Consent Statement Research Articles

Resilience, compassion fatigue, moral distress and moral injury of nurses.

Background: Compassion fatigue, moral distress, and moral injury are interconnected phenomena that have a detrimental impact on the delivery of nursing care. Nurses possess the inherent resilience necessary to effectively handle these three adverse occurrences. Aim: To determine the mediating impact of resilience on compassion fatigue, moral distress, and moral injury among nurses in Saudi Arabia. Design: The final product was a structural equation model (SEM) generated using a quantitative correlation cross-sectional design, and we followed the STROBE guidelines for this study. Methods: The study involved a sample of 511 staff nurses, who were selected using consecutive sampling. The study was conducted in three government hospitals in Saudi Arabia. Ethical considerations: This study received approval from Ethics Committee under approval number H-2021-151 on March 5, 2021. The survey's description and consent statements were clearly presented on Google survey forms in both English and Arabic. Results: Results showed that resilience negatively influenced moral distress, while compassion fatigue and moral injury had a positive influence. Likewise, compassion fatigue had a direct, positive effect on moral distress and moral injury, and moral distress had a direct, positive effect on moral injury. Analyses also showed that resilience had positive, indirect effects on moral injury through the mediation of both compassion fatigue and moral distress. Similarly, compassion fatigue had a positive, indirect effect on moral injury through the mediation of moral distress. Conclusion: Because resilience enables nurses to adapt, it helps them overcome obstacles in their career and professional lives. Resilience is frequently cited by nurses as a protective quality. Moral injury, compassion fatigue, and moral distress can negatively impact the health of nurses. Implications for the profession and/or patient care: Nurse leaders should develop programs and initiate efforts to improve nurses' resilience as an important protective trait against compassion fatigue, moral distress, and moral injury. Patient or Public Contribution: There was no public or patient participation in this study.

Systematic scoping review of cluster randomised trials conducted exclusively in low-income and middle-income countries between 2017 and 2022

ObjectiveCluster randomised trials (CRTs) are used for evaluating health-related interventions in low-income and middle-income countries (LMICs) but raise complex ethical issues. To inform the development of future ethics guidance, we...

Correction: Omission of informed consent statements for the use of photographs, errors in describing consent for using photographs of minors, and absence of statements regarding conflict of interest of editorial board membership.

Correction: Omission of informed consent statements for the use of photographs, errors in describing consent for using photographs of minors, and absence of statements regarding conflict of interest of editorial board membership.

The quality of reporting in case reports of permanent neonatal diabetes mellitus: a cross-sectional study

BackgroundAlthough randomized trials and systematic reviews provide the best evidence to guide medical practice, many permanent neonatal diabetes mellitus (PNDM) studies have been published as case reports. However, the quality of these studies has not been assessed. The purpose of this study was to assess the extent to which the current case reports for PNDM comply with the Case Report (CARE) guidelines and to explore variables associated with the reporting.MethodSix English and four Chinese databases were searched from their inception to December 2022 for PNDM case reports. The 23 items CARE checklist was used to measure reporting quality. Primary outcome was the adherence rate of each CARE item and second outcome was total reporting score for each included PNDM case report. Linear and logistic regression analyses were used to examine the connection between five pre-specified predictor variables and the reporting quality. The predictor variables were impact factor of the published journal (<3.4 vs. ≥3.4, categorized according to the median), funding (yes vs. no), language (English vs. other language), published journal type (general vs. special) and year of publication (>2013 vs. ≤ 2013).ResultIn total, 105 PNDM case reports were included in this study. None of the 105 PNDM case reports fulfilled all 23 items of the CARE checklist. The response rate of 11 items were under 50%, including prognostic characteristics presentation (0%), patient perspective interpretation (0%), diagnostic challenges statement (2.9%), clinical course summary (21.0%), diagnostic reasoning statement (22.9%), title identification (24.8%), case presentation (33.3%), disease history description (34.3%), strengths and limitations explanation (41.0%), informed consent statement (45.7%), and lesson elucidation (47.6%). This study identified that the PNDM case reports published in higher impact factor journals were statistically associated with a higher reporting quality.ConclusionThe reporting of case reports for PNDM is generally poor. As a result, this information may be misleading to providers, and the clinical applications may be detrimental to patient care. To improve reporting quality, journals should encourage strict adherence to the CARE guidelines.

An empirical study on differences between self-assessed and measured real risk in online behaviour

As the leading cause of security breaches is human susceptibility to hackers' deception, the riskiness of an individual's online behaviour and low awareness regarding privacy protection significantly influence the overall security of an information system. Thus, this study aimed to compare self-assessed and measured real risk in online behaviour among online users. The additional aim was to modify the questionnaire by replacing the existing trick question about password quality with the new questions on accepting the terms and conditions. An international online Behavioral Cognitive Internet Security Questionnaire (BCISQ), validated in previous studies, was used for data collection. The examinees involved in this study were 278 students from different faculties. The results showed a relatively high level of risk in online behaviour, as 22.7% of examinees revealed their passwords. In comparison, only 10.8% read the consent statement. Students who behave in a riskier manner self-assess themselves as being significantly safer in online behaviour, which is contradictory. They also performed worse in all other examined variables. The new version of the simulation subscale, with improved internal consistency and reliability (Cronbach's Alfa=0.810), consists of only three items, which are questions used in the previous version, without adding any of the two tested trick questions. Generally, this study concludes that, on average, information security awareness is still low among online users and that even the ones realistically acting riskier believe they are acting more safely.

Financial Toxicity in the Spanish Speaking Population

Advances in therapy have significantly improved cancer survival outcomes but with a harmful patient consequence: financial toxicity. Financial toxicity consists of a patient's many economic burdens from cancer treatment, encompassing direct healthcare costs as well as additional devastating financial consequences, such as job loss and medical bankruptcy. With rising cancer treatment costs, financial toxicity has become a problem that is increasingly impactful in both cancer treatment and survivorship, amplifying disparities, negatively impacting quality of life, treatment adherence and survival. The long-term research goal that this study will contribute to is to develop culturally appropriate and effective patient navigation resources and psychosocial support resources for interventions to increase coping and resilience to financial toxicity in high-risk populations. This study will seek to generate the early data needed to help develop the content and method of delivering strategies, tailored for an underserved, Spanish-speaking Latino population. Eligibility Participant must be 18 years of age or older at the time of study participation, able to read and speak Spanish, have diagnosis of cancer within the past 2 years or be on active treatment for their cancer; all disease sites and all stages are eligible for enrollment. We will exclude patients unable to give consent. Methods This is a prospective observational study of cancer patients and survivors, with participants to be recruited from Scripps MD Anderson Cancer Center. Participating clinics will be screened in the electronic medical record for individuals who meet above eligibility criteria. At the time of clinic visits, eligible individuals will be approached. Individuals who express that they would like to participate in the survey study will receive the study packet with the consent statement and baseline survey questions. Study participants will also be invited to participate in the OPTIONAL patient navigation portion of the study. Participants who are not active on the MyScripps patient portal will be invited to join the patient navigation portion of the study. Those elect to participate will be provided a device if they do not have their own. Participants will be given a Greenphire Clincard on which they will receive a total of $75 in three installments. Research team members will enter the item responses into the REDCap database. They will undergo a follow-up survey during a range from 4 months to 9 months from the initial survey date. Those participating in the patient navigation portion of the study will be contacted by the navigator on a monthly basis through the electronic portal or telephone. Statistics We plan to enroll N= 80 Spanish-speaking patients in the survey study. For correlation testing, we hypothesize a moderate effect size (correlation = 0.32) for the association between the primary outcome measure, the baseline measure of self-efficacy (Hope State score) and the baseline financial toxicity score (Economic Strain and Resilience in Cancer). For feasibility testing of navigation participation, feasibility will be assessed through descriptive statistics. We hypothesize that it is feasible for 50% of invited patients to participate. When the sample size is 40, a two-sided 95% confidence interval for participant completion rate will extend 0.15 from the observed proportion for an expected proportion of 0.50. Analysis The primary outcome measure is financial toxicity, measured using the ENRICh instrument at baseline. The primary predictor is the baseline Hope State score. This modeled association is of primary interest in the analysis. We will conduct descriptive and univariate/multivariate analyses on this association of primary interest, including Chi-square test, t-test. Other univariate and multivariate analyses of associations between financial toxicity and other measures obtained from survey measures, as well as clinical, demographic, socioeconomic, and care delivery variables, considered descriptive and exploratory, will be performed. Accounting for multiple comparisons will be based on stepdown procedures and familywise error rate control; we plan to control this overall error rate using the Holm-Sidak adjustment, or procedure with equitable properties.

Levofloxacin-Associated Encephalopathy.

1Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Japan 2Department of Internal Medicine, Toyooka Public Hospital, Toyooka, Japan 3Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Japan The authors have no conflicts of interest to declare. Institutional review board statement: Ethical approval was not required because this was a case report. Therefore, the need for ethics approval was waived by the Ethics Committee of Hyogo Prefectural Tamba Medical Center. Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report and accompanying images. A copy of the written consent form is available for review by the editor of this journal.

Health and well-being of serving and ex-serving UK Armed Forces personnel: protocol for the fourth phase of a longitudinal cohort study

IntroductionThis is the fourth phase of a longitudinal cohort study (2022–2023) to investigate the health and well-being of UK serving (Regulars and Reservists) and ex-serving personnel (veterans) who served during...

The influence of celebrities on the conspicuous consumption of Saudi youth

This study aims to assess the influence of celebrities on the conspicuous consumption of Saudi youth. A descriptive study using a social survey method with 309 randomly selected Saudi students was conducted. A questionnaire was used to gather data. The model included 36 questions. The study utilized the Likert scale, SPSS statistical software, mono-variation analysis, the least difference (LSD) test. The assessment of the sample demographic variables shows that the research population is diversified. The results showed that the most prominent areas of conspicuous consumption for youths were buying clothes, perfumes, cosmetics, and jewelry (the average was 2.70 out of 3). It was also concluded that the major way that celebrities use to present products to the audience is the indirect marketing method (the average was 2.87 out of 3). The main reasons behind youth following celebrities were the celebrity’s attractiveness and a large number of followers (the average was 2.89 out of 3). The manifestations of celebrities’ influence on youths were apparent in their conspicuous consumption as the youths were interested in being the first to buy the products announced by celebrities, which gave them a sense of distinction compared to their friends (the average was 2.89 out of 3). Unplanned purchases were the main difficulty that youth faced in regard to budget management (the average was 2.75 out of 3). The study recommends intensifying awareness of rationalizing consumption and eliminating the negative values of conspicuous consumption among Saudi youths. AcknowledgmentInternational Review Board (IRB) Statement: IRB Registration Number with KACST, KSA:H-01-R-059 Informed Consent Statement: Informed Consent was obtained from all subjects involved in the study.This research project was funded by the Deanship of Scientific Research, Princess Nourah bint Abdulrahman University, through the Program of Research project Funding After Publication, grant No (PRFA-P-42-6).

Familial Case of Porphyria with an Epileptic Seizure in the Moscow Region

Objective a clinical case of a 37-year-old patient with familial acute porphyria is presented (the patient's sister died at the age of 28 during an attack of acute porphyria). Material and methods: we used a qualitative urine test for porphyria with Erdich reagent and quantitative determination of porphyrins (porphobilinogen and delta-aminolevulenic acid on a spectrophotometer “Hitachi 3900”. Results.The attack began with pain in the abdomen and lower back, tachycardia, arterial hypertension during menstruation. After taking ketorol and surgical intervention, tonic-clonic convulsions developed with involuntary release of pink urine. CT of the brain shows signs of ischemic cerebrovascular accident in the parietal region of the right hemisphere. There was a decrease in the level of hemoglobin in the blood and APTT. A urine test for porphyria was positive. Porphobilinogen and delta-aminolevulinic acid in the blood are elevated. After the appointment of glucose at a dose of 300 g of dry matter per day in an oral solution, the condition improved. Conclusion. The presented case demonstrates the difficulties in diagnosing and managing patients with acute porphyria, despite the awareness of the attending physicians about this disease. The patient developed an epileptic seizure and brain damage according to CT, which could be posterior reversible encephalopathy. To improve the efficiency of diagnosis and treatment of porphyria in all laboratories, a simple and cheap qualitative urine test for porphyria with Ehrlich's reagent should be organized and Hitachi 3900 spectrophotometers should be purchased at regional medical centers. Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.

Expert consensus on standardized management of tumor gene sequencing for cancer patients

AbstractBackgroundTumour gene detection by next‐generation sequencing (NGS) can comprehensively analyze the molecular characteristics of tumors, and predict drug efficacy and tumor resistance mechanisms through tumour cell models, thereby realizing individualized and precise treatment. Therefore, the whole process of standardized management is required. This consensus aims to refine the standardized management of tumor gene sequencing for cancer patients based on the NGS platform, hoping to provide help for the personalized treatment of cancer patients, and further promoting the development of precision medicine.Methods and resultsStandardized management for tumour gene detection of cancer patients includes patient management before gene testing, during gene testing, and after gene testing. Tumour patients should select appropriate test samples and test content before receiving genetic testing. There should be a clear informed consent statement during the test, a detailed report should be provided after the test, and counseling and monitoring follow‐up should be provided. The management of genetic testing of tumour patients should cover early screening and early diagnosis of tumors, molecular classification and companion diagnosis of tumours, and monitoring of tumour recurrence.ConclusionEffective management and standardized procedures for gene detection of cancer patients, covering the whole process before, during and after detection, will benefit the majority of patients from early screening, personalized diagnosis and treatment, prognosis evaluation and other aspects of cancer, and promote the healthy development of the precision medicine industry.

3830 lead extraction from two patients with left bundle branch area pacing.

3830 lead extraction from two patients with left bundle branch area pacing.

Considerations for Percutaneous Nephrolithotomy in Transgender Female Patients

Clinical History: A 38-year-old transgender female with history of HIV, bilateral orchiectomy, bilateral breast and buttock augmentation, and kidney stones presented for surgical evaluation of right nonobstructing kidney stones. CT scan showed two nonobstructing stones in the right lower pole measuring 8 and 7 mm. She specifically requested no ureteral stent and nonprone positioning because of recent facial plastic surgery. She elected to proceed with supine minipercutaneous nephrolithotomy (PCNL). There are several special considerations that should be taken when performing PCNL on transgender patients. Physical Examination: NAD, AAOx3. Abdomen was soft, nontender, and negative for costovertebral tenderness. Diagnosis: Right lower pole nonobstructing kidney stones. Intervention: A supine mini-PCNL was performed to accommodate patient's recent facial surgery and aversion to ureteral stent placement. In the Galdakao-modified Valdivia supine position, access was obtained using combined fluoroscopic, ultrasound, and endoscopic approaches. Access site was dilated to 18F, and the stones were extracted without incident. A retrograde flexible ureteroscope was used to evaluate all calices and confirm that no additional stones were present. A 14F nephrostomy tube was placed and no ureteral stent was left. Follow-up: Patient effectively underwent surgery without complication and was sent to post-anesthesia care unit (PACU) postoperatively where she recovered well. She was observed overnight for pain control. On postoperative day 1, the nephrostomy tube was clamped and there was confirmed urinary drainage in the foley. The nephrostomy tube and foley catheter were removed. She was instructed on wound care and informed to follow-up for her postoperative visit. Follow-up renal bladder ultrasound (RBUS) confirmed that she was stone free. Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure No competing financial interests exist. Runtime of video: 4 mins 51 secs

Successful Intraductal Sialolithiasis Removal Using Sialendoscopy: A Case Report and Surgical Video Tips

Introduction: Sialolithiasis is major cause of the obstructive salivary gland disease, accounting for ~60% of all cases. Other etiologies include strictures, mucoid debris, anatomic ductal abnormalities, and scar tissue.1 About 80% to 95% of sialolithiasis cases occur in the submandibular gland, 5% to 20% in the parotid gland, and only 1% to 2% in the remaining glands. The treatment of the obstructive salivary gland has evolved in the past 25 years with the introduction of thin semiflexible endoscopes and microinstruments such as forceps, baskets, wires, lasers, and balloons. These advancements allow for sialendoscopy and other intraductal manipulations including stone removal, dilatation of strictures, and cleansing of mucus plugs.2 In addition, these procedures can be used in combination with minimally invasive external approaches.3 Sialendoscopy is the main option for effectively treating these obstructive conditions, leading to improvements in overall quality of life.4 The objective of the surgical video is to clarify the basic steps involved in effectively removing intraductal sialolithiasis. Materials and Methods: A 36-year-old man presented with complaints of pain, swelling, and difficulty swallowing during meals, in the right submandibular salivary gland area. The symptoms had been present for the past 2 years and had worsened progressively, with no improvements with analgesics. The patient had a history of drinking less water during the past 10 years, but otherwise had no remarkable medical history. During the neck clinical examination, the right submandibular gland was found to be smaller than the contralateral gland, and no atypical lymph nodes were detected. Intraoral examination revealed a palpable 8 mm sialolith in the right floor of the mouth, which caused a discharge of milky saliva on manipulation. The remaining mucosa appeared normal. A CT scan revealed a 9 mm elliptical sialolith in the middle third of the right submandibular duct, consistent with the clinical examination and suspicion of obstructive sialolithiasis. Laboratory tests were normal. As treatment, sialendoscopy was indicated. The procedure was conducted following the standards set by Marchal et al.5 The intervention was performed for both diagnostic and therapeutic interventions, using a semirigid modular sialendoscope (Karl Storz, Tuttlingen, Germany) with a diameter of 1.7 mm, along with working channel, salivary probes, conic dilatators, bougies, baskets for stones, dilatator balloons, and silastic stents to the main duct to maintain papilla patency.6 The sialolith was completely removed without any adverse events. Results: The patient recovered uneventfully postoperatively and was discharged the next day. Conclusion: Our findings support the use of sialendoscopy for obstructive sialolithiasis. Patients usually obtain a complete resolution of their clinical symptoms and the technology has a high success rate when performed by an experienced team. The patient who agreed to participate in the study has written and signed the informed consent statement. No competing financial interests exist. No funding was received for this article. Runtime of video: 4 mins 49 secs

Laparoscopic Approach for the Management of Duodenal Duplication

Introduction: Intestinal duplication cysts are rare congenital malformations, mainly found in the midgut that generate nonspecific symptoms. The clinical presentation is mainly with abdominal pain, intestinal obstruction, and digestive bleeding. The open surgical approach is usually performed. We present a case of a 7-year-old patient in whom an effective laparoscopic management was implemented. Materials and Methods: A 7-year-old patient was admitted because of weight loss and frequent emesis. A mass in the mesogastrium was palpated upon physical examination. Imaging studies showed a lesion with cystic content in the first duodenal portion measuring 4.7 × 4.4 × 5.6 cm, suggestive of duodenal duplication cyst causing obstruction of the gastric outlet tract. Nutritional support was performed with total parenteral nutrition for a week and laparoscopic resection was programmed. Using an open technique, insertion of a 5-mm umbilical port and two other ports of equal size in the right iliac fossa and epigastrium was performed. Upon entry into the abdominal cavity, a dilated duodenal bulb and collapsed second and third portions of the duodenum were seen. Pyloroduodenotomy was performed, and dissection of the muscle fibers showed a cystic lesion in the first portion of the duodenum, located between the muscle layer and the mucosa, which was subsequently completely resected and referred to pathology analysis. The procedure was completed without complications, and the postoperative evolution was adequate, with discharge on the fourth postoperative day. Results: There are few reports of management with minimally invasive techniques for intestinal duplications, Galazka et al. performed a retrospective analysis of patients presented with congenital abdominal cystic lesions between 2011 and 2019. Of the 39 cases analyzed, 6 were found to have intestinal duplications, 4 of these underwent surgical management by laparoscopy without reporting complications, but did not report the exact location of the cysts.1 In the case of duodenal duplication, there is a case report of an 8-month-old patient with a prenatal diagnosis who underwent laparoscopic resection dependent on the medial wall of the second duodenal portion, without postoperative complications.2 Conclusions: The accumulation of secretions within the intestinal duplication cyst leads to progressive growth, with compression of adjacent structures producing pain and obstruction. They are rare malformations with nonspecific symptoms that require surgical management to avoid associated complications; enucleation or resection of the lesion are the pillars of treatment. Despite few reports in the literature, it is possible to perform a laparoscopic approach in this type of pathology analysis. This approach allows short recovery times, early initiation of oral intake, and better cosmetic results. No competing financial interests exist. Patient Consent Statement: All attempts have been exhausted in trying to contact the patient, next of kin, and/or parent/guardian for informed consent to publish their information, but consent could not be obtained. Runtime of video: 2 mins 58 secs The video was presented at “XXIV Congreso Colombiano de Cirugía Pediátrica,” March 2023, Rionegro, Colombia. The video was presented at “48th Congreso Semana Quirúrgica Nacional,” November 2022, Cartagena, Colombia.

Hugo RAS Robot-Assisted Partial Nephrectomy for High-Nephrometry Score Complex Renal Mass: Case Report and Surgical Technique

Hugo™ robot-assisted surgery (RAS) system has been conceived with enhanced modularity cart features and an independent arm-cart docking, nonetheless its role for nephron-sparing surgery has not been defined yet. From October 2022, 15, consecutive patients underwent off-clamp robot-assisted partial nephrectomy (RAPN) for T1 tumors. We are a solely off-clamp partial nephrectomy (PN) center, consequently the T2 RAPN was carried out clampless. Furthermore, we acquired experience and familiarity with Hugo RAS, thanks to an initial series of 15 robotic radical prostatectomies. We report the first RAPN with the new Hugo RAS system for a large highly complex right posterior hilar renal mass (8 cm, cT2) in a 63-year-old man with a BMI of 35.3 kg/m2. The choice to perform RAPN for high-nephrometry score renal mass without hilar clamping was because of the technique we usually perform at our center as we have never done on-clamp procedures. The purpose was to assess the feasibility and the modularity of Hugo RAS independent arm-cart docking even in complex posterior hilar renal tumor, and to explore its role in the setting of off-clamp RAPN. Preoperative hemoglobin, serum creatinine, and estimated glomerular filtration rate were 15.5 g/dL, 0.92 mg/dL, and 115.1 mL/min per 1.73 m2, respectively. The patient was placed on an extended flank position. A modified three-arm configuration was used by a conventional transperitoneal route. Port placement and docking time required 5 minutes. Complete kidney mobilization, identification of arterial branches feeding the tumor, and straightforward approach to the renal mass represented standard key steps of our off-clamp RAPN technique. Tumor enucleation was achieved developing an anatomical cleavage plane. Intraoperative bleeding was controlled with double suction, a slight increase of the pneumoperitoneum to 20 mm Hg, monopolar energy, and renorraphy with a 2/0 Monocryl single-running suture using a sliding-clip technique. No intraoperative complications occurred. No additional port placement was necessary. Console time was 110 minutes, estimated blood loss were ~500 mL. Patient was discharged on postoperative day 3 after bladder catheter and abdominal drain removal, with hemoglobin, serum creatinine, and eGFR of 11.8 g/dL (∆Hb 3.7 g/dL), 0.94 mg/dL, and 112.6 mL/min per 1.73 m2, respectively. Histologic evaluation revealed a chromophobe renal cell carcinoma. Considering the intra- and perioperative outcomes, the lack of complications, and the fast docking, this robotic platform seems to be an user-friendly technology. Currently, the small series considered as the granularity of data regarding the application of Hugo RAS in the RAPN setting hinder to assess that this novel platform is comparable with conventional robotic systems. Further studies with a larger cohort are needed to establish the noninferiority of this platform, but preliminary results seem encouraging. The authors declare no conflict of interest and any commercial associations during the past 3 years. No funding was received for this article. Informed Consent Statement: Informed consent was obtained from all subjects involved in the study. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. Institutional Review Board Statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Source of Work: This study was carried out at Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy. Runtime of video: 4 mins 45 secs

Sphincter First HoLEP: A New Technique to Improve Continence

Introduction: Transurethral enucleation of the prostate has proven to be a safe, effective, and durable technique in treating benign prostatic hyperplasia. Despite this, rates of postoperative stress urinary incontinence (SUI) are still an issue. We have been using en bloc enucleation for the past 4 years and, after mastering this technique, we developed an enucleation technique that, upon initially releasing the external sphincter, avoids the lesion caused by stretching and keeps the sphincteric mucosa intact. Our objective is to evaluate the safety, feasibility, and effect in SUI of a new surgical technique: sphincter first HoLEP (sf-HoLEP). Materials and Methods: sf-HoLEP was performed in 50 subjects by a single surgeon. Demographic and clinical data were collected. The annexed video shows the enucleation technique in detail. Results: Mean age was 72.8 years. Preoperative mean international prostatic symptoms score (IPSS) was 23.3. Preoperative mean peak flow and postvoid volume were 8.4 mL/s and 129.8 mL, respectively. Preoperative mean prostatic specific antigen was 6.1 ng/mL. Mean preoperative prostate volume was 95.8 cc (range 40–170 cc). sf-HoLEP was performed in the 50 subjects. The mean resected tissue was 68.8 g. No major complications were reported. Immediate continence was achieved in 48% of patients. At 1 and 6 months, the rate of reported stress incontinence was 4% and 2%. Compared with preoperative, IPSS scores, quality of life score, peak flow, and postvoid volume showed significative improvement at 6 months. Conclusion: sf-HoLEP is an innovative, feasible, and safe technique. sf-HoLEP seems to improve continence rates. Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. We declare that all authors have no conflicts of interest. Runtime of video: 9 mins 00 secs

Rezum: a novel transurethral water vapor therapy for benign prostatic hyperplasia

Rezum: a novel transurethral water vapor therapy for benign prostatic hyperplasia

The First Robotic Day Care Procedure in the Management of Testicular Vein Syndrome: A Rare Cause of Hydroureteronephrosis

Clinical History: A 46-year-old gentleman with no comorbidities presented with dull aching pain in the left loin for 6 months. Physical Examination: Examination was unremarkable. Diagnosis: He was evaluated with contrast-enhanced CT scan of the urinary tract that revealed left gross hydroureteronephrosis secondary to midureteral stricture caused by compression of the left testicular vein. Renogram (diethylenetriamine pentaacetate scan) was performed that showed 44% split renal function of the left kidney with a glomerular filtration rate of 86 mL/min. Intervention: He underwent a day-case robotic ureteroureterostomy and intraoperatively the upper ureter was dilated with testicular vein transposing above the midureter that had a stricture, causing dilatation of proximal ureter with hydronephrosis. Upper ureter was transected above the stricture and brought anterior to the testicular vein and the constricted segment was excised. Ureteroureterostomy was performed over 5F/26 cm Double-J stenting using 2-0 Stratafix suture. Outcomes: Follow-up included stent removal at 6 weeks and serial creatinine thereafter has been normal. Follow-up imaging was done in the form of ultrasonography that showed resolution of hydronephrosis at 3 months and 6 months. Patient Consent Statement: Written informed consent was obtained from the patient to publish this research. No competing financial interests exist.This research received no specific grant from any funding agency, commercial or nonprofit sectors. All authors confirm that they have been involved in the conception and design of the study, drafting of the study for intellectual content, and are accountable to the accuracy of all aspects of the content.Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure Runtime of video: 4 mins 17 secs

Single-Port Robotic Transvesical Simple Prostatectomy Step by Step

We detail the instruments required to perform a single-port robotic transvesical simple prostatectomy, as well as the surgical technique to perform this operation using the single-port robot. A 3-cm transverse incision is made three fingerbreadths above the pubic symphysis and a longitudinal cystotomy is made. The roll wound retractor rolling ring is inserted into the bladder lumen, with the access port, SP Short Entry Guide, and AirSeal trocar within it. The robot is then docked to the SP cannula, and the bladder is insufflated to 8 mm Hg. A semilunar incision is made through the bladder mucosa using the monopolar scissors along the posterior aspect of the bladder neck or median lobe. The forceps can be used to retract the prostatic adenoma, while using the monopolar scissors to further bluntly dissect the adenoma from the capsule. The prostatic adenoma can be removed en bloc, but is usually removed en lobe. A vesicourethral mucosal advancement flap is performed with 3-0 V-Loc suture from apex to base at 3-o-clock and 9-o-clock; a double-arm 3-0 V-Loc suture is then used to approximate the bladder and urethral mucosa, by running from 6-o-clock to 12-o-clock. Prostatic adenoma specimens can be removed from the SP Access Port directly or removed from the bladder using the robotic camera for observation. The cystotomy is closed in two layers with 3-0 Vicryl suture. The patient is observed for 2 hours on continuous bladder irrigation to determine ambulatory discharge eligibility. Follow-up is in 3 to 7 days for trial of void. Disclosure: Portions of this video and title were presented at the AUA 2023 in the form of a video abstract and as an AUA Core Curriculum video. https://www.auajournals.org/doi/pdf/10.1097/JU.0000000000003288.06 Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. There are no commercial associations during the past 3 years that might create a conflict of interest in connection with the video. Runtime of video: 7 mins 37 secs