Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding regarding various surgical steps including the challenge of specimen retrieval and extraction, whether to install a drainage system and the best option for wound closure. Laparoscopic specimen entrapment and extraction occurs at what is falsely considered the "end of the procedure". During open surgery, after the specimen has been mobilized, the specimen is simply lifted out of the larger incision which has been made to achieve the surgical objectives. In contrast, significant laparoscopic skill is required to entrap and safely extract laparoscopic specimens. Indeed, the Urologist and surgical team which are transitioning from open surgery may disregard this important part of the procedure which may lead to significant morbidity. As such, it is imperative that during laparoscopic procedures, the "end of the procedure" be strictly defined as the termination of skin closure and dressing placement. Taking a few minutes to focus on safe specimen entrapment and extraction will substantially reduce major morbidity. The following review focus on the technology and technique of specimen entrapment and extraction, on the matter of whether to install a drainage system of the abdominal cavity and the options for adequate closure of trocar site wounds. This article's primary objectives are to focus on how to minimize morbidity while maintain the advantages of a minimally invasive surgical approach.

OBJECTIVE: To compare pelvic floor muscle training and a sham procedure for the treatment of lower urinary tract symptoms and quality of life in women with multiple sclerosis. METHODS: Thirty-five female patients with multiple sclerosis were randomized into two groups: a treatment group (n = 18) and a sham group (n = 17). The evaluation included use of the Overactive Bladder Questionnaire, Medical Outcomes Study Short Form 36, International Consultation on Incontinence Questionnaire Short Form, and Qualiveen questionnaire. The intervention was performed twice per week for 12 weeks in both groups. The treatment group underwent pelvic floor muscle training with assistance from a vaginal perineometer and instructions to practice the exercises daily at home. The sham group received a treatment consisting of introducing a perineometer inside the vagina with no exercises required. Pre- and post-intervention data were recorded. RESULTS: The evaluation results of the two groups were similar at baseline. At the end of the treatment, the treatment group reported fewer storage and voiding symptoms than the sham group. Furthermore, the differences found between the groups were significant improvements in the following scores in the treatment group: Overactive Bladder Questionnaire, International Consultation on Incontinence Questionnaire Short Form, and the General Quality of Life, and Specific Impact of Urinary Problems domains of the Qualiveen questionnaire. CONCLUSIONS: The improvement of lower urinary tract symptoms had a positive effect on the quality of life of women with multiple sclerosis who underwent pelvic floor muscle training, as the disease-specific of quality of life questionnaires demonstrated. This study reinforces the importance of assessing quality of life to judge the effectiveness of a treatment intervention.

Objectives: Voiding dysfunction and urinary retention were frequent complications of sling. More recently synthetic supplies such as polypropylene mesh have been included in the armamentarium for sub urethral support. Methods: A prospective non randomized study was conducted. Sling procedure was performed in 436 consecutive patients with SUI. Patients were divided in groups according to mesh type, being 210 on autologous and 226 on synthetic. Patients were surveyed on voiding condition, continence and satisfaction. Surgical results were assessed according to Blaivas classification. Results were considered significant p<0.05. Results: Mean patient age was 48,4 years. Mean operative time for autologous sling was of 107,6 min versus 20,6min for synthetic. Mean hospitalization was 36h on autologous versus 24h on synthetic and mean follow up was 25 months. We found 87,1% and 92,9% of patients continent in autologous and synthetic group, respectively. Failure was presented by 7% in autologous and 4,8 % in synthetic group (p=0.1961). The global rate of BOO was of 4,5 % (20/436), when analysed by groups we found on autologous a rate of 8.5% (18/210), compared to 0.9% on synthetics (2/226) (p=0.000126). Conclusions: Autologous and synthetic slings presented comparable success rates, however BOO was more common among patients treated by autologous slings.

Introducción: Disfunción en el vaciamiento y retención urinaria son complicaciones frecuentes del cabestrillo. Recientemente se han incluido en el arsenal para el soporte sub-uretral, suministros sintéticos tales como la malla de polipropilenol. Métodos: Se llevó a cabo un Estudio prospectivo no aleatorizado. El procedimiento cabestrillo se realizó en 436 pacientes consecutivos con IUE (Incontinencia Urinaria de Esfuerzo). Las pacientes fueron divididas en grupos según el tipo de malla, en autólogos 210 y 226 sintéticos. Las pacientes fueron evaluadas en cuanto a condición de vaciamiento, continencia y satisfacción. Los resultados quirúrgicos fueron evaluados en función de la clasificación de Blaivas. Se consideró significativo p<0,05. Resultados: La media de edad fue 48,4 años. El tiempo medio operatorio para los Cabestrillo autólogos fue de 107,6 minutos frente a 20,6 min para el sintético. El promedio de hospitalización fue de 36 horas para autólogos frente a 24 horas para los sintéticos y la media de seguimiento fue de 25 meses. Se encontró 87,1% y 92,9% de las pacientes continentes en los grupos autólogos y sintéticos, respectivamente. Fallo en el procedimiento se presentó en un 7% en el grupo autólogo y 4,8% en el sintético (p=0,1961). La tasa global de obstrucción del tracto urinario inferior fue de 4,5% (20/436), cuando se analizó por grupos, encontramos en el grupo autólogo una tasa de 8,5% (18/210), en comparación con el 0,9% en el grupo sintético (2/226) (p=0,000126). Conclusiones: Cabestrillos autólogos y sintéticos presentan las tasas de éxito comparables, sin embargo la obstrucción del tracto urinario inferior fue más común entre las pacientes tratadas con fascias autólogas.

Purpose: The treatment of urinary tract stones in obese patients may differ from the treatment of non-obese patients and their success rate varies. Our objective was to compare ureteroscopic treatment outcomes of ureteral and renal stones, stratified for stone size and location, between overweight, obese and non-obese patients. Materials and Methods: Charts were reviewed for 500 consecutive patients presenting at our institution for renal and ureteral stones. A total of 107 patients underwent flexible or semi-rigid ureteroscopy with Ho:YAG laser lithotripsy and met criteria for review and analysis. Results: Overall, initial stone-free rates were 91%, 97%, and 94% in normal, overweight and obese individuals respectively. When compared to non-obese patients, there were no significant differences (p value = 0.26; 0.50). For renal and proximal ureteral stones, the stone-free rate in overweight and obese individuals was 94% in both groups; and a stone-free rate of 100% was found for distal stones, also in both groups. Conclusions: Ureteroscopic treatment of stones in obese and overweight patients is an acceptable treatment modality, with success rates similar to non-obese patients.

Though the primary role of lasers in urology has always been in the treatment of urolithiasis, there are several other indications for their use. There are many different types of lasers currently available, each with unique properties conducive to treating certain disorders. As such, it is critical that today's urologist understands each laser's characteristics in order to optimize patient selection and treatment. The lasers which are primarily used in urologic applications include the carbon dioxide (CO2) laser; the Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG); the Potassium Titanyl Phosphate (KTP) laser and the Holmium:YAG (Ho:YAG) laser. This review focuses on the unique characteristics of each of these lasers as well as the instrumentation needed utilize and deploy these tools in the urinary tract.

Aunque el uso primario de láser en urología ha sido siempre el tratamiento de la litiasis, hay otras indicaciones para su utilización. Existen muchos tipos diferentes de láseres actualmente disponibles, cada uno de ellos con unas propiedades únicas que les permiten tratar ciertas enfermedades. Es crítico que el urólogo actual entienda las características de cada láser para optimizar la selección del paciente y el tratamiento. Los láseres utilizados primariamente en aplicaciones urológicas incluyen el láser de dióxido de carbono (CO2); el de Neodinio:Ytrio-Aluminio-granate (Nd:YAG); el láser de potasio titanilo y fosfato (KTP), y el de Holmio:YAG (Ho:YAG). Esta revisión está enfocada a las características únicas de cada uno de estos láseres, así como al instrumental necesario para utilizarlos en el aparato urinario.