Posterior retroperitoneal laparoscopic adrenalectomy (PRLA) has emerged as a revolutionary, minimally invasive technique for adrenal gland surgery, offering significant advantages over traditional open approaches. This narrative review aims to provide a comprehensive update on PRLA, focusing on its anatomical foundations, surgical technique, and clinical implications. We conducted an extensive review of the current literature and surgical practices to elucidate the key aspects of PRLA. The procedure leverages a unique “backdoor” approach, accessing the adrenal glands through the retroperitoneum, which necessitates a thorough understanding of the posterior abdominal wall and retroperitoneal anatomy. Proper patient selection, meticulous surgical planning, and adherence to key technical principles are paramount for successful outcomes. In this paper, the surgical technique is described step by step, emphasizing critical aspects such as patient positioning, trocar placement, and adrenal dissection. PRLA demonstrates reduced postoperative pain, shorter hospital stays, and faster recovery times compared to open surgery, while maintaining comparable oncological outcomes for appropriately selected cases. However, the technique presents unique challenges, including a confined working space and the need for surgeons to adapt to a posterior anatomical perspective. We conclude that PRLA, in the right clinical setting, offers a safe and effective alternative to traditional adrenalectomy approaches. Future research should focus on expanding indications and refining techniques to further improve patient outcomes.

Background/Objectives: The objective of this study is to explore potential correlations between prostate volume, LUTS, and IIEF, with a particular emphasis on the relationship between prostate dimensions—width, height, and length—and both LUTS and IIEF and to assess patients based on risk factors such as hypertension, diabetes, cardiovascular disease, smoking, alcohol consumption, and PSA levels. Methods: A retrospective multicenter study was conducted between January 2007 and December 2023, focusing on male patients over the age of 40. The study evaluated hypertension, diabetes, cardiovascular diseases, smoking, alcohol consumption, and lower urinary tract symptoms (LUTS) through the completion of the IPSS and QoL questionnaires, sexual function using the IIEF-15, and PSA levels. Abdominal ultrasound was performed to determine prostate volume and its dimensions (width, height, and length). Results: A total of 943 patients were included in the study, with a mean age of 61.89 ± 8.51 years. From the 40–49 age group to the 80–90 age group, IPSS increased from 10.29 to 14.26 points, PSA from 1.1 ng/mL to 3.05 ng/mL, and prostate volume from 23.79 mL to 41.16 mL. Meanwhile, over the same age intervals, IIEF showed a decline from 52.57 to 24.76 points. The IPSS demonstrated a statistically significant positive correlation (p < 0.05) with prostate volume and patient age, while showing an inverse correlation with IIEF. The only statistically significant correlation between IPSS and prostate dimensions was with the length diameter of the prostate (p = 0.011). The severity of sexual symptoms was inversely correlated with both prostate volume and age. Additionally, IIEF was negatively correlated with the width and length diameters of the prostate. Hypertension (p = 0.57), diabetes (p = 0.57), smoking (p = 0.76), and alcohol consumption (p = 0.27) did not have a statistically significant impact on IPSS, and IIEF except for cardiovascular diseases, which showed a significant correlation with IPSS in patients experiencing moderate to severe symptoms (p = 0.0001). The statistically significant correlation between cardiovascular diseases and IIEF was observed only in patients with severe symptoms (p = 0.0001). Conclusions: There is a correlation between prostate volume, IPSS, and IIEF. Only length of the prostate shows a statistically significant correlation with both IPSS and IIEF. PSA levels increase progressively with each decade of age. Hypertension, diabetes, smoking, and alcohol consumption do not have a statistically significant impact on LUTS and erectile function. Cardiovascular diseases show a correlation with patients experiencing moderate to severe LUTS, as well as with those who have severe symptoms according to the IIEF evaluation.

Posterior retroperitoneal laparoscopic adrenalectomy (PRLA) has emerged as a revolutionary minimally invasive technique for adrenal gland surgery, offering significant advantages over traditional open approaches. This narrative review aims to provide a comprehensive update on PRLA, focusing on its anatomical foundations, surgical technique, and clinical implications. We conducted an extensive review of the current literature and surgical practices to elucidate the key aspects of PRLA. The procedure leverages a unique "backdoor" approach, accessing the adrenal glands through the retroperitoneum, which necessitates a thorough understanding of posterior abdominal wall and retroperitoneal anatomy. Proper patient selection, meticulous surgical planning, and adherence to key technical principles are paramount for successful outcomes. The surgical technique is described step-by-step, emphasizing critical aspects such as patient positioning, trocar placement, and adrenal dissection. PRLA demonstrates reduced postoperative pain, shorter hospital stays, and faster recovery times compared to open surgery, while maintaining comparable oncological outcomes for appropriately selected cases. However, the technique presents unique challenges, including a confined working space and the need for surgeons to adapt to a posterior anatomical perspective. We conclude that PRLA, in the right clinical setting, offers a safe and effective alternative to traditional adrenalectomy approaches. Future research should focus on expanding indications and refining techniques to further improve patient outcomes.

Background/Objectives: Radical cystectomy (RC) represents one of the most complex and morbid surgical procedures in Urology. Extraperitoneal open RC has emerged as an alternative to traditional transperitoneal approach for the treatment of muscle-invasive bladder cancer. Frailty is one of the most important risk factors for perioperative morbidity and mortality and this category of patients can benefit the most with the extraperitoneal approach. The purpose of this study was to evaluate the feasibility and the safety of extraperitoneal open RC in our experience; Methods: We retrospectively collected the data of 75 frail patients who underwent extraperitoneal open RC, performed by a single experienced surgeon. We assessed the frailty status using the simplified frailty index (sFI). We recorded data regarding general characteristics, intraoperative, pathological, postoperative complications and mortality (within 90 days); Results: We analyzed 61 men and 14 females with sFI equal or higher than 3. The median age was 77 years. Fifty-one patients had ASA score of 3 or more. Sixty procedures were with radical intention, while fifteen were palliative. Cutaneous ureterostomy was performed in 70 cases and extraperitonized ileal conduit in five cases. The median operative time was 150 minutes. The median blood loss was 400 mL. The median time up to flatus was 2 days. The median postoperative stay was 7 days. Thirteen patients had Clavien-Dindo 3 or 4 complications. Two patients died in first 90 days postoperatively; Conclusions: The extraperitoneal open RC in frail patients demonstrated to be a feasible and safe alternative approach in definitive or palliative setting in our experience.

Video width="640" height="480" controls controlsList="nodownload" poster="https://www.revistachirurgia.ro/pdfs/video/posterior_retroperitoneoscopic_bilateral_adrenalectomy.jpg" style="margin-top: -20px;" source src="https://www.revistachirurgia.ro/pdfs/video/posterior_retroperitoneoscopic_bilateral_adrenalectomy.mov" type="video/mp4" Your browser does not support the video tag. /video Introduction: Bilateral adrenal involvement occurs in about 20% of pheochromocytomas, more commonly in genetic syndromes like MEN2A (Multiple Endocrine Neoplasia 2A). Posterior retroperitoneoscopy surpasses the disadvantages of the other laparoscopic approaches, being particularly useful when bilateral adrenalectomy is indicated. The aim of this study was to present the first published experience in Romania with posterior retroperitoneoscopic bilateral adrenalectomy in the treatment of bilateral pheochromocytoma. Materials and Methods: We report the case of a 47-years-old female referred in Urology department for surgical treatment of bilateral pheochromocytoma in the setting of MEN2A syndrome (her daughter and sister with the "high risk" mutation in RET gene) for which she has been actively screened. The ultrasound of thyroid gland and the significantly increased serum calcitonin were highly suggestive for medullary thyroid carcinoma. The computed tomography of chest/abdomen/pelvis revealed inhomogeneous, contrast-enhancing bilateral adrenal masses, 38/38 mm on the right and 36/26 mm on the left side, respectively. The free plasma metanephrines were significantly increased. After adequate preoperative preparation of the patient, we performed bilateral adrenalectomy using posterior retroperitoneoscopic approach, during the same procedure. Results: The total operative time was 90 minutes. The estimated blood losses were minimal. The postoperative surgical evolution of the patient was uneventful. Major cardiovascular and metabolic perioperative complications were prevented by anesthesia team. The lumbar drain was removed in the postoperative day 1. The pathology results reported negative surgical margins, PASS score of six on the left side and two on the right side, respectively. Three months later, the patient underwent total thyroidectomy with cervical lymph node dissection for medullary thyroid carcinoma (pT1bN0L0V0Mx). The last clinical and imaging evaluation (at 12 months postoperatively) revealed no evidence of tumour recurrence. Conclusion: Posterior retroperitoneoscopic adrenalectomy is a direct, painless, cosmetic and feasible technique and the ideal option when bilateral procedure is considered. To our knowledge, it is the first publication regarding bilateral adrenalectomy in Romania using this approach.

Background/Objectives: Radical cystectomy (RC) represents one of the most complex and morbid surgical procedures in the field of Urology. Extraperitoneal open RC has emerged as an alternative to the traditional transperitoneal approach for the treatment of muscle-invasive bladder cancer. Frailty is one of the most important risk factors for perioperative morbidity and mortality, and this category of patients can benefit the most from the extraperitoneal approach. The purpose of this study was to evaluate the feasibility and the safety of extraperitoneal open RC in our experience; Methods: We retrospectively collected the data of 75 frail patients who underwent an extraperitoneal open RC, performed by a single experienced surgeon. We assessed their frailty status using the simplified frailty index (sFI). We recorded data regarding general characteristics, intraoperative, pathological, and postoperative complications, and mortality (within 90 days); Results: We analyzed 61 males and 14 females with an sFI equal to or higher than 3. The median age was 77 years. Fifty-one patients had an ASA score of 3 or more. Sixty procedures were with radical intention, while fifteen were palliative. Cutaneous ureterostomy was performed in 70 cases and extraperitonized ileal conduit in five cases. The median operative time was 150 min. The median blood loss was 400 mL. The median time to flatus was 2 days. The median postoperative stay was 7 days. Thirteen patients had Clavien–Dindo III or IV complications. Two patients died in first 90 days postoperatively; Conclusions: The extraperitoneal open RC in frail patients was demonstrated to be a feasible and safe alternative approach in definitive treatment or a palliative setting in our experience.