Chryssanthos Kouriefs

The 12‐year outcome analysis of an endourethral wallstent for treating benign prostatic hyperplasia

To evaluate the long‐term results of using the UrolumeTM endourethral prosthesis (American Medical Systems, Minnetonka, MN, USA) for managing benign prostatic hyperplasia (BPH), an alternative minimally invasive option.

Combined Vaginal and Vesicoscopic Collaborative Repair of Complex Vesicovaginal Fistulae

INTRODUCTION This study aimed to describe and demonstrate the feasibility of a minimally invasive surgical technique for the repair of complex vesicovaginal fistulae that may not be amenable to vaginal repair. TECHNICAL CONSIDERATIONS Nine cases of vesicovaginal fistulae, which were repaired laparoscopically at Kings College Hospital, London and Ygia Polyclinic Private Hospital, Limassol between 2011 and 2013, were identified. The repair was carried out by direct placement of the ports into the urinary bladder (vesicoscopy). Preoperative, intraoperative, and postoperative data were collected from a prospective database. All 9 operations were completed without any conversion to open surgery. Four ureteric reimplantations were necessary for ureteric involvement. There were no intraoperative complications but some intraoperative technical difficulties. No early postoperative complications were documented, and the hospital stay varied from 2 to 8 days. The fistula repair success rate was 89% at a median follow-up of 30 months. CONCLUSION This surgical technique is feasible and offers an alternative approach to the classical open or laparoscopic transperitoneal approach. It supplements the vaginal approach for fistulae that are not suitable for pure vaginal approach, allowing close collaboration between the laparoscopic urologist and the vaginal surgeon.

Eroded Tape: A Case of an Early Vesicoscopy Rather Than Laser Melting

OBJECTIVE To report our experience on vesicoscopic excision of eroded foreign material in the bladder. MATERIALS AND METHODS The use of xenografts in female urology is becoming more prevalent and so are their complications. Erosion of foreign material into the bladder often goes unrecognized for a long time and patients are troubled by irritative urinary symptoms, recurrent infections, and stone formation. The treatment of such erosions is traditionally reported through the transurethral route using laser or electrocautery to cut the foreign material. Such methods have a high rate of incomplete material removal and as a result a high recurrence rate. Leaving a urothelial defect results in prolonged time to symptom resolution. Between 2012 and 2015, 5 patients with eroded tapes were referred for tertiary care to Kings College Hospital and Ygia Polyclinic; all patients had undergone a variety of endoscopic, vaginal, and/or open attempts for mesh removal that failed. We offered vesicoscopic excision of the eroded portion of the tape. RESULTS We here report 5 cases with tape erosions referred to our team that were treated with vesicoscopic excision of the material and primary closure of the urothelial defect. The foreign material was completely removed in all cases and there is no recurrence at a median follow-up of 30 months. CONCLUSION Vesicoscopic excision of bladder-eroded foreign material is feasible and efficient. We recommend this technique to be considered as a primary approach to tapes eroding into the bladder.

When Physical Examination Signs Point to Sinister Causes

A 55-year-old male presented with mild abdominal discomfort. On physical examination, a right upper quadrant abdominal mass was palpable and an obstructed right varicocele was evident. Ultrasonography and computed tomography revealed a 15 cm right renal tumor with a 2 cm aortocaval lymph node. The patient underwent an uneventful laparoscopic transperitoneal radical nephrectomy and lymphadenectomy and was discharged after 2 days. No complications or recurrence were noted at 6 months follow-up. This report signifies the importance of physical examination and attention to cardinal clinical signs and also the feasibility of laparoscopy in large renal tumor in expert hands.

Surgery Illustrated - Surgical Atlas: Laparoscopic cryotherapy for renal tumours

There has been a dramatic change in the way urologists approach the management of renal tumours in general and in particular for small renal masses. Nephron-sparing options were generally considered mainly in case of a solitary kidney, bilateral tumours or impaired renal function. However, there has been a recent shift from radical nephrectomy towards nephron-sparing treatments even in the presence of a normal functioning contralateral kidney, and the proposed 4 cm upper limit for the size of the tumour has been challenged. A further shift is being established by the use of a laparoscopic approach replacing open surgery, even in the presence of multiple tumours in a solitary kidney. Recent trends include single-port surgery and multi-arm robotic assistance. There is now an increasing acceptance of laparoscopic cryotherapy for renal tumours. An illustrated description of our technique is presented below.

Laparoscopic cryotherapy for renal tumours.

There has been a dramatic change in the way urologists approach the management of renal tumours in general and in particular for small renal masses. Nephron-sparing options were generally considered mainly in case of a solitary kidney, bilateral tumours or impaired renal function. However, there has been a recent shift from radical nephrectomy towards nephron-sparing treatments even in the presence of a normal functioning contralateral kidney, and the proposed 4 cm upper limit for the size of the tumour has been challenged. A further shift is being established by the use of a laparoscopic approach replacing open surgery, even in the presence of multiple tumours in a solitary kidney. Recent trends include single-port surgery and multi-arm robotic assistance. There is now an increasing acceptance of laparoscopic cryotherapy for renal tumours. An illustrated description of our technique is presented below.

Surgery Illustrated - Surgical Atlas

There has been a dramatic change in the way urologists approach the management of renal tumours in general and in particular for small renal masses. Nephron-sparing options were generally considered mainly in case of a solitary kidney, bilateral tumours or impaired renal function. However, there has been a recent shift from radical nephrectomy towards nephron-sparing treatments even in the presence of a normal functioning contralateral kidney, and the proposed 4 cm upper limit for the size of the tumour has been challenged. A further shift is being established by the use of a laparoscopic approach replacing open surgery, even in the presence of multiple tumours in a solitary kidney. Recent trends include single-port surgery and multi-arm robotic assistance. There is now an increasing acceptance of laparoscopic cryotherapy for renal tumours. An illustrated description of our technique is presented below.

Laparoscopic cryotherapy for renal tumours: SURGERY ILLUSTRATED

There has been a dramatic change in the way urologists approach the management of renal tumours in general and in particular for small renal masses. Nephron-sparing options were generally considered mainly in case of a solitary kidney, bilateral tumours or impaired renal function. However, there has been a recent shift from radical nephrectomy towards nephron-sparing treatments even in the presence of a normal functioning contralateral kidney, and the proposed 4 cm upper limit for the size of the tumour has been challenged. A further shift is being established by the use of a laparoscopic approach replacing open surgery, even in the presence of multiple tumours in a solitary kidney. Recent trends include single-port surgery and multi-arm robotic assistance. There is now an increasing acceptance of laparoscopic cryotherapy for renal tumours. An illustrated description of our technique is presented below.