Until then we have some old reports here:

1. Andrology
2. Endourology
3. Reconstruction
4. Calculus Disease
5. Incontinance
6. Oncology
7. Oncology Prostate
8. Prostate BPH
9. Equipment
10. Special Interest

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Journal:	Journal of Urology
Authors:	Traxer O, Gettman MT, Napper CA, Scott DJ, Jones DB, Roehrborn CG, Pearle MS and Cadeddu JA.	Issue:	2001, 166: 1658-1661

Title:

The impact of intense laparoscopic skills training on the operative performance of urology residents.

Abstract:
Surgical training is undergoing more and more scrutiny and, with the advent of laparoscopic techniques, greater time is being spent in the statistical analysis and calculation of the surgeon’s ability. In this paper urology residents were randomised into two groups, after both groups had performed a porcine laparoscopic nephrectomy. One group then received 30 minutes of simulator training on a daily basis for ten days. Following this period, a further porcine laparoscopic nephrectomy was performed by both groups. Surprisingly, according to the reported results, the group that had received simulator training performed no better than the control group at the second porcine laparoscopic nephrectomy. It was apparent that the trained group had become statistically more proficient at performing the simulator tasks. It is difficult to comprehend that, despite the fact that the urology residents were selected from years 3, 4 and 5, both groups of residents scored the same on baseline evaluation of their laparoscopic experience. Certainly possible sources of inaccuracy exist in the evaluation of the residents’ ability to perform the laparoscopic nephrectomy, as ‘expert’ assessors rated performances in different areas by rating as a mark out of five. It is difficult to ascertain what exactly the authors want to conclude from these results. They do indeed wish the practice of simulator training to continue but add the proviso that this should be supplemented with in-vivo training. The learning curve shall always exist and if the learning curve can be shortened by animal training then ultimately the patient will benefit. However, if simple techniques can be mastered on a simulator, then the benefits gained from animal training will be greater.

Reviewer: Paul William Foster

Journal:	Journal of Urology
Authors:	Gill IS, Ponsky LE, Desai M, Kay R and Ross JH.	Issue:	2001, 166: 1811-1814

Title:

Laparoscopic cross-trigonal Cohen ureteroneocystostomy: novel technique.

Abstract:
The possible application of laparoscopic technique to different operations appears limitless. A balance needs to be met between ingenious techniques and applications and random, poorly researched experimentation. This paper describes a novel laparoscopic transvesical technique for unilateral ureteric reimplantation. Three cases were described with ages of 10, 11 and 32 respectively. Laparoscopic ports were placed transvesically to allow the facilitation of ureteric cross-trigonal reimplantation via a mucosal tunnel. The ureter was secured with three detrusor stitches and the mucosal flaps were sutured over the intra-vesical distal ureter. With regard to operative time 2.5 hours was the shortest and 4.5 hours was the longest duration of the procedure. Blood loss was minimal, ranging from 10 to 50 cc. None of the reported cases were converted to an open procedure. Postoperative stay was short at between one and two days and a Foley catheter remained in situ for up to 3 weeks. Unfortunately, in one of the cases reported, grade II reflux persisted although this was improved from grade IV reflux preoperatively. In this case it was seen that the distal two stitches in the mucosal tunnel had torn through. It is obvious that greater numbers and experience will result in more useful evaluation of this possible application of laparoscopic technique. The fact remains that this technique may well have a future as, preoperatively, the patients are anaesthetically-speaking fit and, even in this small number of patients, operative time is acceptable and the complication rate shows an acceptable trend. The use of intracavitary freehand laparoscopic suturing may well become commonplace.

Reviewer: Paul William Foster

Journal:	Journal of Urology
Authors:	Guazzoni G, Cestari A, Montorsi F, Lanzi R, Nava L, Centemero A and Rigatti P.	Issue:	2001, 166: 820-824

Title:

Eight-year experience with transperitoneal laparoscopic adrenal surgery

Abstract:
The long-term results of laparoscopic surgery are becoming more widely available and this paper reports the eight-year experience of transperitoneal laparoscopic adrenal surgery. In the reporting institution, around twenty cases per year were performed over an eight-year period. Indeed the results are favourable; of 161 cases performed, only 4 cases were converted to an open procedure although no mention was made as to whether these cases were converted during the learning curve period. The reporting institution was using a laparoscopic technique for both unilateral and bilateral resections as well as conservative procedures such as de-roofing or enucleation of lesions. Operative time is always a concern with complicated laparoscopic procedures and in this paper it is reported as 160, 245 and 90 minutes respectively for unilateral, bilateral and conservative procedures. With regard to complications, three patients needed to return to theatre for open exploration of bleeding and a further three patients suffered severe blood loss. Wound infection occurred in two patients. The post-operative in-patient stay was also relatively short, with even the bilateral cases having on average a less than 3-day postoperative stay. The authors report the key to their success as being preoperative selection and prompt ligation of the adrenal vein, although their operative findings did not correspond to preoperative CT scans in three cases (these cases were subsequently converted to an open procedure as a result of this). Certainly this paper does report, over a relatively long time-period, that with adequate preoperative selection laparoscopic adrenalectomy can be performed safely and with minimal complications.

Reviewer: Paul William Foster

Journal:	BJU International
Authors:	Ather MH, Paryani J, Memon A and Sulaiman MN.	Issue:	2001; 88:173-177

Title:

A 10-year experience of managing ureteric calculi: changing trends towards endourological intervention - is there a role for open surgery?

Abstract:
The aim of this paper was to study changing practice in the management of ureterolithiasis with the introduction of newer technologies, the efficacy and safety of endourology, extracorporeal shock wave lithotripsy (ESWL) and open surgery, and to determine if any indication remains for open ureterolithotomy in a tertiary endourology unit. A 12-year retrospective review (1987-1998) was conducted of all primary ureteric stones. In all, 1195 patients were treated, 44% by ESWL, 37% by ureteroscopy and intracorporeal shock wave lithotripsy (ISWL), and 20% by open surgery. At the 3-month follow-up, the stone-free rates for ESWL monotherapy, ureteroscopy and open surgery were 95%, 85% and 97%, giving an efficiency quotient of 73%, 64% and 94%, respectively. The overall complication rate for ESWL was 13%, for ISWL 32% and for open surgery 13% (often serious and potentially life-threatening). The group concluded that, with recent advances in endourology, the indications for open surgery have decreased considerably, from 26% in 1987-1995 to 8% in 1996-1998. However, the remaining indications for open ureterolithotomy include failure of less invasive modalities, the presence of medical/anatomical abnormalities, a concomitant open procedure, and the presence of large impacted calculi, for which the patients prefer to avoid multiple procedures.

Reviewer: Justin Collins

Journal:	Journal of Urology
Authors:	K.Yoshimura, K.Okubo, K.Ichioka, N.Terada, Y.Matsuta and Y.Arai	Issue:	2001, 165: 1893-6

Title:

Laparoscopic partial nephrectomy with a microwave tissue coagulator for small renal tumor.

Abstract:
Even though radical nephrectomy remains the gold standard for the surgical treatment of renal cell carcinoma, research is still being directed at possible nephron sparing surgery. In the local excision of renal tumours haemostasis is a major concern especially if pedicle clamping is not performed. This paper sought to evaluate the use of a microwave tissue coagulator in laparoscopic partial nephrectomy. The study did show that the microwave tissue coagulator was, intra-operatively speaking, safe to use and resulted in a relatively small amount of bleeding (50ml). Outcome was relatively poor with three patients (50%) suffering haematoma, gross haematuria and a positive resection margin respectively. The follow up of the patients was only 4 months at the conclusion of the study. This is a relatively poor study with small numbers and no controls. The safety aspects of microwave coagulation (such as local heat damage to the kidney and surrounding organs) are far from proven. This paper adds microwave tissue coagulation to the long list of equipment (e.g. laser, argon beam) used as an option for haemostasis, which have little long-term evidence-based research on their use.

Reviewer: Paul William Foster

Journal:	Journal of Urology
Authors:	Ono Y, Kinukawa T, Hattori R, Gotoh M, Kamihira O and Ohshima S.	Issue:	2001, 165: 1867-1870

Title:

The long-term outcome of laparoscopic radical nephrectomy for small renal cell carcinoma.

Abstract:
Radical nephrectomy for renal cell carcinoma has been performed laparoscopically since 1992. This paper describes the long-term outcome for patients with tumours less than 5cm in size. Although the period of review is from 1992 to 2000, with 103 laparoscopic cases versus 46 open, the median length of follow up is only 29 months. The results compare well with open surgery: 5% transfusion rate, 10% operative complications (4% converted for haemostasis, 2% converted for bowel injury), 3% post op complications (ileus, lymphocoele, PE) and a calculated 95% disease-free and survival rate. Encouragingly, there were no port site recurrences, although the follow up period is still short. The mean operative time (4.7 hrs) was longer than previously reported for the laparoscopic technique. However, the authors have not commented on whether there was a change in this over a period of time. These results confirm laparoscopic radical nephrectomy as a safe alternative to open surgery, although there is still a need for longer-term data.

Reviewer: John Parkin

Journal:	Journal of Urology
Authors:	Ono Y, Kinukawa T, Hattori R, Gotoh M, Kamihira O and Ohshima S.	Issue:	2001, 165: 1867-1870

Title:

The long-term outcome of laparoscopic radical nephrectomy for small renal cell carcinoma..

Abstract:
The usual caveat applies to this study - it is not a prospective randomised study, but a comparison of the results of 103 patients undergoing laparoscopic radical nephrectomy with those of 46 patients undergoing open surgery for tumours of the same size in the same period. All patients had tumours less than 5cms in diameter and there were no significant differences in patient characteristics. In 99 of the 103 laparoscopic procedures the kidney was successfully removed, with emergency laparotomy required in the remaining 4 cases for uncontrollable bleeding. Mean operating time was 4.7 hours (3.3 hours for open cases), and mean blood loss was 254mls (465mls open). There were 10 (10%) intra-operative complications in the laparoscopic group, including 1 duodenal and 1 colonic injury. This compared to 2 (4%) intra-operative complications in the open surgery patients. The mean time to resumption of normal activity was 23 days (laparoscopic) versus 57 (open). 102 of the laparoscopic patients were followed up (median follow up 29 months). 100 survived without recurrence, with 2 having died without recurrence at months 45 and 34. 3 patients had developed metastases, and local recurrence had occurred in 1. 41 of the 44 open surgery patients survived without recurrence, whilst 3 patients had developed metastatic disease (2 deaths). 5 year disease-free survival rates showed no statistically significant difference (95.1% laparoscopic, 89.7% open) and overall patient survival rates were almost identical (95% and 95.6% respectively). Importantly, seeding of the port sites did not occur in any of the patients undergoing laparoscopic surgery. Within the limitations of this study, these results support the continuing interest in laparoscopic surgery for these small renal tumours.

Reviewer: Jonathan Rees

Journal:	Journal of Urology
Authors:	Dunn MD, Portis AJ, Naughton C, Shalhav A, McDougall EM, Clayman R	Issue:	2001, 165: 1888-1892

Title:

Laparoscopic cyst marsupialization in patients with autosomal dominant polycystic kidney disease.

Abstract:
Autosomal dominant polycystic kidney disease can cause pain, hypertension and renal failure. The mainstay of management is medical, although surgical intervention is occasionally sought as cyst decompression has been documented to relieve pain and reduce hypertension. The authors review their experience with laparoscopic cyst marsupialization in 15 patients (9 unilateral, 6 bilateral) with a mean follow up of 2.2 years. Mean operative time was 5.5 hours, marsupializing an average of 204 cysts, with a hospital stay of 3.2 days. There were three major complications, all urinoma formation that were treated with a ureteric stent for one month. Pain was reduced in 11 patients (73%), but returned in two of those; hypertension improved or resolved in 27%, and worsened in 33%; renal function did not change in most patients (87%) although it improved in 1 (6.5%). The patients with bilateral cysts appeared to have better results. These results are similar to those reported following open surgery, except for the length of the procedure, although this is balanced by a shorter postoperative stay. This is the largest series reported, and suggests that laparoscopic cyst marsupialization can be performed safely, and with success, to improve the symptoms of autosomal dominant polycystic kidney disease.

Reviewer: John Parkin

Journal:	Journal of Urology
Authors:	Soulie M, Seguin P, Richeux L, Mouly P, Vazzoler N, Pontonnier F, Plante P.	Issue:	2001, 165: 1960-1963

Title:

Urological complications of laparoscopic surgery: experience with 350 procedures at a single center.

Abstract:
Most open urological procedures have now been performed laparoscopically. There is debate regarding the advantages that this technique has over conventional surgery, with regard to balancing the increased operative time required against a reduction in morbidity, postoperative pain and length of hospitalisation. This paper discusses the complications encountered since commencing laparoscopic surgery in 1993, during a total of 350 procedures. The mortality was 0.3%, conversion rate 1.1%, major complications 3.7% and minor complication 1.7%. The majority of the intraoperative complications were vascular or bowel injury, whilst postoperatively they were pulmonary embolism (which included the single death) and wound infection. Bowel injury was caused in one case by the Veress needle, and in the other two by herniation into an inadequately repaired 10mm port site. All conversions were performed during the first 120 cases. The authors conclude that, in retrospect, most intraoperative complications could have been prevented by better mastery of the different procedural steps, and that laparoscopy must be regarded as major surgery, despite having been given the term minimally invasive surgery.

Reviewer: John Parkin

Journal:	Journal of Urology
Authors:	Herr HW and Schneider M.	Issue:	2001, 165: 1971-1972

Title:

Outpatient flexible cystoscopy in men: a randomised study of patient tolerance.

Abstract:
This study is a randomised trial of immediate versus delayed flexible cystoscopy following instillation of 10cc 2% lidocaine gel in 100 consecutive men on routine flexible cystoscopy lists. The delayed group waited a minimum of 10 minutes before cystoscopy. Pain was assessed using both a 4-point descriptive pain scale and a 10cm linear analogue scale. There were no statistical differences in the level of pain reported between the two groups (1.7 v 1.6 and 2.1 v 1.8 for immediate v delayed cystoscopy on the 4-point and linear scale respectively). This suggests that there is no benefit in waiting 10 minutes to perform flexible cystoscopy after local anaesthetic instillation, and supports practice in busy departments where this has not been routinely happening.

Reviewer: John Parkin

Journal:	BJU International
Authors:	M Kumar, R Kumar, AK Hemal and NP Gupta	Issue:	2001, 87: 607-12.

Title:

Complications of retroperitoneoscopic surgery at one centre

Abstract:
Following on from Gaur’s paper on retroperitoneoscopy, the authors from the All India Institute of Medical Sciences (New Delhi) describe their experience with 316 retroperitoneoscopic cases performed between 1994 and 2000. The commonest procedures performed were simple and radical nephrectomy (167), nephrouretectomy (31) and ureterolithotomy (40). Other indications for surgery included urolithiasis, PUJ obstruction, adrenal diseases, chyluria and retroperitoneal lymph node disease. Surgical access was obtained by the open technique. In all ablative procedures, the specimen was removed intact by enlargement of the port site(s). A drain was routinely left at the end of all procedures. The major complication rate in this series was 3.5% - including bleeding (7), colonic perforation (1), collections (2) and hernia (1). The minor complication rate of 15.8% is comparable with other series and, in this series, includes the occurrence of peritoneal tears. Other common minor complications included emphysema, kidney puncture, fever, ileus and port-site infection. Conversion to an open procedure occurred in 37 patients of whom 32 were converted electively, 4 were for emergency control of bleeding and 1 for repair of colonic perforation. The authors give useful technical advice on both the avoidance and management of peritoneal tears. They also describe means by which the incidence of surgical emphysema can be reduced - for example, avoiding the excessive opening of tissues planes during port placement and making only a small incision in the thoracolumbar fascia. As a point of technique, it is recommended that the insufflation pressure be reduced to 5mm Hg at the end of the procedure to detect bleeding that was previously tamponaded by the pneumoperitoneum. Figure 1 graphically illustrates the reduction in complication rates associated with the increase in the number of operative cases. This fact repeatedly appears in the majority of published series relating to the development of laparoscopic surgical techniques. It may be not only a reflection of increased operative experience but also a reflection of improved case selection. The authors advise that patients with a previous history of calculus disease, ESWL and genitourinary infection are at particular risk of complications. These conditions are frequently associated with the development of tissue fibrosis. In conclusion, it is suggested that the advantages of retroperitoneoscopy over transperitoneal laparoscopy can be conferred without an increase in the rate of surgical complications.

Reviewer: John McGrath

Journal:	BJU International
Authors:	Gaur DD, Rathi SS, Ravandale AV and Gopichand M	Issue:	87: 602 - 606

Title:

A single-centre experience of retroperitoneoscopy using the balloon technique.

Abstract:
The role of laparoscopy in urology continues to gather momentum and debate is ongoing regarding the relative merits of the transperitoneal versus the retroperitoneal approach. In this single centre report, Gaur and colleagues describe their experience from the first 351 retroperitoneoscopic laparoscopic procedures (RLPs) performed at the Bombay Hospital Institute. The commonest procedures performed over a ten-year period include varicocelectomy (48), ureterolithotomy (43), pyelolithotomy (43), simple nephrectomy (38) and pyeloplasty (25). In the initial period, surgical access was established with an open technique but, in the latter half of the series, a closed percutaneous technique was employed. RLP was successful in 318 of 351 procedures (90.6%) though the reasons for open conversion are not specifically alluded to. The major complication rate was 1.4%, including avulsion of ureter (1), torn renal pelvis (1), colonic injury (2) and severe hypotension (1). Minor complications occurred in 11.5% of patients. The commonest of these were emphysema and primary and secondary haemorrhage. Previous retroperitoneal surgery and the presence of ipsilateral dense scarring are suggested contra-indications to the use of RLPs, though previous abdominal surgery is not. Mean hospital stay across the series was 3.06 days with a mean return to work within 14 days. Aside from technical success of the procedure, there is no reference made to the clinical outcome for each group of patients. In the area of retroperitoneoscopy, this paper certainly describes one of the largest single centre series, though larger multicentre reports from Europe and the USA have been published. However, there are a number of criticisms that can be made with regard to the content and conclusions of the paper. The authors start by stating that, to date, published data is insufficient and patient numbers too small to establish the safety and efficacy of RLPs. In the ensuing paragraph, the authors then claim that RLPs are ‘known to be safer and better’ than equivalent open procedures! In their conclusion, on the basis of only 17 obese patients and 35 patients with renal failure, the authors then claim that one can assume that RLP is safe for these specific groups of patients. The group has chosen not to include retroperitoneal tear as a complication as ‘one would not normally consider this a complication in open surgery’. This reduces their complication rate by 7.4% and skews their comparison with other series where a tear is considered as a minor complication. After the introduction of the closed technique for surgical access, conversion to the open method had to be used in 12 patients for ‘technical reasons’. It is essential to know if these were equipment failures or patient-related complications, if others are to adopt the technique. In summary, this paper is a useful addition to the literature in the field of retroperitoneoscopy. Unfortunately, not all of the conclusions drawn by the authors are substantiated by the published data. Its broad safety as a surgical technique gains further credence but, in order to draw conclusions on the ‘efficacy’ of individual procedures, one must surely also rely on the clinical outcome of each patient group.

Reviewer: John McGrath

Journal:	Journal of Urology
Authors:	Guilloneau B, Cappele O, Martinez J, Navarra and Vallancien G	Issue:	2001, 165:1078-81

Title:

Robotic assisted, laparoscopic pelvic lymph node dissection in humans.

Abstract:
Robotics is an exciting possibility in surgery. Although it conjures scepticism and apprehension in many, it is inevitable that it will be introduced in some form into surgical practice. This paper explores the use of a remote surgeon (3m from patient) operating via robotic movement transduction in human laparoscopic pelvic lymph node dissection. The procedure was performed on 10 consecutive patients and compared to the previous 10 performed laparoscopically. The unscrubbed surgeon operated via two joysticks corresponding to the movement of the left and right operating instruments and a microphone to control displacement of the scope. There was a scrubbed assistant available to maintain the integrity and sterility of the operating field and instruments. The results showed an increased operating time in the robotic group and also an increased complication rate in the robotic group. Two patients in the robotic group developed post-operative lymphocoeles, one of these patients having developed a post-operative deep vein thrombosis. The only reported complication in the laparoscopic group was 1 case of post-operative urinary retention. This paper, if nothing else, does report the feasibility of robotic use in laparoscopy. Unfortunately robotics, as yet, cannot translate tactile feedback, an obvious drawback. The use of a robotic scope holder with voice activated pan and zoom, however, are an eminent possibility. Robotics in the future may improve operative dexterity and could allow surgeons to operate remotely.

Reviewer: Paul William Foster

Journal:	Journal of Urology
Authors:	Hemal AK, Gupta NP, Wadhwa SN, Goel A and Kumar R	Issue:	2001, 57: 644- 649

Title:

Retroperitoneoscopic nephrectomy and nephroureterectomy for benign nonfunctioning kidneys: a single-centre experience

Abstract:
This paper reports the results from apparently the largest (n = 185) single-centre series of retroperitoneoscopic nephrectomy (n = 154) and nephroureterectomy (n = 31) for benign disease undertaken over a period of 4.5 years. Since 1990, laparoscopic nephrectomy has become established within the urological surgical armamentarium, with its obvious benefits over standard open surgery such as less postoperative pain and rapid convalescence. This series, from a prestigious unit in India, included cases with varied aetiologies for nonfunction including PUJ obstruction, stone disease, TB and congenital anomalies such as obstructive megaureter and dysplasia. A significant minority had had previous surgery or percutaneous nephrostomies (n = 32 + 20). All cases were done retroperitoneoscopically using the technique previously described by the authors. 167 (90%) cases were successfully completed with a mean operating time of 100 minutes (45 – 240) and blood loss of 133ml (30 – 1200). 7 major and 32 minor complications were noted with most occurring in the first 100 cases. 4 complications required emergency conversion to open surgery. There were no deaths. The authors describe helpful techniques, which they have developed over the series to help in difficult situations. They suggest controlling the hilum first in cases where there is significant retroperitoneal fibrosis. They also offer advice on port placement and what to do if the peritoneum is opened.

Reviewer: Sandy Gujral

Journal:	Journal of Urology
Authors:	Riedl CR, Daniltchenko D, Koenig F, Simak R, Loening SA, Pflueger H.	Issue:	2001, 165:1121-3

Title:

Fluorescence endoscopy with 5-aminolevulinic acid reduces early recurrence rate in superficial bladder cancer

Abstract:
Previous anecdotal evidence has demonstrated an approximate 20% higher detection rate in superficial transitional cell carcinoma (TCC) using 5-aminolevulinic acid (ALA) fluorescence endoscopy compared to standard white light cystoscopy. This was the first published prospective randomized study, with 102 patients from several centres undergoing transurethral resection of bladder tumour either with white light or ALA fluorescence endoscopy. A second look trans urethral resection with ALA fluorescence endoscopy was performed 6 weeks after the initial operation, with all patients having the former tumour site, as well as newly-diagnosed lesions, resected and sent for histological diagnoses. The controlled study found ALA fluorescence endoscopy to reduce residual tumour recurrence rate by 59%, and the group concluded "ALA fluorescence endoscopy is an innocuous and inexpensive diagnostic procedure that significantly improves bladder tumour detection rates compared to white light endoscopy".

Reviewer: Justin Collins

Journal:	BJU International
Authors:	Yeung CK, Tam YH, Sihoe JD, Lee KH, Liu KW.	Issue:	2001, 87: 509-13

Title:

Retroperitoneoscopic dismembered pyeloplasty for pelvi-ureteric junction obstruction in infants and children.

Abstract:
Open Anderson-Hynes dismembered pyeloplasty remains the gold standard against which all other forms of surgery for pelvi-ureteric junction obstruction are compared. To date, minimally-invasive techniques such as endopyelotomy, AccusizeTM incision and retrograde balloon dilatation have not been shown to offer the same success rates as the open procedure. In 1993 Schuessler et al. reported the first successful laparoscopic dismembered pyeloplasty in an adult patient and Peters et al. went on to describe the first successful paediatric case in 1995. Reports suggest that this technique may offer the advantages of a minimally-invasive approach with the success rates of open pyeloplasty. The majority of reported cases utilizes the transperitoneal approach and are in adult subjects. The authors from Hong Kong describe their initial experience with 13 paediatric and infant cases of PUJ obstruction, using the retroperitoneal approach (RDP). In brief, the patient is placed in the semi-prone position and three ports are inserted posteriorly. A 1-cm incision is made in the mid-axillary line and the retroperitoneal space is developed by distension with a glove balloon. A 0o endoscope is sited through this incision and two additional 3 - 5 mm working ports are placed under direct vision above and below the camera port. Several useful points of technique are described to facilitate the procedure; for example, the placement of a suture through the abdominal wall into the upper pole of the renal pelvis and then exteriorized again to act as a ‘hitch stitch’ at the upper limit of the pyeloplasty. In addition, they describe placing a feeding tube within the lumen of the ureter to aid manipulation and identification of the anterior and post walls of the anastamosis. RDP was successful in 12 of 13 cases with conversion occurring in a patient who had previously had a nephrostomy for drainage of a pyonephrosis. Mean operative duration was 143 (103-235) minutes. At a mean follow-up of 10 (3.5-16) months all patients were pain-free with renographic evidence of free drainage. The authors conclude that the technique of RDP is a safe, technically feasible and successful approach to the management of PUJ obstruction. They advocate the use of the retroperitoneal approach to avoid mobilization of the colon and the presumed risk of visceral damage and bowel obstruction due to adhesions. This paper counters previous claims that the retroperitoneal approach is both time-consuming and technically too demanding, compared with the transperitoneal route.

Reviewer: John McGrath

Journal:	Journal of Urology
Authors:	Riedl CR, Daniltchenko D, Koenig F, Simak R, Loening SA and Pflueger H.	Issue:	2001l, 165: 1121-1123.

Title:

Fluorescence endoscopy with 5-aminolevulinic acid reduces early recurrence rates in superficial bladder cancer.

Abstract:
Aminolevulinic acid (ALA) assisted fluorescence endoscopy is reported to increase tumour detection rates by up to 25% when compared to conventional cystoscopy. This 2 centre randomised control study compared early recurrence rates when these two methods were employed. Patients were randomized to undergo transurethral resection with either conventional white light or ALA fluorescence assisted cystoscopy. ALA instillation was performed 1-4 hrs prior to resection. All abnormal or suspicious areas of urothelium were resected. Patients with >T1 disease on initial histology were excluded from further participation in the study and underwent cystectomy. All other patients had ALA assisted cystoscopy at 6 weeks. Previous sites of resection were re-biopsied and new lesions removed. 102 patients completed the trial with equal numbers in each group. No significant differences in tumour characteristics were noted between the two arms of the study. Total percentage recurrence rates of 27.4% were reported. The rate of recurrence was significantly lower in the ALA group (16%) compared to the conventional cystoscopy group (39%). There were no reported adverse events. Costs were quoted at $20,000 for equipment and $60 per instillation. It was concluded that ALA assisted endoscopy significantly improved tumour detection and subsequently reduced early recurrence rates.

Reviewer: David Scholfield

Journal:	BJU International
Authors:	J. Binder and W. Kramer	Issue:	2001, 87:408-10

Title:

Robotically-assisted laparoscopic radical prostatectomy

Abstract:
Schuessler et al. first described laparoscopic radical prostatectomy in 1992 and the technique has since been adopted and refined by various other European centres. It remains one of the most technically demanding laparoscopic procedures in view of the difficulty of surgical access and the need for precise intracorporeal suturing. The authors evaluated a telerobotic surgical system (the da Vinci Surgical System) to assess its ability to facilitate the specific laparoscopic procedures required for radical prostatectomy. The system was initially developed in 1999 and rapidly taken up by cardiac surgeons where it was reported to improve both endoscopic vision and anastamotic techniques. For radical prostatectomy, patients are placed supine with their legs on spreader bars to accommodate placement of the robotic cart. The robot has three working arms – a median arm supporting a 30o 3-D endocamera and two lateral arms with Endo-wrist™ articulations allowing for wrist-like movements of instruments. The camera is inserted sub-umbilically whilst the instrument ports are inserted para-rectally. The authors placed two further working ports medial to the iliac crests for the placement of conventional laparoscopic instruments. During the procedure, the operating urologist sat at a remote console and controlled the three robotic arms. A scrub nurse and assistant remained at the operating table and assisted using the two conventional ports for access. The procedure was performed in 9 out of 10 patients and lasted a median of 9 (8.75 – 11) hours. Conversion occurred because of bleeding and this patient was the only individual requiring blood transfusion. Resection margins were positive in 3 patients (one with pT3b tumour and two with pT3a tumour). At discharge, all but one patient complained of mild to moderate stress incontinence. The authors concluded that the benefits of the robotic system included improved endoscopic visualization, facilitated use of laparoscopic tools by the Endo-wrist™ articulation and relaxed working position at the console. Limitations included the expense of the system and the limited availability of instruments. The authors do not comment on other parameters such as depth of field assessment, sensory feedback, system failures or patient outcomes following prolonged general anaesthesia. However, technological advances continue to facilitate and increase the range of procedures that can be usefully performed laparoscopically and the further development of telerobotic systems is awaited with great interest.

Reviewer: John McGrath

Journal:	Urology
Authors:	Fraundorfer MR, Gilling PJ, Kennett KM and Dunton NG.	Issue:	2001, 57: 454-8

Title:

Holmium laser resection of the prostate is more cost effective than transurethral resection of the prostate: results of a randomized prospective study.

Abstract:
120 patients with BPH and bladder outflow obstruction proven by urodynamics were randomised to either holmium laser prostatectomy (61) or transurethral resection (TURP) (59). Outcomes relating to their in-patient care were compared. Resection time was 41 minutes for laser prostatectomy, and 25 minutes for TURP. Catheter duratrion was 20 hours for laser prostatectomy and 37 hours for TURP. Average hospital stay was 26 hours for laser prostatectomy, and 47 hours for TURP. No blood transfusions were required following laser prostatectomy, but 4 blood transfusions were given following TURP. After 1 year follow-up, TURPs were complicated by 1 episode of clot retention, 1 DVT, 3 patients who required bladder-neck incision, and 2 patients requiring re-operation. Holmium laser prostatectomies were complicated by 2 episodes of retention, and 1 patient required bladder-neck incision. The TURPs appeared to be attended by a greater number of complications than the laser prostatectomies, although the overall numbers were small, and the follow-up time relatively short. The authors calculated the total cost of the two procedures, and concluded that the cost of laser prostatectomy, in the first year, was 25% less than TURP, and may therefore prove more cost-effective, although operating time was significantly prolonged.

Reviewer: Richard Parkinson

Journal:	Journal of Urology
Authors:	Moody JA and Lingeman JE.	Issue:	2001, 165: 459-62

Title:

Holmium laser enucleation for prostate adenoma greater than 100g: comparison to open prostatectomy.

Abstract:
The use of the holmium laser for prostatectomy was compared to open prostatectomy for adenomas of over 100g in this study of 20 patients. 10 patients undergoing each procedure were analysed retrospectively. The operation time was similar for each technique: 173 minutes for the open procedure vs 197 minutes for laser prostatectomy. The haemoglobin level dropped by 2.9g/dl in patients undergoing the open procedure and 4 patients required blood transfusion. The haemoglobin level did not fall in the laser group. Open prostatectomy was also associated with a longer hospital stay (6 days vs 2 days), and prolonged catheterisation (exact times not given). Laser prostatectomy was complicated by stress incontinence in 4 patients, although this was reported to be self-limiting, and settled within 3 months in all cases. There was also 1 case of prostate perforation, and 1 patient required intermittent self-catheterisation for neurogenic bladder dysfunction. Open prostatectomy was complicated by 1 case of stress incontinence lasting for 18 months and requiring 3 pads per day. There was also 1 case of urge incontinence at 20 months follow-up, and two patients had bladder-neck contractures. The authors suggest that holmium laser prostatectomy is a safe and feasible procedure, and may be associated with favourable post-operative outcomes. Although stress incontinence following laser prostatectomy was self-limiting and relatively short-lived, more information about its severity would help to define the importance of what is a common (40%) post-operative problem.

Reviewer: Richard Parkinson

Journal:	BJU International
Authors:	McNeill S, Chrisofos M and Tolley D	Issue:	2000, 86: 619-623

Title:

The long-term outcome after laparoscopic nephroureterectomy: a comparison with open nephroureterectomy.

Abstract:
This paper describes a retrospective analysis of a series of 25 laparoscopic nephroureterectomies and compares the results with a series of 42 open nephroureterectomies. The aims were primarily to assess the adequacy of resection using the laparoscopic approach and therefore the primary end-point used was disease-specific death. As with all retrospective series, the comparison between the two groups is open to criticism. The open group contained a higher proportion of ureteric tumours (which might be prone to earlier local invasion) and were followed-up for a longer period on average. The average post-operative stay after open surgery (10.7 days) also appears unusually high. Notwithstanding these observations, the survival rates appear similar and the mean time to death was similar in both groups. It is also interesting to note that all deaths resulted from G3 disease. The data supports the contention that laparoscopic nephroureterectomy can be performed safely and does not appear to grossly compromise long-term survival. It is a shame that when introducing this procedure to their institution, the authors did not attempt a randomised prospective trial, which would have strengthened the findings.

Reviewer: Kieran Jefferson

Journal:	BJU International
Authors:	Thompson A, Pearce I, Robinson E, Ladds TJ and Payne SR	Issue:	2001, 85: 1019-1022

Title:

Bacteriological safety and cost-effectiveness of a non-refluxing calve in the irrigation system during outpatient flexible cystoscopy.

Abstract:
The standard practice during a flexible cystoscopy list, to avoid the theoretical risk of contamination caused by reflux during the procedure, is to change the bag of irrigation fluid and ‘giving set’ between patients. A prospective randomised clinical trial was performed to determine the safety and cost-effectiveness of a non-refluxing valve in the irrigation system during flexible cystoscopy, allowing the use of a single bag of fluid per list. 124 patients (60 in study group, 64 controls) of 220 attending for flexible cystoscopy in a four-month period fitted the study criteria. Half of the lists were randomised to use the anti-reflux valve so that consecutive patients would use the same method of irrigation, and an MSU sample was taken before the procedure and 3-4 days afterwards. There was no difference in the infection rate between the study and control groups (1.7 v 4.7% p=0.62). The one patient in the study group who developed a UTI had not followed an infected patient, and there were no infections in subsequent patients on that list. The cost analysis revealed a saving of 37% (£1.39) per procedure on cost of disposable equipment when using the valve. This saving depends on how many patients there are on a flexible cystoscopy list: the number of patients per list in the study varied between 5 and 13, but calculations revealed that the minimum number to produce a cost saving was four. This study suggests that use of a non-refluxing valve between the cystoscope and ‘giving set’ during flexible cystoscopy is safe and can lead to significant cost savings on disposable items as the bag of irrigation fluid and ‘giving set’ do not need to be changed between patients.

Reviewer: John Parkin

Journal:	Journal of Urology
Authors:	Jabbour ME, Desgrandchamps F, Cazin S, Teillac P, Le Duc A and Smith AD	Issue:	2000, 163: 1105-1106

Title:

Percutaneous management of grade II upper urinary tract transitional cell carcinoma: The long term outcome.

Abstract:
Percutaneous management of Grade II upper tact TCC in the presence of normal contralateral kidney remains controversial. The authors have reviewed their experience of managing grade II disease percutaneously over 14 years. Twenty out of 24 patients with Ta and T1 disease underwent actual percutaneous treatment. All patients underwent rigorous follow-up involving urine cytology (3 monthly), cystocopy and IVU (6monthly) and flexible ureteropyeloscopy and CT scan (1 year). After a median follow-up of 48 months (9 months-12 years) 25% of patients had a recurrence and in 1 patient (5%) with T1 disease, invasive and metastatic disease developed. The disease specific survival was 100% for stage Ta and 80% for T1 disease. Importantly, no tumour seeding was detected along the percutaneous tract. It is important to note that this treatment option may not be successful in all patients as stated by the authors where nephroureterectomy was required in 5 patients due to bleeding, inability to resect the tumour or muscle invasive nature of the tumour. The study also highlights the need of a rigorous follow-up involving regular upper tract inspection. The authors conclude that offering a conservative endoscopic approach electively to healthy individuals with superficial grade II upper tract TCC and a normal contralateral kidney seems viable. It will be useful to confirm the results in a larger series and also to incorporate patient views while offering this treatment option.

Reviewer: Hrishi Joshi

Journal:	Journal of Urology
Authors:	Shalhav AL, Dunn MD, Portis AJ, Elbahnasy AM, McDougall EM and Clayman RV	Issue:	2000, 163: 1100-1104

Title:

Laparoscopic nephroureterectomy for upper tract transitional cell cancer: The Washington University Experience.

Abstract:
The authors have evaluated their experience of laparoscopic nephroureterectomy for upper tract TCC in 25 patients. They compared the results with that of the open nephroureterectomy performed in 17 patients of a contemporary series. In the laparoscopic group, in all patients (except for one) the distal ureter was managed by transurethral ureteral unroofing and electrocoagulation and the intact organ was retrieved using an 8 cm lower midline or subcostal incision. A rigorous postoperative follow-up protocol with telephone checks was used. Average follow-up was 75 months. The authors report that the operating theatre efficiency of the laparoscopic procedure was inferior to open nephroureterectomy as the operating time was twice as long as the open procedure (7.7 hr). This may be related to the relative lack of surgeon experience with this procedure. However, the analgesic requirements, hospital stay and the speed of recovery were superior in the patients undergoing laparoscopic procedure. More importantly efficacy of the laparoscopic procedure was similar to that of open in regard to bladder recurrence, metastatic disease and crude and cancer specific survival. The major disconcerting fact noted was the higher incidence of retroperitoneal recurrence in the laparoscopic group. The authors also highlight the need for accurate reporting of the grade and stage and the meticulous follow-up in this group of patients. It would also have been important to include patient preferences and quality of life assessments in the evaluation of this procedure. As the techniques of the laparoscopic procedures continue to evolve the authors suggest that when operating time decreases and the question of the retroperitoneal seeding is answered satisfactorily this procedure may well become the procedure of choice for the ablative management of upper tract TCC.

Reviewer: Hrishi Joshi

Journal:	Journal of Urology
Authors:	Logarakis NF, Jewett MAS, Luymes J and D'a Honey RJ	Issue:	2000, 163: 721-725

Title:

Variation in clinical outcome following shock wave lithotripsy

Abstract:
Outcome following shock wave lithotripsy depends on various factors. This paper describes outcome analysis following shock wave lithotripsy of renal and ureteric stones based on the results of an individual operator at one centre. Based on the treatment of 4244 stones by 12 urologists (each treating more than 100 stones), treatment results were compared with the individual urologists’ treatment methods. The results showed clinically and statistically significant intra-institutional differences in success rates following ESWL. The urologists who treated the greatest number of patients using a high number of shocks and the longest fluoroscopy time achieved the best results. These findings coincide with every day clinical experience. This also highlights the importance of accurate stone targeting that is related to, amongst various factors, experience of the urologist performing ESWL and a measurable learning curve. Some issues that could influence the outcome, such as the differences in the renal anatomy (e.g. lower pole angle), degree of obstruction and inter-observer variations in the interpretation of the x-ray and stone free states and the urologists involved in the follow-up, may not have been uniform in this study. However, the paper documents the importance of intra-institutional variation in stone free and success rate following ESWL and highlights the need to develop programmes of outcome analysis at individual centres to improve the results.

Reviewer: Hrishi Joshi

Journal:	Journal of Urology
Authors:	Dagnone AJ and Norman RW	Issue:	2000, 163: 21-23

Title:

Serum phosphate in stone formers: what does a low serum phosphate level mean?

Abstract:
Metabolic evaluation is important to identify underlying abnormality in patients with urinary calculi. However, recommended tests vary and the relative importance of the tests is not well established. This study was performed to determine whether serum phosphate is an independent risk factor for recurrent calcium stone formation and whether it may be used as an early marker for occult disease. The charts of 76 (50 recurrent and 26 single) recurrent stone formers (mean age 52) with 6 or more years of regular stone clinic follow-up were reviewed. Correlation and logistic regression analyses were performed to compare initial serum phosphate levels with urinary laboratory values, stone recurrences and complications due to stones. The results indicate no consistent association between initial and future serum phosphate levels, stone recurrences or urinary parameters. The authors suggest that serum phosphate does not appear to be an independent risk factor for stone recurrence and a reliable early predictor of occult disease. This study adds to the controversy surrounding the importance of a renal phosphate leak in the pathogenesis of calcium stone formation and value of a routine serum phosphate monitoring. In this regard a prospective controlled study will be able to determine the importance of these findings.

Reviewer: Hrishi Joshi

Journal:	Journal of Urology
Authors:	McAleer IM and Kaplan GW	Issue:	1999, 162: 1041-1044

Title:

Renal function before and after pyeloplasty: Does it improve?

Abstract:
Timing of surgical correction of presumed ureteropelvic junction (PUJ) obstruction in infancy has varied and its effect on improvement in renal function is unclear. This paper has retrospectively reviewed the data on 79 patients, from 2 weeks to 18 years old (median age 6 months), with PUJ obstruction and moderate or severe hydronephrosis who underwent pyeloplasty. The main aim of the study was to see if there is any improvement in renal function after pyeloplasty. Seventy-three percent of patients were male. Pre-natal hydronephrosis had been diagnosed in 58 (73%) patients of whom 19 (33%) were observed for a variable period before pyeloplasty was performed. In all patients diuretic renogram was performed before and after operation. Pre-operative renogram showed a drainage time of > 20 mins (in 58 cases measurable drainage time was never achieved). Pre-operative renal function ranged from 5 to 67% (mean 41%, median 45%). Following pyeloplasty, there was no statistical difference in pre-operative and post-operative renal function in all patients. There was no change in renal function in patients with an abnormal renal biopsy regardless of severity of renal scarring or when renal function was 40% or less. Drainage improved postoperatively as revealed by reduced drainage time on renograms. However, in a subgroup of patients with prenatally diagnosed hydronephrosis and who were initially followed with observation, differential renal function decreased after pyeloplasty. Although retrospective in nature, with a possibility of bias in selecting patients for observation and treatment, this study suggests that pyeloplasty should be considered when ultrasound and diuretic renography suggest obstruction because renal function does not improve significantly after pyeloplasty over preoperative values. There is a risk of deterioration in renal function that may not be recoverable and hence observational management may not be indicated in prenatally diagnosed PUJ obstruction.

Reviewer: Hrishi Joshi

Journal:	Journal of Urology
Authors:	Borer JG, Cisek LJ, Atala A, Diamond DA, Retik AB and Peters CA	Issue:	1999, 162: 1725-1730

Title:

Paediatric retroperitoneoscopic nephrectomy using 2 mm instrumentation.

Abstract:
Retroperitoneoscopic access is well established for nephrectomy for benign diseases in adults. It has also been used in children with modifications such as the use of 2 mm instrumentation. This paper describes further modifications to the retroperitoneal approach in children with regard to patient positioning and the number, site and technique of trocar placement. Using these modifications, successful nephrectomy was performed in 9 girls and 5 boys, 3 months to 9.8 years old. The suggested modifications include prone patient positioning and lumbodorsal incision, which facilitate consistent and accurate placement of dilating device and allows the surgeon to take advantages of gravity. This, in the authors' experience, expedites kidney dissection including hilar dissection and vascular control and elimination of the need for bowel retraction. It also helps in expeditious conversion to open procedure when necessary. A slightly stiffer catheter is used to perform balloon dissection, which provides easier and secure placement of the device into the retroperitoneum. Another suggested modification is placement of secondary trocars, which minimises the risk of peritoneal or visceral organ injury. The use of 2 mm instrumentation facilitates the procedure in the relative confines of the pneumoperitoneum of the smallest children. The authors perform the majority of the dissection with a 5 mm endoscope as visualisation is better and then change it to a 2 mm endoscope for specific aspects of the procedure such as vascular clip application and specimen retrieval. Mean operative time with these modifications was 142 minutes with an estimated blood loss of <15 ml and no reported complication. Overall, average hospital stay was 2 days. This paper adds to the literature on safety and efficacy of the retroperitoneal approach to laparoscopic nephrectomy in children.

Reviewer: Hrishi Joshi

Journal:	Scandinavian Journal of Urology and Nephrology
Authors:	Tiselius HG, Hellgren E, Andersson A, Borrud-Ohlsson A and Eriksson I	Issue:	1999, 33: 286-290

Title:

Minimally invasive treatment of Infection staghorn stones with shock wave lithotripsy and chemolysis

Abstract:
Infection staghorn stones constitute a particular treatment problem due to factors such as large stone burden, possible additional urinary tract pathologies and associated infection. Lavage chemolysis, which is one of the minimally invasive treatment options, has been used in the treatment of such stones with variable success. The authors have used repeated shock wave lithotripsy (SWL) and percutaneous chemolysis using Renacidin (hemiacidrin) in the treatment of 118 consecutive patients with infection staghorn stones. The overall stone free rate was 60% with 77% success rate in patients from their nearby area. The reported complications included septicaemia (3 patients) and the need for repositioning of nephrostomy catheters. An in vitro dissolution treatment, using the stone fragments retrieved, may be helpful in better selection of the patients for percutaneous chemolysis. The major disadvantage of the treatment has been the prolonged hospital stay (mean stay 32 days, range 5-82 days). The long-term follow-up results were not reported for the majority of patients. As concluded by the authors, although not a standard method, the combined treatment using repeated SWL and percutaneous chemolysis with Renacidin may be a good option in high-risk patients and in all those patients in whom other procedures are impossible.

Reviewer: Hrishi Joshi

Journal:	BJU International
Authors:	Irani J, Siquier J, Piers C, Lefebvre O, Doe B and Aubert J	Issue:	1999, 84: 276-279

Title:

Symptom characteristics and the development of tolerance with time in patients with indwelling double-pigtail ureteric stents

Abstract:
This study included 39 patients in whom ureteric stents were inserted for benign conditions causing ureteric obstruction. It was aimed to assess the symptoms of, and factors predicting the tolerance to, double-pigtail ureteric stents along with the development of tolerance with time. The assessment was performed using a questionnaire and a 10 cm Visual Analogue Scale (VAS) to evaluate tolerance at 24 hours and one week after stent placement. It was repeated on the day before stent removal. The questionnaire examined the symptoms of flank and suprapubic pain along with urinary symptoms of frequency, urgency, nocturia, dysuria and haematuria. The modes of questionnaire administration as well as response rates are not mentioned. The questionnaire’s design was based on clinical experience and previous studies but there is no mention if it was pilot tested. The results show that all patients with ureteric stents have untoward symptoms. Although symptoms such as dysuria and haematuria significantly improve with time, the overall tolerance to stents remains unchanged. Tolerance was lower in men, especially younger men. Another important observation was that all the stents were of the same length and showed no relation to the symptoms. This is against the common belief that intravesical segment of the stent has a strong bearing on the severity of urinary symptoms and the practice of using the stent size based on patients’ height and built. The authors conclude that the results could be useful in patient information and urologists’ decisions in selecting dwell time of stents.

Reviewer: Hrishi Joshi

Journal:	European Urology
Authors:	Riedl CR, Plas E, Hubner WA, Zimmerl H, Urlich W and Pfluger H	Issue:	1999, 36: 53-59

Title:

Bacterial colonisation of ureteric stents

Abstract:
This prospective study aimed to assess and correlate the frequency of bacterial colonisation of ureteric stents, stent associated bacteriuria and utility of urinary cultures in a clinical setting. The study consisted of examination of 93 polyurethane ureteric stents from 71 patients. Nine patients had permanent ureteric stenting for malignant obstruction while 63 patients had temporary ureteric stenting. During the study, cultures were performed of urine samples taken prior to stent removal together with those of the cranial and caudal ends of stents. Results show that bacterial colonisation of the ureteric stents was seen on 70% of temporarily and 100% of permanently placed stents. However, clinically overt infection was a rare event. Prophylactic antibiotics did not reduce the colonisation rates. Stent colonisation did not differ with the indwelling time. Clinically overt infection was observed in 6.5% of temporarily and 33% of permanently stented patients. Urinary cultures correctly identified all colonising micro-organisms in only 21% patients. Hence the authors conclude that stent colonisation is a common event and prophylactic antibiotics should not be administered routinely. In the case of urosepsis, the stent should be removed, and identification of the micro-organisms as well as administration of the appropriate antibiotics should be based on the stent and blood cultures.

Reviewer: Hrishi Joshi

Journal:	Urology
Authors:	Watson RA, Esposito M, Rier F, Irwin RJ and Lang EK	Issue:	1999, 54: 234-239

Title:

Percutaneous nephrostomy as adjunct management in advanced upper urinary tract infection.

Abstract:
This paper is a retrospective review of 315 percutaneous nephrostomies performed in 181 male and 134 female patients for pyonephrosis. The common aetiological factors causing pyonephrosis included urinary calculi and neoplasms. The causative organisms included the gram negative and positive organisms along with fungi. The advantages are evacuation of pus, direct irrigation of the kidneys and ability to drain multiple, loculated sites. PCN also affords direct access for antegrade pyelography and subsequent endoscopic procedures. The authors found a clinically important disparity between the results of cultures obtained from the nephrostomy and those obtained from bladder urine specimens. This has resulted in significant change in, or addition of, antibiotic and/or anti-fungal agents in 73% of their cases. Complications of PCN observed in this series were modest and included bleeding and haematoma, infected urinoma and perinephric abscess. The paper highlights some important aspects of PCN in a rather scattered manner. The results of long term follow-up and eventual outcome in relation to underlying pathology and PCN are not explained. In conclusion, the authors recommend that PCN should be performed as a standard part of emergent care for patients with pyonephrosis.

Reviewer: Hrishi Joshi

Journal:	Journal of Urology
Authors:	Abbou CC, Cicco A, Gasman D, Koznek A, Antiphon P, Chopin DK and Solomon L	Issue:	1999, 167: 1776-1780

Title:

Retroperitoneal laparoscopic versus open radical nephrectomy

Abstract:
Laparoscopic nephrectomy for renal tumour remains controversial. This retrospective review compares retroperitoneal laparoscopic nephrectomy with traditional open radical nephrectomy in 58 consecutive patients with tumour size < 90mm. Out of the 58 patients, 29 underwent open radical nephrectomy (group 1) while 29 underwent retroperitoneal laparoscopic radical nephrectomy (group 2). The reason for selection to either group as well as selection of tumour size < 90mm is unclear. Results show that both groups were similar with regard to age, size of tumour and AUA score. The mean tumour size was larger in group 1 (5.7 ±2.01 cm) than in group 2 (4.02 ±1.87 cm), while the operative time was slightly shorter in group 1 (121.4 min) than in group 2 (145min). However, group 2 patients had less blood loss (100ml) and less postoperative hospital stay (4.8 ±2 days) than group 1 (284 ml and 97 ±3.6 days) and also required less parenteral pain medication. Group 2 patients suffered fewer complications (8%) than group 1 (24%) with one patient requiring conversion to open procedure. Surgical margins were tumour free in all patients in both groups. During follow up (mean 14 months and 15 months in groups 1 and 2 respectively), one patient died in group 1 and 1 patient developed hepatic metastasis in group 2. The authors conclude that retroperitoneal laparoscopic nephrectomy for renal tumours is a feasible and effective procedure with advantages such as a shorter hospital stay, less morbidity and less post operative pain maintained. However, further assessment is required regarding renal cancer, specimen retrieval, long term follow up and tumour size. The authors recommend that the technique should be restricted to tumours less than 5cm.

Reviewer: Hrishi Joshi

Journal:	Journal of Urology
Authors:	Pearle MS, Watermull LM and Mullican MA	Issue:	1999, 162: 23-26

Title:

Sensitivity of non-contrast helical computerized tomography and plain film radiography compared to flexible nephroscopy for detecting residual fragments after percutaneous nephrostolithotomy.

Abstract:
It is important to achieve a stone free status after PCNL for large burden stone disease in order to minimise the risk of stone recurrence. However, determination of the stone free state is not always easy and varies with the modality of investigation. Second look flexible nephroscopy after PCNL is considered to be gold standard. In this paper, a prospective study was conducted on 36 patients (41 renal units) to compare plain film radiography, thin cut non contrast helical CT scan and flexible nephroscopy to detect residual stones. All these patients had a large burden stone disease (size > 3cm or staghorn stone) and underwent PCNL. Postoperative plain film radiography detected an average of 0.7 stones per renal unit (sensitivity 46% and specificity 82%), while CT scan (sensitivity 100% and specificity 62%) detected 3.4 stones per renal unit. All these patients underwent flexible nephroscopy where an average of 2.3 stones per renal unit was detected. The plain film X-ray missed stones in 54% of cases, while no stone was missed by CT scan. However CT was falsely positive (as compared to flexible nephroscopy) in 12.2% units. This was presumably due to tiny stone flecks which could not be removed by flexible nephroscope. The overall stone free rate after flexible nephroscopy was 92.6%. Liberal use of flexible nephroscopy improves stone free rates, but increases morbidity and expense (a mean of $5625 for flexible nephroscopy against a mean of $220 for CT scan). Hence the authors conclude that selective use of flexible nephroscopy after PCNL based on unnecessary operations in 20% of patients will result in a cost saving of $109,687 per 100 patients.

Reviewer: Hrishi Joshi

Journal:	Journal of Endourology
Authors:	Desai M, Ridhorkar V, Patel S, Bapat S and Desai M	Issue:	1999, 13: 359-364

Title:

Paediatric percutaneous nephrolithotomy: assessing impact of technical innovations on safety and efficacy.

Abstract:
The authors report their experience of percutaneous nephrolithotomy in 45 renal units (40 patients) in the paediatric age group (<15 years). Ultrasound guided peripheral puncture, minimal tract dilatation (<21 Fr in most cases), 14 Fr paediatric nephroscope and a specially designed slender probe (0.8mm) with a 7 Fr suction cannula for pneumatic lithotripsy was used. Overall, stone clearance rate was 91% (n=41). Complications were minimal with serious pyrexia (n=5), prolonged nephrostomy leak (n=1) and pelvic perforation with hyponatraemia (n=1). None of the patients required blood transfusion. The conclusions drawn from this study are that minimal alterations in the standard technique and use of specially designed instruments make this modality a good option in the management of paediatric urolithiasis.

Reviewer: Sunil Kumar

Journal:	Scandinavian Journal of Urology and Nephrology
Authors:	Serra AC, Perez JH, Gacia de Vicuna FM, Baron AR, de la Torre FI and Rodriguez JV	Issue:	1999, 33: 171-175

Title:

Renal haematoma as a complication of Extracorporeal Shock Wave Lithotripsy

Abstract:
This retrospective study was aimed at evaluation of risk and causative factors of renal haematoma following ESWL. Over a period of 9 years, the authors identified 31 patients with post ESWL haematoma in 10,953 patients undergoing ESWL (incidence rate 0.28%). All Lithotripsy procedures were performed on an out patient basis using 3 different Siemens Lithostar machines. Of 31 patients with post ESWL haematoma, 24 (74%) presented with low back pain and this formed the commonest presentation. The diagnosis was based on an US scan performed at the end of the ESWL session, with additional CT scanning performed in severe cases and in patients with doubtful diagnosis. After the treatment, when the haematoma was diagnosed, 71% of patients had residual calculi. All patients received conservative treatment and were followed up regularly. Further ESWL was performed in seven of these patients with no ultrasonographic or clinical change in the haematoma. Study of the underlying factors revealed that 11 patients (36%) were hypertensive. Other risk factors for the development of haematoma were clotting disorders and previous ESWL. Spontaneous clearance of haematoma was observed in 64% of patients after a mean time of 11 months. In conclusion, the authors comment that development of post ESWL renal haematoma is a rare event. Conservative management is highly successful. Presence of haematoma is not a contraindication for further treatments. It is nevertheless safer to postpone any further treatments for at least three weeks.

Reviewer: Hrishi Joshi

Journal:	Journal of Urology
Authors:	Tawfiek ER, Liu J and Bagely DH.	Issue:	1998, 160: 1643-1647

Title:

Ureteroscopic treatment of ureteropelvic junction obstruction.

Abstract:
The methodology of endopyelotomy continues to evolve. A potential problem with endopyelotomy is crossing vessels near the pelviureteric junction injury which may give rise to significant morbidity. In this small series, the authors present their experience with ureteroscopic endopyelotomy guided by endoluminal ultrasound. Prior to endopyelotomy endoluminal ultrasound was performed using catheters from 3.5-6.2 F containing an ultrasound transducer. Endoscopic incision was performed using either electrocautery or holmium-YAG laser and a stent placed at the end of the procedure. Five of the 37 patients based upon the sonographic findings were considered not to be candidates for the procedure. Crossing vessels were identified in 53% of patients and a septum denoting high insertion in 36%. In 16 patients, sonographic findings changed the location of the incision. While other series report bleeding requiring transfusion in up to 23% of cases, and distal ureteral stricture in 21% of cases, no patient in this series required transfusion or developed distal ureteral stricture. Success rate defined as pain-free with resolution of obstruction on diuretic renography was achieved in 87.5% over a mean follow-up of 10 months.

Reviewer: Andrew Elves

Journal:	Urology
Authors:	Gill IS, Soble JJ, Tak Sung G, Winfield HN, Bravo EL and Novack AC.	Issue:	1998, 52 (2): 180-186

Title:

Needlescopic adrenalectomy - the initial series: comparison with conventional laparoscopic adrenalectomy.

Abstract:
This article compares a series of 15 needlescopic adrenalectomies performed through two 2 mm, one 5 mm subcostal ports and one 10/12 mm umbilical port with 21 conventional laparoscopic adrenalectomies. Needlescopic adrenalectomy was a significantly shorter operation (169 vs. 220 minutes), with less blood loss (61 vs. 183 ml), a shorter hospital stay (1.1 vs. 2.7 days) and shorter convalescence than laparoscopic adrenalectomy. The only complication reported was conversion from needle to conventional laparoscopy. The authors conclude needlescopic adrenalectomy is feasible, safe and effective, but prior laparoscopic experience is essential.

Reviewer: Jonathan Cartledge

Journal:	British Journal of Urology
Authors:	Gill HS and Liao JC.	Issue:	1998, 82: 8-11

Title:

Pelvi-ureteric junction obstruction treated with Acucise retrograde endopyelotomy.

Abstract:
We have a gold standard for the treatment of PUJ obstruction, the open dismembered pyeloplasty. Although endoscopic techniques appear attractive, they appear to have a success rate of about 60-70% at best, and little long-term follow up is available. This study reminds us that an endourological approach to the PUJ is attractive. We await a randomised controlled study with long term follow up.

Reviewer: Jonathan Glass

Journal:	Urology
Authors:	Roehrborn CG, Preminger G, Newhall P, Denstedt J, Razvi H, Chin LJ, Perlmutter A, Barzell W, Whitmore W, Fritzsh R, Sanders J, Sech S and Womack S.	Issue:	1998, 51 (1): 19-27.

Title:

Microwave thermotherapy for benign prostatic hyperplasia with the Dornier urowave: Results of a randomized, double blind, multicenter, sham-controlled trial.

Abstract:
A total of 220 patients in 5 institutions with BPH were randomised to receive 90W transurethral microwave therapy, with monitoring of urethral and rectal temperature, or a sham treatment which involved catheterisation but no delivery of energy, under local anaesthetic. The authors do not report treatment time. Primary outcome measure was improvement in AUA score, secondary outcome measures flow rate, problem index, BPH impact index & QOL. At six months follow up they report improvement (p<0.05) in AUA score & flow rate for treatment over sham. Active treated patients experienced more frequency, dysuria and ejaculatory dysfunction. The authors conclude that microwave thermotherapy improves patients perceptions of symptoms more than the recorded improvement, and point out that longer follow up is required.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Schlick RW, Planz K.	Issue:	1997, 80: 908-910.

Title:

Potentiallly useful materials for biodegradable ureteric stents

Abstract:
As the BJU editorial points out this paper could have been much improved with better experimental design but the concept remains very interesting. The idea is a plastic that dissolves when the pH of the solution bathing it changes. Thus by controlling urinary pH a stent can be kept in situ for a desired length and the dissolved.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Wolf JS, Osama ME and Clayman R.	Issue:	1997, 158: 759-764.

Title:

Long term results of endoureterotomy for benign ureteral and ureteroenteric strictures

Abstract:
The authors review retrospectively the results of endoureterotomy for benign ureteral and ureteroenteric strictures in 69 patients to determine efficacy and factors associated with a successful outcome. Success was defined as symptomatic improvement and radiological resolution of obstruction. Not all patients were evaluated post-operatively by renography. In those patients with pre-operative ipsilateral kidney function contributing less than 25% of overall renal function, none was successful. Of the remaining 38 patients with benign ureteral stricture treatments with >25% function in the ipsilateral kidney, the success rate was 80% at three years. No procedure failed beyond 11 months. The 30 patients undergoing endoureterotomy for ureteroenteric strictures success rates were lower with a continuing incidence of failures at 3 years. Non-ischaemic aetiology, use of a greater than 12F stent and injection of triamcinolone into the bed of the incised stricture were associated with a better outcome for strictures greater than 1cm.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Ramon J, Lynch TH, Eardley I, Elkman P, Frick J, Jungwirth A, Pillai M, Wiklund P, Goldwasser B, Fitzpatrick JM.	Issue:	1997, 80: 128-135.

Title:

Transurethral needle ablation of the prostate for the treatment of benign prostatic hyperplasia: a collaborative multicentre study.

Abstract:
A case series of 68 patients undergoing TUNA for BPH. Again, like many of the alternative treatments for BPH, TUNA appears to produce a satisfactory short-term symptomatic improvement with only a small change in the flow rate, which are shown also in sham studies. This makes the interpretation of the results unreliable.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Mostafid AH, Harrison NW, Thomas PJ, Fletcher MS.	Issue:	1997, 80: 116-122.

Title:

A prospective randomized trial of interstitial radiofrequency versus transurethral resection for the treatment of benign prostatic hyperplasia.

Abstract:
A good study using the P(det) Q(max), IPSS and QOL scores as outcome measures following IRFT and TURP. P(det) Q(max) fell significantly in both groups but half the IRFT treated group remained obstructed on the Abrams-Griffiths nomogram and the flow rates at 6 months were disappointing. Both had good symptomatic results but TURP always came out better. The results of long term follow-up are awaited.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Choong S, Whitfield HN, Meganathan V, Nathan MS, Razack A, Gleeson M.	Issue:	1997, 80: 69-71.

Title:

A prospective randomized double blind study comparing lignocaine gel and plain lubricating gel in relieving pain during flexible cystoscopy.

Abstract:
Unlike previous studies, this study suggests that the proper use of lignocaine can significantly affect the pain felt during a flexible cystoscopy. If 20 mls of 2% lignocaine gel was left inside the urethra for 25 minutes, then the number of patients who felt moderate or severe pain (3/26, 11%) was considerably less than patients who received plain gel (14/21, 67%). The relative risk reduction was 82% (CI 53 to 94%) and the absolute risk reduction was 55% (CI 28 to 75%). The number of patients needed to be treated was 2 (CI 1 to 4) for a significant reduction in pain. There was little difference between the pain scores when lignocaine was left for 15 or 25 minutes and these results would suggest that lignocaine should be inserted in the urethra at least 15 minutes before cystoscopy in all patients.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Preminger GM, Clayman RV, Nakada SY, Babayan RK, Albala DM, Fuchs GJ and Smith AD.	Issue:	1997, 157: 1625-1629.

Title:

A multicenter clinical trial investigating the use of a fluoroscopically controlled cutting balloon catheter for the management of ureteral and ureteropelvic junction obstruction.

Abstract:
The authors assess the efficacy of a fluoroscopically controlled cutting balloon in the treatment of 63 patients with ureteropelvic junction obstructions (n=66) and 45 patients with ureteral strictures (n=49). There appears to be no standard pre-operative investigation protocol, and outcome was assessed by either IVP and/or diuretic renogram at 2 weeks following removal of the stent. Successful incision of pelviureteric junction was achieved in 98% of patients undergoing endopyelotomy, and incision of the ureteral stricture was successful in 92% of patients undergoing endoureterotomy. The patency rate with a mean follow-up of 7.8 months was 77% for endopyelotomy; 72% of the primary and 100% of the secondary ureteropelvic obstructions remained patent. The patency rate among those patients undergoing endoureterotomy was 55% with a mean follow-up of 8.7 months.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Meretyk S, Gofrit ON, Gafni O, Pode D, Shapiro A, Verstandig A, Sasson T, Katz G and Landau EH.	Issue:	1997, 157: 780-786.

Title:

Complete staghorn calculi: random prospective comparison between extracorporeal shock wave lithotripsy monotherapy and combined with percutaneous nephrostolithotomy.

Abstract:
This prospective randomised study compared ESWL monotherapy using a Dornier HM3 lithotriptor with combined percutaneous lithotripsy and ESWL for the treatment of 50 staghorn calculi. Stone-free rate at 6 months was significantly higher in those patients receiving combined PCNL and ESWL (74% verses 22%). Therefore the number needed to treat is 2 to increase the stone-free rate for 6 months. Interestingly, morbidity was significantly higher in the ESWL group particularly with respect to sepsis. Unplanned ancillary procedure rate was higher in the ESWL monotherapy group though there was no significant difference in the number of procedures performed with anaesthesia. The authors conclude that PCNL with ESWL should be the treatment of choice for most patients with staghorn calculi.

Reviewer: Mark Feneley

Journal:	Cancer
Authors:	Wong WS, Chinn DO, Chinn M, Chinn J and Tom WL.	Issue:	1997, 79: 963-974.

Title:

Cryosurgery as a treatment for prostate carcinoma.

Abstract:

Reviewer: Mark Feneley

Journal:	European Urology
Authors:	Hahn RG, Nilsson A, Farahmand BY, Persson PG.	Issue:	1997, 31: 199-203.

Title:

Blood haemoglobin and the long-term incidence of acute myocardial infarction after transurethral resection of the prostate.

Abstract:
This study examined risk factors for acute myocardial infarction post-TURP. There were 52 infarcts in 811 patients (6%). The strongest risk factor was a low haemoglobin which doubled the risk, and there was an associated relationship with a previous myocardial infarct. Risk factors that were not proven included age greater than 75 years, blood loss at operation, water absorption during surgery or premorbid condition.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Thomas KJ, Cornaby AJ, Hammadeh M, Philp T and Matthews PN.	Issue:	1997, 79: 186-189.

Title:

Transurethral vaporization of the prostate: a promising new technique.

Abstract:
This was a pilot study assessing the efficacy and safety of transurethral vaporization of the prostate (TUVP) using a grooved roller electrode in 116 patients with symptomatic BPH. Assessment was by flow rate, residual volume and symptom score. The authors found the technique easy to master although glands greater than 60g were considered too large to vaporize. Mean symptom scores improved by 67% and mean peak flow increased from 8.5ml/s to 20.5ml/s. One advantage of TUVP is said to be a reduction in haemorrhage. No patients required blood transfusion. Another advantage is said to be a shorter hospital stay although only 57% of patients had their catheters removed within 24 hours. There were 11 UTI's and 15% developed retrograde ejaculation. None of the sexually-active patients developed post-operative erectile dysfunction. The authors rightly point out that a randomized trial of TUVP against TURP is required.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Ahmed M, Bell T, Lawrence WT, Ward JP and Watson GM.	Issue:	1997, 79: 181-185.

Title:

Transurethral microwave thermotherapy (Prostatron version 2.5) compared with transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: a randomized, controlled, parallel study.

Abstract:
This was a well-constructed, randomized trial of a high-energy protocol with transurethral microwave thermotherapy (TUMT) against TURP in 60 patients with moderate to severe bladder outflow obstruction who were unequivocally obstructed on the Abrams-Griffiths nomogram. Follow up was for 6 months so durability was not assessed. The AUA symptom score in the TUMT group did show a significant reduction (18.4 to 5.2). However, in contrast to TURP, the TUMT patients remained urodynamically obstructed after treatment. The most likely explanation for the improved symptom score after TUMT is a placebo response. The trial also showed that TUMT is not without significant complications: three patients needed an indwelling catheter for 10 days to 6 weeks and 4 of 18 sexually-active men suffered with retrograde ejaculation after TUMT.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Mulligan ED, Lynch TH, Mulvin D, Greene D, Smith JM and Fitzpatrick JM.	Issue:	1997, 79: 177-180.

Title:

High-intensity focused ultrasound in the treatment of benign prostatic hyperplasia.

Abstract:
This study also evaluated transrectal delivery of HIFU in thirteen patients. Two patients required TURP within 5 months because of no subjective symptomatic improvement and one other developed a urethral stricture. In the other patients the mean IPSS was reduced from 23 to 6 after 6 months and this appeared to be maintained at 2 years. The mean Qmax initially improved from 9.9 pre-treatment to 14.2ml/s at 6 months but by two years had reduced to 10.6ml/s. Although HIFU is at an early stage of clinical evaluation, neither of these studies demonstrate results which match the objective improvement after TURP and as with all of the new technology treatments of BPH, durability will need to be carefully assessed in long-term randomised trials.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Sullivan LD, McLoughlin MG, Goldenberg LG, Gleave ME and Marich KW.	Issue:	1997, 79: 172-176.

Title:

Early experience with high-intensity focused ultrasound for the treatment of benign prostatic hyperplasia.

Abstract:
This study, the first of two in this issue which look at high intensity focused ultrasound (HIFU) for BPH, used the transrectal Sonablate 200 probe in 25 patients with BPH. Patients with large prostates, middle lobes and many prostatic calculi were found to be unsuitable for this treatment. The best results were obtained when the bladder neck was treated. In these patients the mean AUA symptom score decreased from 20.25 to 9.5 and Qmax increased from 9.18 to 13.7. 10 patients required catheterisation for between 3 and 6 days. This new treatment modality is now reaching the stage of development at which a randomised trial against TURP may be justified.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Petas A, Talja M, Tammela T, Taari K, Lehtoranta K, Valimaa T and Tormala P.	Issue:	1997, 157: 173-176.

Title:

A randomized study to compare biodegradable self-reinforced polyglycolic acid spiral stents to suprapubic and indwelling catheters after visual laser ablation of the prostate.

Abstract:
In this small randomised study a self-reinforced polyglycolic acid spiral stent is compared to suprapubic catheters and indwelling catheters following neodynium: YAG laser ablation of the prostate. Of the 27 patients receiving the spiral stent, 20 voided freely on day 1 or 2 post-operatively, compared to 8 of 23 with suprapubic catheters alone. In those patients with an indwelling urethral catheter, mean time to removal of the catheter was 6.5 days. There was no significant difference in outcome with regard to flow rates or symptom scores between the groups. While the results would indicate a significant reduction in the catheterisation time following use of the spiral stent, suprapubic catheterisation was still required for 1-2 days in most patients and there would appear to be no advantage with regard to outcome.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Steenkamp JW, Heyns CF and de Kock ML.	Issue:	1997, 157: 98-101.

Title:

Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison.

Abstract:
In this paper, 210 men with proven urethral strictures were randomised to undergo filiform dilation under direct vision (106 patients) or optical internal urethrotomy (104 patients) as an outpatient procedure under local anaesthetic. Patients were intensively followed up with retrograde urethrograms for 4 years though criteria for recurrence are not defined. The author also examined the influence of a number of factors upon prognosis. Though the recurrence rate was slightly higher in the dilation group, no statistical difference was found between the two treatment arms. Both methods were found to become less effective with increasing stricture length. The authors conclude that either dilation or internal urethrotomy may be used for strictures less than 2 cm whilst those longer than 4cm may be best treated by primary urethroplasty.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Soderdahl DW, Knight RW and Hansberry KL.	Issue:	1996, 156: 1354-6.

Title:

Erectile dysfunction following transurethral resection of the prostate.

Abstract:
The authors have objectively measured the incidence of erectile dysfunction following transurethral resection of the prostate in 40 men assessing pre-operative and post-operative nocturnal penile tumescence. Patients were also asked to complete a questionnaire post-operatively describing their perceived potency level before and after surgery. No significant difference was observed in penile tumescence, number of erectile events or duration of event before and after surgery. Penile rigidity improved post-operatively though this was not significant. A subjective decrease in quality of erection after surgery was reported in 27.5% of patients. However a significant number of these patients equated retrograde ejaculation with decreased potency.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Herschorn S, Steele DJ, and Radomski SB.	Issue:	1996, 156: 1305-9.

Title:

Followup of intraurethral collagen for female stress urinary incontinence.

Abstract:
This study examined patient selection parameters and durability of response to intraurethral glutaraldehyde cross-linked collagen injections in 187 women for female stress incontinence. Previous incontinence surgery had been performed in 63% of the patients. All patients had been incontinent for longer than 2 years before treatment. Treatment outcome was determined by a change in the individual incontinence grades before and after injection according to the methods of Stamey and Blavias. Twenty three percent were cured and 52% were improved while injection failed in 25%. No difference in outcome was observed with regard to patient age, pretreatment grade of incontinence or hypermobility. The probability of patients cured by intraurethral injection remaining dry at three years was 46%.

Reviewer: Mark Feneley

Journal:	European Urology
Authors:	Madersbacher S, Klingler CH, Schatzl G, Schmidbauer G, Marberger M.	Issue:	1996, 30: 437-455.

Title:

The urodynamic impact of transrectal high-intensity focused ultrasound on bladder outflow obstruction.

Abstract:
This uncontrolled prospective study analysed the use of high intensity focused ultrasound (HIFU) in the treatment of BPH. Temperatures greater than 80oC are generated resulting in necrosis of all cellular elements within the focal area. Of 30 patients, 80% were obstructed pre-operatively on urodynamic grounds, but only 37% post-operatively. However, only 4 patients were clearly unobstructed after the procedure. The authors conclude the HIFU should not be considered as an alternative for severely obstructed patients or those with an absolute indication for surgery.

Reviewer: Mark Feneley

Journal:	European Urology
Authors:	Jung P, Matttelaer P, Wolff JM, Mersdorf A, Jakse G.	Issue:	1996, 30: 418-423.

Title:

Visual laser ablation of the prostate: efficacy evaluated by urodynamics and compared to TURP.

Abstract:
In this unrandomised study, patients with significant morbidity underwent visual laser ablation of the prostate and those without underwent TURP. Both groups underwent pre-operative pressure/flow studies to clarify the nature of their disease. Patients in the TURP group did significantly better regarding peak urinary flow compared to VLAP, which performed very badly in big prostates. However, it did cause less morbidity.

Reviewer: Mark Feneley

Journal:	European Urology
Authors:	Matani Y, Mottrie AM, Stockle M, Voges GE, Fichtner J, et al.	Issue:	1996, 30: 414-417.

Title:

Transurethral prostatectomy: a long-term follow-up study of 166 patients over 80 years of age.

Abstract:
This retrospective series of 166 patients aged over 80 years undergoing TURP in Germany revealed that more than 85% patient did relatively well from TURP. The mortality was not significantly worse than the expected mortality in this age group. Patients were operated on providing they had voiding symptoms and outcome is defined by a limited number of characteristics; nevertheless it appeared to be favourable.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Mueller EJ, Ziedman EJ, Desmond P, Thompson IM, Optenberg SA and Wasson J	Issue:	1996, 78: 893-896.

Title:

Reduction of length of stay and cost of transurethral resection of the prostate by early catheter removal.

Abstract:
Accompanied by a commentary by Mr David Kirk, this is a non-randomised report of 119 patients having their catheters removed one day post-TURP being compared to 152 patients who had a TURP the previous year. Immediate complications, including transfusion, failure to void and clot retention, occurred in 5% and 6.6 % respectively. Hospital stay was reduced from 3.1 to 1.28 days in the group whose catheters were managed aggressively, theoretically saving hundreds of dollars per patient.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Carter AC / BLUES	Issue:	1996, 78: 876-885.

Title:

A standard protocol for the evaluation of laser treatment of the prostate

Abstract:
A protocol suggested by the British Laser Urological Evaluation Society for use in any trial of operative intervention for benign prostatic obstruction. It includes sections for demographic details, operative details such as anaesthetic details, peri- and post-operative complications and progress at three follow-up visits, plus a patient acceptability and sexual function questionnaire. More sophisticated evaluations such a section for pre- and post-operative cystometry is not included in the "core" dataset.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Shoroff S, Watson GM, Parikh A, Thomas R, Soonawalla PF and Pope A	Issue:	1996, 78: 836-839.

Title:

The holmium: YAG laser for ureteric stones

Abstract:
The holmium: YAG laser is a multifunctional laser since it can cut and coagulate tissue such as prostate (trials are in progress) as well as drill holes in calculi with a pulse duration of 350ms. This makes it potentially interesting to the endourologist/healthcare provider from an economic point of view. This report from London describes its successful use in fragmenting 134 ureteric stones accessed using semi-rigid or flexible ureteroscopes. Total clearance was achieved in 87% cases (96% from the lower ureter), but 3 ureters were perforated during the treatment and these were treated by JJ stent insertion for 6 weeks.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	van Iersel MP, Thomas CMG, Witjes WPJ, de Graaf R, de la Rosette J	Issue:	1996, 78: 742-746.

Title:

Clinical implications of the rise and fall of prostate specific antigen after laser prostatectomy.

Abstract:
The effect of visual laser ablation of the prostate on serum PSA has not previously been described. Forty-five patients undergoing this procedure had serial estimations postoperatively up to 52 weeks. At 24 hours the mean PSA was 23 times higher than the preoperative level, dependent upon the prostate size and energy applied. Gradually the PSA reached a new level, mean 1.7 ng/ml below the preoperative level, by 78 days postoperatively. The authors conclude that the serum PSA is potentially misleading until 4 months after laser prostatectomy.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	MacFarlane JP, Foley SJ and Shah PJR	Issue:	1996, 78: 729-732.

Title:

Long-term outcome of permanent urethral stents in the treatment of detrusor-sphincter dyssynergia.

Abstract:
This paper from the spinal injuries unit at Stanmore reviews 5-year followup of 11 urethral stents. Two stents had to be removed within a year because of encrustation and pain/UTI respectively. Five others developed bladder neck obstruction which was treated by bladder neck incision. Of the remaining four patients, one died, one had haematuria and one suffered recurrent UTI. The authors conclude that urethral stenting is an effective alternative to sphincterotomy.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Elashry O M, DiMeglio R B, Nakada S Y, McDougall E M and Clayman R V.	Issue:	1996, 156: 1581-1585.

Title:

Intracorporeal electrohydraulic lithotripsy of ureteral and renal calculi using small calibre (1.9F) electrohydraulic lithotripsy probes

Abstract:
This paper reviews the use of 1.9F or small electrohydraulic lithotripsy probes in conjunction with rigid or flexible ureteroscopes in the treatment of 45 patients (57 with renal and 32 ureteral calculi). Fragmentation (fragments 2mm or smaller) was achieved in 98% of patients with no significant morbidity. Overall stone free rate was 92% , with a stone free rate of 87% for patients with lower pole calculi at 8.7 months.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Klutke C G, Nadler R B, Tiemann D and Andriole G L.	Issue:	1996, 156: 1703-1706.

Title:

Early results with antegrade collagen injection for post-radical prostatectomy stress urinary incontinence

Abstract:
The incidence of urinary incontinence following radical prostatectomy is 5-40%. Previous experience with retrograde injection of collagen in this group of patients has been disappointing. This paper reports the results of antegrade injection of collagen via a suprapubic approach after retrograde filling of the bladder with a flexible cystoscope in 20 men with post-radical prostatectomy stress incontinence. Degree of incontinence was assessed by patients on a subjective scale. The technique is described in detail. At a mean follow-up of 8.5 months, 9 out of 20 patients (45%) had significant subjective improvement and 5 (25%) were totally dry.

Reviewer: Mark Feneley

Journal:	European Urology
Authors:	Madersbacher S, Klingler CH, Schatzl G, Schmidbauer G, Marberger M.	Issue:	1996, 30: 437-455.

Title:

The urodynamic impact of transrectal high-intensity focused ultrasound on bladder outflow obstruction.

Abstract:
This uncontrolled prospective study analysed the use of high intensity focused ultrasound (HIFU) in the treatment of BPH. Temperatures greater than 80oC are generated resulting in necrosis of all cellular elements within the focal area. Of 30 patients, 80% were obstructed pre-operatively on urodynamic grounds, but only 37% post-operatively. However, only 4 patients were clearly unobstructed after the procedure. The authors conclude the HIFU should not be considered as an alternative for severely obstructed patients or those with an absolute indication for surgery.

Reviewer: Mark Feneley

Journal:	European Urology
Authors:	te Slaa E, de la Rosette JJMCH.	Issue:	1996, 30: 1-10.

Title:

Lasers in the treatment of benign prostatic obstruction: past, present, and future.

Abstract:
This review article describes the broad areas of laser use in TURP, its problems and outcomes and the hopes for the future.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Hosking DH, Bard RJ	Issue:	1996, 156: 899-902.

Title:

Ureteroscopy with intravenous sedation for the treatment of distal ureteral calculi: a safe and effective alternative to shock wave lithotripsy.

Abstract:
In this retrospective cohort study, the authors review their experience with ureteroscopy under sedo-analgesia in 68 patients. 66 stones (97%) were successfully removed without complications. Tolerance of the procedure was reported as good in 81% of patients. No information is given about the stone size, but only one patient required fragmentation of the stone prior to basket removal. While the authors advocate this technique, comparison with shock wave lithotripsy and relative cost-effectiveness are not addressed. Insertion of a double pigtail ureteral stent for the prevention of urological complications

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Jensen KM, Jorgensen JB, Mogensen P.	Issue:	1996, 78: 213-218.

Title:

Long-term predictive role for urodynamics: an 8-year follow-up of prostatic surgery for lower urinary tract symptoms.

Abstract:
Pivotal to this Danish study is the interview undertaken 6 months and 8 years after TURP in 139 and 79 men respectively by the same investigators. Success is defined in terms of the patients overall subjective evaluation of the outcome: much better, better, worse or much worse. The difference in the proportion of patients reporting success after 8 years compared with 6 months is similar (11% vs 15%), whether or not the patients were obstructed according to the Abrams-Griffiths nomogram. Long-term failure was more likely to be reported by younger men without bladder outflow obstruction.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	De La Rossette JJMCH, de Wildt MJAM, Hofner K, Carter S St C, Debruyne FMJ and Tubaro A.	Issue:	1996, 156: 97-102.

Title:

High energy thermotherapy in the treatment of benign prostatic hyperplasia: results of the European benign prostatic hyperplasia study group.

Abstract:
Many new therapies for BPH are now available though long-term follow up is presently awaited for many modalities before the benefits can be assessed. This paper reports the results of high energy transurethral microwave thermotherapy in the treatment of BPH. One hundred and sixteen patients were evaluated using symptom scores, trans-rectal ultrasound, free voiding and pressure flow studies. Sixty seven patients have achieved 1 year follow up. Improvement in all parameters was observed at three months and this appears to be sustained at 1 year in those patients in whom follow up is available. Irritative symptoms were noted in a large number of patients for up to 4 weeks. The authors conclude that high energy transurethral microwave thermotherapy shows significant improvement in subjective and objective outcome measures, and best candidates for this procedure are those patients with moderate to severe bladder outlet obstruction.

Reviewer: Mark Feneley

Journal:	European Urology
Authors:	Saporta L, Aridogan IA, Erlich N, Yachia D.	Issue:	1996, 29: 439-445.

Title:

Objective and subjective comparison of transurethral resection, transurethral incision and balloon dilatation of the prostate.

Abstract:
This study evaluated transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), and transurethral balloon dilatation of the prostate (TUBDP) in the treatment of patients with bladder outflow obstruction. There were 20 patients in each group and within 3 years 5 patients in the TUBDP had required additional treatment, 3 patients in the TUIP group and 1 patient in the TURP group. Overall, the TURP group did better regarding objective and subjective features of the disease.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Pit MJ, Tegelaar RJ and Venema PL.	Issue:	1996, 78: 99-103.

Title:

Isothermic irrigation during transurethral resection of the prostate: effects on peri-operative hypothermia, blood loss, resection time and patient satisfaction.

Abstract:
Reductions in body temperature and resultant cardiac stress are known to occur during TURP and may be the cause of documented increases in long-term postoperative mortality. This prospective randomised trial from The Netherlands compared those parameters listed above plus age, body weight and weight of tissue resected, in 59 men undergoing TURP under spinal anaesthesia. Group 1 received isothermic irrigation (37.5 0C) using a counter-current fluid heater and group 2 received irrigation at room temperature (20.6 0C). Statistical differences were observed with respect to reductions in core (upper rectal) temperature and patient perception of cooling, both being significantly greater in group 2; no differences were observed between groups with respect to other parameters. The authors suggest there are strong arguments for performing every TURP using isothermic irrigation since it does not negatively interfere with the procedure.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Eden CG and Coptcoat MJ.	Issue:	1996, 78: 234-242.

Title:

Assessment of alternative tissue approximation techniques for laparoscopy.

Abstract:
Recognising that laparoscopic suturing is clumsy, time-consuming and leaky, these reconstructive laparoscopy enthusiasts tested the strength of gelatin/resorcin/formaldehyde glue, fibrin glue and laser tissue-welding by performing open porcine uretero-ureterostomies. Evaluations included operating time and leak pressures, a Whitaker test, light and scanning electron microscopy 6 weeks later. Fibrin glue gave the best results. Six retroperitoneoscopic dismembered pyeloplasties were then performed, using either interrupted 4/0 polyglactin sutures or fibrin glue, subsequently assessed by the same criteria. Again, the fibrin glued anastomoses performed better, particularly since they did not leak at physiological pressures. Employment of this technique in patients is underway.

Reviewer: Mark Feneley