OBJECTIVE: Specimen retrieval bags were used to remove cysts and masses in minimally invasiveurologic surgeries for more than 3 decades. This study aims to describe the steps in making a home-made specimen retrieval bag named JuRoLap and its safety and resiliency. MATERIALS AND METHODS: The bag’s name was taken from the initials of the institution combined withthe department's short-name (uro) and laparoscopy (Lap). The bag is composed of a non-toxicpolyvinyl chloride (PVC) urine bag custom fitted according to the expected specimen size. The sideswere sealed using an impulse sealer leaving one side open. The bag ways rolled and introducedintracorporeally via the 12mm port. It was opened followed by specimen placement using standardlaparoscopic instruments. Purse-string suture at the one-side opening was tightened and extractedthrough the umbilical port extending the incision as necessary. RESULTS: JuRoLap was used in 33 cases removing various organs such as adrenals, kidney, ureter,bladder and prostate. It was easily prepared, safe, resilient and economical costing approximatelyUSD 0.68. It was essential to routinely check its durability by doing a leak test prior to sterilization.Proper rolling, transparent plastic component of the bag and the use of two laparoscopic graspersprovided ease in bag deployment and specimen entrapment. It was also observed that smaller incisionon extraction site as compared to the specimen size was needed due to the resiliency of the bag.Despite the required learning curve in organ entrapment and extraction, there were no complicationsand specimen leakage noted. CONCLUSION JuRoLap specimen retrieval bag is organ size specific, safe, resilient and low cost specimenretrieval bag innovation.
Laparoscopy

Abstract: The genitourinary tract is known to be infiltrated in 3–10% of cases of advanced rectal adenocarcinoma. It is usually managed with total pelvic exenteration with urinary diversion. Complications are encountered because of this diversion. This case series aims to present four cases of locally advanced rectal adenocarcinoma involving the prostate who underwent en bloc prostatectomy in Jose Reyes Memorial Medical Center. Methods: This case series consists of review of records of hospital charts, documentation of specimens from the database of the department. Results: The study consists of four (4) male patients in their 50s presenting with primary rectal adenocarcinoma with invasion to the prostate, bladder or seminal vesicle. Two out of 4 patients had shorter hospital days (6 days) while 2 patients spent 14 and 28 days. Two out of 4 patients have anastomotic leakage, 1 had nosocomial pneumonia and no one had urinary tract infection, postoperatively. All 4 patients had a histopathologic diagnosis of rectal adenocarcinoma with a tumor size of 3.5 to 7.0 cm. Two patients are positive for lymphovascular space invasion while 1 patient has a positive line of resection margin. Two patients had neoadjuvant chemotherapy and radiotherapy while 1 patient had 1 adjuvant chemotherapy and radiotherapy. One patient was lost to follow-up. Conclusion En bloc prostatectomy combined with abdominoperineal resection to treat locally advanced rectal adenocarcinoma provides good local control with the risk of having less postoperative complications. Since there is only one stoma, there is less chance of infection and better quality of life. Complete resection of the tumor can be obtain but can also cause urologic morbidity even after chemotherapy and radiotherapy.
Proctectomy

PURPOSE: Robot-assisted laparoscopic partial nephrectomy (RLPN) is gaining acceptance as an alternative to open partial nephrectomy and laparoscopic partial nephrectomy for small renal masses. However, it still remains a technically challenging procedure even for experienced laparoscopists. Endophytic tumors or renal hilar tumors pose an additional challenge. MATERIALS AND METHODS: We reviewed the medical records of 11 patients (mean age: 49.3 years; range: 31-67 years) who underwent RLPN for small, complex renal masses including hilar tumors and endophytic tumors. RLPN was performed with the Da Vinci(R) surgical system (Intuitive Surgical, Sunnyvale, USA) with three robot arms and intraoperative ultrasonography (Tile-pro(R) System). RESULTS: RLPN was performed successfully without complications in all cases. The mean tumor size was 3.2 cm (range, 1.1-8.0 cm). The mean operative time was 177 minutes (range, 150-260 minutes), and the mean warm ischemia time was 32 minutes (range, 25-41 minutes). The mean estimated blood loss was 177 ml (range, 50-350 ml), and the mean hospital stay was 4 days (range, 3-7 days). Pathology found four patients with clear cell type renal cell carcinoma, one with multilocular multicystic renal cell carcinoma, two with papillary type, one with chromophobe type, and three with angiomyolipoma. CONCLUSIONS: RLPN is a feasible and safe surgery for complex renal tumors. In our experiences, RLPN could be a nephron-sparing surgical option for patients with compromised renal function and it could be an alternative to open partial nephrectomy and laparoscopic partial nephrectomy for a select group of patients.
Angiomyolipoma ; Arm ; Carcinoma, Renal Cell ; Humans ; Kidney Neoplasms ; Length of Stay ; Medical Records ; Nephrectomy ; Operative Time ; Robotics ; Warm Ischemia

PURPOSE: To determine the ability of a novel palpation device to differentiate between benign and malignant tissues of the kidney and bladder by measuring tissue elasticity. MATERIALS AND METHODS: A novel palpation device was developed, mainly composed of a micromotor, a linear position sensor, a force transducer, and a hemisphere tip and cylindrical body probe. Motion calibration as well as performance validation was done. The tissue elasticity of both benign and malignant tissues of the kidney and bladder was measured using this device. A single investigator performed the ex-vivo palpation experiment in twelve kidneys and four bladder specimens. Malignant tissues were made available from partial nephrectomy specimens and radical cystectomy specimens. Palpations for benign renal parenchyma tissue were carried out on nephroureterectomy specimens while non-involved areas in the radical cystectomy specimens were used for benign bladder samples. Elastic modulus (Young's modulus) of tissues was estimated using the Hertz-Sneddon equation from the experimental results. These were then compared using a t-test for independent samples. RESULTS: Renal cell carcinoma tissues appear to be softer than normal kidney tissues, whereas tissues from urothelial carcinoma of the bladder appear to be harder than normal bladder tissues. The results from renal cell carcinoma differed significantly from those of normal kidney tissues (p=0.002), as did urothelial carcinoma of the bladder from normal bladder tissues (p=0.003). CONCLUSION: Our novel palpation device can potentially differentiate between malignant and benign kidney and bladder tissues. Further studies are necessary to verify our results and define its true clinical utility.
Adult ; Aged ; Elastic Modulus ; Elasticity Imaging Techniques/*instrumentation ; Equipment Design ; Female ; Humans ; Kidney/physiology ; Kidney Neoplasms/*diagnosis/physiopathology ; Male ; Middle Aged ; Palpation/*instrumentation ; Phantoms, Imaging ; Pilot Projects ; Urinary Bladder/physiology ; Urinary Bladder Neoplasms/*diagnosis/physiopathology

INTRODUCTION: National annual prostatic digital rectal exam (DRE) campaign advocated by the Philippine Urological Association (PUA) started 2 decades ago in over 60 urological centers in the country. It is being used as a tool to educate Filipinos regarding benign and malignant prostate diseases. However, after each campaign, most patients were lost to follow-up leading to delay in diagnosis and low adherence to medications.
OBJECTIVE: To evaluate the effect of short message service (SMS) in the adherence to follow-up of participants after a campaign.
METHODS: The investigators enrolled 126 participants aged 40 years old and above with significant LUTS and/or a prostate cancer suspect, in a two arm, parallel, randomized controlled pilot study at the Jose R. Reyes Memorial Medical Center (center with the most number of participants annually in the Philippines). Participants received daily SMS text messages for 3 days (n = 63) or usual care (n = 63). The primary outcome was follow-up at the outpatient clinic within 1 month after campaign. The investigators used Epi Info version 7 to analyze the data.
RESULTS: Among participants receiving SMS, 21/63 (33.3%) returned, compared to 5/63 (7.94%) in the control group. The relative risk [RR] = 4.2, odds ratio = 5.8 and uncorrected chi-square (X2) = 12.4, at 95% confidence inetrval; p = 0.000429).
CONCLUSION: This pilot study illustrated the feasibility of using SMS reminder among Filipino national prostatic DRE participants to improve adherence to follow-up. However, further research needs to be done to investigate the impact on adherence to medications and delay in diagnosis.

Human ; Male ; Middle Aged ; Text Messaging ; Odds Ratio ; Risk ; Control Groups ; Pilot Projects ; Arm ; Prostatic Diseases ; Prostatic Neoplasms ; Ambulatory Care Facilities

Introduction: Limited access to the perineum and limited operating room space are just some of the limitations of the standard lithotomy docking for robot-assisted radical prostatectomy (RARP-LD). The side-docking technique (RARP-SD) may address these problems. Methods: Thirty cases of robot-assisted radical prostatectomy were matched to 120 cases of RARP-LD cases by propensity scoring using age, body mass index (BMI), clinical T stage, biopsy Gleason score, and ultrasound prostate volume. Operative and docking time, complications were used to compare peri-operative and safety outcomes. Results: Evaluation of 30 RARP-LD and 30 RARP-SD cases was done after propensity matching. Patient age, BMI, clinical T stage, biopsy Gleason score, and prostate volume were similar between the two groups (p>0.050). The mean docking time of RARP-SD is shorter than that of RARP-LD cases (7.56 vs. 4.12, p <0.001), but this did not translate to a shorter operative time. There were less peri-operative complications in the RARP-SD cases. Conclusions RARP-SD has a docking time and produces less complication than RARP-LD.
Prostatic Neoplasms

INTRODUCTION

Testicular torsion is a true urologic emergency. It occurs when the blood supply to the testis is compromised as the vessels twist along the spermatic cord. Early diagnosis and prompt treatment are critical to prevent prolonged ischemia time which is crucial to its prognosis. This paper aimed to present cases of testicular torsion who underwent testis sparing surgery for torsion.

METHODS

Cases of testicular torsion admitted at the institution from January 2023 to July 2024 were reviewed. Demographic data, scrotal ultrasound findings, intraoperative findings and ischemia time were documented. Patients who underwent tunica albuginea fasciotomy with tunica vaginalis flap were monitored post-surgery via scrotal ultrasound, documenting testicular size.

RESULTS

Twenty seven (27) cases of testicular torsion were reviewed. Of these cases, 4 improved after detorsion and orchidopexy, 12 cases with > 72 hours ischemia time and failed detorsion underwent orchiectomy, 11 cases with < 72 hours of ischemia time, tunica albuginea fasciotomy were performed. Five (5) of these 11 cases showed no improvement in appearance and no bleeding was observed and subsequent orchiectomy was performed. Six cases demonstrated improvement in appearance and bleeding after tunica albuginea fasciotomy, tunica vaginalis flap used to cover the resulting defect. Of these 6 cases, 2 cases showed intact testicular size, 1 case had testicular atrophy on monitoring and 3 cases were lost to follow-up.

CONCLUSION

Testicular torsion remains to be a critical urologic emergency. Prompt diagnosis and immediate surgery required to improve salvage rates. Tunica albuginea incision, with subsequent tunica vaginalis flap may be an option for the urologist to improve salvage, although not consistently prevent testicular atrophy.

Human ; Male ; Testicular Torsion ; Spermatic Cord Torsion