Laparoscopic procedures for urological diseases in children have been proven to be safe and effective. However, the availability of laparoscopic procedures is still partly limited to experienced, high-volume centers because the procedures are technically demanding. The da Vinci robot system is being used for an increasing variety of reconstructive procedures because of the advantages of this approach, such as motion scaling, greater optical magnification, stereoscopic vision, increased instrument tip dexterity, and tremor filtration. Particularly in pediatric urologic surgery, where the operational field is limited owing to the small abdominal cavity of children, robotic surgical technology has its own strengths. Currently, robots are used to perform most surgeries in children that can be performed laparoscopically. In this review, we aimed to provide a comprehensive overview of the current role of robot-assisted laparoscopic surgery in Pediatric Urology by analyzing the published data in this field. A growing body of evidence supports the view that robotic technology is technically feasible and safe in pediatric urological surgery. Robotic technology provides additional benefits for performing reconstructive urologic surgery, such as in pyeloplasty, ureteral reimplantation, and enterocystoplasty procedures. The main limitations to robotic surgery are its high purchase and maintenance costs and that the cost-effectiveness of this technology remains to be validated.
Child ; Humans ; Laparoscopy/*methods ; Robotic Surgical Procedures/*methods ; Urologic Diseases/*surgery ; Urologic Surgical Procedures/*methods

OBJECTIVE: To investigate the operative technique and the clinical value of retroperitoneal laparoscopic enucleation of the renal hamartoma. METHODS: Twenty-five patients of renal hamartoma received retroperitoneal laparoscopic enucleation. The patients were placed in lateral decubitus position. All laparoscopic surgical procedures were performed retroperitoneally using 3 port-sites. The tumor was exposed and resected along the edge, and the tumor clipped out with a lithotomy forceps. The renal hamartoma was confirmed through a pathological diagnosis during the operation. The resection surface was sutured with fibrin and absorbable hemostatic gauze. RESULTS: The operations were finished successfully in all patients. The diameter of tumors ranged from 1.8 cm x 2.0 cm to 4.5 cm x 4.9 cm. The operative time was 50 - 90 (mean=70) min. The blood loss was 30 - 80 (mean=55) mL. The hospital stay was 7 - 9 (mean=8) days. CONCLUSION Retroperitoneal laparoscopic enucleation of the renal hamartoma is safe and effective, whose advantages include minimal invasive, less blood loss, short hospital stay, and rapid convalescence.
Adult ; Female ; Hamartoma ; surgery ; Humans ; Kidney Diseases ; surgery ; Laparoscopy ; Male ; Middle Aged ; Retroperitoneal Space ; surgery ; Urologic Surgical Procedures ; methods

Nonvascular intervention of the urinary tract is a well-established uroradiologic subspecialty, which is more important for avoiding invasive open surgery in the age of rising demand about the value of less invasive treatment. Various kinds of nonvascular intervention are recently performed under image-guidance and are as follows: percutaneous nephrostomy, percutaneous nephrostolithotomy, percutaneous dilatation of the urinary tract, sclerotherapy for renal cysts, percutaneous catheter drainage, percutaneous foreign body retrieval and biopsy. Percutaneous nephrostomy is a basic technique to provide a direct access to urinary tract, which makes it possible to perform other interventional procedures. Although nonvascular intervention may produce some complications, it is generally considered to be less invasive than open surgery and has advantages such as short hospital stay, early return to normal life and therefore economic savings. This review is described to help clinicians easily understand the procedures, indications, techniques, and complications with figures of cases the authors experienced.
Adult ; Catheterization ; Female ; Humans ; Male ; Middle Aged ; Nephrostomy, Percutaneous/*methods ; Urinary Tract/pathology/surgery ; Urologic Diseases/therapy

Adult ; Aged ; Chyle ; Female ; Humans ; Kidney ; surgery ; Laparoscopy ; methods ; Lymphatic Diseases ; surgery ; Lymphatic System ; surgery ; Male ; Middle Aged ; Retroperitoneal Space ; Urine ; Urologic Surgical Procedures ; methods

OBJECTIVEAimed at illustrating the means of early diagnosis for prevention of the impairment of kidney function, the results of conservative medical therapy and the surgical treatment in patients with endometriosis of urinary tract.

METHODSSurgical interventions were done in 5 cases with pathological of endometriosis. Ureters were involved by endometriotic lesion in 3 patients, ureters and bladder in one and urethra in another patient. All of the cases were shown at least partial obstruction of the urinary tract by clinical symptoms, diagnostic examinations and the outcomes of various kinds of treatment.

RESULTSHydropnephrosis and hydroureter were shown by ultrasonography, IVP or retrograde pyelography in one case of ureteral obstruction. A small lump of endometriotic foci along the urethra was detected by manual examination and ultra-sonography in one patient. The relieving of the symptoms and signs of the obstruction of the urinary tract in two cases by GnRH-a or progest in was the evidence of the endometriotic lesion. There were two patients underwent surgical resection of the endometriotic foci surrounding the ureter after medical therapy.

CONCLUSIONSUrinary tract endometriosis are rarely seen and usually escape the attention of the physicians, while they usually cause obstruction of the urinary tract and finally impairment of kidney function if not treated in time. This kind of disease can be easily diagnosed by imaging detection with ultra-sonography, IVP or retrograde pyelography. Conservative treatment with GnRH-a and long acting progesterone as well as surgical treatments are effective for this kind of disease.

Adult ; Endometriosis ; diagnosis ; drug therapy ; surgery ; Female ; Gonadotropin-Releasing Hormone ; therapeutic use ; Humans ; Middle Aged ; Urologic Diseases ; diagnosis ; drug therapy ; surgery

AIMTo investigate the feasibility of the autologous fascia graft in urethra defect reconstruction.

METHODSIn 24 adult male rabbits, a standardized defect (17 mm) was created within the midportion of each urethra. Two-cm long fascial tube grafts were interposed between the cut ends of the urethra. Twenty-four rabbits were divided into 12 groups. At 0, 3, 10, 15, 21, 30, 45, 60, 90, 120, 150, and 180 days postoperatively, one group was killed. In the first four groups, rabbits were killed and specimens were obtained for histological examination. After 21 postoperative days, in the subsequent eight groups, retrograde urethrograms were carried out to evaluate urethral patency and caliber, then rabbits were killed and specimens were obtained.

RESULTSIn the histological study, advancement of the urethral transitional epithelium along scaffold provided by the fascial graft was determined. At the 30th day, the new urethra was completely covered with the transitional epithelium. Fistula formation was observed in two of 24 rabbits. In urethrograms, narrowing was determined in three of 16 rabbits.

CONCLUSIONFor segmental urethral reconstruction, fascial graft is a good urethral substitute because of its rapid epithelization capacity, low contraction degree and thinness. We therefore propose the use of fascial grafts for reconstruction of male-urethra defects in humans.

Animals ; Disease Models, Animal ; Fascia ; diagnostic imaging ; pathology ; transplantation ; Male ; Pilot Projects ; Rabbits ; Radiography ; Urethra ; diagnostic imaging ; pathology ; surgery ; Urethral Diseases ; pathology ; surgery ; Urologic Surgical Procedures, Male ; methods

OBJECTIVE: To discuss the efficacy and safety of simultaneous bilateral endoscopic surgery (SBES) for bilateral upper urinary tract calculi, and to summarize the initial experience. METHODS: Patients diagnosed with bilateral upper urinary tract calculi who underwent SBES in the Department of Urology, Beijing Chao-Yang Hospital from January 2019 to January 2020 were enrolled retrospectively. The demographic and clinical data of the patients were recorded, and the operation status, stone free rate (SFR) and peri-operative complications were analyzed. The primary end point was SFR, and second end point was peri-operative complications. RESULTS: A total of 23 patients underwent SBES, of which SBES was completed in 19 patients (12 males, and 7 females). The mean age was (41.3±12.0) years. Fourteen patients underwent modified supine position surgery and 4 patients in prone split-leg position. There was no statistical difference in the demographic and baseline clinical data of the patients in different positions. One patient underwent right percutaneous nephrolithotomy (PCNL) and left endoscopic combined intra-renal surgery (ECIRS) in the prone split-leg position, while 18 patients received simul-taneous surgery with PCNL and contralateral retrograde intra-renal surgery (RIRS). The mean anesthesia and operation time was (128.7±26.5) min and (70.7±20.3) min, respectively, which was significantly longer in the patients with prone split-leg position than in the patients with modified supine position, anesthesia time in the patients with prone split-leg position and modified supine position: (148.4±20.4) min vs. (121.6±25.3) min, respectively, t=－2.121, P=0.049, while the operation time in the patients with prone split-leg position and modified supine position: (86.4±21.1) min vs. (65.1±17.4) min, respectively, t=－2.222, P=0.040. There was no significant difference between the two groups in indwelling of nephrostomy [prone split-leg position and modified supine position: (2.6±0.9) d vs. (2.1±1.0) d, respectively; t=－0.880, P=0.391] and the length of hospital stay [prone split-leg position and modified supine position: (6.0±2.7) d vs. (5.2±1.8) d, respectively; t=－0.731, P=0.475]. One month after the operation, the SFR was 78.9%, and 3 patients had minor peri-operative complications (Clavien-Dindo grades Ⅰ/Ⅱ) without any serious complications (Clavien-Dindo grades Ⅲ/Ⅳ/Ⅴ). CONCLUSION The simultaneous bilateral endoscopic surgery would decrease the operation time and anesthesia exposure under the premise of ensuring the SFR, which is helpful to reduce the risk of peri-operative complications, especially to the patients who can not tolerate the second-stage or long-time operation.
Adult ; Calcinosis/surgery* ; Endoscopy ; Female ; Humans ; Kidney Calculi ; Male ; Middle Aged ; Nephrolithotomy, Percutaneous ; Nephrostomy, Percutaneous ; Retrospective Studies ; Treatment Outcome ; Urologic Diseases/surgery*

OBJECTIVETo investigate the application of Koyanagi technique for repairing proximal hypospadias with penoscrotal transposition.

METHODSKoyanagi procedure was used for repairing proximal hypospadias with penoscrotal transposition in 26 boys (mean age 4.2 years) between July 2005 and June 2010.

RESULTSPrimary healing was achieved in 22 cases. Three patients suffered from urinary fistula and the external urethral orifice in one patient was retracted to penis coronary sulcus, who were re-operated successfully. Two cases showed slight penile ventral curvature. Slight stricture of the urethral external orifice was noted in one case, which relieved after one to two times of urethral sounding every week for eight months. 20 patients were followed up for 6-36 months (mean 10.5 months) with good cosmetic result and normal urethra function. The penoscrotal transposition was also corrected.

CONCLUSIONSThe original Koyanagi procedure might be one of the simple and effective method for repairing proximal hypospadias with penoscrotal transposition.

Abnormalities, Multiple ; surgery ; Child ; Child, Preschool ; Free Tissue Flaps ; Humans ; Hypospadias ; surgery ; Male ; Penis ; abnormalities ; surgery ; Reconstructive Surgical Procedures ; methods ; Scrotum ; abnormalities ; surgery ; Urethra ; surgery ; Urethral Diseases ; surgery ; Urologic Surgical Procedures, Male ; methods

The testicular prosthesis can be an afterthought for providers when performing an orchiectomy for testicular cancer, torsion, atrophic testis, or trauma. However, data suggest that patients find the offer of a testicular prosthesis and counseling regarding placement to be extremely important from both a pragmatic and a psychosocial perspective. Only two-thirds of men undergoing orchiectomy are offered an implant at the time of orchiectomy and of those offered about one-third move forward with prosthesis placement. The relatively low acceptance rate is in stark contrast with high patient satisfaction and low complication rates for those who undergo the procedure. The most common postoperative patient concerns are minor and involve implant positioning, size, and weight. Herein, we provide an up-to-date review of modern preoperative evaluation, patient selection, expectation management, surgical technique, and expected outcomes for testicular prostheses.
Counseling ; Gonadal Dysgenesis, 46,XY/surgery* ; Humans ; Male ; Orchiectomy ; Patient Satisfaction ; Patient Selection ; Postoperative Complications/epidemiology* ; Prosthesis Implantation/methods* ; Spermatic Cord Torsion/surgery* ; Testicular Diseases/surgery* ; Testicular Neoplasms/surgery* ; Testis/surgery* ; Urologic Surgical Procedures, Male/methods*

Congenital renal arteriovenous malformations are very rare benign lesions. They are more common in women and rarely manifest in elderly people. In some cases, they present with massive hematuria. Contemporary treatment consists of transcatheter selective arterial embolization which leads to resolution of the hematuria while preserving renal parenchyma. Despite the emergence of the minimally invasive procedures, open surgery in the form of partial nephrectomy or nephrectomy remain viable options. This paper aimed to report a rare case of congenital renal arteriovenous malformation, its clinical manifestations and the surgical treatment chosen.

Human ; Female ; Middle Aged ; Arteriovenous Malformations- General Surgery, treatment, management ; Vascular Malformations ; Cardiovascular Abnormalities ; Cardiovascular Diseases ; Nephrectomy ; Urologic Surgical Procedures ; Surgical Procedures, Operative ; congenital ; Hematuria ; Recurrence