P. Bellinzoni

Laparoscopic unroofing of simple renal cysts

OBJECTIVE The aim of this study was to assess the clinical reliability of laparoscopic treatment for simple renal cysts. METHODS Twenty patients with symptomatic simple renal cysts underwent laparoscopic unroofing of the cysts. Four of these patients also underwent concomitant laparoscopic cholecystectomy because of symptomatic gallbladder stones. RESULTS In all cases the cyst wall was widely resected with no significant surgical complication. Cholecystectomy was easily performed without additional morbidity. Postoperative renal ultrasonography and intravenous urography demonstrated the absence of cyst recurrences and the integrity of the excretory tract. Symptoms were resolved by the operation in all cases. CONCLUSIONS Laparoscopic unroofing is a safe, effective, and minimally invasive treatment for selected symptomatic simple renal cysts.

Open Surgical Revision of Laparoscopic Pelvic Lymphadenectomy for Staging of Prostate Cancer: The Impact of Laparoscopic Learning Curve

We attempt to clarify the impact of the learning curve on the first 30 laparoscopic pelvic lymphadenectomies performed at our institute. Open surgical revision of the area of laparoscopic dissection was performed at radical retropubic prostatectomy. The mean number of obturator and iliac lymph nodes removed laparoscopically was 8.7 and 8.8 from the right and left sides, respectively. The mean number of residual obturator and iliac lymph nodes removed at open operation was 3.2 and 3 from the right and left sides, respectively. The amount of residual lymph node tissue after laparoscopic lymphadenectomy progressively decreased with time, especially after the first 20 cases. A microscopic pelvic lymph node metastasis was found at open operation in patients 6, 14 and 15, who had false-negative results at laparoscopy. Due to the learning curve effect, the first 30 patients who undergo laparoscopic pelvic lymphadenectomy should be assessed again by an open operation at radical retropubic prostatectomy.

Robot-assisted uretero-ureterostomy for iatrogenic lumbar and iliac ureteral stricture: Technical details and preliminary clinical results

BACKGROUND Although the incidence of iatrogenic ureteral strictures is low, the treatment remains challenging. OBJECTIVE To report our technique of robot-assisted uretero-ureterostomy (RAUU) for adults with iatrogenic lumbar and iliac stricture. DESIGN, SETTING, AND PARTICIPANTS A descriptive study was performed by our department. Since April 2009, five patients underwent RAUU: Two patients had developed a lumbar or iliac ureteral stricture following a ureterorenoscopy, one had ureteral catheter positioning, one had colon surgery, and one had resection of retroperitoneal cystic lymphangioma. Preoperative evaluation includes history, computed tomography (CT) scan, and mercaptoacetyltriglycine-3 (MAG3) diuretic renal scan. SURGICAL PROCEDURE A flank position was used for all patients with lumbar stenosis. A supine position with the bed turned 30° was required for iliac stricture. The optical port, two 8-mm robotic ports, and one 5-mm assistant port were used. A precise definition of the site and extension of the stricture was done using the flexible ureterorenoscope. After the stricture resection, the anastomosis was performed with two running sutures on a ureteral double-J stent. MEASUREMENTS Success was defined as no postoperative symptoms and evidence of no obstruction at the CT/urography and at the MAG3 scan at 6-mo follow-up. RESULTS AND LIMITATIONS RAUU was technically feasible in all five patients. Average operating time was 135min, and median hospital stay was 3 d. No significant complications occurred. Absence of stricture recurrence and no reduction of kidney function were confirmed by CT/urography and MAG3 scans. At a mean follow-up of 8 mo, all patients were asymptomatic. The main limitations were the short follow-up and the small sample size. CONCLUSIONS RAUU is feasible and safe for repairing iatrogenic lumbar and iliac ureteral strictures. The flexible ureterorenoscopy is useful to localise the obstruction and to correctly define its site and extension to spare as much ureter as possible.

259 Serum isoform [-2]proPSA (p2PSA) and its derivates, %p2PSA and PHI (prostate health index), are more accurate than the reference standard test (PSA) in men scheduled for repeat biopsy

Aim In men with a negative first biopsy but persistent suspicion of PCa, the AUA and EAU recommend to repeat a biopsy. Repeat biopsies are negative in approximately 80% of men and they may be associated with economic costs, anxiety, discomfort, and sometime severe complications. The aim of this study was to determine the performance characteristics and clinical utility of the isoform [-2]proPSA and its derivates in detecting PCa in men scheduled for repeat biopsy . Material & Methods: This study was an observational prospective evaluation of a cohort of men with one or two previous negative prostate biopsies, with persistent suspicion of PCa (suspected DRE, elevated tPSA and or low %fPSA) who were scheduled for repeat biopsy. Men receiving medical therapy known to affect serum PSA (dutasteride and finasteride), suffering from prostatitis and having had invasive treatment for benign prostatic hyperplasia (BPH), such as TURP or HoLEP, were excluded. The primary endpoint was to determine the diagnostic accuracy of %p2PSA ⎨[(p2PSA pg/mL)/(fPSA ng/ml x 1000)]x100⎬ and Beckman-Coulter PHI [(p2PSA/fPSA) x √tPSA)] (index tests), and to compare it with the accuracy of established PCa serum tests (tPSA, fPSA and %fPSA) (reference standard tests). Multivariable logistic regression models, fitted for the prediction of the presence of PCa, were complemented by predictive accuracy analysis (ROC curves). All the patients underwent ambulatory repeated TRUS-guided prostate biopsies (18-22 cores). .