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

Male ; Humans ; Child ; Penis/surgery* ; Urologic Surgical Procedures, Male/methods*

Male ; Humans ; Child ; Penis/surgery* ; Urologic Surgical Procedures, Male/methods*

BACKGROUND: The KangDuo-Surgical Robot-01 (KD-SR-01) system is a new surgical robot recently developed in China. The aim of this study was to present our single-center experience and mid-term outcomes of urological procedures using the KD-SR-01 system. METHODS: From August 2020 to April 2023, consecutive urologic procedures were performed at Peking University First Hospital using the KD-SR-01 system. The clinical features, perioperative data, and follow-up outcomes were prospectively collected and analyzed. RESULTS: A total of 110 consecutive patients were recruited. Among these patients, 28 underwent partial nephrectomy (PN), 41 underwent urinary tract reconstruction (26 underwent pyeloplasty, 3 underwent ureteral reconstruction and 12 underwent ureterovesical reimplantation [UR]), and 41 underwent radical prostatectomy (RP). The median operative time for PN was 112.5 min, 157.0 min for pyeloplasty, 151.0 min for ureteral reconstruction, 142.5 min for UR, and 138.0 min for RP. The median intraoperative blood loss was 10 mL for PN, 10 mL for pyeloplasty, 30 mL for ureteral reconstruction, 20 mL for UR, and 50 mL for RP. All procedures were successfully completed without conversion, and there were no major complications in any patient. The median warm ischemia time of PN was 17.3 min, and positive surgical margin was not noted in any patient. The overall positive surgical margin rate of RP was 39% (16/41), and no biochemical recurrence was observed in any RP patient during the median follow-up of 11.0 months. The surgical success rates of pyeloplasty and UR were 96% (25/26) and 92% (11/12) during the median follow-up of 29.5 months and 11.5 months, respectively. CONCLUSION The KD-SR-01 system appears feasible, safe, and effective for most urological procedures, based on our single-center experience.
Male ; Humans ; Robotic Surgical Procedures/methods* ; Robotics ; Treatment Outcome ; Retrospective Studies ; Ureter/surgery* ; Urologic Surgical Procedures/methods* ; Laparoscopy/methods*

OBJECTIVE: To study the trend of surgical type, surgical procedure and etiological distribution of upper urinary tract repair in recent 10 years. METHODS: The preoperative and perioperative variables and follow-up data of upper urinary tract reconstruction surgery in RECUTTER (Reconstruction of Urinary Tract: Technology, Epidemiology and Result) database from 2010 to 2021 were searched, collected and analyzed. The surgical type, surgical procedure, duration of hospitalization, time of operation, incidence of short-term complications, and proportion of the patients undergoing reoperations were compared between the two groups of 2010-2017 period and 2018-2021 period. RESULTS: A total of 1 072 patients were included in the RECUTTER database. Congenital factors and iatrogenic injuries were the main causes of upper urinary tract repair. Among them, 129 (12.0%) patients had open operation, 403 (37.6%) patients had laparoscopic surgery, 322 (30.0%) patients had robot-assisted laparoscopic surgery and 218 (20.3%) patients had endourological procedure. In the last decade, the total number of surgeries showed a noticeable increasing annual trend and the proportion of robot-assisted laparoscopic surgery in 2018-2021 was significantly higher than that in 2010-2017 (P < 0.001). The 1 072 patients included 124 (11.6%) cases of ileal ureter replacements, 440 (41.1%) cases of pyeloplasty, 229 (21.4%) cases of balloon dilation, 109 (10.2%) cases of ureteral reimplantation, 49 (4.6%) cases of boari flap-Psoas hitch surgery, 60 (5.6%) cases of uretero-ureteral anastomosis, 61 (5.7%) cases of lingual mucosal onlay graft ureteroplasty or appendiceal onlay flap ureteroplasty. Pyeloplasty and balloon dilatation had been the main types of surgery, while the proportion of lingual mucosal onlay graft ureteroplasty plus appendiceal onlay flap ureteroplasty had increased significantly in recent years (P < 0.05). In addition, the time of operation was significantly increased (P < 0.05) after 2018, which was considered to be related to the sharp increase in the proportion of robot-assisted laparoscopic surgery. We found that minimally invasive surgery (endourological procedure and robot-assisted laparoscopic surgery) as an independent risk factor (P=0.050, OR=0.472) could reduce the incidence of short-term post-operative complications. CONCLUSION We have justified the value of the RECUTTER database, created by the Institute of Urology, Peking University in data support for clinical research work, and provided valuable experience for the construction of other multi-center databases at home and abroad. In recent 10 years, we have observed that, in upper urinary tract reconstruction surgery, the surgery type tends to be minimally invasive and the surgery procedure tends to be complicated, suggesting the superiority of robot-assisted laparoscopic surgery.
Humans ; Laparoscopy/methods* ; Retrospective Studies ; Robotic Surgical Procedures ; Treatment Outcome ; Ureter/surgery* ; Ureteral Obstruction/surgery* ; Urologic Surgical Procedures/methods*

No abstract available.
Humans ; Laparoscopy/methods ; Minimally Invasive Surgical Procedures/*methods ; Periodicals as Topic ; Robotic Surgical Procedures/*methods ; Urolithiasis/diagnosis/therapy ; Urologic Surgical Procedures/*methods ; Urology/trends

Tissue transfer techniques are an essential part of the reconstructive urologist's armamentarium. Flaps and graft techniques are widely used in genital and urethral reconstruction. A graft is tissue that is moved from a donor site to a recipient site without its native blood supply. The main types of grafts used in urology are full thickness grafts, split thickness skin grafts and buccal mucosa grafts. Flaps are transferred from the donor site to the recipient site on a pedicle containing its native blood supply. Flaps can be classified based on blood supply, elevation methods or the method of transfer. The most used flaps in urology include penile, preputial, and scrotal skin. We review the various techniques used in reconstructive urology and the outcomes of these techniques.
Genitalia/surgery ; Humans ; Mouth Mucosa/transplantation ; Reconstructive Surgical Procedures/*methods ; Skin Transplantation/methods ; *Surgical Flaps ; Tissue Transplantation/*methods ; Ureter/surgery ; Urethra/surgery ; Urologic Surgical Procedures/*methods

OBJECTIVETo explore the clinical application of the tubularized incised plate (TIP) in the surgical treatment of hypospadias.

METHODSThis study included 169 cases of hypospadias treated by TIP surgery from January 2007 to April 2009. The patients ranged in age from 1.5 to 12 years (mean 3.68 yr). The TIP technique was modified based on that described by Snodgrass, with the urethral plate longitudinally incised and a urethral stent kept in place. The patients were hospitalized for 10 days postoperatively, and followed up for an average of 2 years, ranging from 6 months to 3 years.

RESULTSComplications developed in 18 (10.6%) of the patients, most frequently meatal stenosis (9 cases, 5.3%) and urethrocutaneous fistula (8 cases, 4.7%).

CONCLUSIONThe TIP technique, as a surgical method, can be applied to most hypospadias cases. The accumulation of clinical experience and skills may help raise the success rate and reduce the complications of TIP surgery.

Child ; Child, Preschool ; Humans ; Hypospadias ; surgery ; Infant ; Male ; Treatment Outcome ; Urethra ; surgery ; Urologic Surgical Procedures ; methods

OBJECTIVETo observe the long-time results of the treatment of buried penis with fixation at the base of penis through pre-pubic route.

METHODSFrom Aug 2002 to Dec 2003, the procedure was performed in 34 children without penile skin insufficiency. The major technique involved the release of hided penis shaft by partly shearing suspensory ligament, fixating the bucks fascia and tunica albuginea at 3 and 9 o'clock positions with the subcutaneous penile skin at the base of penis just under the pubic symphysis.

RESULTSTwenty-one patients have been reviewed over one year with satisfactory appearance. Thirteen patients were lost to follow-up. No recurrence happened in our group.

CONCLUSIONWe compare this technique with major treatment methods for buried penis in children at present, and we conclude this technique is a reasonable, simplified and aesthetical method for the treatment of buried penis in children.

Child ; Child, Preschool ; Follow-Up Studies ; Humans ; Male ; Penis ; abnormalities ; surgery ; Urologic Surgical Procedures, Male ; methods

OBJECTIVETo investigate the effect of free internal prepuce lamina patch urethroplasty on long-segment urethral stricture.

METHODSEight patients of long-segment urethral stricture underwent resection of atresia posterior urethra and/or incision of stricture anterior urethra, free internal prepuce lamina patch as of corresponding length and width were taken for the reconstruction of the urethra, and mean while multi-hole silica ge tract was placed in the urethra.

RESULTSMiction was easy and fluent in 7 cases, and unobstructed in 1 case after two urethral soundings.

CONCLUSIONFree internal prepuce lamina patch urethroplasty was a good method for treating long-segment urethral stricture.

Adult ; Humans ; Male ; Middle Aged ; Urethra ; surgery ; Urethral Stricture ; surgery ; Urologic Surgical Procedures, Male ; methods