Purpose: During the last 10 years laparoscopy has been applied to treat most urological pathology including malignancies. There has been concern regarding peritoneal dissemination and port ...

Epidemiologic studies indicate that millions of people suffer from recurrent cystitis, a pathology requiring antibiotic prophylaxis and entailing high social costs. Cranberry is a traditional folk remedy for cystitis and, which, in the form of a variety of products and formulations has over several decades undergone extensive evaluation for the management of urinary tract infections (UTI). The aim of this retrospective study is to summarize and review the most relevant and recent preclinical and clinical studies on cranberries for the treatment of UTIs. The scientific literature selected for this review was identified by searches of Medline via PubMed. A variety of recent experimental evidence has shed light on the mechanism underlying the anti-adhesive properties of proanthrocyanidins, their structure-activity relationships, and pharmacokinetics. Analysis of clinical studies and evaluation of the cranberry efficacy/safety ratio in the prevention of UTIs strongly support the use of cranberry in the prophylaxis of recurrent UTIs in young and middle-aged women. However, evidence of its clinical use among other patients remains controversial.

Purpose This study was designed to determine the role of laparoscopic adrenalectomy (LA) in the surgical management of adrenocortical carcinoma (ACC).

Laparoscopic partial nephrectomy (LPN) remains a technically challenging procedure largely because of the lack of methods for obtaining consistent parenchymal hemostasis. The objective of this study was to determine if the extent of resection influences the ability of the harmonic scalpel to achieve hemostasis and to define the cases in which the harmonic scalpel is appropriate for LPN. Thirty LPNs were performed in a 25-kg domestic pig model. The blunt blade of the laparoscopic harmonic scalpel (LaparoSonic Coagulating Shears; Ethicon Endo-Surgery, Cincinnati, OH) at power level 5 was used to divide the parenchyma. Control of the renal hilar vessels was not obtained. Three standardized types of resections were performed: I = peripheral wedge biopsy; II = upper- or lower-pole nephrectomy; and III = heminephrectomy. Bleeding was graded on a scale from 0 to 4: 0 = no hemostasis; 1 = steady bleeding; 2 = moderate bleeding; 3 = parenchymal oozing; and 4 = dry. Hemostasis grades of 2 or less were clinically significant bleeding necessitating supplemental coagulation. The mean hemostasis scores showed a significant (P < 0.02) trend toward inadequate hemostasis with increasing extent of resection: 3.3 for Type I, 3.0 for Type II, and 2.4 for Type III. The percent of kidneys with grade 2 bleeding or worse was 9% for Type I surgery, 25% for Type II, and 57% for Type III. Successful hemostasis with the harmonic scalpel correlates with the extent of parenchymal resection in the porcine model. Most wedge excisions can be done with the harmonic scalpel alone, whereas larger resections necessitate supplemental coagulation. On the basis of this study, heminephrectomies with the harmonic scalpel are not recommended because of the high incidence of significant hemorrhage.

Telemedicine is the use of telecommunication technology to deliver healthcare. Telementoring has been developed to allow a surgeon at a remote site to offer guidance and assistance to a less-experienced surgeon. We report on our experience during laparoscopic urologic procedures with mentoring between Rome, Italy, and Baltimore, USA. Over a period of 3 months, two laparoscopic left spermatic vein ligations, one retroperitoneal renal biopsy, one laparoscopic nephrectomy, and one percutaneous access to the kidney were telementored. Transperitoneal laparoscopic cases were performed with the use of AESOP, a robotic for remote manipulation of the endoscopic camera. A second robot, PAKY, was used to perform radiologically guided needle orientation and insertion for percutaneous renal access. In addition to controlling the robotic devices, the system provided real-time video display for either the laparoscope or an externally mounted camera located in the operating room, full duplex audio, telestration over live video, and access to electrocautery for tissue cutting or hemostasis. All procedures were accomplished with an uneventful postoperative course. One technical failure occurred because the robotic device was not properly positioned on the operating table. The round-trip delay of image transmission was less than 1 second. International telementoring is a feasible technique that can enhance surgeon education and decrease the likelihood of complications attributable to inexperience with new operative techniques.