Milton Berger

Immediate ureterovaginal fistula secondary to oocyte retrieval--a case report.

OBJECTIVE To report a case of ureterovaginal fistula secondary to transvaginal oocyte retrieval (TVOR). DESIGN Case report. SETTING IVF Center IN a private hospital. PATIENT(S) A 31-year-old woman presented immediately after TVOR with right lower abdominal pain with irradiation to the suprapubic area and vaginal discharge. INTERVENTION(S) Vaginal examination, creatinine dosage in plasma and vaginal discharge, excretory urography. A double-J catheter was inserted under general anesthesia. MAIN OUTCOME MEASURE(S) Clinical follow-up. RESULT(S) Vaginal leakage ceased a few hours after catheter insertion. Transfer of two embryos was performed 3 days after TVOR, but no pregnancy occurred. The double-J catheter was removed 21 days after its placement. Imaging studies done 6 weeks later demonstrated a normal urinary tract morphology. CONCLUSION(S) Given the elective nature of TVOR and IVF, patients should be informed about all potential complications, including ureterovaginal fistula.

Laparoscopic ureterolysis with omental wrap for idiopathic retroperitoneal fibrosis

Study Type – Therapy (case series)
Level of Evidence 4

Vaginoplasty With Full-thickness Mesh Skin Graft for Vaginal Agenesis

OBJECTIVE To present a novel technique in reconstructive urology for congenital vaginal agenesis using a full-thickness mesh skin graft and to evaluate the functional capacity for maintenance of satisfactory intercourse. METHODS From January 2009 to August 2015, seven patients diagnosed with vaginal agenesis underwent vaginoplasty using a full-thickness mesh graft from lower abdominal skin. Herein, the authors describe the technique and initial results in adult patients. RESULTS The mean hospital stay was 8 days. There were no major complications or need for blood transfusions. The most relevant postoperative result was the functionality of the neovagina and satisfactory donor site results. At 6-month follow-up, all patients reported satisfactory sexual intercourse. The average depth of the vagina was 11.3 cm. There were no significant complications at donor site or at neovagina that needed surgical intervention. CONCLUSION We obtained positive functional results with minimal donor site morbidity by performing vaginal reconstruction using a full-thickness mesh skin graft.

Child non-ischemic priapism, a conservative approach: Case report and updated review

Non-ischemic priapism in children is an uncommon entity usually related to blunt trauma in the perineal region and subsequent fistula formation into the corpus cavernosum. In this report we present the case of a 7-year-old boy who had undergone perineal trauma and developed non-ischemic priapism confirmed radiologically. He was treated by conservative measures along with ultrasonographic monitoring. We discuss the diagnostic approach, the radiologic findings and the mainly conservative management of this infrequent pathology.

Robotic surgery in public hospitals of Latin-America: a castle of sand?

IntroductionThere is no information about the evolution of robotic programs in public hospitals of Latin-America.ObjectiveTo describe the current status and functioning of robotic programs in Latin-American public hospitals since their beginning to date.MethodsWe conducted a survey among leading urologists working at public hospitals of Latin-America who had acquired the Da Vinci laparoscopic-assisted robotic system. Questions included: date the program started, its utilization by other services, number and kind of surgeries, surgery paying system, surgery related deaths, occurrence and reasons of robotic program interruptions and its use for training purposes. Medians and 25–75 centiles (IQR) were estimated.ResultsSince 2009, there are ten public hospitals of four Latin-American countries that acquired the Da Vinci robotic system. The median number of months robotic programs has been functioning without considering transitory interruption: 43 (IQR 35, 55). Median number of urologic and total surgeries performed: 140 (IQR 94, 168) and 336 (IQR 292, 621), respectively. The corresponding median number of urologic and total surgeries performed per month: 3 (IQR 2, 5) and 8 (IQR 5, 11). Median number of total surgeries performed per year per institution was 94 (IQR 68,123). The median proportion of urologic cases was 40% (IQR 31, 48), ranging from 24 to 66%. Five of ten institutions had their urology programs transitory or definitively closed due to the high burden costs.ConclusionAdoption and development of robotic surgery in some public hospitals of Latin-America have been hindered by high costs.

Posterior Urethral Valves Disorder in Non-Twin Siblings: Case Report and Literature Review

Although a rare condition, Posterior Urethral Valves (PUVs) are the most common obstructive cause of chronic renal disease in children. In order to provide an early diagnosis, it is crucial to identify families with a high risk of developing this disorder. Here, we report a rare case of non-twin siblings with PUV. The first sibling was diagnosed at 2 months of age, presenting with renal insufficiency and managed properly. Despite the brother’s history and general prenatal care, the second sibling presented with the same disorder, at 3 months of age, suffering from acute renal insufficiency, urinary tract infection and severe anemia, revealing even more important complications than the first sibling. We have reviewed the 12 cases of non-twin siblings previously reported in the literature, and noticed that in the majority of these families, late diagnosis was observed. Herein, we discuss aspects of management of the disorder, and highlight the importance of specific antenatal evaluation in boys with a positive family history.

Abstract 473: Long term clinical and biochemical outcomes following immunotherapy with an novel autologous immunomodulated vaccine in patients with prostate cancer.

Background: VAP is an new autologous immunomodulate vaccine, that was previously demonstrate to be safe in an initial phase I trial with local advance prostate cancer patients. The extension of this initial trail into a Phase IIb is now been reported. The primary endpoint of the study reported here is clinical response (PSA and survival) in local advance (T2 and T3) prostate cancer patients, with safety and immunologic responses as secondary endpoints. Methods: Tumor cells from 107 prostatectomy patients were collected (HCPA - Porto Alegre - Brazil). 48 (45%) patients with T3 or T2 with co-morbidity factors were enrolled. 22 patients received the vaccine and 26 were in the control group. Vaccine was given by intradermal injections (4x weekly, 2x monthly and after 3 months). First two doses also ontained BGC as adjuvant. DTH was measured 48 hours after the vaccine doses that did not contained BCG. PBMCs and were collected via apheresis at baseline and D+54 for Tcell proliferation assay in some patients. Clinical flow up was performed and all standard care was given to all patients. Results: The overall follow up was 7.4 years. No grade 3 or 4 toxicity attributable to vaccine was noted. Side effects were largely limited to grade 1 or 2 injection site reactions. DTH was positive (= or higher than 5 mm) in 73% of the vaccinated patients. Cancer related mortality was 9% (2/22) on the vaccinated group and 19% (5/26) on the non-vaccinated group. PSA was undetectable (less than 0.04 ng/ml) in 85% (17/20) of the vaccinated patients and in 48% (10/21) of the non-vaccinated patients after 5 years of follow up.In vitro specific T cell proliferation was demonstrated in vaccinatedpatients. Conclusions: VAP is safe and well tolerated vaccine. There is evidence of clinical activity and immune changes in selected patients. Further studies to confirm these results are warranted. (Financial support from FINEP - Brazilian Innovation Agency) Citation Format: Fernando T. Kreutz, Gustavo Schroeder, Milton Berger. Long term clinical and biochemical outcomes following immunotherapy with an novel autologous immunomodulated vaccine in patients with prostate cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 473. doi:10.1158/1538-7445.AM2013-473