Molecular Biophysics
Sigmoid Vaginoplasty Using the Modified Single Monti Tube Following Vaginectomy for Rhabdomyosarcoma
Options for vaginal reconstruction include buccal mucosal grafts, skin grafts, skin flaps, peritoneal flaps and different bowel segments. Sigmoid vaginoplasty has several advantages including natural lubrication, lower stenosis rates, regular dilation is not usually required and the anatomic proximity that allows the neovagina to reach the perineum.1 Vaginoplasty using non-tailored bowel segments requires a long bowel segment and may cause tension on the vascular pedicle that may result in ischemia and stenosis of the neovagina.Bladder Cancer in a Long-term Survivor of the Prune Belly Syndrome
Prune belly syndrome (PBS) is a rare but morbid complexity of congenital anomalies that consists of abdominal wall defect, bilateral cryptorchidism, and urinary tract dilation. With the recent advances in perinatal care, the life expectancy of patients with PBS has improved. Although renal and sexual outcomes are frequently discussed in the literature, little is known about urinary tract malignancies in adulthood. Herein, we present a case of advanced bladder cancer in a 38-year-old man with PBS.Ovotesticular Disorder Mimicking Acute Spermatic Cord Torsion
Ovotesticular disorder is a rare form of sexual development in which a patient may have one ovary and one testis, or more commonly a gonad or gonads containing both ovarian and testicular tissue. Patients with this condition typically present in infancy with ambiguous genitalia. Delayed presentations of clinically symptomatic, older patients with normal external genitalia are extremely rare. We present a case of a 14-year-old male with normal external genitalia who presented with symptoms and signs consistent with spermatic cord torsion but found to have ovotesticular disorder on evaluation.Persistent Anhydramnios and Lower Urinary Tract Obstruction in a Patient With a Vesicoamniotic Shunt
Persistent anhydramnios after placement of a vesicoamniotic shunt is a rare but potentially serious concern in a patient in utero. We present the case a male fetus who at 32-week gestation had bilateral hydroureteronephrosis, a distended bladder, and anhydramnios. A vesicoamniotic shunt was placed, but the anhydramnios persisted. Postnatally, the child was found to have a migrated shunt, left grade V vesicoureteral reflux and posterior urethral valves. He underwent a posterior urethral valves ablation and removal of the migrated shunt.Bedside Intervention for Neonatal Hydrometrocolpos and Imperforate Hymen
Low complexity cases of neonatal hydrometrocolpos from imperforate hymen are typically treated with hymenotomy or hymenectomy. Although this is commonly performed in the operating room, bedside management is also safe and effective. We present a case of prenatally diagnosed, simple hydrometrocolpos treated via bedside hymenotomy on the first day of life. The patient received periprocedural antibiotics prior to the procedure and had full resolution of hydrometrocolpos without any complication or need for further intervention.Single Position Laparoscopic Radical Nephrectomy and Tumor Thrombectomy for Left Renal Cell Carcinoma With High-Risk Mayo 0 Thrombus
Approximately 4%-10% of locally advanced renal cell carcinomas have venous tumor thrombus.1 It is become a tendency to treat this complex pathology with a minimally invasive approach, without compromising oncological outcomes.2-5 For the left renal cancer with high-risk mayo grade 0 and 1 tumor thrombus, due to the obstruction of the superior mesenteric artery and the influence of the lateral position, laparoscopic surgery cannot take into account the 2 vital surgical steps of "tumor thrombectomy" and "nephrectomy" in a single position at the same time, making it has become a problematic issue in minimally invasive treatment.Management of Urethral Hemangioma
Hemangiomas are benign proliferations of blood vessels, and urethral hemangiomas are extremely rare presentations of this condition. As the condition is quite rare, there is very little literature about best management strategies. The best resources for determining management are case reports which focus on treatment via transurethral ablation or endoscopic resection. However, there is no guidance on management of urethral hemangiomas which are refractory to these minimally invasive methods. Herein, we summarize the literature for urethral hemangioma management, present the case of a male presenting with refractory hematuria due to a hemangioma in the penile urethra, and describe the operative technique for the open excision and reconstruction of this hemangioma.Nephron-Sparing Approach For Familial Bilateral Synchronous Wilms Tumors
Wilms tumors are the most common renal malignancy of childhood, often presenting as asymptomatic abdominal masses. These tumors can occur either in a unilateral or bilateral fashion, with bilateral tumors more commonly associated with various genetic syndromes and familial inheritance with some known loci. Bilateral tumors present challenges with regards to balancing oncologic control with renal function. Here, we present an unusual case of a young female patient diagnosed with bilateral Wilms tumors on the background of a strong family history and unknown genetic loci.Robotic Puboprostatic Fistula Repair with Holmium Laser Pubic Debridement
Urosymphyseal fistula (UF) with osteomyelitis most commonly occurs as a result of prostate cancer and benign prostate hyperplasia therapy. UF presentation typically includes debilitating pelvic pain exacerbated with ambulation. Traditional management required open surgical genitourinary (GU) reconstruction with pubectomy leading to significant morbidity. However, progressive utilization of robotic approaches and advances in holmium laser technology has led to a less invasive alternative. Herein, we present our series of robotic-assisted holmium laser debridement of pubic osteomyelitis in the setting of UF.Congenital Giant Megaureter in a 16-Year-Old Female Presenting With Abdominal Pain: A Case Report and Review of Literature
We describe a case of congenital giant megaureter in a 16-year-old female. She presented with a 5-day history of abdominal distention, right flank pain and tenderness. Right pyelonephritis was suspected. Computerized tomography showed a large cystic abdominal mass with no appreciably functioning left kidney causing secondary compression of the contralateral right ureter. A left upper nephroureterectomy was performed, draining over 3.5 L of fluid. Our experience suggests that congenital giant megaureter should be considered in the differential for pediatric patients presenting with a cystic abdominal mass.Whole Exome Sequencing Identifies a Rare Mutation in NACAD as a Possible Cause of COVID Orchitis in Brothers
COVID orchitis (testicular pain) is reported in 10-15% of men with long COVID. We identified 2 siblings with COVID orchitis and hypothesized that genetic mutations are associated with susceptibility. Blood samples from 5 COVID-19 (+) men, three of whom had orchitis were evaluated by whole-exome-sequencing. A rare deletion on chromosome 7 was found in NACAD among the 3 men with orchitis. Interestingly, circulating ACE2 levels was decreased in men with COVID orchitis. This pilot study generated the hypothesis that men who develop COVID orchitis could have underlying genetic variants and altered levels in circulating ACE2 that may increase their risk.Robotic-Assisted Testicular Autotransplantation
Silber and Kelly first described the successful autotransplantation of an intra-abdominal testis in 1976. Subsequent authors incorporated laparoscopy and demonstrated the viability of transplanted testes based on serial postoperative exams. We sought to extend this experience with use of the da Vinci surgical robot, thereby demonstrating a novel robotic technique for the management of cryptorchidism. The procedure was performed for an 18-year-old male with a solitary left intra-abdominal testis.Ring Flap Metoidioplasty
To describe our technique for performing ring flap metoidioplasty in transgender men.Pediatric Penile Non-Involuting Congenital Hemangioma With an Associated Pyogenic Granuloma: Surgical Management of a Rare Vascular Anomaly
Vascular anomalies include both tumors and malformations. Infantile hemangiomas are the most common benign vascular tumor of infancy that proliferate after birth and eventually involute. By contrast, congenital hemangiomas are formed at birth and are categorized into three groups: rapidly involuting, partially-involuting, and non-involuting congenital hemangiomas (NICH). NICH do not regress and grow with age. Pyogenic granulomas, another acquired vascular tumor, develop over vascular lesions and cause bleeding.Misdiagnosis of Congenital Posterior Urethroperineal Fistula and Comparison With Urethral Duplications and Rectourethral Fistula
Congenital posterior urethroperineal fistula (CUPF) is a urothelium-lined tract between the posterior urethra and perineum. This condition is rare and has been proposed to be a urethral duplication variant. A case of CUPF that was misdiagnosed and surgically treated as a rectourethral fistula is presented. The clinical presentation, diagnosis, and treatment of CUPF are discussed and compared with those of Y-type urethral duplications and H-type rectourethral fistulas.Fluorescent Guided Lymph Node Harvest in Laparoscopic Wilms Nephroureterectomy
Lymph node harvest is an integral part of Wilms tumor surgery with both SIOP and COG protocols asking for more than 6 lymph nodes to best evaluate for nodal spread and a subsequent need for intensification of treatment. The majority of studies show that in both open and minimally invasive resections the median number of nodes removed is 4. Indocyanine green and near infrared fluorescence may be the key to solving this problem. In adult gynaecology, colorectal and breast cancers, ICG is used to identify sentinel nodes and facilitate nodal retrieval.The Tomato Model
Percutaneous renal access (PCA) is one of the most difficult intervention in endourology. Hands-on training is a useful tool for a good understanding of the puncturing technique, reducing the learning curve, and lowering risks of complications during first procedures. The ideal surgical simulator should efficiently improve trainees’ skills, be easily accessible, low-cost, and realistic. We aim to present novel fluoroscopy-guided PCA simulator named TOMATO model.Straight-Up Approach to Bedside Ureteral Stents
To demonstrate placement of bedside double-j ureteral stents in an Emergency Department or hospital floor setting.Robot-assisted Magnetic Resonance Imaging-ultrasound Fusion Transperineal Targeted Biopsy
To demonstrate the key steps to perform robot-assisted magnetic resonance imaging-ultrasound fusion transperineal prostate biopsy.Vaginal Free Graft Dorsal Onlay Urethroplasty
Female urethral stricture is a rare, but often underrecognized, cause of voiding dysfunction in females.1 Vaginal free graft urethroplasty has been shown to have good efficacy and durability in treating urethral stricture, though accessible descriptions of technique are not widely available.1,2 Accordingly, we set out to describe and demonstrate our technique for vaginal mucosal free graft dorsal onlay urethroplasty.Dorsal Onlay Buccal Mucosal Graft Urethroplasty in Post Radiation Female Urethral Stricture - A Technical Appraisal With Outcomes
Female urethral stricture following radiation has been reported sparsely in the literature with just a handful of case reports. Radiation to the pelvis affects the genitourinary tracts and afflicts damage by causing periurethral fibrosis, necrosis, and subsequent tissue contraction, posing as a hurdle to the reconstructive surgeon. We studied the technique and outcomes of dorsal onlay buccal mucosal graft (BMG) urethroplasty in patients of radiation-induced female urethral stricture disease (FUSD).Sexual-Sparing Robot Assisted Radical Cystectomy in Female: A Step-By-Step Guide
To show different approaches for sexual-sparing robot assisted radical cystectomy in women.Rectourethral Fistula Repair Using Robotic Transanal Minimally Invasive Surgery (TAMIS) Approach
Small nonirradiated rectourethral fistula (RUF) without tissue necrosis or peri-fistula abscess are often treated via a trans-sphincteric or transperineal approach. Attempts at transanal rectal advancement flap to reduce associated morbidity have been widely abandoned due to poor visualization, inability to close the urethral defect in a watertight fashion, and compromise of rectal flap vascularity. Robotic transanal minimally invasive surgery (R-TAMIS) has emerged as a useful tool to address distal rectal lesions as it provides enhanced visualization and surgical dexterity.Patient Tolerability With Office Transperineal Biopsy Using a Reusable Needle Guide
Transrectal ultrasound-guided (TRUS) prostate biopsy is associated with a 1%-5% risk of severe sepsis, despite the use of prophylactic antibiotics. Recent studies have demonstrated the feasibility of transperineal (TP) prostate biopsy in the outpatient setting under local anesthetic (LA). We demonstrate the safety, efficacy, and tolerability of our technique for performing TP biopsy under LA in the clinic setting using a reusable needle guide.Salvage Enbloc Thulium Fiber Laser Enucleation of Prostate for Giant Prostatomegaly After Prostatic Urethral Lift
To demonstrate technique of salvage thylium fiber laser enucleation of prostate in men with history of prior prostatic urethral lift (PUL) implant. PUL is an accepted treatment modality for benign prostatic hyperplasia (BPH) and is currently recommended for surgical management of prostates <80 g in size.1 However, in reality some patients with prostate >80 g also receive PUL.2 A substantial number of these patients may requirement re-treatment for recurrent or persistent lower urinary tract symptoms after PUL.
