Novel biomarkers of acute kidney injury: Evaluation and evidence in urologic surgery

atients undergoing urologic surgery are at risk of acute kidney injury （AKI） and consequently long-term deterioration in renal function. AKI is further associated with signifcantly higher odds of perioperative complications, prolonged hospital stay, higher mortality and costs. Therefore, better awareness and detection of AKI, as well as identifcation of AKI determinants in the urological surgery setting is warranted to pre-empt and mitigate further deterioration of renal function in patients at special risk. New consensus criteria provide precise definitions of diagnosis and description of the severity of AKI. However, they rely on serum creatinine （SCr）, which is known to be an inaccurate marker of early changes in renal function. Therefore, several newurinary and serum biomarkers promise to address the gap associated with the use of SCr. Novel biomarkers may complement SCr measurement or most likely improve the diagnostic accuracy of AKI when used in combinations. However, novel biomarkers have to prove their clinical applicability, accuracy, and cost effectiveness prior to implementation into clinical practice. Most preferably, novel biomarkers should help to positively improve a patient’s long-term renal functional outcomes. The purpose of this review is to discuss currently available biomarkers and to review their clinical evidence within urologic surgery settings.

The impact of urological resection and reconstruction on patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)

Objective:Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are increasingly being used to treat peritoneal malignancies.Urological resections and reconstruction(URR)are occasionally performed during the surgery.We aim to evaluate the impact of these procedures on peri-operative outcomes of CRS and HIPEC patients.Methods:A retrospective review of a prospectively maintained database of all patients who underwent CRS-HIPEC from April 2001 to February 2016 was performed.Outcomes between patients who had surgery involving,and not involving URR were compared.Primary outcomes were the rate of major complications and the duration of stay in the intensive care unit(ICU)and hospital.Secondary outcomes were that of overall survival(OS)and prognostic factors that would indicate a need for URR.Results:A total of 214 CRS-HIPEC were performed,21 of which involved a URR.Baseline clinical characteristics did not vary between the groups(URR vs.No URR).Urological resections comprised of 52%bladder resections,24%ureteric resections,and 24%involving both bladder and ureteric resections.All bladder defects were closed primarily while ureteric reconstructions consisted of two end-to-end anastomoses,one ureto-uretostomy,five direct implantations into the bladder and three boari flaps.URR were more frequently required in patients with colorectal peritoneal disease(p Z 0.029),but was not associated with previous pelvic surgery(76%vs.54%,p Z 0.065).Patients with URR did not suffer more serious complications(14%vs.24%,p Z 0.42).ICU(2.2 days vs.1.4 days,p Z 0.51)and hospital stays(18 days vs.25 days,p Z 0.094)were not significantly affected.Undergoing a URR did not affect OS(p Z 0.99),but was associated with increased operation time(570 min vs.490 min,p Z 0.046).Conclusion:While concomitant URR were associated with an increase in operation time,there were no significant differences in postoperative complications or OS.Patients with colorectal peritoneal metastases are more likely to require a URR compared to other primary tumours,and needs to be considered during pre-operative planning.

Gastrointestinal tract access for urological natural orifice transluminal endoscopic surgery

We conducted a literature review of natural orifice transluminal endoscopic surgery(NOTES),focusing on urologic procedures with gastrointestinal tract access,to update on the development of this novel surgical approach.As part of the methods,a comprehensive electronic literature search for NOTES was conducted using Pub Med and Cochrane Library from March 2002 to February 2016 for papers reporting urologic procedures performed utilizing gastrointestinal tract access.A total of 11 peer-reviewed studies examining utility of gastrointestinal access for NOTES urologic procedures were noted,with the first report in 2007.The procedures reported in the studies were total/radical nephrectomy,partial nephrectomy,adrenalectomy,and prostatectomy.The transgastric approach was identified in five studies examining total/radical nephrectomy(n = 2),partial nephrectomy(n = 1),partial cystectomy(n = 1),and adrenalectomy(n = 1).Six studies evaluated transrectal approach for NOTES,describing total/radical nephrectomy(n = 3),partial nephrectomy(n = 1),robotic nephrectomy with adrenalectomy(n = 1) and prostatectomy(n = 1).Feasibility was reported in all studies.Most studies were preclinical and acute,and limited by concerns regarding restricted instrumentation and infection risk.We concluded that gastrointestinal access for urologic NOTES demonstrates promise as described by outlined feasibility studies in preclinical models.Nonetheless,clinical application awaits further advancements in surgical technology and concerns regarding infectious potential.

Beyond prostate, beyond surgery and beyond urology: The “3Bs” of managing non-neurogenic male lower urinary tract symptoms

Lower urinary tract symptoms(LUTS),consisting storage,voiding and postmicturition symptoms,is a comprehensive definition involving symptoms that may occur due to several causes.Instead of simply focusing on the enlarged prostate,more attention has to be paid to the entire urinary tract as well as multiple system comorbidities.Therefore,prostate surgery alone does not necessarily provide adequate management and cross-disciplinary collaborations are sometimes required.Based on current literature,this paper proposes the“3Bs”concept for managing non-neurogenic male LUTS,namely,“beyond prostate”,“beyond surgery”and“beyond urology”.The clinical application of the“3Bs”enables urologists to carry out integrated,individualized and precise medical care for each non-neurogenic male LUTS patient.

Management of Urological Lesions Secondary to Obstetrical Gyneco Surgery in the Urology Department of the Gabriel Toure University Hospital Centre

Summarizes: The objective of this work was to study the clinical, diagnostic, therapeutic and evolutionary aspects of urological lesions secondary to gynaeco-obstetrical surgery in the urology department of the Gabriel Touré University Hospital. Material and method: It was a transversal and retrospective study carried out in the urology department of the Gabriel Touré University Hospital Centre in Bamako over 8 years. It focused on the files of 25 patients operated on for a urological lesion secondary to gynaeco-obstetrical surgery. Sociodemographic, epidemiological, diagnostic, therapeutic and evolutionary parameters were analysed. Results: Urologic lesions secondary to gynaeco-obstetrical surgery were found in 0.72% of urologically operated patients. The mean age of the patients was 39 ± 10.4 years (extremes: 18 and 60 years). The average time to diagnosis was 121, 88 ± 15 days (extremes: 0 and 365 days). Clinical signs were: oligo anuria (16%), urine leakage (52%), lumbar pain (24%). The diagnosis was made by the methylene blue test in 56% of patients, by the uro-scanner (20%) and by intravenous urography (16%). In 8% of patients, the diagnosis was made during surgery. The surgical interventions involved were: hysterectomy (48%), cesarean section (40%), genital prolapse cure (8%), ovarian cystectomy (4%). Lesions were dominated by vaginal vesico fistulas (48%) followed by ureterovaginal fistulas (20%), ureteral ligatures (16%). Treatment consisted of ureterovesical reimplantation according to Lich Gregory with ureteral intubation (36%), fistulography (48%). Healing was achieved in 92% of patients. Conclusion: Hysterectomy for cervical malignancy and cesarean section are the main etiologies of urological lesions secondary to gynaeco-obstetrical surgery. Open surgery is the only alternative for the management of these lesions in our context. Controlling anatomy is the main preventive measure.

Preoperative Cardiovascular Risk Assessment Prior Non Cardiac Surgery: A Case Series of Patients Undergoing Urological Surgery in Ngaoundere, Cameroon

Background and objective: Preoperative cardiovascular risk control is critical to reducing the frequency of perioperative cardiovascular events and improving the survival and quality of life of surgical patients. This study aimed at assessing preoperative cardiovascular of patients undergoing urological surgery in Ngaoundere, Cameroon. Methodology: A cross-sectional study was carried at the urological surgery department of the Ngaoundere Islamic Clinic. Participants’ sociodemographic, clinical and biological data were collected and analyzed using Sphinx V5 software. Results: A total of 58 patients were included in the study. Their mean age was 61.33 ± 16.16 years. The most represented age group was the one over 70 years (34.50%). In total, 50 (86.20%) patients had low risk surgical procedures and 20 (34.5%) patients had poor functional capacity. Lee score was calculated for all patients with low functional capacity. Of these patients, 17 (85%) had a low risk of cardiovascular events. Conclusion: The present study reveals a low preoperative cardiovascular risk in urological surgery in Ngaoundere, Cameroon;however, this observation does not exclude the need of systematic evaluation of preoperative cardiovascular risk for better prevention of postoperative complications, in surgical setting in our context.

Performance in the Fundamentals of Laparoscopic Surgery: Does it reflect global rating scales in the Objective Structured Assessment of Technical Skills in porcine laparoscopic surgery?

Objective:To correlate the utility of the Fundamentals of Laparoscopic Surgery(FLS)manual skills program with the Objective Structured Assessment of Technical Skills(OSATS)global rating scale in evaluating operative performance.Methods:The Asian Urological Surgery Training and Educational Group(AUSTEG)Laparoscopic Upper Tract Surgery Course implemented and validated the FLS program for its usage in laparoscopic surgical training.Delegates’basic laparoscopic skills were assessed using three different training models(peg transfer,precision cutting,and intra-corporeal suturing).They also performed live porcine laparoscopic surgery at the same workshop.Live surgery skills were assessed by blinded faculty using the OSATS rating scale.Results:From March 2016 to March 2019,a total of 81 certified urologists participated in the course,with a median of 5 years of post-residency experience.Although differences in task time did not reach statistical significance,those with more surgical experience were visibly faster at completing the peg transfer and intra-corporeal suturing FLS tasks.However,they took longer to complete the precision cutting task than participants with less experience.Overall OSATS scores correlated weakly with all three FLS tasks(peg transfer time:r=0.331,r^(2)=0.110;precision cutting time:r=0.240,r^(2)=0.058;suturing with intracorporeal knot time:r=0.451,r^(2)=0.203).Conclusion:FLS task parameters did not correlate strongly with OSATS globing rating scale performance.Although FLS task models demonstrated strong validity,it is important to assimilate the inconsistencies when benchmarking technical proficiency against real-life operative competence,as evaluated by FLS and OSATS,respectively.

Urologic Complications after Gynaecologic and Obstetric Surgery at the Urology-Andrology Teaching Clinic of Teaching Hospital of Cotonou

Objective: To study the epidemiology and current trend in the management of urologic complications following obstetric and gynaecologic surgeries at CUUA University hospital of Cotonou. Patients and Methods: It was a retrospective study of patients referred with urologic complications following obstetric and gynaecological surgeries. The study took place at the Teaching Clinic of Urology Andrology at CNHU of Cotonou between April 1, 2008 and March 31, 2013. Results: Forty-one patients were studied. They represented 3.5% of people hospitalized at CUUA throughout the study period. The average age was 41 years swith range of 20 and 57 years. Twenty-one (51.2%) of them were married. Thirty patients (73.2%) were referred from a non-academichospital, while 7 patients (17.1%) were referred from academic hospital. Caesarean section was the primary gynecological surgery in 22 cases (53.7%) and hysterectomy in 19 cases (46.3%). Clinically, the pre- dominant symptoms were leakage of urine throughout the vagina and obstructive anuria with or without back pain. We found 31 cases of VVF, 5 cases of bilateral ligation of the ureters, 3 cases of unilateral ligation of the ureter, 1 ureteralinjury and 1 uretero-vaginal fistula. These complications were diagnosed postoperatively in 95.1% of cases. Surgeries done included VVF repair in 31 cases (75.6%), unilateral ureteral reimplantation in 4 cases (9.8%), removal of ligation of the ureters in 3 cases (7.3%), bilateral ureteral reimplantation for 2 cases (4.9%) and end-to-end anastomosisin 1 case (2.4%). The postoperative period was uneventful in 29 cases and we observed 7 cases of surgical site infection. The overall success rate was 87.8%. Conclusion: Urological complications following gynecologic surgeries managed at the urologic department of teaching hospital of Coto-nou had an even higher incidence. Early diagnosis especially during the operative procedure would save the patients’ serious complications and open surgery due to the lack of endo-urological facilities. The most important factor in prevention is good knowledge of pelvicanatomy and good knowledge of the surgical techniques of caesarean operation section and trans-abdominal hysterectomy.

Incidence and risk factors of in-hospital venous thromboembolism in non-oncological urological inpatients:A single center experience

Objective To determine incidence and risk factors for venous thromboembolism(VTE)development of in-hospital VTE in urological inpatients who underwent non-oncological surgery in a tertiary hospital in China.Methods Consecutive 1453 inpatients who were admitted to a non-oncological urological ward in the tertiary hospital from January 1,2018 to December 31,2018 were enrolled in the study,and the VTE events were diagnosed by ultrasound or computed tomographic pulmonary angiography.Patients’occurrence of VTE and characteristics which may contribute to the development of VTE were collected and analyzed as incidence and risk factors.Results The incidence of VTE in non-oncological urological inpatients is 2.3%.In our cohort,patients who experienced previous VTE(adjusted odds ratios[aOR]14.272,95%CI 3.620-56.275),taking anticoagulants or antiplatelet agents before admission(aOR 10.181,95%CI 2.453-42.256),D-dimer(max)≥1μg/mL(aOR 22.456,95%CI 6.468-77.967),lower extremity swelling(aOR 10.264,95%CI 2.242-46.994),chest symptoms(aOR 79.182,95%CI 7.132-879.076),operation time of more than or equal to 180 min(aOR 10.690,95%CI 1.356-84.300),and Caprini score(max)of more than or equal to 5(aOR 34.241,95%CI 1.831-640.235)were considered as risk factors for VTE.Conclusion In this study,we found that the incidence of VTE in non-oncological surgery was about 2.3%,which was higher than some previous studies.Risk factors could be used for early detection and diagnosis of VTE.

Fertility outcomes following bariatric surgery

Obesity impacts human health in more than one way.The influence of obesity on human reproduction and fertility has been extensively examined.Bariatric surgery(BS)has been used as an effective tool to achieve long-term weight loss in both sexes.BS improves hormonal profiling,increasing the odds of spontaneous pregnancy and success rates following assisted reproductive techniques in infertile females.For obese males,BS does improve sexual function and hormonal profile;however,conflicting reports discuss reduced sperm parameters following BS.Although the benefits of BS in the fertility field are acknowledged,many areas call for further research,like choosing the safest surgical techniques,determining the optimal timing to get pregnant,and resolving the uncertainty of sperm parameters.

Robotic assisted andrological surgery

The introduction of the operative microscope for andrological surgery in the 1970s provided enhanced magnification and accuracy, unparalleled to any previous visual loop or magnification techniques. This technology revolutionized techniques for microsurgery in andrology. Today, we may be on the verge of a second such revolution by the incorporation of robotic assisted platforms for microsurgery in andrology. Robotic assisted microsurgery is being utilized to a greater degree in andrology and a number of other microsurgical fields, such as ophthalmology, hand surgery, plastics and reconstructive surgery. The potential advantages of robotic assisted platforms include elimination of tremor, improved stability, surgeon ergonomics, scalability of motion, multi-input visual interphases with up to three simultaneous visual views, enhanced magnification, and the ability to manipulate three surgical instruments and cameras simultaneously. This review paper begins with the historical development of robotic microsurgery. It then provides an in-depth presentation of the technique and outcomes of common robotic microsurgical andrological procedures, such as vasectomy reversal, subinguinal varicocelectomy, targeted spermatic cord denervation （for chronic orchialgia） and robotic assisted microsurgical testicular sperm extraction （microTESE）.

Natural orifice transluminal endoscopic surgery in urology: The Chinese experience

Objective:To describe the Chinese experience of natural orifice transluminal endoscopic surgery(NOTES)in urology.Methods:From December 2008 to May 2017,35 animal experiments and 305 clinical surgeries of NOTES or natural orifices specimen extractions(NOSE)were performed in China.The animal experiments included five kidney biopsies,24 nephrectomies and six partial nephrectomies.The clinical surgeries included 12 transvaginal NOSE(TV-NOSE),266 hybrid transvaginal NOTES(TV-NOTES)and 27 pure TV-NOTES.The TV-NOSE procedure was performed in five transumbilical laparoendoscopic single-site(U-LESS)nephrectomies,four suprapubic-assisted laparoendoscopic single-site surgery(SA-LESS)nephroureterectomies,and three laparoscopic radical cystectomies.The hybrid TV-NOTES procedure included 210 nephrectomies,31 adrenalectomies,eight nephroureterectomies,13 partial nephrectomies,and four heminephrectomies.The pure TV-NOTES procedure included five renal cyst decortications and 22 nephrectomies.Results:A total of 29 animal experiments were successfully performed.One partial nephrectomy was converted to standard laparoscopic surgery.Two kidney biopsies and two nephrectomies were unsuccessful.A total of 297 clinical surgeries were successfully performed.Six patients who underwent hybrid TV-NOTES were converted to open surgery.Two patients who underwent pure TV-NOTES were converted to SA-LESS.There were 22 major complications,16 occurred intraoperatively and six postoperatively.The mean visual analog score(VAS)of 48 h after the operation was 2.5 points in TV-NOSE,2.3 points in hybrid TV-NOTES and 1.7 points in pure TV-NOTES.The mean follow-up of 50.6(3.0-87.0)months showed that all patients were in good condition.The umbilicus scars were nearly invisible in TV-NOSE and hybrid TV-NOTES.The vaginal incision healed well.Conclusions:TV-NOSE and TV-NOTES are feasible,safe,and effective with little injury,low pain,fast recovery,and good cosmetic outcomes in properly selected patients.They are worth consideration for urological clinical practice.

Clinical Application of Percutaneous Nephrostomy in Some Urologic Diseases

Percutaneous nephrostomy was applied in some other urologic diseases and the efficacy was evaluated. Percutaneous nephrostomy for percutaneous nephrolithotomy （PNL） was performed in patients with various renal, perinephric and bladder diseases （n=79）. The tract establishment, operation duration and complications were observed and the efficacy was assessed. The results showed that the tracts were successfully established in 79 cases. The operation lasted 4–20 min. 12F–16F single tract was established in nephrohydrop patients and 16F–20F single or multiple tracts were established in patients with pyonephrosis, renal cortical abscess, renal cyst and perinephric abscess. During dilation, no leakage of liquor puris was noted. Establishment of 18F single tract was achieved in one urinoma patient. In two patients with foreign body in kidney, the foreign bodies were removed via established 14F single tract. 18F tracts were established in 2 patients with bladder contracture, which was followed by the placement of 16F balloon urethral catheter for drainage. No complications, such as massive bleeding, intestinal injury and spreading of infection took place in our series. All the patients were followed up for 2–12 months. No long-term complications such as dropping of drainage tube occurred. It is concluded that as a minimally invasive technique, percutaneous nephrostomy has the advantages of convenience, simplicity and causing less complications and can be used for various urologic diseases.

Quality of life after colorectal surgery:A prospective study of patients compared with their spouses

BACKGROUND Although radical surgery for colorectal cancer improves the oncological outcomes,a significant portion of patients suffer from alterations in their quality of life(QoL).There are many studies investigating the QoL of patients who have colorectal cancer but none of these focus on the QoL of spouses.AIM To compare the QoL of patients after colorectal surgery to the QoL of spouses.METHODS This prospective study consisted of patients who were married and who underwent surgery at the University of Ankara,Department of Surgery between March 2006 and November 2010.Patients’spouses were also enrolled.The study was approved by the Ethics Committee of the Faculty of Medicine,Ankara University,and all patients provided written informed consent.The study included patients who underwent curative surgery for colorectal carcinoma[n=100;abdominoperineal excision(n=33),low anterior resection(n=33),left hemicolectomy(n=34)]and their spouses(n=100).The patients and spouses completed the Medical Outcome Study 36-item Short Form Survey(SF-36)and the World Health Organization Disability Assessment Schedule II(WHODAS-II)preoperatively and at postoperative months 15 to 18.RESULTS During this 4.5-year study period,273 patients with sigmoid or rectal cancer were admitted to the hospital.Of these patients,119 were eligible and willing to participate.Eleven patients had either systemic or locally inoperable disease,three patients had a severe surgical complication,and five patients were lost to followup.Therefore,a total of 100 patients completed the follow-up period.There was a statistically significant positive correlation between the disability scores of patients and the scores of their spouses for some of the WHODAS-II subscales,such as“self-care,”“life activities,”and“participation in society,”as well as for the total WHODAS-II score.There was also a positive correlation between the QoL of patients and the QoL of their spouses in most of the SF-36 subscales.Statistically significant correlations were observed for the“bodily pain,”“general health,””vitality,”“social function,”“emotion,”“mental health,”and mental component summary score subscales of the SF-36.When gender differences were evaluated,the QoL of male patients’spouses changed more when compared with female patients’spouses for all of the WHODAS-II subscales.Colorectal cancer surgery has a significant effect on the QoL of both patients and their spouses,these effects were more significant among male patients’spouses.CONCLUSION Preoperative counseling regarding potential problems should therefore collectively address patient and their spouse as a couple rather than the patient alone,particularly for patients undergoing low anterior resection and abdominoperineal resection procedures.

Day of Surgery Cancellation in Urology at a Public Tertiary Hospital and a Private Specialist Hospital

Background: There is a high variability in the reasons for cancellation of elective urological surgery cases. Case cancellation rate is expected to be high in the Public Health System with perceived inefficiencies compared to private facilities in the same developing economy. Aims and Objectives: This comparative analysis was to determine the case cancellation rate and the reasons for cancellation of elective urological surgeries in a public tertiary hospital and a private specialist hospital in Accra. This is intended to form a basis for interventions aimed at reducing the case cancellation rate. Methods: This was a retrospective analysis of prospectively collected data on Day of Surgery cancelled elective urological cases from September 2014 to October 2015 at the urology unit of the Korle-Bu Teaching Hospital (KBTH), a public Tertiary Hospital and the Trust Specialist Hospital (TSH), a privately managed hospital in Accra. The reasons for case cancellation were categorized into structural factors, patient factors and process factors. Results: There was no significant difference between the case cancellation rate for elective urological cases at KBTH and the TSH which were 20.8% and 17.1% respectively (p = 0.317). For KBTH, the reasons for cancellation of elective urological cases were due to structural factors in 11/117 (9.4%), patient factors in 15/117 (12.8%) and process factors in 91/117 (77.8%) which was due mainly to surgery running late. At the TSH, the reasons were due to structural factors in 1/29 (3.4%), patient factors in 27/29 (93.1%) mainly due to patient not turning up and process factors in 1/29 (3.4%). Conclusion: The case cancellation rate of elective urological surgeries in both the Public Tertiary Hospital and the Private Specialist Hospital were high with no significant difference between the two. However, in the Public Tertiary Hospital, process factors predominated as the cause of these cancellations while patient factors were the predominant cause in the privately managed facility. Exposure of theater managers in public facilities to management practices in privately run facilities should be encouraged to help improve the efficiency of the public facilities.

A systematic review of dedicated models of care for emergency urological patients

Objective:To systematically evaluate the spectrum of models providing dedicated resources for emergency urological patients(EUPs).Methods:A search of Cochrane,Embase,Medline and grey literature from January 1,2000 to March 26,2019 was performed using methods pre-published on PROSPERO.Reporting followed Preferred Reporting Items for Systematic Review and meta-analysis guidelines.Eligible studies were articles or abstracts published in English describing dedicated models of care for EUPs,which reported at least one secondary outcome.Studies were excluded if they examined pathways dedicated only to single presentations,such as torsion,or outpatient solutions,such as rapid access clinics.The primary outcome was the spectrum of models.Secondary outcomes were time-to-theatre,length of stay,complications and cost.Results:Seven studies were identified,totalling 487 patients.Six studies were conference abstracts,while one study was of full-text length but published in grey literature.Four distinct models were described.These included consultant urologists allocated solely to the care of EUPs(“Acute Urological Unit”)or dedicated registrars or operating theatres(“Hybrid structures”).In some services,EUPs bypassed emergency department assessment and were referred directly to urology(“Urological Assessment Unit”)or were managed by other dedicated means.Allocating services to EUPs was associated with reduced time-to-theatre,length of stay and hospital cost,and improved supervision of junior medical staff.Conclusion:Multiple dedicated models of care exist for EUPs.Low-level evidence suggests these may improve outcomes for patients,staff and hospitals.Higher quality studies are required to explore patient outcomes and minimum requirements to establish these models.

The growth of computer-assisted(robotic)surgery in urology 2000e2014:The role of Asian surgeons

Objective:A major role in the establishment of computer-assisted robotic surgery(CARS)can be traced to the work of Mani Menon at Vattikuti Urology Institute(VUI),and of many surgeons of Asian origin.The success of robotic surgery in urology has spurred its acceptance in other surgical disciplines,improving patient comfort and disease outcomes and helping the industrial growth.The present paper gives an overview of the progress and development of robotic surgery,especially in the field of Urology;and to underscore some of the seminal work done by the VUI and Asian surgeons in the development of robotic surgery in urology in the US and around the world.Methods:PubMed/Medline and Scopus databases were searched for publications from 2000 through June 2014,using algorithms based on keywords“robotic surgery”,“prostate”,“kidney”,“adrenal”,“bladder”,“reconstruction”,and“kidney transplant”.Inclusion criteria used were published full articles,book chapters,clinical trials,prospective and retrospective series,and systematic reviews/meta-analyses written in English language.Studies from Asian institutions or with the first/senior author of Asian origin were included for discussion,and focused on techniques of robotic surgery,relevant patient outcomes and associated demographic trends.Results:A total of 58 articles selected for final review highlight the important strides made by robots in urology,from robotic radical prostatectomy in 2000 to robotic kidney transplant in 2014.In the hands of an experienced robotic surgeon,it has been demonstrated to improve functional patient outcomes and minimize perioperative complications compared to open surgery,especially in urologic oncology and reconstructive urology.With increasing surgeon proficiency,the benefits of robotic surgery were consistently seen across different surgical disciplines,patient populations,and strata.

Laparoscopic single site surgery: Experience in pediatric urology

Laparoendoscopic single-site surgery(LESS) has been developed to benefit patients by enabling surgeons to perform scarless surgery. In this review we aimed to summarize and critically analyze the available evidence on the current status and future prospects for LESS in pediatric urology, with special emphasis on our experience with LESS in children. The clinical data available clearly demonstrate that LESS can safely and effectively be performed in a variety of pediatric urology settings. As clinical experience increases, expanding indications are expected to be documented and the efficacy of the procedure to improve. So far, the quality of evidence of all available studies remains low; mostly being small case series or case-control studies from selected centers. Thus, the only objective benefit of LESS remains improved cosmetic outcome. Prospective randomized studies are awaited to determine which LESS procedures will be established and which are unlikely to stand the test of time. Technological advances hold promise to minimize the challenging technical nature of scarless surgery. In this respect, robotics may be a driving force in the development of LESS.

Robotic laparoendoscopic single-site surgery(R-LESS) ：current status in urology

Laparoendoscopic single-site surgery(LESS)is technically challenging;it can reduces instrument triangulation and robust retraction and is associated with a steep learning curve.The instruments of the daVinci  surgical system(Intuitive Surgical)are designed with seven degrees of motion mimicing the dexterity of the human hand and wrist.This inherent feature of the robotic arm provides superior ergonomics when performing LESS,especially for complex reconstructive surgery.This review analyzes the evidence supporting current and future application of robotic technology in the field of urologic LESS.

Enhanced recovery after surgery in transurethral surgery for benign prostatic hyperplasia

Enhanced recovery after surgery(ERAS)measures have not been systematically applied in transurethral surgery for benign prostatic hyperplasia(BPH).This study was performed on patients with BPH who required surgical intervention.From July 2019 to June 2020,the ERAS program was applied to 248 patients,and the conventional program was applied to 238 patients.After 1 year of follow-up,the differences between the ERAS group and the conventional group were evaluated.The ERAS group had a shorter time of urinary catheterization compared with the conventional group(mean±standard deviation[s.d.]:1.0±0.4 days vs 2.7±0.8 days,P<0.01),and the pain(mean±s.d.)was significantly reduced through postoperative hospitalization days(PODs)0-2(POD 0:1.7±0.8 vs 2.4±1.0,P<0.01;POD 1:1.6±0.9 vs 3.5±1.3,P<0.01;POD 2:1.2±0.7 vs 3.0±1.3,P<0.01).No statistically significant difference was found in the rate of postoperative complications,such as postoperative bleeding(P=0.79),urinary retention(P=0.40),fever(P=0.55),and readmission(P=0.71).The hospitalization cost of the ERAS group was similar to that of the conventional group(mean±s.d.:16927.8±5808.1 Chinese Yuan[CNY]vs 17044.1±5830.7 CNY,P=0.85).The International Prostate Symptom Scores(IPSS)and quality of life(QoL)scores in the two groups were also similar when compared at 1 month,3 months,6 months,and 12 months after discharge.The ERAS program we conducted was safe,repeatable,and efficient.In conclusion,patients undergoing the ERAS program experienced less postoperative stress than those undergoing the conventional program.