 upper tract stone cases were performed resulting in 79 evaluations. The Storz digital scored the highest of the three ureteroscopes. The image quality was very good on the LithoVue outside the patient, but we did notice some distortion when performing laser lithotripsy that impaired vision. We found no difference in the ease of ureteral access between the ureteroscopes. The instrument demonstrated internal consistency (Cronbach’s alpha 1⁄4 0.85). The mean inter-item Pearson correlation coefficient was 0.46 (0.10 to 0.88), the highest of which related maneuverability to overall satisfaction (0.88). Respondents who had completed residency scored the ureteroscopes significantly lower in the areas of maneuverability, intuitiveness and overall satisfaction (P 1⁄4 0.019, 0.003, and 0.046 respectively). CONCLUSIONS: We report our results from a pilot study evaluating a novel flexible ureteroscope evaluation instrument during clinical use. All ureteroscopes performed well on our evaluation instrument during clinical use. Further validation is needed to assess the quality of this evaluation instrument.

New laser radiation hydrodynamic effect in endoscopic urological surgery

Authors describe new effect of laser radiation in endoscopic urological surgery (BPH enucleation, en-bloc removal of bladder cancer, stricture endotomy): two-phase jet - a result of superintensive boiling in the area of laser radiation absorption and consisting of steam-gas microbubbles and hot water. In this case, the area of thermal influence appears significantly more, than thickness of a layer in which laser radiation is absorbed. Cutting soft tissue, the jet coagulates section walls due to heat generated at steam condensation. The same jet is formed behind the macrobubble, which is formed in liquid (Moses effect), because of boiling.

15 years’ survey of safety and efficacy of Serenoa repens extract in benign prostatic hyperplasia patients with risk of progression

Aim: The aim of this study is to investigate the efficacy and safety of long-term therapy with Serenoa repens extract with regard to halting benign prostatic hyperplasia progression. Material and methods: An open non-comparative observational study of the continuous use of S. repens plant extract at a dosage of 320 mg once a day for 15 years was performed in 30 patients at risk for benign prostatic hyperplasia progression. Changes in IPSS (International Prostatic Symptoms Scale) and QoL (Quality of life) scores and changes in Qmax, voided volume, residual urine volume, and prostate volume were evaluated during the study. Results: The study showed an absence of progression based on both subjective (the sum of scores on the IPSS and QoL scales) and objective (prostate volume, urination rate, residual urine volume) criteria. Furthermore, the patients had no adverse events related to the study drug, including prostate cancer. Conclusions: The 15 years’ study results suggest that taking S. repens plant extract continuously at a daily dose of 320 mg is an effective and safe way to prevent the progression of benign prostatic hyperplasia.