ABSTRACT Introduction: We aim to publish our innovative modified biplanar 0-90 endoscopic guided puncture technique for percutaneous nephrolithotomy in supine recorded with a GoPro® camera for standardization of the technique. It solves drawbacks of the fluoroscopic technique, i.e., in kidneys with complex anatomy, it may be challenging to distinguish calyces as they are often superposed, and it does not allow for all benefits of a combined endoscopic approach (1, 2). Our technique shortens puncture and fluoroscopic time and is easy to teach and reproduce. Methods: A 77-year-old female patient had previous double J insertion due to an obstructing stone in the right distal ureter. She managed to pass the distal stone but remained with the double J and a 20mm stone (1300HU) in the right renal pelvis. The shared decision was for the actual standard of care (3, 4) endoscopic combined intrarenal surgery (ECIRS). The MiniECIRS started with flexible ureteroscopy and a posterior calix which gave direct access to the stone was chosen. The tip of the flexible scope was used to mark point A with the C-arm in the 0-degree position and line B in the 90-degree position. Puncture was fast and the MiniECIRS was uneventful with a single mid-pole access guided by the flexible scope. The surgeon had a Full-HD GoPro® camera mounted on his head, controlled by the surgical staff. All essential surgical steps were recorded. Results: The quality of the recorded movie was graded as excellent, and the camera did not cause any discomfort to the surgeon. Operative and X-Ray time were 120minutes and 2minutes (7.64mGy). Hemoglobin drop was 0.8g/dL. The post-operative day-1 computed tomography scan was stone-free. The patient was discharged 24h after surgery. Kidney stent was left with a string and removed after 5days. The patient remained asymptomatic and metabolic evaluation revealed a calcium oxalate stone, low urinary volume and hypocitraturia which were treated with potassium citrate and hydration. Conclusion: The Modified Biplanar (0-90 degree) Endoscopic-Guided Puncture Technique for Percutaneous Nephrolithotomy joins the reproducibility of the same technique under fluoroscopy with advantages regarding safety and efficiency of ECIRS. Introduction 090 0 90 0-9 GoPro ie i e i.e. anatomy superposed 1, 1 (1 2. 2 . 2) reproduce Methods 77yearold yearold 77 year old ureter mm 1300HU HU (1300HU pelvis 3, 3 (3 4 ECIRS (ECIRS) chosen Carm C arm 0degree degree 90degree midpole mid pole FullHD Full HD head staff Results excellent XRay X Ray minutes 7.64mGy. 764mGy mGy 7.64mGy 7 64mGy (7.64mGy) 08gdL gdL 8g dL g 0.8g/dL postoperative post operative day1 day day- stonefree. stonefree free. free stone-free h 5days days hydration Conclusion (0-9 EndoscopicGuided Endoscopic Guided 09 9 0- i.e ( (ECIRS (7.64mGy (0- (0

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

ABSTRACT Objective: To elucidate the current scenario of endourology in Brazil for the treatment of urinary lithiasis, with an emphasis on regional differences and the reasons why certain techniques are still underutilized. Materials and Methods: An electronic questionnaire was sent by email to the 4,745 members of the Brazilian Urological Society (BSU) in 2016 to collect information on the 3 main endourological procedures used in the treatment of nephrolithiasis: Semi-rigid ureteroscopy (URS), Flexible ureteroscopy (F-URS) and percutaneous nephrolithotripsy (PCNL). Results: A total of 1,267 urologists answered the questionnaire. It was observed that the vast majority perform URS (95.6%), while 80.2% perform F-URS and only 72.1% perform PCNL. Regarding the surgical volume, most perform up to 10 procedures per month (73.4% to 88.2%) and the main impediment was the lack of patients with the pathology (42.1% to 67.7%). The lack of equipment or hospital infrastructure was one of the main limiting factors for rigid (23%) and flexible (38.1%) URS, mainly in the North and Northeast regions of the country. Regarding PCNL, most of them reported lack of practical experience in the method (29.9%). Finally, most urologists expressed interest in taking courses in endourology. Conclusion: Ureteroscopy, rigid or flexible, is already well established in the country, requiring the direction of more resources for its practice, especially in less developed regions. Regarding PCNL a significant part of Brazilian urologists still lack practical experience in this procedure, emphasizing the need for greater investment in teaching this technique.

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

OBJETIVO: Avaliar a crioterapia percutânea como tratamento primário para o câncer de próstata de alto risco. PACIENTES E MÉTODOS: De outubro de 2000 a fevereiro de 2005, 21 pacientes com câncer de próstata de alto risco foram submetidos a 24 crioablações de próstata como tratamento primário. A mediana de idade dos pacientes foi de 70,9, e a média do PSA pré-tratamento de 19,5 ng/dl. O tempo de seguimento variou de 6 a 60 meses (mediana de 41 meses). RESULTADOS: Os índices de falha do PSA foram de 39% e 52,9% respectivamente aos 12 e 24 meses de seguimento. A sobrevida livre de doença em 5 anos foi de 42,8%. De maneira geral os índices de complicações foram baixos, com 8% de incontinência urinária e nenhum caso de lesão retal. Os índices de impotência foram de 96%. Em doze pacientes (57,2%) onde houve falha da crioablação, 7 (58,3%) apresentaram recidivas locais (biópsia positiva) e os demais recidiva a distância. CONCLUSÃO: A crioablação percutânea da próstata é um tratamento minimamente invasivo da próstata, seguro, porém ainda com resultados modestos em pacientes com câncer de próstata de alto risco, quando se considera a sobrevida livre de doença em 5 anos, havendo portanto necessidade de associação de outras modalidades terapêuticas no tratamento deste grupo específico de doentes.

PURPOSE: To evaluate percutaneous cryotherapy as a primary treatment option for high-risk prostate cancer patients. PATIENTS AND METHODS: From October 2000 to February 2005, 21 high-risk (Gleason e•8 and/or PSA > 10 and/or stage > T2a) prostate cancer patients underwent 24 percutaneous prostate cryoablation procedures. Patients' median age was 70.9, and the average pretreatment PSA was 19.5 ng/dL. The follow-up period ranged from 6 to 60 months (median, 41 months). RESULTS: The PSA failure rate was 39%, 52.9%, and 42.8% at 12, 24, and 60 months of follow-up, respectively. Overall complication rates were low, with 8% of urinary incontinence and no cases of rectal injury; however, 96% of erectile dysfunction occurred. The cryoablation procedure failed in 12 patients (57.2%); 7 (58.3%) of these were local failures (positive prostate biopsies). CONCLUSION: Percutaneous cryoablation of the prostate is a safe minimally invasive treatment, but it has poor PSA-free survival outcomes in high-risk prostate cancer patients.