: Distal ureteral injury is a rare complication of laparoscopic radical prostatectomy (LRP). The authorsreport such a case which was repaired successfully with an exclusively laparoscopic approach. Theyalso describe the advantages of the flank position when performing this minimally invasive approach. THE CASE: 61-year-old Filipino male, with a PSA of 10 ng/cc, diagnosed with localized prostatecancer undergoes LRP, utilizing a posterior approach to the seminal vesicles. Intraoperatively, alarge intravesical median lobe was noted which was dissected meticulously after the division of thebladder neck. The excision of the 60gm prostate was completed in the conventional manner followedby a urethrovesical anastomosis. Blood loss was minimal with no apparent intraoperative events.Histopathology confirmed prostate cancer, Gleason score (4+3) with negative margins. Postoperatively,he had progressively high pelvic drain output and noticeably a relatively low urethral catheter output.CT urogram done on POD 8 showed a distal left ureteral disruption with intraabdominal extravasation.The authors performed a laparoscopic left ureteroneocystostomy on POD 9. The patient did wellafter the repair. After removing the indwelling catheter on postoperative day 14, he was dischargedin a good clinical condition. The ureteral stent was removed one month after the reimplantation.Follow-up CT urogram showed unobstructed flow through the reimplanted left ureter. Follow-upPSA at this time was 0.01ng/cc. CONCLUSION Ureteral injury following LRP is a devastating complication which may go undiagnosedintraoperatively. Prompt recognition, followed by a timely minimally invasive repair through alaparoscopic approach is needed to correct this problem.

OBJECTIVE: The primordial principle in living kidney donation is leaving the better functioning kidney (BFK) with the donor. However, when laparoscopic donor nephrectomy (LDN) is utilized, certain conditions may warrant removing the BFK. These include lesser complex vasculature, renal calculi, or left-sidedness. Reported here are the long-term outcomes of removing the BFK among living donors. METHODS: Chart review was done on all donor nephrectomy patients over a five-year period. Patients whose BFK were removed via LDN were identified. Clinical indications, patient demographics, perioperative and postoperative outcomes were summarized. Creatinine and eGFR at one-day, one-month and one-year follow-up were used to determine renal functional outcomes. RESULTS: Between January 2011 to December 2015, 810 donor nephrectomies were performed: 366 (45.2%) and 444 (54.8%) had open donor nephrectomy and LDN, respectively. BFK was removed in 26 (5.8%) in the LDN and none in the open group. Mean age was 28.9+7.5 (18-49), with a male to female ratio of 4:1. The clinical indications were less complex vasculature in 18 (69%), left-sided BFK in 7 (27%) and renal calculi in 1 (3.8%). The mean operative time was 173 +25 (130–272) minutes, with a mean blood loss of 111 +96 (50-200)cc. The mean length of stay was 3.0+0.2 (2.8-4) days. Grade 1 complications were seen in 5 (19%) patients. There was no mortality. The eGFR after 1 year is 79.4+14.1 (54-91) cc/min. CONCLUSION Removing the BFK during LDN does not impact negatively on the safety and renal functional outcomes of living kidney donors.

INTRODUCTION: Currently, there are limited studies on laparoscopic radical prostatectomy (LRP) in the country. The authors report the clinical and oncological outcomes of LRP over a 10-year experience in a large volume center in the Philippines. METHODS: This retrospective study included 101 patients treated consecutively with LRP from 2008 to 2017. Patient demographics, preoperative prostate features, perioperative data and complications were summarized to determine surgical outcomes. Histopathological results were analyzed to determine oncological efficacy. RESULTS: The mean age was 64.8-7.1 years (R:46-84), BMI was 25.3±3.0 kg/m2 (R:18.7-34.1), prostate volume was 41.1+21.2g (R:7.9-133) and preoperative PSA was 21.5+19.9 ng/mL (R:2.0-100). Operative time was 276.1+70.0 mins. (R:165-475) and estimated blood loss was 604.7+478.4 mL (R: 100-3700). Five (5%) required conversion to open. Time to oral intake was 1.3+0.7 days (R:1-5). Bowel function returned in 2.0+0.9 days (R: 1-4). The drain was removed after 3.7+1.2 days (R:0-9) in 89 patients while 12 patients were discharged with the surgical drain. The length of stay was 4.5+1.8 days (R: 3-14). Pathologically, 26 (25.7%) had extracapsular extension and 14 (13.8%) had seminal vesicle involvement. Three out of 44 (6.8%) who had pelvic lymphadenectomy had nodal metastasis. Thirty (29.7%) had positive surgical margins, the most common site being the apex (17, 56.6%). Thirty-one (30.6%) had Grade I to III complications. There was no mortality. CONCLUSION Laparoscopic radical prostatectomy continues to be a feasible minimally invasive alternative treatment for localized prostate cancer with an acceptable safety profile and high oncological efficiency.

Previous abdominal surgeries have been viewed as a relative contraindication to laparoscopy. The authors report a case of a distal third ureteral stricture previously managed by multiple endoscopic and open procedures and successfully repaired with an exclusively laparoscopic approach.

A 37-year-old female, diagnosed case of chronic endometriosis had previously undergone an open excision of left ovarian cyst and an ipsilateral open psoas hitch reimplantation. Her right distal third ureteral stricture had been on chronic ureteral stent replacement for the past three years. After a comprehensive preoperative evaluation, the patient underwent a successful and uncomplicated laparoscopic ureteral reimplantation on the left. The authors describe their surgical technique and the challenges they encountered therein.

Recurrent distal third ureteral stricture previously managed by multiple open and endoscopic surgeries is a challenging disease to manage. An experienced minimally-invasive surgical team can successfully manage this problem laparoscopically without immediately resorting to open.

Augmentation intestinal cystoplasty is usually the preferred method. However, this is complicated by mucus production, recurrent infection and cystolithiasis. In this report, the authors present a unique case of laparoscopically-assisted ureterocystoplasty and describe the operative technique and its advantages.

A 68-year-old female with a contracted urinary bladder and a solitary functioning kidney was diverted with a percutaneous nephrostomy tube for the past ten years. She consulted for a possible reconstructive procedure.

After a comprehensive preoperative evaluation, she underwent laparoscopically-assisted ureterocystoplasty. The operative time was 265 minutes with minimal blood loss. She had an unremarkable postoperative course. On follow-up, a voiding diary revealed urine volume of around 300 milliliters at 3 hour intervals, preservation of renal function, and no evidence of urinary infection.

Ureterocystoplasty was done using a combination of minimally invasive and open techniques. This procedure spared the patient a lifelong diversion with a nephrostomy tube and provided a better quality of life.