Rommel Prata Regadas

Single-incision multiport laparoscopic orchidopexy: initial report

PURPOSE We report the first use of single-incision multiport access to perform 1-stage laparoscopic orchidopexy in children without section of the spermatic vessels. MATERIAL AND METHODS Three boys with cryptorchidism were submitted to primary laparoscopic 1-stage orchidopexy by using 3 ports (a 10-mm [or 5-mm] port placed using open technique and 2 additional 5-mm [or 3-mm] ports) inserted through the same periumbilical skin incision with different entrances through the abdominal wall. After dissection of the testicular vessels and vas deferens, a 5-mm port was placed in a tunnel from the scrotum to pull the remnant of the gubernaculum down and fix the testicle in a dartos pouch. RESULTS The mean operative time was 83.3 minutes. The estimated blood loss was almost nil, and there were no intraoperative complications. CONCLUSION This approach was feasible and safe. However, as with any new technique, its use requires a larger number of cases and a longer follow-up to fully evaluate its benefits and limitations.

Stapleless laparoscopic assisted radical cystectomy with ileal neobladder in a male and with ileal loop in a female: initial report from Brazil

ABSTRACTIntroduction: Here, we report our initial experience with laparoscopic assisted radicalcystectomy without the use of surgical staples.Cases Report: A 70 year old male and a 55 year old female were diagnosed to have T2G3transitional cell carcinoma of the bladder with negative metastatic work-out. Both patients werescheduled and agreed to a laparoscopic assisted radical cystectomy. In both cases, urinary diversion(orthotopic ileal Studer neobladder in the male and ileal conduit in the female) was performedextracorporeally following radical cystectomy. In both cases control of the bladder vascular pediclewasaccomplished with a combination of metallic and hem-o-lock clips. The total surgical time was 6.5hours in both cases. Estimated intra-operative blood loss was 500 cc and 350 cc respectively, howeverboth patients required postoperative blood transfusions. No intraoperative complications occurred. Inboth cases, pathology revealed negative surgical margins.Conclusions: Extracorporeal creation of urinary diversion decrease the overall operativetime. Laparoscopic pelvic lymphadenectomy can be performed following the extended template. Theuse of surgical clips instead of vascular Endo-GIA titanium staples to control the bladder vascularpedicles is feasible and safe in selected patients, thus reducing intraoperative surgical costs. Considerableexperience with laparoscopic radical prostatectomy is necessary before one attempts laparoscopicradical cystectomy.Key words : bladder neoplasms; cystectomy; urinary diversion; lymphadenectomy; laparoscopyInt Braz J Urol. 2005; 31: 214-21

Experimental model of human corpus cavernosum smooth muscle relaxation

PURPOSE To describe a technique for en bloc harvesting of the corpus cavernosum, cavernous artery and urethra from transplant organ donors and contraction-relaxation experiments with corpus cavernosum smooth muscle. MATERIALS AND METHODS The corpus cavernosum was dissected to the point of attachment with the crus penis. A 3 cm segment (corpus cavernosum and urethra) was isolated and placed in ice-cold sterile transportation buffer. Under magnification, the cavernous artery was dissected. Thus, 2 cm fragments of cavernous artery and corpus cavernosum were obtained. Strips measuring 3 x 3 x 8 mm(3) were then mounted vertically in an isolated organ bath device. Contractions were measured isometrically with a Narco-Biosystems force displacement transducer (model F-60, Narco-Biosystems, Houston, TX, USA) and recorded on a 4-channel Narco-Biosystems desk model polygraph. RESULTS Phenylephrine (1 microM) was used to induce tonic contractions in the corpus cavernosum (3-5 g tension) and cavernous artery (0.5-1 g tension) until reaching a plateau. After precontraction, smooth muscle relaxants were used to produce relaxation-response curves (10(-12) M to 10(-4) M). Sodium nitroprusside was used as a relaxation control. CONCLUSION The harvesting technique and the smooth muscle contraction-relaxation model described in this study were shown to be useful instruments in the search for new drugs for the treatment of human erectile dysfunction.

Extraperitoneal surgical repair of parastomal hernia of Bricker's urinary diversion with polypropylene mesh: stoma reimplantation through the mesh.

Introduction: Parastomal hernias affect 4.5–9% of patients submitted to ileostomy. Correcting this hernia represents a challenge. There are two basic approaches to the surgical correction of parastomal hernias: stoma relocation and repair in situ. We describe an alternative modified technique for extraperitoneal correction of large parastomal hernias using a polypropylene mesh and reimplantation of the urostomy in situthrough the mesh. Patient and Methods: An 80-year-old patient submitted to Bricker urinary diversion developed a large parastomal hernia affecting almost the entire circumference causing local pain and difficulties in appliance attachment. An ellipsoid skin incision around the urostomy was done and skin flaps were dissected up to the aponeurotic borders keeping the hernia sac intact. A polypropylene mesh was sutured onto the aponeurotic borders, the urostomy was led back through a central opening in the mesh, and the skin segment was stitched onto the mesh. Results: The patient was discharged on the third postoperative (PO) day. On day 14 PO he presented a small area of dehiscence treated with resuture. By the 30th month, no changes had occurred in the stoma or in the upper urinary tract and the patient was asymptomatic with no signs of tumor or hernia recurrence. Conclusions: Simple to perform and associated with low morbidity, the procedure represents an alternative for the treatment of parastomal hernias that would otherwise require stomal relocation.

Multiple Site Fracture of Both Rods in a Malleable Penile Implant

Penile prosthesis implant is the definitive treatment for refractory erectile dysfunction. Fracture of malleable prosthesis is rarely described due to its low incidence. We describe a case of multiple, bilateral fracture of a malleable penile implant, ten years after implantation. After the diagnosis, a review surgery was performed and the implants were replaced. No corporal rupture or urethral lesion was observed. Review of the literature shows few articles reporting penile implant fractures, and to our knowledge no other article has described multiple, bilateral fractures of a penile prosthesis.

MP26-05 RELAXING EFFECT OF PHOSPHODIESTERASE INHIBITORS AND β3-ADRENOCEPTOR AGONIST IN AN EXPERIMENTAL MODEL OF DETRUSOR OVERACTIVITY

nanoparticles. Based on characterization of the ECA matrix by biomimetic analyses, this novel collagen-based biotextile may serve as a promising pelvic fascial substitute material for slings and reconstructive surgery. These findings support further experimentation of adding other nano-particles and cross-linking manufacturing steps to further enhance the balance between additional biomechanical and biocompatibility features.

Laparoscopic Surgery in 46,XX Disorder of Sex Development: Hysterosalpingectomy with Gonadectomy

PURPOSE We present the outcomes of one of the largest series specifically of laparoscopic hysterosalpingectomy with bilateral gonadectomy in 46,XX patients with congenital adrenal hyperplasia raised as a male. PATIENTS AND METHODS From June 2005 to March 2008, five patients raised as male were treated at our institution using laparoscopic surgery. 46,XX disorder of sex development was diagnosed in all the patients because of congenital adrenal hyperplasia. Hysterosalpingectomy with bilateral gonadectomy was performed completely laparoscopically in all five patients. RESULTS All procedures were completed with minimal blood loss. The duration of the surgeries was 70-125 minutes. There were no complications during surgery or conversion to open surgery. The hospital stay ranged from 1 to 2 days, except in one patient who presented urinary retention and was discharged from the hospital a week after the surgery. CONCLUSIONS Laparoscopic surgery can be safely used as part of the diagnosis and treatment of 46,XX disorder of sex development. Laparoscopy can be useful in the diagnosis as well as surgical management of Müllerian structures as well as intraabdominal gonads contrary to social sex.

Stapleless Laparoscopic Assisted Radical Cystectomy With Ileal Neobladder in a Male and With Ileal Loop in a Female: Initial Report From Brazil

INTRODUCTION Here, we report our initial experience with laparoscopic assisted radical cystectomy without the use of surgical staples. CASES REPORT A 70 year old male and a 55 year old female were diagnosed to have T2G3 transitional cell carcinoma of the bladder with negative metastatic work-out. Both patients were scheduled and agreed to a laparoscopic assisted radical cystectomy. In both cases, urinary diversion (orthotopic ileal Studer neobladder in the male and ileal conduit in the female) was performed extracorporeally following radical cystectomy. In both cases control of the bladder vascular pedicle was accomplished with a combination of metallic and hem-o-lock clips. The total surgical time was 6.5 hours in both cases. Estimated intra-operative blood loss was 500 cc and 350 cc respectively, however both patients required postoperative blood transfusions. No intraoperative complications occurred. In both cases, pathology revealed negative surgical margins. CONCLUSIONS Extracorporeal creation of urinary diversion decrease the overall operative time. Laparoscopic pelvic lymphadenectomy can be performed following the extended template. The use of surgical clips instead of vascular Endo-GIA titanium staples to control the bladder vascular pedicles is feasible and safe in selected patients, thus reducing intraoperative surgical costs. Considerable experience with laparoscopic radical prostatectomy is necessary before one attempts laparoscopic radical cystectomy.