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Prostate biopsy is a current and well-codified procedure; antibiotic prophylaxis and rectal enema limit the risk of infection. To date, there has been no reported viral transmission between patients due to a contaminated ultrasound probe. In this study, we report the case of a patient who contracted the hepatitis C virus after transrectal prostate biopsy as part of an individual screening for prostate cancer.

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BACKGROUND: The robot-assisted laparoscopic approach for radical prostatectomy (RARP) is being performed increasingly worldwide to treat localized prostate cancer (PCa). The aim of this study was to compare the learning curves of two surgeons with different surgical experiences. METHODS: A prospective collection of peri-operative data was made: age, body mass index, PSA, clinical stage, biopsy Gleason score, operative time (OT), blood loss (BL), pathological stages, final Gleason scores, and complications. Patients were included, in two groups. The first group comprised the first 100 patients undergoing RARP by an expert laparoscopic surgeon. The second group of 100 patients was operated on by a junior surgeon without robotic console experience. Post-operative complications were defined according to the Clavien grading system for surgical morbidity RESULTS: For groups 1 and 2 median age was 63 and 62 years, respectively; median pre-operative PSA level was 10 and 8, respectively; the median BMI was 24 and 25, respectively. The median operative time (OT) was 179 and 160 min, respectively (p > 0.05); and median blood loss was 217 and 346 ml, respectively (p = 0.04). The overall transfusion rate was 1.5% and two major complications were recorded in group 1 and four in group 2. CONCLUSIONS: RARP is safe and reproducible even during the initial learning curve. Overcoming the learning curve is multifactorial and is necessarily dependent on the surgeon. However, joining a well-trained team probably affects positively the performance of the surgeon. The value of expert centers to train new surgeons to RARP needs to be evaluated.

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BACKGROUND: A robot-assisted laparoscopic approach for radical prostatectomy (RALRP) is being adopted increasingly worldwide for the treatment of localized prostate cancer (CaP). Complications assessment is essential to the objective evaluation of any new procedure. This study aimed to assess the perioperative complications encountered during the implementation of a robot-assisted urologic surgery program. METHODS: A prospective data collection for all men with a diagnosis of CaP who underwent RALRP between 2005 and 2009 in our department was achieved. Together with perioperative data, all the perioperative complications encountered were specifically recorded, including robot dysfunctions. The RALRP was performed with the three-arm Da Vinci system using a transperitoneal approach with six ports. To assess the perioperative complications, the validated Clavien-Dindo classification of surgical procedures was used. Two surgeons were involved in these procedures. A modified Clavien-Dindo classification also was used to account for intraoperative complications. RESULTS: According to the Clavien-Dindo classification, 16 complications (6.7% complication rate) were recorded during the first 240 procedures. Besides postoperative complications, five procedures (2.1%) were directly affected by robot malfunctions without notable consequences for the patients. Considering these five additional complications, an 8.8% complication rate was recorded using a modified Clavien-Dindo classification. The main limitation of the study was its design restricted to RALRP procedures alone. The second limitation was that the authors' modified classification needs to be validated with a larger series and for different surgical procedures. CONCLUSIONS: The findings show that RALRP is a safe alternative to classical surgery and that the robotic approach is reliable. The authors believe that the reliability of technological devices should be systematically discussed when outcome analysis of a new procedure is performed.

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PURPOSE: To assess the effectiveness of robot-assisted pyeloplasty in patients with clinically symptomatic ureteropelvic junction obstruction (UPJO). PATIENTS AND METHODS: We retrospectively reviewed our database for all patients who were treated for UPJO by a single surgeon using a robot-assisted procedure between 2005 and 2007. We collected the following: Patient age, clinical presentation, perioperative data, complications, length of hospital stay, and outcome. Preoperative evaluation of UPJO always included an injected renal CT scan and furosemide-mercaptoacetyltriglycine (MAG-3) renal scintigraphy. Patients were seen at 3 and 6 months after surgery and once a year thereafter. Postoperative success was defined as symptomatic response and radiographic evidence of no further obstruction. RESULTS: Twenty patients with a mean age of 36.8 +/- 16 years (range 15-69 yr) were included. Six (30%) patients had previously undergone endoscopic treatment. The mean operative time was 150.3 +/- 36.22 minutes (range 150-240 min). The mean follow-up was 19.9 +/- 10.03 months (range 3-37 mos). Two (10%) procedures necessitated conversion to laparoscopic procedures, and there was no conversion to laparotomy. Four (20%) patients experienced minor complications: Two urinary tract infections and two urinomas. Repeated early surgery was needed in one patient for temporary (ie, 8 days) stent placement in the case of urinoma. There was no recurrence of the UPJO, and no repeated surgery was deemed necessary during the follow-up period. The success rate was estimated to be 95%. CONCLUSIONS: Functional outcomes after robot-assisted procedures for alleviation of UPJO are very promising. Our data showed that the robot-assisted procedure was safe and featured negligible morbidity. Therefore, we conclude that our approach is a viable alternative to open surgery.

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The management of ureteropelvic junction (UPJ) obstruction has evolved over the past 20 years in response to the development of new technology. Open surgery is still the reference standard against which all other surgical interventions must be measured. The surgical approach has, however, gone through rapid changes, and the open procedure initially described has evolved considerably. Endoscopic and laparoscopic approaches have largely supplanted open pyeloplasty for the majority of primary ureteropelvic junction obstruction cases. Laparoscopic approaches provide a balance between a highly successful technique in all patients and improved postoperative recovery. It has been shown to improve postoperative outcomes with shorter recovery times and hospital stays, and to provide equivalent functional results with a success rate of 95%. Nevertheless, laparoscopic pyeloplasty is not a simple procedure. There are a certain number of disadvantages, such as the limited range of laparoscopic instrument movement, the two dimensional image, the unfamiliar hand-eye coordination and the relatively inefficient ergonomic position. Since 2000, however, robots have provided a magnified three-dimensional view giving a greater degree of freedom. This system has simplified suturing and has improved precision of the operating technique. However, the system is very expensive and, providing it is available in their institution, it seems easier for beginners to learn the robotic technique. Additionally, it has similar success rates (both radiological and clinical) to those obtained with open techniques.

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STUDY OBJECTIVE: To evaluate the aesthetic benefit of lumboscopy versus lumbotomy in a group of patients undergoing pyeloplasty. MATERIAL AND METHOD: A telephone survey was conducted in 103 people operated by pyeloplasty via lumboscopy or lumbotomy. The questions concerned the appearance of the scar (size, relief; visible or invisible), skin complications, satisfaction with the scar, postoperative pain, length of hospital stay and return to physical activity or work. RESULTS: The response rate was 58.2% corresponding to 32 lumboscopies and 29 lumbotomies. Lumboscopy scars were shorter (2.7 vs 15.6 cm for lumbotomies, p<0.001). Lumbotomy scars were palpable in 75% of cases versus 53.1% of lumboscopy scars of (p=0.037). Almost 96.5% of lumbotomy scars were visible versus only 68.7% of lumboscopy scars (p=0.0057). Lumbotomies were complicated by incisional hernia in 14.2% of cases, while no incisional hernias were observed in the lumboscopy group (p=0.02). 85% of patients were satisfied with their scars in the lumboscopy group versus 56% of patients operated by lumbotomy (p=0.0286). CONCLUSION: This study showed a statistically significant difference in terms of a purely aesthetic benefit and scar solidity in favour of lumboscopy, which supports the growing place of this surgical technique in urology.

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INTRODUCTION: Prolapse is a common disease with a multifactorial aetiology that may be either isolated or associated with other pelviperineal defects. Surgical reconstruction of the infravesical anterior segment by isolated colpomyorraphy of prolapse is often disappointing with a recurrence rate of 40% according to the literature. Several procedures, consisting of strengthening of the anterior vaginal wall have been proposed. The use of prosthetic material has revolutionized the treatment of cystocele with a reduction of the recurrence rate but at the price of a poorly defined morbidity. Few published studies have assessed the use of xenogeneic tissue in the treatment of anterior vaginal prolapse. The objective of this study was to demonstrate the feasibility, morbidity and short-term results of the use of Pelvicol reticulated collagen mesh in the treatment of cystoceles. OBJECTIVE: To demonstrate the feasibility and short-term results of the transvaginal treatment of cystoceles using collagen implant transobturator (TO) fixation. Many new prosthesis-based techniques are designed to decrease recurrences after repair without prosthesis, but they are often non-standardized, with inadequate evaluation and insufficient follow-up. In contrast with synthetic material, few published studies have investigated the use of xenogeneic tissue. PATIENTS AND METHODS: Twenty-eight patients with a mean age of 70.6 years (range: 53-84) with grade 2 and 3 cystocele and a history of transvaginal prolapse repair in 7 cases, were operated by 2 operators according to an identical technique: the bladder was dissected via a transvaginal approach and a 4 x 7 cm porcine dermis collagen prosthesis was then placed underneath the bladder and fixed, at its anterolateral angles via a TO approach to the midline suburethral part by a resorbable suture. Vaginal hysterectomy was associated in 11 cases. RESULTS: The mean specific prosthesis insertion time was 25 minutes. No intraoperative complication and no serious bleeding were reported. The mean hospital stay was 3.6 days (range: 2-9). The mean follow-up was 8 months (range: 6-16). One case of mesh expulsion was observed on D15, followed by complete healing without recurrence of the cystocele. One case of slight pain of the medial aspect of the thigh was observed with a favourable secondary outcome. The postoperative anatomical results showed complete repair of the prolapse at 1 month and on review. Two cases of de novo SUI were treated by transobturator suburethral tape with a good postoperative result. CONCLUSION: The technique is feasible, simple, safe and ensures very satisfactory short-term results. Follow-up of these patients will be continued.

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The authors report a case of fibro-epithelial polyp in a young woman with Turner syndrome with features of a right ureteropelvic junction syndrome in a horseshoe kidney. The patient presented a history of chronic low back pain associated with macroscopic haematuria leading to various complementary investigations including ureteroscopy. The endoscopic appearance of the tumour suggested the diagnosis despite the presence of atypical renal pelvis cytology. Pyeloplasty and proximal ureterectomy allowed confirmation and treatment of this rare lesion.

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