Petar Erdeljan

First Prize: A Phantom Model as a Teaching Modality for Laparoscopic Partial Nephrectomy

PURPOSE To evaluate a materials model for laparoscopic ultrasound identification and partial nephrectomy of kidney tumors. METHODS Five urology fellows performed laparoscopic ultrasonography (LUS) examination of the tumor model, and the time for identification was recorded. After identifying the tumor, they performed a laparoscopic partial nephrectomy using the target tumor with measurement of operative parameters. They completed a questionnaire and rated the quality of the renal tumor model on a 5-point Likert scale. RESULTS The participants were able to identify 49 tumors by LUS (98%). The mean time to identify the renal tumors by LUS was 1.12 minutes ± 0.93 standard deviation (SD). A partial nephrectomy was successfully completed on 49 tumor models (98%). The mean resection time was 7.69 minutes ± 3.8 SD. All of the participants considered that this model was helpful in the practice of LPN. The fellows would recommend this model as a teaching tool for residents/fellows to perform tumor imaging by LUS and for practicing LPN in a simulated environment. CONCLUSION We have developed a unique model that simulates small kidney tumors that can be used for training surgeons in the clinical skills of laparoscopic partial nephrectomy.

Robot-Assisted Pyeloplasty: Follow-Up of First Canadian Experience with Comparison of Outcomes Between Experienced and Trainee Surgeons

BACKGROUND AND PURPOSE 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. PATIENTS AND METHODS 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. RESULTS 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 (P < 0.05). 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). CONCLUSIONS 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.

A phantom model as a teaching modality for laparoscopic partial nephrectomy.

Index BR01 Basic Research Kidney BR01-01 Beneficial effects montelukast which is cysteinyl-leukotriene receptor antagonist on renal damage after unilateral ureteral obstruction in rats Emin Özbek, Turkey BR01-02 Pomegranate extract attenuates unilateral ureteral obstruction-induced renal injury by reducing oxidative stress Emin Özbek, Turkey BR01-03 Changes in stone composition in Australia over the past 30 years Simon Bariol, Australia BR01-04 Applying Theoretical Chemistry to the Study of Calcium Oxalate Nephrolithiasis Julie M Riley, United States BR01-05 Serum fetuin-A level may play a more important role than urine fetuin-A levels in the formation of urinary stone disease Ajet Xhafa, Albania BR01-06 Renal oxygenation during robotic-assisted laparoscopic partial nephrectomy; characterization using laparoscopic digital light processing (DLP ) hyperspectral imaging Ephrem O Olweny, United States BR01-07 Vorinostat may have renoprotective effects in ischemia-reperfusion injury Yung Khan Tan, Singapore BR01-08 Terpene Compound Drug as Medical Expulsive Therapy for Ureterolithiasis: A Meta-analysis Michael Erlano Chua, Philippines BR01-09 Clamping Renal Artery Alone Produces Less Ischemic Damage Compared to Clamping Renal Artery and Vein Together: Assessment of Renal Ischemia by Measuring Isoprostane Levels in a Rat Model Benjamin R Lee, United States BR01-10 Helical CT Can Be Used To Determine Stone Composition Osman Raif Karabacak, Turkey BR01-11 The protective effects of phosphodiesterase4-specific inhibitor Rolipram on acute ischemiareperfusion injury in rat kidney Emin Mammadov, Turkey BR01-12 Evaluation of metabolic abnormalities in patients with primary hyperparathirodism and urolithiasis Ural Oguz, Turkey BR01-13 Comparison of 3 techniques of inducing Cold Ischemia for partial nephrectomy in an animal model Janet Colli, United States BR01-14 Low energy ESWT, a novel treatment for diabetic nephropathy (Animal study) Milad Hanna, United Kingdom BR01-15 Extra-renal and intra-renal autonomic nervous system redefined Achim Lusch, United States BR01-16 99mTc-MAG3 renography in the experimental evaluation of small animal renal function Iason Kyriazis, Greece BR01-17 An unique renoprotective cocktail helps in extending the warm ischemia time in a rat Jacob Cohen, United States BR02 Basic Research Urolithiasis BR02-01 What is the Antibiotic of Choice for Obstructing Stone Patients with Sepsis? A ConditionSpecific Antibiogram Andreas Neisius, United States BR02-02 A Prospective 6-week Randomized Controlled Trial to Evaluate the Efficacy and Safety of Na Bicarbonate, Citric Acid, Na Citrate, and Tartaric Acid Coumpound Drug Compared to Potassium Citrate in the Dissolution of Renal Stones Michael Erlano Chua, Philippines BR02-03 Retrograde Intrarenal Surgery in a Porcine Model Ural Oguz, Turkey BR02-04 Stone biochemical composition but without a stone to analyse Eleanor Rhiannon Ray, United Kingdom BR02-05 Doppler evaluation before and after extracorporeal shock wave lithotrispy: is there a change in resistive index? Maria Chiara Sighinolfi, Italy

Third Prize: Effects of Subinhibitory Concentrations of Ciprofloxacin on Staphylococcus Saprophyticus Adherence and Virulence in Urinary Tract Infections

BACKGROUND AND PURPOSE Staphylococcus saprophyticus is a frequent cause of both uncomplicated and complicated urinary tract infections (UTI) in young females and has recently been established as the most prominent gram-positive uropathogen. Although the effects of subinhibitory concentrations of antimicrobials on numerous other pathogenic bacteria have been studied, little is known regarding how S saprophyticus responds under such conditions. MATERIALS AND METHODS In this study, we investigated the effects of subminimum inhibitory concentrations (MIC) of ciprofloxacin (CIP) on S saprophyticus attachment to glass microscope slides, ureteral stent material, and T24 bladder cells, as well as its effects on S saprophyticus-induced proinflammatory cytokine expression in bladder cells. RESULTS Adherence to glass microscope slides, ureteral stent material, and bladder cell monolayers were all significantly increased in the presence of sub-MIC levels of CIP. While the S saprophyticus challenge of T24 bladder cell monolayers significantly upregulated both interleukin (IL)-6 and IL-8 expression, sub-MIC CIP abrogated these effects, returning their secretion to control levels. CONCLUSIONS Our results demonstrate that exposure to sub-MIC CIP increases S saprophyticus adherence to both abiotic and biotic surfaces including urinary device material and cultured bladder cells. In addition, low levels of this antimicrobial downregulate S saprophyticus-stimulated proinflammatory cytokine secretion in the bladder. These changes may make S saprophyticus more effective at colonizing the urinary tract and highlights the need for clinicians to consider the impact of subinhibitory concentrations of antimicrobials on bacteria when designing treatment strategies to manage UTI.

Preliminary Assessment of a Renal Tumor Materials Model

PURPOSE To evaluate a materials model for laparoscopic guided cryotherapy or radiofrequency tissue ablation (RFA) of kidney tumors through expert surgeon assessment. MATERIALS AND METHODS During the inaugural American Urological Association 2010 Tissue Ablative course content, validity testing of a renal tumor model was undertaken. Five expert faculty in cryotherapy and RFA techniques for renal tumors performed laparoscopic ultrasonography (US) examination of the tumor model. They performed US guided placement and activation of the treatment probe into the tumor of the model. They completed a questionnaire and rated the quality of the renal tumor model on a 5 point Likert scale. RESULTS All of the subjects assigned a score of 5 of 5 on the Likert scale regarding the ability to identify the tumor with US, were able to deploy the ablative probe into the model under US guidance, and would recommend the use of this teaching model to residents or fellows. They thought that this tumor model was appropriate for teaching laparoscopic US imaging of a renal tumor during ablative treatment procedures, teaching and practicing laparoscopic US-guided cryotherapy, and teaching and practicing laparoscopic US-guided RFA. CONCLUSION We have developed a unique model that simulates small kidney tumors that can be used for training surgeons in ablative techniques.