Background: Adherent perinephric fat (APF) is one of the challenging factors of laparoscopic partial nephrectomy (LPN). The aim of this study was to investigate the effect of intraoperative laparoscopic ultrasound (ILUS) on determining renal tumor localization and dissection in patients with APF who underwent LPN. Methods: Prospectively collected data from 517 patients who underwent LPN from October 2010 to September 2020 in tertiary university hospital were evaluated retrospectively. The cohort was divided into two main groups according to the Mayo Adhesive Probability (MAP) score: Group 1 (MAP score ≤3) and Group 2 (MAP score ≥4). After implementing propensity score-matched analysis including the complexity of tumor, age, and body mass index, Group 1 consisted of 202 patients with ≤3 MAP score and Group 2 included 46 patients. Then, both groups were allocated into two subgroups according to whether ILUS was used. Demographics, perioperative features such as perirenal fatty tissue dissection, tumor excision, operation time, and perioperative outcomes accepted as trifecta, considering warm ischemia time, negative surgical margin, and complications were compared. Results: In Group 1, ILUS use did not seem to affect perioperative outcomes in both subgroups. However, ILUS has a positive effect on perirenal fatty tissue dissection (10 versus 19 minutes, P = .011), tumor excision (4 versus 7 minutes, P = .005), and operation time (78 versus 90 minutes, P = .046) in Group 2. Trifecta outcomes were also better in higher MAP scores and ultrasound-used subgroups (P = .019). Conclusions: ILUS should be considered a helpful and effective instrument in overcoming APF in LPN. It might also have a positive effect on trifecta outcomes.

Background/Objectives: Rectal injuries are rare but serious complications during pelvic surgeries. This study aimed to share our experience with primary repair of rectal injuries occurring during pelvic uro-oncological surgeries. Methods: A total of 494 patients who presented to our clinic with diagnoses of non-metastatic bladder tumors and prostate cancer and underwent radical prostatectomy, and 214 patients who underwent radical cystectomy between 2010 and 2024 were included in the study. Data from 15 patients who experienced rectal injury during pelvic uro-oncological surgery were retrospectively reviewed. Patients scheduled for radical prostatectomy received rectal enemas twice a day (morning and evening) the day before surgery. Patients scheduled for radical cystectomy received a liquid diet for three days preoperatively, along with rectal enemas morning and evening. Results: Rectal injury occurred in 7 (1.4%) patients during radical prostatectomy and in 8 (3.7%) patients during radical cystectomy. All rectal injuries were detected intraoperatively. The defect was closed in two layers: muscular and serosal. Patients had no active complaints during follow-up, and no rectourinary fistula was observed. Conclusions: Intraoperative detection of rectal injury during pelvic uro-oncological surgery and high-quality primary repair of the defect play a critical role in preventing morbidity and mortality associated with rectal injury. Preoperative mechanical bowel preparation reduces contamination of the procedure, improves the visibility of the defect, and allows for high-quality primary repair.

Güncel literatürde az çalışan mesane (AÇM) ve detrusor yetersiz aktivitesi (DYA) için çeşitli tanımlar bulunmaktadır. DYA, International Continence Society tarafından “mesanenin uzunsürede boşalması, normal zaman aralığında mesanenin tamamen boşalamamasıyla sonuçlanan azalmış güçte veya sürede detrusor kasılması” şeklinde tanımlanmaktadır. AÇM, DYA ile ilişkili semptomları ve klinik özellikleri tanımlamak için kullanılması gereken bir terimdir. Toplum tabanlı popülasyonlarda AÇM’nin yaygınlığı basit, güvenilir ve invaziv olmayan tanı tekniklerinin olmaması nedeniyle bilinmemektedir. AÇM’yi değerlendirmek için klinik olarak mevcut tek araç, DYA’yı ortaya çıkarabilen invaziv ürodinamidir, ancak DYA için evrensel olarak kabul edilebilir tanı kriterleri yoktur. Hastalık ilerledikçe, AÇM’li kişiler akut ve kronik idrar retansiyonu, üriner sistem enfeksiyonu, hidronefroz ve böbrek yetmezliği gibi ciddi komplikasyonlar yaşayabilir. Bu nedenle, AÇM’yi yönetmek öncelikle işeme sonrası kalan idrarı en aza indirmeyi ve üst toplayıcı sisteme zarar gelmesini önlemeyi içerir. Mevcut terapiler arasında konservatif tedaviler, farmakoterapi, elektriksel stimülasyon ve cerrahi yer almaktadır. Dahası, ekstrakorporeal şok dalga tedavisi ve kök hücre tedavisi gibi yeni yöntemler, çok sayıda klinik deneye tabi tutulmuş ve AÇM’yi iyileştirmede önemli bir potansiyel olarak gösterilmiştir. Mühendislik alanındaki kayda değer ilerlemelerle birlikte mesane replasman alternatifleri önemli derecede ilgi görmüştür.