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Arab Journal of Urology
Journal Prestige (SJR): 0.415

Citation Impact (citeScore): 1
Number of Followers: 7

This is an Open Access Journal

Open Access journal
ISSN (Print) 2090-598X
Published by Elsevier

[3305 journals]

Risk factors for the development of flank hernias and bulges following
surgical flank approaches to the kidney in adults
- Abstract: Publication date: December 2018Source: Arab Journal of Urology, Volume 16, Issue 4Author(s): Tarek Osman, Ahmed Emam, Ahmed Farouk, Karim ElSaeed, Ahmed M. Tawfeek, Abdelawal AbuHalima ObjectivesTo evaluate the incidence and risk factors for the development of flank incisional hernias or bulges following surgical flank approaches to the kidney.Patients and methodsIn all, 100 consecutive adult patients who underwent variable renal surgeries via flank approaches were included in this prospective study. The incidence and risk factors for flank hernias and bulges were studied at 1- and 6-months postoperatively.ResultsAt 6 months postoperatively, the incidence of flank bulge was 14% and for lumbar hernia was 10%. The univariate analysis showed 13 significant factors to be associated with the occurrence of a flank bulge or hernia following flank incisions. When the significant risk factors in the univariate analysis were studied by multivariate analysis, using a logistic regression analysis, four independent risk factors were identified. These were: body mass index (BMI) ≥26.3 kg/m2 (P = 0.04), the use of a self-retaining retractor during surgery (P = 0.02), not preserving or identifying the neurovascular bundle (NVB) during surgery (P = 0.028), and postoperative abdominal distention (P = 0.001). Moreover, all cases included in our study who underwent en masse wound closure, developed surgical wound infection or who had constipation developed postoperative flank bulge or hernia.ConclusionHigh BMI, the use of self-retaining retractor, not identifying or preserving the NVB, postoperative abdominal distention, en masse wound closure, surgical wound infection, and constipation are significant risk factors associated with postoperative flank hernia and bulge.
Simulation-based training in urology residency programmes in the USA:
Results of a nationwide survey
- Abstract: Publication date: December 2018Source: Arab Journal of Urology, Volume 16, Issue 4Author(s): Mohamed Kamel, Ehab A. Eltahawy, Renee Warford, Carol R. Thrush, Yasser A. Noureldin ObjectiveTo evaluate the current usage of simulation in urological education in the USA and the barriers to incorporating a simulation-based educational curriculum, as the shift towards competency-based medical education has necessitated the introduction of simulation for training and assessing both non-technical and technical skills.Materials and methodsResidency programme directors at Accreditation Council for Graduate Medical Education (ACGME)-accredited urology training programmes in the USA were invited to respond to an anonymous electronic survey. The study evaluated the programme directors’ experiences and opinions for the current usage of existing urology simulators. The survey also elicited receptiveness and the barriers for incorporating simulation-based training curricula within urology training programmes.ResultsIn all, 43 completed surveys were received (35% response rate). Amongst responders, 97% (42/43) reported having access to a simulation education centre, and 60% (25/42) have incorporated simulation into their curriculum. A total of 87% (37/43) agreed that there is a role for a standardised simulator training curriculum, and 75% (30/40) agreed that simulators would improve operating room performance. A total of 64% (27/42) agreed that cost was a limiting factor, 12% (5/42) agreed on the cost-effectiveness of simulators, 35% (17/41) agreed there was an increased need for simulator education within work-hour limitations, and 38% (16/42) agreed a simulation programme would reduce patient risks and complications.ConclusionsThe majority of urology programme directors consider that there is a role for incorporating a simulation-based curriculum into urology training. Barriers to implementation include cost burden, need for constant technology updates, need for advanced planning, and willingness of faculty to participate in administration.
The use of a string with a stent for self-removal following ureteroscopy:
A safe practice to remain
- Abstract: Publication date: December 2018Source: Arab Journal of Urology, Volume 16, Issue 4Author(s): Karen M. Doersch, Amr Elmekresh, G. Luke Machen, Marawan M. El Tayeb objectivesTo examine the safety and effectiveness of the use of a stent with a string attached after ureteroscopy (URS) for self-removal of the stent by the patient.Patients and methodsAfter Institutional Review Board approval, a retrospective chart review was performed concerning patients who underwent URS and received an indwelling stent with or without a string attached to the stent (94 vs 349, respectively). Amongst the string group patients received a single- or a double-arm-stringed stent (31 vs 63, respectively). Statistical analyses included chi-squared and Student’s t-tests.ResultsThe string group consisted of 94 procedures, in which 59.6% of the patients were male with a mean (SD) age of 50.0 (16.5) years. In the no-string group, 51.3% of the 349 procedures were performed in males and the mean (SD) age was 54.9 (18.1) years. Complication rates were 12.8% in the string group and 14.0% in the no-string group (P = 0.867). In the string group, 17.0% of the patients returned to the Emergency Department, whilst 15.8% of the no-string patients returned (P = 0.753). The complication rate in the single- and double-arm groups were 12.9% and 12.7%, respectively (P > 0.910). Self-removal of stents was successful in 94.7% of patients (89/94).ConclusionsThe use of a stent with a string after URS appears safe and effective. Few patients had difficulty removing their stents and complication rates were similar in the groups with and without a string attached to their stents. Single- and double-arm-stringed stents have similar complication rates.
Is the 4.5-F ureteroscope (Ultra-Thin) an alternative in the management of
ureteric and renal pelvic stones'
- Abstract: Publication date: December 2018Source: Arab Journal of Urology, Volume 16, Issue 4Author(s): Hakkı Uzun, Nezih Akça ObjectivesTo compare the 7.5–9.5F ureteroscope (URS) with the 4.5–6.5F URS (Ultra-Thin) in terms of success and complication rates in adult patients with ureteric and renal pelvic stones.Patients and methodsIn all, 41 patients treated with 7.5–9.5F semi-rigid URS (Group 1) and 33 patients treated with the Ultra-Thin (Group 2) were prospectively included in the study. All patients underwent holmium laser ureteroscopic lithotripsy. In each group, when the selected ureteroscopic intervention failed to reach or disintegrate the stone, the URS was replaced with the other one. Outcome criteria were: success and complication rates, stone size and stone surface area, operative time, laser time, usage of guidewire, and postoperative JJ-catheter placement.ResultsThe ureteroscopic lithotripsy in 36 of 41 (87.8%) and 24 of 33 (72.7%) patients was completed without a need to replace the URS with the other one in groups 1 and 2, respectively (P = 0.67). After replacement of the 7.5–9.5F URS with the Ultra-Thin for patients who failed in Group 1, the overall stone-free rate (SFR) improved to 97.5% (P = 0.014). In Group 2, after replacement of the Ultra-Thin with the 7.5–9.5F URS for the failed patients, the overall SFR improved to 96.9% (P = 0.02). There was no significant difference between the groups for complications. Postoperative JJ stenting was significantly less in Group 2 (21.2%) in comparison to Group 1 (46.3%) (P = 0.02).ConclusionsThe Ultra-Thin has a similar success rate as the 7.5–9.5F URS in the treatment of ureteric stones and is a feasible option in patients in whom a conventional URS cannot be advanced through any segment of the ureter.
Efficacy of silodosin on the outcome of semi-rigid ureteroscopy for the
management of large distal ureteric stones: blinded randomised trial
- Abstract: Publication date: December 2018Source: Arab Journal of Urology, Volume 16, Issue 4Author(s): Ahmed Mohey, Tarek M. Gharib, Hisham Alazaby, Mostafa Khalil, Ahmed Abou-Taleb, Yasser A. Noureldin ObjectiveTo evaluate the efficacy of silodosin therapy, as a new α-adrenergic receptor (α-AR) blocker, on the success rate of semi-rigid ureteroscopy (URS) for the management of large distal ureteric stones.Patients and methodsThis prospective study recruited 127 adult patients with single distal ureteric stone of ≥1 cm. The patients were randomly allocated to two groups: the first group included 62 patients who received silodosin (8 mg) for 10 days before URS (Silodosin group), whilst the second group included 65 patients who received placebo, in the form of multivitamins, for 10 days before URS (Placebo group). All patients underwent URS and a pneumatic lithoclast was used for stone fragmentation.ResultsThe mean (SD) operative time was shorter in the Silodosin group compared with the Placebo group, at 41.61 (4.67) vs 46.85 (4.6) min, respectively. Furthermore, advancing the ureteroscope to access the stone failed in a statistically significant number of patients in the Placebo group compared with the Silodosin group (13 vs two, respectively). The complication rate was significantly higher in the Placebo group compared with the Silodosin group (20% vs 6.4%, P = 0.036). Additionally, the need for postoperative analgesia was significantly lower in the Silodosin group compared with the Placebo group (8.1% vs 26.2%, P = 0.009).ConclusionSilodosin therapy prior to URS management of large distal ureteric stones seems to be associated with better advancing of the ureteroscope to access the stone, shorter procedure time, higher stone-free rate, lower incidence of complications, and lesser need for postoperative analgesia.
Thulium laser enucleation of the prostate (ThuLEP): Results,
complications, and risk factors in 139 consecutive cases
- Abstract: Publication date: December 2018Source: Arab Journal of Urology, Volume 16, Issue 4Author(s): Marco Raber, Noor N.P. Buchholz, Augusto Vercesi, Nashaat A. Hendawi, Vincenzo Inneo, Giuseppe Di Paola, Lorenzo Tessa, Ismail M. Hassan ObjectivesTo report our experience with the emerging technique of thulium laser enucleation of the prostate (ThuLEP) for the treatment for prostate hyperplasia.Patients and methodsOur inclusion criteria were an International Prostate Symptom Score (IPSS) of>15 and a quality-of-life (QoL) score of>3 in patients with confirmed bladder outflow obstruction, no longer responsive to medical therapy, with a significant post-void residual urine volume (PVR;>100 mL), with or without recurrent urinary tract infection and/or acute urinary retention. Patients with neurogenic bladder, urethral strictures, bladder stones, and previously failed transurethral prostate surgery were excluded.ResultsIn all, 139 men were included in the study. The mean age was 67.8 years. The IPSS and QoL score improved by 17.6 and 2.6, respectively. The flow rate increased from a mean of 9.6 mL to 31.2 mL and the PVR decreased from a mean of 131 mL to 30 mL. On univariate and multivariate analyses, operating time was a predictive factor for haemoglobin drop during the operation. Heparin prophylaxis was the only risk factor identified for postoperative bleeding. Two patients (0.01%) required blood transfusion. One patient (0.007%) required re-intervention for bleeding control, and two patients developed urethral and bladder neck strictures (0.01%).ConclusionThuLEP is safe and reproducible. Whilst it significantly reduces intraoperative bleeding as compared to transurethral resection of the prostate, operating time and perioperative heparin prophylaxis may still lead to a Hb drop and constitute a risk factor for postoperative bleeding. Therefore, a potential risk of deep vein thrombosis requiring heparin prophylaxis should be carefully considered and balanced with the expected clinical benefit of the operation.
Autologous versus synthetic slings in female stress urinary incontinence:
A retrospective study
- Abstract: Publication date: December 2018Source: Arab Journal of Urology, Volume 16, Issue 4Author(s): Sherif Mourad, Hisham Elshawaf, Mahmoud Ahmed, Diaa Eldin Mostafa, Mohamed Gamal, Ahmed A. Shorbagy ObjectiveTo evaluate and compare the clinical (patient’s morbidity, quality of life [QoL]) and economic impact of autologous vs synthetic slings in female stress urinary incontinence (SUI), as over the last decade, the introduction of synthetic vaginal tapes for managing SUI has gained wide acceptance being quicker with low morbidity. Synthetic vaginal tapes have been progressively replacing the use of autologous rectus fascia. However, the high cost of these synthetic tapes is almost always an obstacle for most patients of limited socio-economic resources in the Egyptian community.Patients and methodsThis retrospective study included 126 women with SUI. Data for patients that matched the study inclusion criteria were collected from the Urology Department of Ain-Shams University Hospitals from March 2011 to May 2013. Patients were categorised into two groups: Group I included 62 patients who underwent an autologous sling procedure using rectus sheath; and Group II included 64 patients that had a synthetic sling, using transobturator tape (TOT). The following variables were compared: operative time, postoperative pain scores, duration of indwelling urethral catheter, hospital stay, cost including the price of the synthetic tape when used, return to normal activity, and QoL assessment (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF]) before and after discharge from hospital.ResultsPatients amongst the two groups were normally distributed with no statistically significant differences in patient’s demographic data and comorbidities. The mean hospital stay was longer and the return to normal activity was delayed in Group I compared to Group II. The highest mean postoperative pain score was recorded in Group I. The overall morbidity was 12.9% and 4.68% in groups I and II, respectively. The mean (SD) overall cost was 2571.65 (254.8) and 3502.34 (196.9) Egyptian pounds (local currency) in groups I and II, respectively, being insignificantly lower in Group I when compared to Group II (P > 0.05). There were statistically significant differences between groups I and II for operative time, hospital stay, and postoperative pain scores. However, the differences in hospital cost amongst Group I and Group II were in favour of Group I. Post-surgical outcome was categorised into either complete cure (dry) or improved or failed with no significant differences in success rate and QoL amongst the study groups. The mean (SD) change in the QoL score was 10.95 (4.19) and 12.32 (4.1) in groups I and II, respectively. The higher success rate (complete cure) was in Group II, at 93.75%. Also, a statistically significant improvement of>70% of mean ICIQ-UI-SF score was shown in all groups when compared to baseline on both the 1- and 6-month follow-up visits.ConclusionAutologous grafts should be considered as a repair option in females with SUI in countries were health insurance policies do not cover the cost of synthetic materials in many instances. The cost-effectiveness of synthetic TOT slings, as a minimally invasive procedure with lower overall morbidity, has yet to be confirmed in larger scale studies with longer periods of follow-up, to confirm the durability of its successful outcomes and be considered as the primary treatment of choice in female SUI.
The first Iraqi experience in sacral neuromodulation for patients with
lower urinary tract dysfunction
- Abstract: Publication date: December 2018Source: Arab Journal of Urology, Volume 16, Issue 4Author(s): Issam S. Al-Azzawi, Mohamed A.J. Al-Tamimi ObjectivesTo present our experience, in Iraq, with sacral neuromodulation (SNM) in patients with refractory lower urinary tract dysfunction, with discussion of the factors that affect the response rate.Patients and methodsIn this prospective, clinical, interventional study, 24 patients were evaluated and treated by a team comprised of a Urologist and a Neurosurgeon with SNM over a 1.5-year period. The gender, age, pathology, and clinical presentation, were all studied and evaluated. Successful clinical response was defined as achieving a ≥50% improvement in voiding diary variables.ResultsThe mean age of those that responded to SNM was 28 years, with females responding better than males (10 of 14 vs four of 10). The SNM response rate according to presentation was six of 10 in those with overactive bladder/urge urinary incontinence, six of nine of those with urinary retention, and two of five in those with a mixed presentation. The response rate in idiopathic voiding dysfunctions was 11 of 13, whilst for neurogenic dysfunctions it was three of 11. Other benefits such as in bowel motion, erectile function, menstruation, power of lower limbs, and quality of life (QoL), were also recorded. The complications were reasonable for this minimally invasive procedure.ConclusionSNM offers a good and durable solution for some functional bladder problems, if patients are well selected. There may also be additional extra-urinary benefits that contribute to improvements in QoL. SNM was well tolerated by our patients with an encouraging response rate, especially in psychologically stable patients with idiopathic dysfunctions.
Radical nephrectomy and intracaval thrombectomy for advanced renal cancer
with extensive inferior vena cava involvement utilising cardiopulmonary
bypass and hypothermic circulatory arrest: Is it worthwhile'
- Abstract: Publication date: December 2018Source: Arab Journal of Urology, Volume 16, Issue 4Author(s): Hosam Serag, Jonathan M. Featherstone, David F. Griffiths, Dheeraj Mehta, John Dunne, Owen Hughes, Philip N. Matthews ObjectiveTo report our long-term outcomes of surgical treatment of renal tumours with inferior vena cava (IVC) tumour thrombus above the hepatic veins, utilising cardiopulmonary bypass (CBP) and hypothermic circulatory arrest (HCA), as surgical resection remains the only effective treatment for renal cancers with extensive IVC tumour thrombus.Patients and methodsWe retrospectively reviewed 48 consecutive patients (median age 58 years) who underwent surgical treatment for non-metastatic renal cancer with IVC tumour thrombus extending above the hepatic veins. Perioperative, histological, disease-free (DFS) and overall survival (OS) data were recorded.ResultsTumour thrombus was level III in 23 patients and level IV in 25 patients. The median (range) CBP and HCA times were 162 (120–300) min and 35 (9–64) min, respectively. Three patients underwent synchronous cardiac surgical procedures. There were three (6.3%) perioperative deaths. American Society of Anesthesiologists grade and perioperative blood transfusion requirement were significant factors associated with perioperative death (P 
Multi-disciplinary and shared decision-making approach in the management
of organ-confined prostate cancer
- Abstract: Publication date: December 2018Source: Arab Journal of Urology, Volume 16, Issue 4Author(s): Syed M. Nazim, Mohamed Fawzy, Christian Bach, M. Hammad Ather Decision-making in the management of organ-confined prostate cancer is complex as it is based on multi-factorial considerations. It is complicated by a multitude of issues, which are related to the patient, treatment, disease, availability of equipment(s), expertise, and physicians. Combination of all these factors play a major role in the decision-making process and provide for an interactive decision-making preferably in the multi-disciplinary team (MDT) meeting. MDT decisions are comprehensive and are often based on all factors including patients’ biological status, disease and its aggressiveness, and physician and centres’ expertise. However, one important and often under rated factor is patient-related factors. There is considerable evidence that patients and physicians have different goals for treatment and physicians’ understanding of their own patients’ preferences is not accurate. Several patient-related key factors have been identified such as age, religious beliefs, sexual health, educational background, and cognitive impairment. We have focused on these areas and highlight some key factors that need to be taken considered whilst counselling a patient and understanding his choice of treatment, which might not always be match with the clinicians’ recommendation.
Corrigendum to “Twin penile skin flap, is it the answer for repair of
long anterior urethral strictures'” [Arab J. Urol. 16(2) (2018)
224–231]
- Abstract: Publication date: September 2018Source: Arab Journal of Urology, Volume 16, Issue 3Author(s): Diaaeldin Mostafa, Hisham Elshawaf, Mohamed Abuelnaga, Mohamed Kotb, Abdelwahab Elkassaby
Robotic stone surgery – Current state and future prospects: A
systematic review
- Abstract: Publication date: September 2018Source: Arab Journal of Urology, Volume 16, Issue 3Author(s): Philippe F. Müller, Daniel Schlager, Simon Hein, Christian Bach, Arkadiusz Miernik, Dominik S. Schoeb ObjectiveTo provide a comprehensive review of robot-assisted surgery in urolithiasis and to consider the future prospects of robotic approaches in stone surgery.Materials and methodsWe performed a systematic PubMed© literature search using predefined Medical Subject Headings search terms to identify PubMed-listed clinical research studies on robotic stone surgery. All authors screened the results for eligibility and two independent reviewers performed the data extraction.ResultsThe most common approach in robotic stone surgery is a robot-assisted pyelolithotomy using the da Vinci™ system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Several studies show this technique to be comparable to classic laparoscopic and open surgical interventions. One study that focused on ureteric stones showed a similar result. In recent years, promising data on robotic intrarenal surgery have been reported (Roboflex Avicenna™; Elmed Medical Systems, Ankara, Turkey). Initial studies have shown its feasibility and high stone-free rates and prove that this novel endoscopic approach is safe for the patient and comfortable for the surgeon.ConclusionsThe benefits of robotic devices in stone surgery in existing endourological, laparoscopic, and open treatment strategies still need elucidation. Although recent data are promising, more prospective randomised controlled studies are necessary to clarify the impact of this technique on patient safety and stone-free rates.
Robot-assisted partial nephrectomy: How to minimise renal ischaemia
- Abstract: Publication date: September 2018Source: Arab Journal of Urology, Volume 16, Issue 3Author(s): Chandran Tanabalan, Avi Raman, Faiz Mumtaz Renal ischaemia research has shown an increase in renal damage proportional to ischaemic time. Therefore, we assessed the importance of renal ischaemic times for warm and cold ischaemia approaches, and explored the different surgical techniques that can help to minimise renal ischaemia in robot-assisted partial nephrectomy (RAPN). Minimising renal ischaemia during nephron-sparing surgery (NSS) is a key factor in preserving postoperative renal function. Current data support a safe warm ischaemia time (WIT) of ≤25 min and cold ischaemic time of ≤35 min, resulting in no significant deterioration in renal function. In general, patients undergoing NSS have increased comorbidities, including chronic kidney disease, and in these patients it is difficult to predict their postoperative renal function recovery. With RAPN, efforts should be made to keep the WIT to 25 min, but may not lead to superior functional outcome. Careful preoperative planning, tumour factors, and meticulous surgical technique are critical for optimum patient outcome.
Successful management of ureteric endometriosis by laparoscopic
ureterolysis – A review and report of three further cases
- Abstract: Publication date: September 2018Source: Arab Journal of Urology, Volume 16, Issue 3Author(s): Deepa Talreja, Vivek Salunke, Shinjini Pande, Chirag Gupta ObjectiveTo review articles highlighting the effectiveness of conservative laparoscopic ureterolysis as a primary treatment option in patients with ureteric endometriosis and to report on a further three cases.Patients and methodsPubMed, EMBASE, Cochrane database were searched to identify articles reporting cases of laparoscopic management of ureteric endometriosis and, in particular management by ureterolysis. We further described three new cases of ureteric endometriosis managed at our institute.ResultsThe present study illustrates the significance of laparoscopic ureterolysis in the management of patients with ureteric endometriosis. In our cases, a systematic surgical approach was followed in order to perform complete but careful excision of the all visible endometriotic implants. During follow-up successful treatment was established by relief of hydroureteronephrosis by ultrasonographic evaluation.ConclusionConsidering the risk of loss of renal function and due to the nonspecific symptoms, a prompt clinical suspicion and thorough preoperative assessment can potentially help in the diagnosis. We conclude that laparoscopic ureterolysis is a minimally invasive technique with low complication and recurrence rates. It is a suitable option as a primary approach for selected patients with ureteric endometriosis, if done in a systematic step-by-step approach.
Contemporary use of ultrasonic versus standard electrosurgical dissection
in laparoscopic nephrectomy: Safety, efficacy and cost
- Abstract: Publication date: September 2018Source: Arab Journal of Urology, Volume 16, Issue 3Author(s): Nand Kishore Arvind, Qutubuddin Ali, Onkar Singh, Shilpi Gupta, Surbhi Sahay ObjectiveTo assess the safety, efficacy and cost-effectiveness of ultrasonic dissection (USD) compared with standard monopolar electrosurgery (ES) in laparoscopic nephrectomy (LN).Patients and methodsRetrospective analysis of patients’ records who underwent elective LN was performed. Patients were divided in to two groups: USD and ES groups depending on the energy source used during LN. The preoperative (demographics, indication for surgery), intraoperative (conversion to open surgery, operative time, estimated blood loss [EBL], complications), and postoperative (morbidity/mortality, volume of drainage, hospital stay, cost) data were collected and analysed.ResultsBetween February 2004 and February 2008, 136 patients were included. The indications for nephrectomy were: inflammatory (51 patients), non-inflammatory (64), and tumours (21). The two groups were similar for preoperative data. The conversion rate to open surgery (12.5%) and mean operative time did not differ significantly between the groups. However, intraoperative mean EBL was significantly less with USD, at 140.8 mL vs 182.6 mL for ES. There were no differences in postoperative parameters and morbidity. USD was significantly more expensive than ES (59 000 vs 26 000 Indian Rupees).ConclusionsES is a safe and feasible tool like USD in LN when used with caution. USD facilitates completion of difficult cases and reduces intraoperative blood loss. However, the majority of LNs can be completed safely with ES. ES is sturdy and cheap; therefore, selective use of USD appears to be the most cost-effective policy in the developing world.
Re: Laparoscopic renal surgery is here to stay. By Angus Chin On Luk,
Rajadoss MuthuKrishna Pandian and Rakesh Heer. Department of Urology,
Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
- Abstract: Publication date: September 2018Source: Arab Journal of Urology, Volume 16, Issue 3Author(s): Elenko Popov, Noor N.P. Buchholz
Laparoscopic renal surgery is here to stay
- Abstract: Publication date: September 2018Source: Arab Journal of Urology, Volume 16, Issue 3Author(s): Angus Chin On Luk, Rajadoss Muthu Krishna Pandian, Rakesh Heer ObjectivesTo review the current literature comparing the outcomes of renal surgery via open, laparoscopic and robotic approaches.Materials and methodsA comprehensive literature search was performed on PubMed, MEDLINE and Ovid, to look for studies comparing outcomes of renal surgery via open, laparoscopic, and robotic approaches.ResultsLimited good-quality evidence suggests that all three approaches result in largely comparable functional and oncological outcomes. Both laparoscopic and robotic approaches result in less blood loss, analgesia requirement, with a shorter hospital stay and recovery time, with similar complication rates when compared with the open approach. Robotic renal surgeries have not shown any significant clinical benefit over a laparoscopic approach, whilst the associated cost is significantly higher.ConclusionWith the high cost and lack of overt clinical benefit of the robotic approach, laparoscopic renal surgery will likely continue to remain relevant in treating various urological pathologies.
Different approaches to the prostate: The upcoming role of a purpose-built
single-port robotic system
- Abstract: Publication date: September 2018Source: Arab Journal of Urology, Volume 16, Issue 3Author(s): Jihad Kaouk, Juan Garisto, Riccardo Bertolo With the aim of minimising the patient’s postoperative pain, expediting recovery and improving cosmesis, the idea of performing a laparoscopic procedure through a single abdominal incision was introduced. In the present report, we describe five different access routes to the prostate that may be at the surgeon’s disposal with the potential of decreasing patient’s perioperative morbidity. Robotic radical prostatectomy has been refined and became a standard of care in surgery for localised prostate cancer. The advent of single-port robotic surgery has prompted the re-discovery of different access routes to the prostate and ideally all of them are feasible. The potential for avoiding the abdominal cavity will decrease the surgical morbidity and minimise the surgical dissection. In the near future, each of the described approaches could be chosen on the basis of the patient’s preoperative comorbidities, body habitus, anatomy, and disease characteristics and location.
How robotic surgery is changing our understanding of anatomy
- Abstract: Publication date: September 2018Source: Arab Journal of Urology, Volume 16, Issue 3Author(s): Fabrizio Dal Moro The most recent revolution in our understanding and knowledge of the human body is the introduction of new technologies allowing direct magnified vision of internal organs, as in laparoscopy and robotics. The possibility of viewing an anatomical detail, until now not directly visible during open surgical operations and only partially during dissections of cadavers, has created a ‘new surgical anatomy’. Consequent refinements of operative techniques, combined with better views of the surgical field, have given rise to continual and significant decreases in complication rates and improved functional and oncological outcomes. The possibility of exploring new ways of approaching organs to be treated now allows us to reinforce our anatomical knowledge and plan novel surgical approaches. The present review aims to clarify some of these issues.
A brief overview of the development of robot-assisted radical
prostatectomy
- Abstract: Publication date: September 2018Source: Arab Journal of Urology, Volume 16, Issue 3Author(s): Oliver W. Hakenberg Robot-assisted radical prostatectomy (RP) has gained remarkable worldwide distribution and has become a standard procedure for localised prostate cancer, indeed a new ‘gold standard’. There are proven advantages in reduced blood loss and shorter recovery time. Whilst case series publications often report improved functional outcomes, systematic hospital and healthcare data analyses mostly do not support these findings. Robotic surgery remains more costly. Its use has also increased knowledge about the anatomy of RP.
Complications in robotic urological surgeries and how to avoid them: A
systematic review
- Abstract: Publication date: September 2018Source: Arab Journal of Urology, Volume 16, Issue 3Author(s): Rafael Rocha Tourinho-Barbosa, Marcos Tobias-Machado, Adalberto Castro-Alfaro, Gabriel Ogaya-Pinies, Xavier Cathelineau, Rafael Sanchez-Salas ObjectivesTo review the main complications related to the robot-assisted laparoscopic (RAL) approach in urology and to suggest measures to avoid such issues.MethodsA systematic search for articles of the contemporary literature was performed in PubMed database for complications in RAL urological procedures focused on positioning, access, and operative technique considerations. Each complication topic is followed by recommendations about how to avoid it.ResultsIn all, 40 of 253 articles were included in this analysis. Several complications in RAL procedures can be avoided if the surgical team follows some key steps. Adequate patient positioning must avoid skin, peripheral nerve, and muscles injuries, and ocular and cognitive complications mainly related to steep Trendelenburg positioning in pelvic procedures. Port-site access and closure should not be neglected during minimally invasive procedures as these complications although rare can be troublesome. Technique-related complications depend on surgeon experience and the early learning curve should be monitored.ConclusionsAdequate patient selection, surgical positioning, mentorship training, and avoiding long-lasting procedures are essential to prevent RAL-related complications. The robotic surgical team must be careful and work together to avoid possible complications. This review offers several steps in surgical planning to reach this goal.
Expanding the indications of robotic surgery in urology: A systematic
review of the literature
- Abstract: Publication date: September 2018Source: Arab Journal of Urology, Volume 16, Issue 3Author(s): Raj P. Pal, Anthony J. Koupparis ObjectivesTo evaluate the recent developments in robotic urological surgery, as the introduction of robotic technology has overcome many of the difficulties of pure laparoscopic surgery enabling surgeons to perform complex minimally invasive procedures with a shorter learning curve. Robot-assisted surgery (RAS) is now offered as the standard for various surgical procedures across multiple specialities.MethodsA systematic search of MEDLINE, PubMed and EMBASE databases was performed to identify studies evaluating robot-assisted simple prostatectomy, salvage radical prostatectomy, surgery for urolithiasis, distal ureteric reconstruction, retroperitoneal lymph node dissection, augmentation ileocystoplasty, and artificial urinary sphincter insertion. Article titles, abstracts, and full text manuscripts were screened to identify relevant studies, which then underwent data extraction and analysis.ResultsIn all, 72 studies evaluating the above techniques were identified. Almost all studies were retrospective single-arm case series. RAS appears to be associated with reduced morbidity, less blood loss, reduced length of stay, and comparable clinical outcomes in comparison to the corresponding open procedures, whilst having a shorter operative duration and learning curve compared to the equivalent laparoscopic techniques.ConclusionEmerging data demonstrate that the breadth and complexity of urological procedures performed using the da Vinci® platform (Intuitive Surgical Inc., Sunnyvale, CA, USA) is continually expanding. There is a gaining consensus that RAS is producing promising surgical results in a wide range of procedures. A major limitation of the current literature is the sparsity of comparative trials evaluating these procedures.
The age of robotic surgery – Is laparoscopy dead'
- Abstract: Publication date: September 2018Source: Arab Journal of Urology, Volume 16, Issue 3Author(s): Hartwig Schwaibold, Felix Wiesend, Christian Bach IntroductionRobot-assisted laparoscopic surgery (RALS) has become a widely used technology in urology. Urological procedures that are now being routinely performed robotically are: radical prostatectomy (RP), radical cystectomy (RC), renal procedures – mainly partial nephrectomy (PN), and pyeloplasty, as well as ureteric re-implantation and adrenalectomy.MethodsThis non-systematic review of the literature examines the effectiveness of RALS compared with conventional laparoscopic surgery for the most relevant urological procedures.ResultsFor robot-assisted RP there seems to be an advantage in terms of continence and potency over laparoscopy. Robot-assisted RC seems equal in terms of oncological outcome but with lower complication rates; however, the effect of intracorporeal urinary diversion has hardly been examined. Robotic PN has proven safe and is most likely superior to conventional laparoscopy, whereas there does not seem to be a real advantage for the robot in radical nephrectomy. For reconstructive procedures, e.g. pyeloplasty and ureteric re-implantation, there seems to be advantages in terms of operating time.ConclusionsWe found substantial, albeit mostly low-quality evidence, that robotic operations can have better outcomes than procedures performed laparoscopically. However, in light of the significant costs and because high-quality data from prospective randomised trials are still missing, conventional urological laparoscopy is certainly not ‘dead’ yet.
The age of robotic surgery – Is laparoscopy dead'
- Abstract: Publication date: September 2018Source: Arab Journal of Urology, Volume 16, Issue 3Author(s): Noor N.P. Buchholz, Christian Bach