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CONTEXT: Three-dimensional (3D) printing has profoundly impacted biomedicine. It has been used to pattern cells; replicate tissues or full organs; create surgical replicas for planning, counseling, and training; and build medical device prototypes and prosthetics, and in numerous other applications. OBJECTIVE: To assess the impact of 3D printing for surgical planning, training and education, patient counseling, and costs in urology. EVIDENCE ACQUISITION: A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. EVIDENCE SYNTHESIS: After screening, 4026 publications were identified for detailed review, of which 52 were included in the present systematic review: two papers reported the use of 3D-printing modeling for adrenal cancer, two papers for urethrovesical anastomosis, 24 papers for kidney transplantation and renal cancer, 13 papers for prostate cancer, seven papers for pelvicalyceal system procedures, and three papers for ureteral stents, and three papers reported 3D-printed biological scaffold development. CONCLUSIONS: Three-dimensional printing shows revolutionary potentials for patient counseling, pre- and intraoperative surgical planning, and education in urology. Together with the "patient-tailored" presurgical planning, it puts the basis for 3D-bioprinting technology. Although costs and "production times" remain the major concerns, this kind of technology may represent a step forward to meet patients' and surgeons' expectations. PATIENT SUMMARY: Three-dimensional printing has been used for several purposes to help the surgeon better understand anatomy, sharpen his/her skills, and guide the identification of lesions and their relationship with surrounding structures. It can be used for surgical planning, education, and patient counseling to improve the decision-making process.

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ABSTRACT Introduction: Video endoscopic inguinal lymphadenectomy - VEIL - has emerged as an alternative to reduce post-surgical complications (PSC) in patients with penile cancer submitted to inguinal lymphadenectomy (IL). In some series, these PSC are observed in more than 50% of patients. The objectives of the present study are to describe the initial experience of VEIL in a Hospital in Teresina, PI, Brazil, and to analyze PSC incidence. Material and Methods: Retrospective descriptive study of patients submitted to VEIL from March 2014 to November 2015. Data were collected regarding surgical time, bleeding, complications, lymph node number, conversion, global complications, drainage time, cellulitis, lymphocele, cutaneous necrosis, miocutaneous necrosis and hospitalization time. Results: 20 lower limbs of 11 patients were operated. Mean age was 51.4 (24-72) years. Mean surgical time was 85 (60-120) minutes. No patient showed intrasurgical complications, bleeding > 50 mL or conversion. Three surgeries evolved with lower limb edema, 2 with lymphoceles and one patient had cutaneous necrosis and another bulging of surgical wound. Mean time of hospitalization was 4 (2-11) days. A mean of 5.8 (1-12) lymph nodes were dissected in each surgery. Conclusion: VEIL is a safe and easy technique with lower incidence of PSC that can be reproduced in small centers.

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INTRODUCTION: Video endoscopic inguinal lymphadenectomy - VEIL - has emerged as an alternative to reduce post-surgical complications (PSC) in patients with penile cancer submitted to inguinal lymphadenectomy (IL). In some series, these PSC are observed in more than 50% of patients. The objectives of the present study are to describe the initial experience of VEIL in a Hospital in Teresina, PI, Brazil, and to analyze PSC incidence. MATERIAL AND METHODS: Retrospective descriptive study of patients submitted to VEIL from March 2014 to November 2015. Data were collected regarding surgical time, bleeding, complications, lymph node number, conversion, global complications, drainage time, cellulitis, lymphocele, cutaneous necrosis, miocutaneous necrosis and hospitalization time. RESULTS: 20 lower limbs of 11 patients were operated. Mean age was 51.4 (24-72) years. Mean surgical time was 85 (60-120) minutes. No patient showed intrasurgical complications, bleeding > 50 mL or conversion. Three surgeries evolved with lower limb edema, 2 with lymphoceles and one patient had cutaneous necrosis and another bulging of surgical wound. Mean time of hospitalization was 4 (2-11) days. A mean of 5.8 (1-12) lymph nodes were dissected in each surgery. CONCLUSION: VEIL is a safe and easy technique with lower incidence of PSC that can be reproduced in small centers.

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ABSTRACT The making of three-dimensional virtual models is a promising technology in preoperative planning, but that is not used in the treatment of anorectal fistulas. The objective of this work is to describe the development and initial experience of the construction of a virtual three-dimensional model of the pelvic anatomy of a patient, allowing the exact identification of the relationships between the fistulous tracts of complex anorectal fistulas and the other pelvic structures. An MRI was performed on this patient, and the images were exported to the Vitrea fX Workstation® software. A radiologist did the analysis and segmentation of the images that were then sent to a three-dimensional image processor (Meshlab v. 1.3.3 - ISTI - CNR Research Center, Pisa University, Italy®). The final 3D color image was analyzed by the surgeon and used to guide the catheterization of the fistulous pathways, the internal orifice and to assist in the identification of adjacent structures. The final three-dimensional model presented a high correlation with the intraoperative findings and facilitated the surgical planning.

RESUMO A criação de modelos virtuais tridimensionais é uma tecnologia promissora no planejamento pré-operatorio, entretanto não é utilizada no tratamento de fistulas anais. O objetivo desse trabalho é descrever o desenvolvimento e a experiência inicial da construção de um modelo virtual tridimensional da anatomia pélvica de um paciente, que permite a identificação exata das relações entre os tratos fistulosos de fistulas anais complexas e as demais estruturas pélvicas. O paciente realizou uma ressonância magnética e as imagens foram exportadas para o programa Vitrea fX software Workstation®. Um radiologista realizou a analise e segmentação das imagens que, em seguida, foram enviadas para um processador de imagens tridimensionais (Meshlab v. 1.3.3 - ISTI - CNR research center, Pisa University, Italy®). A imagem 3D colorida final foi analisada pelo cirurgião e utilizada para guiar a cateterização dos trajetos fistulosos e orifício interno e para auxiliar na identificação das estruturas adjacentes. O modelo tridimensional final apresentou alta correlação com os achados intraoperatorios e facilitou o planejamento cirúrgico.

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Herlyn-Werner-Wunderlich (HWW) syndrome is part of a spectrum of Müllerian duct anomalies that occur during embryonic development. The syndrome is characterized by uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. Only few cases of this disease were reported worldwide. We present a 23-year-old female patient with chronic pelvic pain for years. The patient was diagnosed with HWW syndrome with a history of hematocolpos and vaginoplasty at the age of 12. Five months later, she sought urgent medical care due to intense pain, and a clinical picture suggestive of peritoneal irritation. Clinical condition deteriorated and the patient underwent an exploratory laparotomy, which failed to identify anything to justify the abdominal pain. Uroculture and blood culture were negative. A magnetic resonance imaging showed a tube-shaped formations extending from the right retrovesical region to the mesogastrium corresponding to the persistence of the mesonephric duct, related to ipsilateral renal agenesis. The patient underwent laparoscopic procedure, identifying a right ureteric remnant blind ending, with distal and proximal obliteration, filled with purulent secretion, which was totally resected. This case differs from the other reported cases due to pelvic pain secondary to infection and abscess in ureteric remnant. We did not find any case with similar clinical presentation.

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OBJECTIVE: To describe our robot-assisted Boari flap ureteric reimplantation (RA-BFUR) technique, Please see Video S1. METHODS: The RA-BFUR technique is based on the open surgical technique of Übelhör, and the experience includes 11 cases. RESULTS: Excellent results were achieved after a mean follow-up period of >12 months. CONCLUSION: The RA-BFUR technique could be considered a safe and effective method of ureteric reimplantation for long distal ureteric strictures.

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Introdução: a fístula vésico-vaginal (FVV) tem sido um problema social por séculos, devido a morbidade significativa. No mundo desenvolvido, a principal causa das FVV são traumas iatrogênicos da bexiga durante cirurgia ginecológica (até 90% dos casos), com neoplasia, radiação e inflamação sendo as causas subseqüentes de maior importância. Várias abordagens e técnicas foram descritas para o seu tratamento incluindo abordagem abdominal, vaginal e endoscópica. A escolha da técnica cirúrgica depende primordialmente da localização, tamanho da fístula, capacidade vesical, viabilidade de tecidos disponíveis e, freqüentemente, da preferência do cirurgião. O desenvolvimento da cirurgia laparoscópica veio minimizar a morbidade associada a laparotomia, reduzindo o período de convalescença, sendo cada vez mais utilizada no manejo de FVV. Resultados: Trinta e cinco pacientes com FVV, com idade média de 38,85 anos (19-69 anos), foram tratadas. A causa mais freqüente da FVV foi a histerectomia abdominal (88,57%). Vinte e sete pacientes eram virgens de tratamento, enquanto sete pacientes haviam sido submetidas a tratamento cirúrgico, prévio por via abdominal sem sucesso e uma paciente foi submetida a três tentativas de correção, uma por via vaginal e duas por via abdominal sem sucesso. O tempo médio de hospitalização foi de 3 dias. Complicações ocorreram em quatro pacientes. Conclusão: a abordagem laparoscópica das FVV constitui uma alternativa excelente à tradicional abordagem abdominal, sendo método minimamente invasivo factível e eficaz no tratamento desta entidade

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Introdução: a fístula vésico-vaginal (FVV) tem sido um problema social por séculos, devido a morbidade significativa. No mundo desenvolvido, a principal causa das FVV são traumas iatrogênicos da bexiga durante cirurgia ginecológica (até 90% dos casos), com neoplasia, radiação e inflamação sendo as causas subseqüentes de maior importância. Várias abordagens e técnicas foram descritas para o seu tratamento incluindo abordagem abdominal, vaginal e endoscópica. A escolha da técnica cirúrgica depende primordialmente da localização, tamanho da fístula, capacidade vesical, viabilidade de tecidos disponíveis e, freqüentemente, da preferência do cirurgião. O desenvolvimento da cirurgia laparoscópica veio minimizar a morbidade associada a laparotomia, reduzindo o período de convalescença, sendo cada vez mais utilizada no manejo de FVV. Resultados: Trinta e cinco pacientes com FVV, com idade média de 38,85 anos (19-69 anos), foram tratadas. A causa mais freqüente da FVV foi a histerectomia abdominal (88,57%). Vinte e sete pacientes eram virgens de tratamento, enquanto sete pacientes haviam sido submetidas a tratamento cirúrgico, prévio por via abdominal sem sucesso e uma paciente foi submetida a três tentativas de correção, uma por via vaginal e duas por via abdominal sem sucesso. O tempo médio de hospitalização foi de 3 dias. Complicações ocorreram em quatro pacientes. Conclusão: a abordagem laparoscópica das FVV constitui uma alternativa excelente à tradicional abordagem abdominal, sendo método minimamente invasivo factível e eficaz no tratamento desta entidade

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PURPOSE: to analyze complications, morbidity, mortality and survival rate in a group of patients with cervical cancer with central pelvic relapse after primary radiotherapy treatment. METHODS: retrospective study of a series of 16 cases of pelvic exenteration after primary radiotherapy treatment. Descriptive statistics, survival curve through Kaplan-Meier's method, and regression analysis to evaluate prognosis were performed. RESULTS: sixteen patients have undergone pelvic exenteration. Epidermoid carcinoma, IIb stage and undifferentiated grade were the most frequent conditions. Post-operatory tumor relapse occurred in half the cases. Eleven patients presented peri or post-surgical complications, the most frequent being pelvic infection, that of the surgical wound, and urinary fistulae. Global survival rate was 64.3%, with average follow-up of 11 months. Regression analysis did not detect any significant prognosis factor for the patient survival. CONCLUSIONS: the survival rate was 64.3%. No particular factor associated to poor prognosis has been found in the present series of cases.

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OBJETIVO: analisar complicações, morbidade, mortalidade e sobrevida num grupo de pacientes com câncer de colo uterino com recidiva pélvica central submetidas à exenteração pélvica pós-tratamento primário com radioterapia. MÉTODOS: estudo retrospectivo de uma série de 16 casos de exenteração pélvica pós-tratamento primário com radioterapia. Foi realizada estatística descritiva, curva de sobrevida pelo método de Kaplan-Meier e análise de regressão linear múltipla para avaliar fatores prognósticos. RESULTADOS: dezesseis pacientes foram submetidas à exenteração pélvica. O carcinoma epidermoide, o estádio IIb e o grau indiferenciado foram as condições mais frequentes. A recidiva tumoral pós-operatória ocorreu na metade dos casos. Onze pacientes apresentaram complicações perioperatórias ou pós-operatórias e as mais frequentes foram infecções pélvica e da ferida operatória e fístulas urinárias. A sobrevida global foi de 64,3 por cento, com um seguimento mediano de 11 meses. A análise de regressão linear múltipla não revelou fatores prognósticos significativos na sobrevida das pacientes. CONCLUSÕES: a taxa de sobrevida foi de 64,3 por cento. Nenhum fator associado a pior prognóstico foi encontrado nesta série.

PURPOSE: to analyze complications, morbidity, mortality and survival rate in a group of patients with cervical cancer with central pelvic relapse after primary radiotherapy treatment. METHODS: retrospective study of a series of 16 cases of pelvic exenteration after primary radiotherapy treatment. Descriptive statistics, survival curve through Kaplan-Meier's method, and regression analysis to evaluate prognosis were performed. RESULTS: sixteen patients have undergone pelvic exenteration. Epidermoid carcinoma, IIb stage and undifferentiated grade were the most frequent conditions. Post-operatory tumor relapse occurred in half the cases. Eleven patients presented peri or post-surgical complications, the most frequent being pelvic infection, that of the surgical wound, and urinary fistulae. Global survival rate was 64.3 percent, with average follow-up of 11 months. Regression analysis did not detect any significant prognosis factor for the patient survival. CONCLUSIONS: the survival rate was 64.3 percent. No particular factor associated to poor prognosis has been found in the present series of cases.

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