ABSTRACT Objective To evaluate the time interval and possible delay in transportation to referral units for the treatment of testicular torsion. Methods We retrospectively analyzed all cases of spermatic cord torsion surgically treated at a university hospital between January 2018 to December 2021. We evaluated the time intervals, including pain onset until the first presentation (D1), interhospital transference time (D2), pain onset until urological evaluation in a tertiary service (D3), urological evaluation until surgery (D4), and time from pain onset to surgical treatment (D5). We analyzed demographic and surgical data, orchiectomy rates, and time intervals (D1–D5). Torsions presented to the first medical presentation within 6h were considered early for testicular preservation. Results Of the 116 medical records evaluated, 87 had complete data for the time interval analysis (D1 to D5) and were considered the total sample. Thirty-three had D1 ≤6h, 53 had D1 ≤24h (includes patients in the D1 ≤6h subgroup), and 34 had D1 >24h. The median time intervals of the total samples and subgroups D1 ≤6h, D1 ≤24h, and D1 >24h were D1 = 16h 42min, 2h 43min, 4h 14min and 72h, D2 = 4h 41min, 3h 39min, 3h 44min and 9h 59min; D3 = 24h, 6h 40min, 7h and 96h; D4 = 2h 20min, 1h 43min, 1h 52min and 3h 44min; D5 = 24h 42min, 8h 03min, 9h 26min and 99h 10min, respectively. Orchiectomy rates of the total sample, subgroups D1 ≤6h, D1 ≤24h, and D1 >24h were 56.32%, 24.24% (p<0.01), 32.08% (p<0.01), and 91.18% (p<0.01), respectively. Conclusion Late arrival at the emergency department or a long interhospital transference time determined a large number of patients who underwent orchiectomy. Thus, public health measures and preventive strategies can be developed based on the data from this study aiming to reduce this avoidable outcome.

ABSTRACT Objective To report the effects of a tunica vagina flap on testicular compartment syndrome. Methods This single-arm clinical trial was conducted from September 2020 to October 2021. Consecutive patients with suspected testicular torsion within 24 hours of pain onset were included. Patients with past testicular torsion, bilateral torsion, or previous atrophy were excluded. The tunica vaginalis was opened, and the intratesticular pressure was measured before testicular retrieval from the scrotum and detorsion (P1), after detorsion (P2), and after transverse incision (P3). A tunica vaginalis flap was performed and a new intratesticular pressure was recorded (P4). The contralateral testicular pressure was recorded before fixation (Pc). The minimum follow-up period was 6 months. Results Fifteen patients were recruited from September 2020 to October 2021. Nine patients completed the follow-up. The median age (range) was 15 years (9-19). The mean P1, P2, P3, P4, and Pc (range) were 43, 60, 23, 20, and 14mmHg, respectively. The atrophy rate was 66.3% and the viability was 88.9%. No major complications were observed. Conclusion The modified tunica vaginalis flap in acute testicular torsion decreased intratesticular pressure. Furthermore, normal testicular pressure can improve testicular preservation. It can also decrease testicular pressure to normal levels and preserve the testicular parenchyma.

ABSTRACT Introduction: Salvage Radical Prostatectomy after radiation therapy is challenging and associated with high rates of serious complications (1, 2). The novel Retzius-Sparing RARP (RS-RARP) approach has shown excellent continence outcomes (3, 4). Purpose: To describe step-by-step our Salvage Retzius-Sparing RARP (sRS-RARP) operative technique and report feasibility, safety and the preliminary oncological and continence outcomes in the post-radiation scenario. Materials and Methods: Twelve males presenting local prostate cancer recurrence after radiotherapy that underwent sRS-RARP were included. All patients performed preoperative multiparametric MRI and PSMA-PET. Surgical technique: 7cm peritoneum opening at Douglas pouch, Recto-prostatic space development, Seminal vesicles and vas deferens isolation and section, Extra-fascial dissection through peri-prostatic fat, Neurovascular bundle control, Bladder neck total preservation and opening, Anterior dissection at Santorini plexus plane, Apex dissection with urethra preservation and section, Prostate release, Vesicouretral modified Van Velthoveen anastomosis, Rocco Stitch, Oncological and continence outcomes reported with minimum 1-year follow-up. Results: Ten patients had previously received external beam radiation (EBR) whereas two received previous brachytherapy plus EBR. At 1, 3 and 12 months after surgery, 25%, 75% and 91.6% of the men used one safety pad or less, respectively. No major complications or blood transfusions were reported. Final pathology reported pT2b 41.6%, pT2c 33.3% and pT3a 25%, positive surgical margins 25%, positive lymph nodes were not found, biochemical recurrence 16.6%. Conclusion: Salvage Retzius-Sparing Robotic Assisted Radical Prostatectomy approach appears to be technically feasible and oncologically safe with potential to provide better continence outcomes.

JUSTIFICATIVA E OBJETIVOS: O reimplante ureteral é comumente utilizado em cirurgia pediátrica e ginecológica. A maioria das técnicas exigem um cirurgião experiente e dura 2-3 horas. Não há consenso sobre a técnica preferida até hoje. Relatamos uma modificação simples do Taguchi para reduzir sua duração e torná-lo mais adequado para a abordagem laparoscópica. MÉTODO: Três pacientes foram submetidos a reimplante ureteral distal, com base na técnica de abordagem minimamente invasiva de Taguchi modificada. Cistografia e ultra-sonografia foram realizadas no 30º, 90º e 180º dias de pós-operatório para monitorização dos rins; um acompanhamento de um ano para recorrência ou sintomas clínicos também foi realizado. RESULTADOS: O tempo operatório para o reimplante ureteral utilizando a nossa técnica foi de 15-25 minutos. Os resultados dos exames realizados nos dias pós-operatórios mostraram rins normais sem hidronefrose. No seguimento de um ano não houve sinais de recorrência ou sintomas clínicos. CONCLUSÃO: Nossas modificações permitiram um manejo mais rápido e fácil do reimplante ureteral distal, com excelentes resultados peri- e pós-operatórios. Tanto quanto sabemos, esta é a primeira descrição detalhada desta técnica através de abordagem minimamente invasiva. No entanto, estudos adicionais e um acompanhamento mais longo serão necessários para confirmar os resultados a longo prazo e os benefícios clínicos da técnica proposta.

BACKGROUND AND OBJECTIVES: Ureteral Reimplant is commonly used in pediatric and gyne-cologic surgery. Most techniques demand an experienced surgeon and lasts 2-3 hours. There is no consensus about the preferred technique until today. We report a simple modification of the Taguchi to reduce duration and make it more suitable for laparoscopic approach. METHOD: Three patients underwent distal ureteral reimplant, based on our modified Taguchi minimally invasive approach technique. Cystography and ultrasonography were performed on the 30th, 90th and 180th postoperative days to monitor kidneys; a one-year follow-up for recurrence or clinical symptoms was also performed. RESULTS: Operative time for ureteral reimplant using our technique was 15-25 minutes. The results of the performed exams on postoperative days showed normal kidneys without hydro-nephrosis. At the one-year follow-up no signs of recurrence or clinical symptoms were present. CONCLUSION: Our modifications allowed a faster and easier management of distal ureteral reimplant, with excellent perioperative and post-operative outcomes. To our knowledge this is the first detailed description of this technique through minimally invasive approach. However, further studies and a longer follow up will be necessaries to confirm the long-term outcomes and clinical benefits of our technical proposal.

ABSTRACT Background Robotic-assisted radical prostatectomy (RALP) is a minimally invasive procedure that could have a reduced learning curve for unfamiliar laparoscopic surgeon. However, there are no consensuses regarding the impact of previous laparoscopic experience on the learning curve of RALP. We report on a functional and perioperative outcome comparison between our initial 60 cases of RALP and last 60 cases of laparoscopic radical prostatectomy (LRP), performed by three experienced laparoscopic surgeons with a 200+LRP cases experience. Materials and Methods Between January 2010 and September 2013, a total of 60 consecutive patients who have undergone RALP were prospectively evaluated and compared to the last 60 cases of LRP. Data included demographic data, operative duration, blood loss, transfusion rate, positive surgical margins, hospital stay, complications and potency and continence rates. Results The mean operative time and blood loss were higher in RALP (236 versus 153 minutes, p<0.001 and 245.6 versus 202ml p<0.001). Potency rates at 6 months were higher in RALP (70% versus 50% p=0.02). Positive surgical margins were also higher in RALP (31.6% versus 12.5%, p=0.01). Continence rates at 6 months were similar (93.3% versus 89.3% p=0.43). Patient’s age, complication rates and length of hospital stay were similar for both groups. Conclusions Experienced laparoscopic surgeons (ELS) present a learning curve for RALP only demonstrated by longer operative time and clinically insignificant blood loss. Our initial results demonstrated similar perioperative and functional outcomes for both approaches. ELS were able to achieve satisfactory oncological and functional results during the learning curve period for RALP.