ABSTRACT Purpose: To conduct a systematic literature review with meta-analysis to identify whether antibiotic prophylaxis after removal of the indwelling urinary catheter reduces posterior infections. Methods: A systematic literature review was conducted in the databases PubMed, Embase, Cochrane, Google Scholar, and Latin American and Caribbean Health Sciences Literature, using the keywords “antibiotics” AND “prostatectomy” AND “urinary catheter.” Results: Three articles were identified having the scope of our review, with 1,040 patients, which were subjected to our meta-analysis revealing a marginally significant decrease in the risk of urinary infection after indwelling urinary catheter removal (odds ratio–OR = 0.51; 95% confidence interval–95%CI 0.27–0.98; p = 0.04; I2 = 0%). No difference was found regarding the presence of bacteriuria (OR = 0.39; 95%CI 0.12–1.24; p = 0.11; I2 = 73%). Conclusions: In our meta-analysis, there was a significant decrease in urinary tract infection with antibiotic prophylaxis after indwelling urinary catheter removal following radical prostatectomy. Purpose metaanalysis meta analysis infections Methods PubMed Embase Cochrane Scholar Literature antibiotics “antibiotics prostatectomy “prostatectomy catheter. Results 1040 1 040 1,04 patients odds ratioOR ratio OR 0.51 051 0 51 95 interval95CI intervalCI interval CI 0.27–0.98 027098 27 98 0.04 004 04 I 0%. 0% . 0%) 0.39 039 39 95CI 0.12–1.24 012124 12 24 0.11 011 11 73%. 73 73% 73%) Conclusions metaanalysis, analysis, 104 1,0 0.5 05 5 9 0.27–0.9 02709 2 0.0 00 0.3 03 3 0.12–1.2 01212 0.1 01 7 10 1, 0. 0.27–0. 0270 0.12–1. 0121 0.27–0 027 0.12–1 012 0.27– 02 0.12– 0.27 0.12 0.2

ABSTRACT Purpose: The purpose of this study is to assess whether the Dunning-Kruger effect occurs in surgical residents when performing laparoscopic cholecystectomy in a porcine model. Methods: Prospective blinded study, which counted with forty PGY-1 general surgery residents who agreed to participate in the study were blindly recruited to perform a laparoscopic cholecystectomy in a porcine model. At the end of the procedure, the participants assigned a score of 0-10 for their own performance and the video of the operation was independently assessed by 2 experienced laparoscopic surgeons using a validated tool. Results: Participants were divided into groups of 10 individuals according to objective performance and compared. The group with the worst objective result was inferior to the group with the best objective result (3.77 ± 0.44 vs. 8.1 ± 0.44, p < 0.001), but they were similar in self-perception of performance (5.11 ± 1.69 vs. 6.1 ± 1.79, p = 0.999). Conclusions: In the studied sample, it was possible to demonstrate the presence of the Dunning-Kruger effect. Purpose DunningKruger Dunning Kruger model Methods PGY1 PGY 1 PGY- procedure 010 0 0-1 tool Results compared 3.77 377 3 77 (3.7 044 44 0.4 vs 81 8 8. 0.001, 0001 0.001 , 001 0.001) selfperception self perception 5.11 511 5 11 (5.1 169 69 1.6 61 6 6. 179 79 1.79 0.999. 0999 0.999 . 999 0.999) Conclusions sample 01 0- 3.7 37 7 (3. 04 4 0. 000 0.00 00 5.1 51 (5. 16 1. 17 1.7 099 0.99 99 3. (3 0.0 5. (5 09 0.9 9 (

ABSTRACT Purpose: Medical expulsive therapy (MET) is recommended for distal ureteral stones from 5 to 10 mm. The best drug for MET is still uncertain. In this review, we aim to compare the effectiveness of tadalafil and tamsulosin for distal ureteral stones from 5 to 10 mm in terms of stone expulsion rate (SER), stone expulsion time (SET) and the side effect profile. Materials and methods: A comprehensive literature search was conducted on MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus and Web of Science, from inception until April 2023. Only randomized controlled trials were included in the analysis. Results: Eleven publications with 1,330 patients were included. We observed that tadalafil has a higher SER (OR 0.55, CI 95% 0.38;0.80, p=0.02, I2=52%) and the same efficacy in SET (MD 1.07, CI 95% -0.25; 2.39, p=0.11, I2=84%). No differences were found when comparing side effects as headache, backache, dizziness, and orthostatic hypotension. Conclusion: Tadalafil has a higher stone expulsion rate than tamsulosin as a medical expulsive therapy for patients with distal stones from 5 to 10 mm without differences in side effects. Purpose (MET 1 uncertain review SER, , (SER) (SET profile methods MEDLINE EMBASE Trials Science 2023 analysis Results 1330 330 1,33 OR 055 0 55 0.55 95 0.380.80, 038080 0.38 0.80, 38 80 0.38;0.80 p002 p 02 p=0.02 I2=52% I252 I I2 52 MD 107 07 1.07 0.25 025 25 -0.25 239 2 39 2.39 p011 11 p=0.11 I2=84%. I284 I2=84% . 84 I2=84%) headache backache dizziness hypotension Conclusion (SER 202 133 33 1,3 05 0.5 9 380 0.380.80 03808 038 0.3 080 0.80 3 8 0.38;0.8 p00 p=0.0 I2=52 I25 1.0 0.2 -0.2 23 2.3 p01 p=0.1 I28 I2=84 20 13 1, 0. 0.380.8 0380 03 08 0.8 0.38;0. p0 p=0. I2=5 1. -0. 2. I2=8 0.380. 0.38;0 p=0 I2= -0 0.380 0.38; p= -

ABSTRACT Introduction: Inguinal hernia and varicocele are common conditions in male population. Laparoscopy brings the opportunity to treat them simultaneously, through the same incision. However, there are different opinions about the risks for testicular perfusion of multiple procedures in the inguinal region. In this study, we assessed the feasibility of simultaneous laparoscopic procedures by studying clinical and surgical outcomes of patients undergoing bilateral inguinal hernioplasty using the transabdominal preperitoneal (TAPP) technique with and without concomitant bilateral laparoscopic varicocelectomy (VLB). Methods: a sample of 20 patients from the University Hospital of USP-SP with indirect inguinal hernia and varicocele with indication for surgical correction was selected. Patients were randomized into two groups, 10 undergoing TAPP (Group I) and 10 undergoing simultaneous TAPP and VLB (Group II). Data regarding total operative time, complications and postoperative pain was gathered and analyzed. Results: there was no statistical difference between groups regarding total operative time and postoperative pain. Only one complication (spermatic cord hematoma) was observed in Group I and no complications were observed in Group II. Conclusions: simultaneous TAPP and VLB in was shown to be effective and safe, which provides a basis for conducting studies on larger scales. Introduction population simultaneously incision However region study (TAPP VLB. . (VLB) Methods 2 USPSP USP SP selected 1 II II) analyzed Results spermatic hematoma Conclusions safe scales (VLB

RESUMO Introdução: hérnia inguinal e varicocele são doenças comuns na população masculina. O advento da laparoscopia traz a oportunidade de tratá-las simultaneamente, pelo mesmo acesso. Entretanto, existem divergências sobre os riscos para a perfusão testicular de múltiplos procedimentos na região inguinal. Neste estudo, avaliamos a viabilidade de procedimentos laparoscópicos simultâneos estudando resultados clínicos e cirúrgicos de pacientes submetidos à hernioplastia inguinal bilateral pela técnica transabdominal préperitoneal (TAPP) com e sem varicocelectomia laparoscópica bilateral (VLB) concomitante. Métodos: uma amostra de 20 pacientes do Hospital Universitário da USP-SP com hérnia inguinal indireta e varicocele com indicação de correção cirúrgica foi selecionada. Os pacientes foram randomizados em dois grupos, sendo 10 submetidos à TAPP (Grupo I) e 10 submetidos à TAPP e VLB simultâneas (Grupo II). O tempo operatório total, complicações e dor pós-operatória foram coletados e analisados. Resultados: não houve diferença estatística entre os grupos com relação ao tempo operatório total e à dor pós-operatória. Apenas uma complicação (hematoma do cordão espermático) foi observada no Grupo I e não foram observadas complicações no Grupo II. Conclusões: no mesmo procedimento, submeter pacientes à TAPP e à VLB no mesmo procedimento se mostrou eficaz e seguro, o que fornece embasamento para a realização de estudos em maiores escalas. Introdução masculina tratálas tratá las simultaneamente acesso Entretanto estudo (TAPP (VLB concomitante Métodos 2 USPSP USP SP selecionada 1 II . II) pósoperatória pós operatória analisados Resultados pósoperatória. operatória. hematoma espermático Conclusões seguro escalas

ABSTRACT Varicocele occurs in 15% of general male population and in 35% of infertile men. Since 1992, surgical correction with laparoscopic varicocelectomy is the gold standard for treatment of symptomatic patients or patients with abnormal seminal analysis. The learning curve for this frequently performed procedure has not yet been described. In the present study, we investigated the learning curve of a single urologist in training performing his first 21 laparoscopic varicocelectomies using qualitative and quantitative tools to evaluate his performance during the process. Our results show that 14 bilateral laparoscopic varicocelectomies are enough to achieve the plateau of the learning curve. 15 35 men 1992 analysis described study 2 process 1 3 199 19

RESUMO Varicocele ocorre em 15% dos homens e em 35% dos homens inférteis. Desde 1992, a correção cirúrgica com varicocelectomia laparoscópica é o padrão ouro para o tratamento de pacientes sintomáticos ou com análise seminal anormal. A curva de aprendizado para esse procedimento frequentemente realizado ainda não foi descrita. No presente estudo, investigamos a curva de aprendizado de um único urologista em treinamento realizando suas primeiras 21 varicocelectomias laparoscópicas usando ferramentas qualitativas e quantitativas para avaliar seu desempenho durante o processo. Nossos resultados mostram que 14 varicocelectomias laparoscópicas bilaterais são suficientes para atingir o platô da curva de aprendizado. 15 35 inférteis 1992 anormal descrita estudo 2 processo 1 3 199 19

ABSTRACT Introduction: flexible ureteroscopy is a minimally invasive surgical technique used for the treatment of renal lithiasis. Postoperative urosepsis is a rare but potentially fatal complication. Traditional models used to predict the risk of this condition have limited accuracy, while models based on artificial intelligence are more promising. The objective of this study is to carry out a systematic review regarding the use of artificial intelligence to detect the risk of sepsis in patients with renal lithiasis undergoing flexible ureteroscopy. Methods: the literature review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The keyword search was performed in MEDLINE, Embase, Web of Science and Scopus and resulted in a total of 2,496 articles, of which 2 met the inclusion criteria. Results: both studies used artificial intelligence models to predict the risk of sepsis after flexible uteroscopy. The first had a sample of 114 patients and was based on clinical and laboratory parameters. The second had an initial sample of 132 patients and was based on preoperative computed tomography images. Both obtained good measurements of Area Under the Curve (AUC), sensitivity and specificity, demonstrating good performance. Conclusion: artificial intelligence provides multiple effective strategies for sepsis risk stratification in patients undergoing urological procedures for renal lithiasis, although further studies are needed. Introduction complication accuracy promising Methods MetaAnalysis Meta Analysis PRISMA. PRISMA . (PRISMA) MEDLINE Embase 2496 496 2,49 articles criteria Results uteroscopy 11 parameters 13 images AUC, AUC , (AUC) specificity performance Conclusion needed (PRISMA 249 49 2,4 1 (AUC 24 4 2,

RESUMO Introdução: a ureteroscopia flexível é uma técnica cirúrgica minimamente invasiva utilizada para o tratamento de litíase renal. A urosepse pós-operatória é uma complicação rara, mas potencialmente fatal. Os modelos tradicionais utilizados para prever o risco dessa condição apresentam precisão limitada, enquanto modelos baseados em inteligência artificial são mais promissores. O objetivo desse estudo é realizar uma revisão sistemática a respeito do uso de inteligência artificial para detecção do risco de sepse em pacientes com litíase renal submetidos à ureteroscopia flexível. Métodos: a revisão de literatura está de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A busca com palavras-chave foi realizada no MEDLINE, Embase, Web of Science e Scopus e resultou no total de 2.496 artigos, dos quais 2 se enquadraram nos critérios de inclusão. Resultados: os dois estudos utilizaram modelos de inteligência artificial para predizer o risco de sepse após utereroscopia flexível. O primeiro teve uma amostra de 114 pacientes e foi baseado em parâmetros clínicos e laboratoriais. O segundo teve uma amostra inicial de 132 pacientes e foi baseado em imagens de tomografia computadorizada no pré-operatório. Ambos obtiveram boas medidas de Area Under the Curve (AUC), sensibilidade e especificidade, demonstrando boa performance. Conclusão: a inteligência artificial fornece múltiplas estratégias eficazes para estratificação do risco de sepse em pacientes submetidos a procedimentos urológicos para litíase renal, ainda que mais estudos sejam necessários. Introdução pósoperatória pós operatória rara fatal limitada promissores Métodos MetaAnalysis Meta Analysis PRISMA. PRISMA . (PRISMA) palavraschave palavras chave MEDLINE Embase 2496 496 2.49 artigos inclusão Resultados 11 laboratoriais 13 préoperatório. préoperatório pré operatório. operatório pré-operatório AUC, AUC , (AUC) especificidade performance Conclusão necessários (PRISMA 249 49 2.4 1 (AUC 24 4 2.

ABSTRACT Purpose: Ureteral access sheaths (UAS) are widely used in ureteroscopy. UAS are believed to pose a significant risk for ureteral stenosis due to ureteral mucosal compression, but little evidence supports this claim. Our systematic review aimed to investigate the relationship between different UAS diameters and stenosis risk. Methods: A systematic search was conducted in PubMed, Embase, Web of Science, Scopus, and Cochrane, from its inception to May 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane guidelines were followed. χ2 test was performed to compare the prevalence within the groups. Results: Six nonrandomized trials and one randomized, with a total of 962 patients, were included. The overall incidence of ureteral stenosis of 0.9%. UAS sizes were: 9.5/11.5Fr, 10/12Fr, 11/13Fr, 12/14Fr, and 14/16Fr. Within each subgroup, the incidence of ureteral stenosis was: 0.4, 8, 0, 1, and 1% (p = 0.099). No trend for stenosis was observed among larger UAS. Conclusions: In this systematic review, no relationship between UAS diameter and incidence of ureteral stenosis was observed. Nonetheless, additional randomized controlled trials are required to support this finding. Purpose (UAS ureteroscopy compression claim Methods PubMed Embase Science Scopus 2023 MetaAnalyses Meta Analyses PRISMA (PRISMA followed χ groups Results 96 patients included 09 0 9 0.9% 95115Fr Fr 5 11 5Fr 9.5/11.5Fr 1012Fr 10 12Fr 10/12Fr 1113Fr 13Fr 11/13Fr 1214Fr 12 14Fr 12/14Fr 1416Fr 14 16Fr 14/16Fr subgroup 04 4 0.4 8 1 p 0.099. 0099 0.099 . 099 0.099) Conclusions Nonetheless finding 202 0.9 0. 009 0.09 20 00 0.0 2

ABSTRACT Purpose: Kidney stones are one of the most common urological diseases worldwide. The size and location of the stone are the most important factors in determining the most suitable treatment options. The aim of this review was to evaluate the displacement of lower pole stones. Methods: Three studies assessing the efficacy of translocating kidney stones from the lower pole of the kidney to other locations during retrograde intrarenal surgery published in the last 20 years were included. A systematic search was conducted in the PubMed, Embase, Latin American and Caribbean Health Sciences Literature (LILACS), and Web of Science databases using the following search terms: “Lower pole,” “Lithotripsy.” Meta-analysis was performed using Review Manager version 5.4. Results: Stone-free rates were improved through displacement (odds ratio – OR = -0.15; 95% confidence interval–95%CI -0.24–-0.05; p = 0.002; I2 = 21%), but at the cost of increased surgical duration (mean difference = -12.50; 95%CI -24.06–-0.95; p = 0.03; I2 = 94%). Although this represents a potentially negative outcome, the improvement in clearance rates justifies the additional investment of time and effort. Conclusions: Displacement of lower pole kidney stones for subsequent lithotripsy brings significant benefits in terms of stone-free rate, with no difference in laser energy usage. However, it results in increased surgical time. Despite these factors, the benefits to patients undergoing the procedure are substantial. Purpose worldwide options Methods 2 included PubMed Embase LILACS, LILACS , (LILACS) Lower pole, Lithotripsy. Lithotripsy “Lithotripsy. Metaanalysis Meta analysis 54 5 4 5.4 Results Stonefree Stone free odds 0.15 015 0 15 -0.15 95 interval95CI intervalCI interval CI 0.24–0.05 024005 0.24– 0.05 24 05 -0.24–-0.05 0.002 0002 002 I 21%, 21 21% 21%) mean 12.50 1250 12 50 -12.50 95CI 24.06–0.95 2406095 24.06– 0.95 06 -24.06–-0.95 0.03 003 03 94%. 94 94% . 94%) outcome effort Conclusions stonefree rate usage However substantial (LILACS “Lithotripsy 5. 0.1 01 1 -0.1 9 0.24–0.0 02400 024 0.24 005 0.0 -0.24–-0.0 0.00 000 00 12.5 125 -12.5 24.06–0.9 240609 2406 24.06 095 0.9 -24.06–-0.9 0. -0. 0.24–0. 0240 02 0.2 -0.24–-0. 12. -12. 24.06–0. 24060 240 24.0 09 -24.06–-0. -0 0.24–0 -0.24–-0 -12 24.06–0 24. -24.06–-0 - -0.24–- -1 -24.06–- -0.24– -24.06– -0.24 -24.06 -0.2 -24.0 -24. -24 -2

RESUMO Introdução: a cirurgia retrógrada intrarrenal (CRIR) é ferramenta em evolução. Sua curva de aprendizado não está bem estabelecida, apesar do uso comum dos ureteroscópios flexíveis atualmente. O objetivo é estimar o número de procedimentos necessários para se realizar CRIR consistentemente. Material e Métodos: Um residente de urologia teve suas primeiras 80 CRIR para tratamento de nefrolitíase analisadas quantitativa e qualitativamente. Os procedimentos foram divididos em 4 grupos contendo 20 cirurgias cada (I a IV), de acordo com sua ordem, para comparação. Resultados: Não houve diferença nos tamanhos dos cálculos entre grupos. Todas as variáveis qualitativas apresentaram variação significativa entre os grupos (p<0,001), exceto entre III e IV. Na análise quantitativa houve diferença entre os grupos I e IV no tempo de colocação do cateter duplo J (p=0,012). Houve uma diferença crescente no tempo de colocação da bainha (p<0,001) e no tempo operatório total (p=0,004). O tempo para o tratamento do cálculo (p=0,011) foi significativo apenas entre os grupos I, II e III. Houve diferença no tempo total de bainha apenas entre os grupos I e III (p=0,023). Taxa livre de cálculos não se alterou entre os grupos. Discussão: as diferenças observadas entres as variáveis qualitativas e quantitativas evidenciam a relação entre o número de cirurgias realizadas e a proficiência no procedimento. As comparações intergrupo mostram otimização sequencial dos parâmetros. Conclusões: estima-se que 60 é um número razoável de cirurgias para que se atinja o platô da curva de aprendizado.

ABSTRACT Introduction: retrograde intrarenal surgery (CRIR) is an evolving tool. Its learning curve is not well established, despite the common use of flexible ureteroscopes today. Our aim is to estimate the number of procedures needed for one to perform RIRS consistently. Material and Methods: a urology resident had his first 80 RIRS for nephrolithiasis analyzed quantitatively and qualitatively. The procedures were divided into 4 groups containing 20 surgeries each (I to IV), according to their order, for comparison. Results: there was no difference in stone sizes between groups. All qualitative variables varied significantly between groups (p<0.001), except between III and IV. In the quantitative analysis, there was a difference between groups I and IV in time for double-J catheter placement (p=0.012). There was an increasing difference in sheath placement time (p<0.001) and in total operative time (p=0.004). The time fot stone treatment (p=0.011) was significant only between groups I, II and III. There was difference in total sheath time only between groups I and III (p=0.023). Stone free status did not change between groups. Discussion: the differences between the qualitative and quantitative variables show the relation between number of surgeries performed and proficiency in the procedure. Intergroup comparisons show sequential optimization of parameters. Conclusions: we found that 60 is a reasonable number of surgeries to be performed in order to reach the plateau of RIRSs learning curve.

RESUMO Introdução: ureteroscopia semi-rígida é o procedimento de escolha para o tratamento da ureterolitíase, mas necessita de uma curva de aprendizado para ser executada com segurança. Objetivo: descrever uma estimativa da curva de aprendizado para realização da ureterorrenolitotripsia semi-rígida em pacientes com ureterolitíase de pequena dimensão e estimar o número mínimo de procedimentos necessários para realizar o procedimento cirúrgico com segurança. Métodos: trata-se de um estudo prospectivo avaliando a curva de aprendizado de um residente de urologia nas primeiras 60 ureteroscopias semi-rígidas em pacientes com ureterolitíase até 1cm. Os pacientes foram divididos em três grupos: Grupo I uma a vinte cirurgias, Grupo II vinte e uma a quarenta cirurgias e Grupo III quarenta e uma a sessenta cirurgias. As cirurgias foram gravadas e analisadas por dois urologistas experientes em endourologia. Foi feita uma análise qualitativa baseada em uma ferramenta previamente validada e uma análise quantitativa. Resultados: todas as variáveis qualitativas tiveram variação significativa entre os Grupos I e II (p<0.001), e entre os Grupos I e III (p<0.001). Houve diferença no tempo para acesso ao ureter, passagem de cateter duplo J e tempo operatório total entre os Grupos I e II (p<0.001) e nos Grupos I e III (p<0.001). Conclusão: após 40 casos parece haver pouco incremento tanto na avaliação quantitativa bem como na avaliação qualitativa em performance cirúrgica para a realização de ureterolitotripsia semi-rígida com segurança em cálculos de até 1cm.

ABSTRACT Introduction: semi-rigid ureteroscopy is the procedure of choice for the treatment of ureterolithiasis, but it requires a learning curve to be performed safely. Objective: To describe an estimate of the learning curve for performing semi-rigid ureterorenolithotripsy in patients with small-sized ureterolithiasis and to estimate the minimum number of procedures necessary to safely perform the surgical procedure. Methods: this is a prospective study evaluating the learning curve of a resident of urology in the first 60 semirigid ureteroscopies in patients with ureterolithiasis up to 1cm. The patients were divided into three groups: Group I one to twenty surgeries, Group II twenty one to forty surgeries and Group III forty one to sixty surgeries. The surgeries were recorded and analyzed by two urologists experienced in endourology. A qualitative analysis was performed based on a previously validated tool and a quantitative analysis. Results: all qualitative variables had significant variation between Groups I and II (p<0.001), and between Groups I and III (p<0.001). There was a difference in time to access the ureter, passage of a double J catheter and total operative time between Groups I and II (p<0.001) and Groups I and III (p<0.001). Conclusion: after 40 cases there seems to be little increase in both quantitative as well as qualitative evaluation in surgical performance for performing semi-rigid ureterolithotripsy safely in calculations up to 1cm.

ABSTRACT Introduction Robot-Assisted Single Site Radical Nephrectomy (RASS-RN) has been reported by surgeons in Europe and United States (1–3). To our best knowledge this video presents the first RASS-RN with concomitant cholecystectomy performed in Latin America. Case A 66 year-old renal transplant male due to chronic renal failure presented with an incidental 1.3cm nodule in the upper pole of the right kidney. In addition, symptomatic gallbladder stones were detected. Results Patient was placed in modified flank position. Multichannel single port device was placed using Hassan's technique through a 3 cm supra-umbilical incision. Standard radical nephrectomy and cholecystectomy were made using an 8.5mm camera, two 5mm robotic arms and an assistant 5mm access. Surgery time and estimated blood loss were 208 minutes and 100mL, respectively. Patient did well and was discharged within less than 48 hours, without complications. Pathology report showed benign renomedullary tumor of interstitial cells and chronic cholecystitis. Discussion Robotic technology improves ergonomics, gives better precision and enhances ability to approach complex surgeries. Robot-assisted Single Port aims to reduce the morbidity of multiple trocar placements while maintaining the advantages of robotic surgery (2). Limitations include the use of semi-rigid instruments providing less degree of motion and limited space leading to crash between instruments. On the other hand, it is possible to perform complex and concomitant surgeries with just one incision. Conclusion RASS-RN seems to be safe and feasible option for selected cases. Studies should be performed to better understand the results using single port technique in Urology.

Abstract Purpose: To evaluate whether the use of the physical surgical simulator may benefit the development of laparoscopic skills. Methods: Ten medical students were divided into two groups: the first one performed ten weekly training sessions with a physical surgical simulator - ETX A2 LAP and, afterwards, one laparoscopic cholecystectomy in a porcine model, while the second group performed only a laparoscopic cholecystectomy. Both groups were compared regarding bleeding, total surgical time, time to perform each surgical step and qualitative parameters, based on a previously validated tool. Results: There was no difference in any of the evaluated parameters. Conclusion: We did not find any evidence of benefit in the use of the physical simulator for surgical performance in medical students.

Purpose To ensure patient safety and surgical efficiency, much emphasis has been placed on the training of laparoscopic skills using virtual reality simulators. The purpose of this study was to determine whether laparoscopic skills can be objectively quantified by measuring specific skill parameters during training in a virtual reality surgical simulator (VRSS). Materials and Methods Ten medical students (with no laparoscopic experience) and ten urology residents (PGY3-5 with limited laparoscopic experience) were recruited to participate in a ten-week training course in basic laparoscopic skills (camera, cutting, peg transfer and clipping skills) on a VRSS. Data were collected from the training sessions. The time that individuals took to complete each task and the errors that they made were analyzed independently. Results The mean time that individuals took to complete tasks was significantly different between the groups (p < 0.05), with the residents being faster than the medical students. The residents' group also completed the tasks with fewer errors. The majority of the subjects in both groups exhibited a significant improvement in their task completion time and error rate. Conclusion The findings in this study demonstrate that laparoscopic skills can be objectively measured in a VRSS based on quantified skill parameters, including the time spent to complete skill tasks and the associated error rate. We conclude that a VRSS is a feasible tool for training and assessing basic laparoscopic skills.

CONTEXT AND PURPOSE: Partial nephrectomy has become the standard of care for renal tumors less than 4 cm in diameter. Controversy still exists, however, regarding the best surgical approach, especially when minimally invasive techniques are taken into account. Robotic-assisted laparoscopic partial nephrectomy (RALPN) has emerged as a promising technique that helps surgeons achieve the standards of open partial nephrectomy care while offering a minimally invasive approach. The objective of the present study was to describe our initial experience with robotic-assisted laparoscopic partial nephrectomy and extensively review the pertinent literature. MATERIALS AND METHODS: Between August 2009 and February 2010, eight consecutive selected patients with contrast enhancing renal masses observed by CT were submitted to RALPN in a private institution. In addition, we collected information on the patients' demographics, preoperative tumor characteristics and detailed operative, postoperative and pathological data. In addition, a PubMed search was performed to provide an extensive review of the robotic-assisted laparoscopic partial nephrectomy literature. RESULTS: Seven patients had RALPN on the left or right sides with no intraoperative complications. One patient was electively converted to a robotic-assisted radical nephrectomy. The operative time ranged from 120 to 300 min, estimated blood loss (EBL) ranged from 75 to 400 mL and, in five cases, the warm ischemia time (WIT) ranged from 18 to 32 min. Two patients did not require any clamping. Overall, no transfusions were necessary, and there were no intraoperative complications or adverse postoperative clinical events. All margins were negative, and all patients were disease-free at the 6-month follow-up. CONCLUSIONS: Robotic-assisted laparoscopic partial nephrectomy is a feasible and safe approach to small renal cortical masses.Further prospective studies are needed to compare open partial nephrectomy with its minimally invasive counterparts.

PURPOSE: Bladder exstrophy (BE) is an anterior midline defect that causes a series of genitourinary and muscular malformations, which demands surgical intervention for correction. Women with BE are fertile and able to have children without this disease. The purpose of this study is to assess the sexual function and quality of life of women treated for BE. MATERIALS AND METHODS: All patients in our institution treated for BE from 1987 to 2007 were recruited to answer a questionnaire about their quality of life and pregnancies. RESULTS: Fourteen women were submitted to surgical treatment for BE and had 22 pregnancies during the studied period. From those, 17 pregnancies (77.2%) resulted in healthy babies, while four patients (18.1%) had a spontaneous abortion due to genital prolapse, and there was one case (4.7%) of death due to a pneumopathy one week after delivery. There was also one case (5.8%) of premature birth without greater repercussions. During pregnancy, three patients (21.4%) had urinary tract infections and one patient (7.14%) presented urinary retention. After delivery, three patients (21.4%) presented temporary urinary incontinence; one patient (7.14%) had a vesicocutaneous fistula and seven patients (50%) had genital prolapsed. All patients confirmed to have achieved urinary continence, a regular sexual life and normal pregnancies. All patients got married and pregnant older than the general population. CONCLUSIONS: BE is a severe condition that demands medical and family assistance. Nevertheless, it is possible for the bearers of this condition to have a satisfactory and productive lifestyle.