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Radical cystoprostatectomy with intracorporeal orthotopic ileal neobladder reconstruction: 3D HD video laparoscopy
The author presents the case of a 64-year-old male patient with a high-grade urothelial carcinoma infiltrating the bladders (pT2-G2), with a CT-scan of the abdomen and thorax negative for secondary localizations. The patient was subjected to a radical cystoprostatectomy with intracorporeal orthotopic ileal neobladder reconstruction, performed entirely in 3D HD videolaparoscopy. After the intervention, the patient is mobilized early. Parenteral feeding is given until restoration of bowel peristalsis. The nasogastric tube is removed with restoration of bowel peristalsis. Continuous antibiotic treatment is administered for 7 days after surgery. Neobladder lavage is performed daily to evacuate mucus. Stents are inspected daily to ensure patency and sterile saline is used if there is any suspicion of obstruction. Deep vein thrombosis prophylaxis is continued. The drain is removed when the draining liquid is less than 50cc per day and when there is no urine leak. A cystogram is performed on postoperative day 14. The stents are removed sequentially at 24 hours of interval. The catheter is extracted from the neobladder 20 days after surgery. The patient is discharged from hospital 21 days after surgery. Two years after the intervention, he presents a negative oncology follow-up. The patient is in a satisfactory general health condition. He has fully recovered and returned to a normal professional life. He urinates regularly and empties his neobladder every 3 to 4 hours, with minimal stress incontinence, particularly in the evening when he is physically tired; he gains erectile activity with the use of medical devices, benefiting from a more effective intracavernous injection therapy and vacuum device, and pharmacotherapy proves less effective.
D Geddo
Surgical intervention
4 months ago
1960 views
12 likes
2 comments
17:33
Radical cystoprostatectomy with intracorporeal orthotopic ileal neobladder reconstruction: 3D HD video laparoscopy
The author presents the case of a 64-year-old male patient with a high-grade urothelial carcinoma infiltrating the bladders (pT2-G2), with a CT-scan of the abdomen and thorax negative for secondary localizations. The patient was subjected to a radical cystoprostatectomy with intracorporeal orthotopic ileal neobladder reconstruction, performed entirely in 3D HD videolaparoscopy. After the intervention, the patient is mobilized early. Parenteral feeding is given until restoration of bowel peristalsis. The nasogastric tube is removed with restoration of bowel peristalsis. Continuous antibiotic treatment is administered for 7 days after surgery. Neobladder lavage is performed daily to evacuate mucus. Stents are inspected daily to ensure patency and sterile saline is used if there is any suspicion of obstruction. Deep vein thrombosis prophylaxis is continued. The drain is removed when the draining liquid is less than 50cc per day and when there is no urine leak. A cystogram is performed on postoperative day 14. The stents are removed sequentially at 24 hours of interval. The catheter is extracted from the neobladder 20 days after surgery. The patient is discharged from hospital 21 days after surgery. Two years after the intervention, he presents a negative oncology follow-up. The patient is in a satisfactory general health condition. He has fully recovered and returned to a normal professional life. He urinates regularly and empties his neobladder every 3 to 4 hours, with minimal stress incontinence, particularly in the evening when he is physically tired; he gains erectile activity with the use of medical devices, benefiting from a more effective intracavernous injection therapy and vacuum device, and pharmacotherapy proves less effective.
Right laparoscopic ureteroureteroplasty
Lower ureteral strictures are commonly managed with ureteral reimplant surgeries. However, some patients still have a good distal ureteral stump, which can be used in the repair of these pathologies. In those cases, reimplant ureteral surgeries and their surgical maneuvers, e.g. psoas hitch, Boari flap, are not the best management options.
This video shows a ureteroureteroplasty in a 37-year-old female patient with ureteral stricture at the level of the crossing iliac vessels due to several previous endoscopic manipulations for the treatment of ureteral/kidney stones.
The ureteroureteroplasty technique was chosen since the proximal and distal parts of the ureter near the stenosed area were healthy.
At the end of the video, preoperative MRI and 1-year follow-up CT urogram 3D reconstructions are placed side by side, demonstrating the resolution of hydronephrosis.
B Lopes-Cançado Machado, V Chamum Costa
Surgical intervention
1 year ago
2241 views
3 likes
0 comments
08:39
Right laparoscopic ureteroureteroplasty
Lower ureteral strictures are commonly managed with ureteral reimplant surgeries. However, some patients still have a good distal ureteral stump, which can be used in the repair of these pathologies. In those cases, reimplant ureteral surgeries and their surgical maneuvers, e.g. psoas hitch, Boari flap, are not the best management options.
This video shows a ureteroureteroplasty in a 37-year-old female patient with ureteral stricture at the level of the crossing iliac vessels due to several previous endoscopic manipulations for the treatment of ureteral/kidney stones.
The ureteroureteroplasty technique was chosen since the proximal and distal parts of the ureter near the stenosed area were healthy.
At the end of the video, preoperative MRI and 1-year follow-up CT urogram 3D reconstructions are placed side by side, demonstrating the resolution of hydronephrosis.
Laparoscopic peritoneal dialysis catheter placement: step by step approach
This is the case of an 87-year-old man with a history of chronic kidney disease stage 5 proposed for dialysis.
The patient had a medical history of diabetes mellitus type 2 over 10 years, hypertension, anemia treated with erythropoietin. The patient was a former smoker.
After explaining to the patient and his family the option between hemodialysis and peritoneal dialysis, the patient opted for the peritoneal one.
He was admitted electively and submitted to 3D laparoscopic peritoneal dialysis catheter placement. The surgery and post-operative period were uneventful. The patient was discharged on postoperative day 2.
F Cabral, J Grenho, R Roque, R Maio
Surgical intervention
2 years ago
2823 views
158 likes
0 comments
06:36
Laparoscopic peritoneal dialysis catheter placement: step by step approach
This is the case of an 87-year-old man with a history of chronic kidney disease stage 5 proposed for dialysis.
The patient had a medical history of diabetes mellitus type 2 over 10 years, hypertension, anemia treated with erythropoietin. The patient was a former smoker.
After explaining to the patient and his family the option between hemodialysis and peritoneal dialysis, the patient opted for the peritoneal one.
He was admitted electively and submitted to 3D laparoscopic peritoneal dialysis catheter placement. The surgery and post-operative period were uneventful. The patient was discharged on postoperative day 2.
Hand-assisted laparoscopic live donor nephrectomy
Introduction and purpose: The shortage of cadaver donor organs and the progressive acceptation of laparoscopic procedures have significantly increased the number of living donor transplants. Laparoscopic nephrectomy has been rapidly and progressively incorporated as a therapeutic option in most hospitals. We describe the current surgical technique for living donor nephrectomy in our hospital.
Materials and methods: A 42-year-old woman with a medical history of hypertension and end-stage renal disease by IgA glomerulonephritis in predialysis program underwent a living donor transplantation. The donor was her sister, a woman aged 51, with no medical past history. We performed a left laparoscopic nephrectomy, and removal of the graft was performed using a hand-assisted device fixed in a supraumbilical 5cm laparotomy.
Results: Hospital stay was 3 days for the donor and 4 days for the receptor. The receptor had a postoperative creatinine of 1.76 mg/dL. In the third year of follow-up creatinine was 1.46 mg/dL.
Conclusions: Laparoscopic donor nephrectomy has proven to be a safe, less invasive, and effective technique for the renal graft. It has encouraged donation from living donors, given its esthetic results and comfort for the donor.
S Valverde-Martinez , A Martin-Parada, A Palacios-Hernandez, O Heredero-Zorzo, P Eguiluz-Lumbreras, J Garcia-Garcia, R Gomez-Zancajo, F Gomez-Veiga
Surgical intervention
2 years ago
1885 views
151 likes
0 comments
08:47
Hand-assisted laparoscopic live donor nephrectomy
Introduction and purpose: The shortage of cadaver donor organs and the progressive acceptation of laparoscopic procedures have significantly increased the number of living donor transplants. Laparoscopic nephrectomy has been rapidly and progressively incorporated as a therapeutic option in most hospitals. We describe the current surgical technique for living donor nephrectomy in our hospital.
Materials and methods: A 42-year-old woman with a medical history of hypertension and end-stage renal disease by IgA glomerulonephritis in predialysis program underwent a living donor transplantation. The donor was her sister, a woman aged 51, with no medical past history. We performed a left laparoscopic nephrectomy, and removal of the graft was performed using a hand-assisted device fixed in a supraumbilical 5cm laparotomy.
Results: Hospital stay was 3 days for the donor and 4 days for the receptor. The receptor had a postoperative creatinine of 1.76 mg/dL. In the third year of follow-up creatinine was 1.46 mg/dL.
Conclusions: Laparoscopic donor nephrectomy has proven to be a safe, less invasive, and effective technique for the renal graft. It has encouraged donation from living donors, given its esthetic results and comfort for the donor.
Mixed robotic laparoscopic synchronous left colectomy and left renal tumor enucleation
A 45-year-old woman with abdominal pain and hematochezia was found with adenocarcinoma of the sigmoid colon causing incomplete obstruction. CT-scan revealed a 5cm exophytic tumor of the superior pole of the left kidney.
Synchronous Left Colectomy (LC) and Renal Tumor Enucleation (RTE) were scheduled. Robotic surgery was preferred for RTE, but when performed first, splenic flexure mobilization could well interfere with subsequent LC.

Starting with a standard robotic LC would make multiple dockings and patient position changes necessary.
To overcome these problems, we adapted the technique of LC to the lateral position required for RTE and performed robotic vascular ligation of the left colon first. Robotic left colon mobilization and RTE were then performed to finally achieve colectomy and colorectal anastomosis by means of laparoscopy with the patient in a standard lithotomy position.
The procedure required only one docking of the robot and only one change in patient position. A compromise in port site positioning was obtained between the two procedures. One short incision was performed to retrieve both specimens and the same robotic instruments were used for both procedures.
Operative time was 350 minutes. The patient recovered well and no complications were noted. She was discharged on postoperative day 7.
M Lotti, RLJ Naspro, L Rocchini, L Campanati, L Da Pozzo, L Ansaloni
Surgical intervention
3 years ago
1352 views
43 likes
0 comments
16:25
Mixed robotic laparoscopic synchronous left colectomy and left renal tumor enucleation
A 45-year-old woman with abdominal pain and hematochezia was found with adenocarcinoma of the sigmoid colon causing incomplete obstruction. CT-scan revealed a 5cm exophytic tumor of the superior pole of the left kidney.
Synchronous Left Colectomy (LC) and Renal Tumor Enucleation (RTE) were scheduled. Robotic surgery was preferred for RTE, but when performed first, splenic flexure mobilization could well interfere with subsequent LC.

Starting with a standard robotic LC would make multiple dockings and patient position changes necessary.
To overcome these problems, we adapted the technique of LC to the lateral position required for RTE and performed robotic vascular ligation of the left colon first. Robotic left colon mobilization and RTE were then performed to finally achieve colectomy and colorectal anastomosis by means of laparoscopy with the patient in a standard lithotomy position.
The procedure required only one docking of the robot and only one change in patient position. A compromise in port site positioning was obtained between the two procedures. One short incision was performed to retrieve both specimens and the same robotic instruments were used for both procedures.
Operative time was 350 minutes. The patient recovered well and no complications were noted. She was discharged on postoperative day 7.
Laparoscopic omentoplasty to support anastomotic urethroplasty in complex and redo pelvic fracture urethral injury patient
Introduction:
The aim of this film was to test the feasibility, safety and efficiency of a new surgical technique using elaborated perineal anastomotic urethroplasty combined with laparoscopic omentoplasty for patients with complex pelvic fracture and for whom a previous urethral defect repair failed.

Material and methods:
We performed a prospective, observational, stage 2a study to observe treatment outcomes of combined perineal and laparoscopic approaches for urethroplasty in patients with complex and redo pelvic fracture urethral defects at a single center in Pune, India, between January 2012 and January 2013.
Anterior urethral strictures were excluded. The primary aim of the study was to evaluate the efficiency of the surgical technique and the secondary aim was to test the feasibility and safety of the procedure. The procedure was considered as ineffective if any additional postoperative procedure was required.

Results:
Fifteen male patients with a median age of 19 years old were included. Seven patients were adolescents (12-18 years of age) and 8 patients were adults (19-49 years of age). The mean number of prior urethroplasties was 1.8 (1-3). All patients underwent elaborated bulbomembranous anastomosis using a perineal approach with inferior pubectomy combined with laparoscopic mobilization of the omentum into the perineum to wrap the anastomosis.
In 15 patients, 14 (93.3%) had a successful outcome and the procedure failed in 1 patient (6.6%). A 14-year-old boy developed a recurrent stricture 2 months after the procedure, which was managed using an internal urethrotomy. Median follow-up was 18 months (13-24 months).

Conclusion:
Combining a laparoscopic omentoplasty with a membranobulbar anastomosis for complex and redo pelvic fracture urethral injury is a successful, feasible and safe technique, and with minimal additional morbidity for the patient. This technique offers the advantages of a perineal incision and allows to use the omentum in order to facilitate the anastomosis.
S Kulkarni, G Barbagli, J Kulkarni, S Surana, V Batra, P Joshi
Surgical intervention
4 years ago
1290 views
66 likes
0 comments
07:58
Laparoscopic omentoplasty to support anastomotic urethroplasty in complex and redo pelvic fracture urethral injury patient
Introduction:
The aim of this film was to test the feasibility, safety and efficiency of a new surgical technique using elaborated perineal anastomotic urethroplasty combined with laparoscopic omentoplasty for patients with complex pelvic fracture and for whom a previous urethral defect repair failed.

Material and methods:
We performed a prospective, observational, stage 2a study to observe treatment outcomes of combined perineal and laparoscopic approaches for urethroplasty in patients with complex and redo pelvic fracture urethral defects at a single center in Pune, India, between January 2012 and January 2013.
Anterior urethral strictures were excluded. The primary aim of the study was to evaluate the efficiency of the surgical technique and the secondary aim was to test the feasibility and safety of the procedure. The procedure was considered as ineffective if any additional postoperative procedure was required.

Results:
Fifteen male patients with a median age of 19 years old were included. Seven patients were adolescents (12-18 years of age) and 8 patients were adults (19-49 years of age). The mean number of prior urethroplasties was 1.8 (1-3). All patients underwent elaborated bulbomembranous anastomosis using a perineal approach with inferior pubectomy combined with laparoscopic mobilization of the omentum into the perineum to wrap the anastomosis.
In 15 patients, 14 (93.3%) had a successful outcome and the procedure failed in 1 patient (6.6%). A 14-year-old boy developed a recurrent stricture 2 months after the procedure, which was managed using an internal urethrotomy. Median follow-up was 18 months (13-24 months).

Conclusion:
Combining a laparoscopic omentoplasty with a membranobulbar anastomosis for complex and redo pelvic fracture urethral injury is a successful, feasible and safe technique, and with minimal additional morbidity for the patient. This technique offers the advantages of a perineal incision and allows to use the omentum in order to facilitate the anastomosis.
Video endoscopic inguinal lymphadenectomy (VEIL) for penile cancer
This video reports the endoscopic technique used for the dissection of inguinal lymph nodes as complementary treatment for penile cancer.
Laparoscopic surgery has been used in iliac and retroperitoneal lymph nodes approaches, as well as for inguinal nodes dissection (video endoscopic) with fewer sequels and faster recuperation, according to conventional surgery indications.
This technique is indicated in patients presenting with penile cancer, in the following situations:
- after local treatment;
- when there is a lymph node mass less than 4cm;
- when mobile palpable lymph nodes appear in the postoperative follow-up;
- when there are risk factors for the development of inguinal metastasis (clinical stage > T1 or information regarding the initial biopsy such as histological grade > 1, lymphatic or vascular invasion).
This operation is performed bilaterally once.
This technique duplicates the conventional technique principles, promoting a radical resection of inguinal lymph nodes, regarding the reduction of surgical morbidity.
The video demonstrates that this procedure is feasible and safe with encouraging results.
References:

1. Bevan-Thomas R, Slaton JW, Pettaway CA: Contemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the M.D. Anderson Cancer Center Experience. J Urol 2002;167:1638-42.

2. Barnholtz-Sloan JS, Maldonado JL, Pow-Sang J, Giuliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol 2007;25:361-7.

3. Bishoff JA, Lackland AF, Basler JW, Teichman JM, Thompson IM: Endoscopy subcutaneous modified inguinal lymph node dissection (ESMIL) for squamous cell carcinoma of the penis. J Urol 2003:169;Suppl 4:78.

4. Dardour JC, Ktorza T: Endoscopic deep periorbital lifting: study and results based on 50 consecutive cases. Aesthetic Plast Surg 2000;24:292-8.

5. D’Ancona CA, de Lucena RG, Querne FA, Martins MH, Denardi F, Netto NR Jr: Long-term follow-up of penile carcinoma treated with penectomy and bilateral modified inguinal lymphadenectomy. J Urol 2004;172:498-501;discussion 501.

6. Folliguet TA, Le Bret E, Moneta A, Musumeci S, Laborde F: Endoscopic saphenous vein harvesting versus ‘open’ technique. A prospective study. Eur J Cardiothorac Surg 1998;13:662-6.

7. Horenblas S. Lymphadenectomy for squamous cell carcinoma of the penis. Part 2: the role and technique of lymph node dissection. BJU Int 2001;88:473-83.

8. Hungerhuber E, Schlenken B, Karl A, et al. Risk stratification in penile carcinoma: 25-year experience with surgical inguinal lymph node staging. Urology 2006;68:621-5.

9. Leijte JA, Kroon BK, Valdés Olmos RA, Nieweg OE, Horenblas S. Reliability and safety of current dynamic sentinel node biopsy for penile carcinoma. Eur Urol 2007;52:170-7.

10. Machado MT, Tavares A, Molina Jr WR, Zambon JP, Forsetto Jr P, Juliano RV, Wroclawski ER: Comparative study between videoendoscopic radical inguinal lymphadenectomy (VEIL) and standard open lymphadenectomy for penile cancer: preliminary surgical and oncological results. J Urol 2005;173:226, Abst 834.

11. Ornellas AA, Seixas AL, Marota A, Wisnescky A, Campos F, de Moraes JR. Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol 1994;151:1244-9.

12. Hegarty PK, Dinney CP, Pettaway CA. Controversies in Ilioinguinal lymphadenectomy. Urol Clin North Am 2010;37:421-34.

13. Protzel C, Alcaraz A, Horenblas S, Pizzocaro G, Zlotta A, Hakenberg OW. Lymphadenectomy in the surgical management of penile cancer. Eur Urol 2009;55:1075-88.

14. Sotelo R, Sánchez-Salas R, Carmona O, Garcia A, Mariano M, Neiva G, Trujillo G, Novoa J, Cornejo F, Finelli A. Endoscopic lymphadenectomy for penile carcinoma. J Endourol 2007;21:364-7;discussion 367.

15. Tobias-Machado M, Tavares A, Ornellas AA, Molina WR Jr, Juliano RV, Wroclawski ER. Video endoscopic inguinal lymphadenectomy: a new minimally invasive procedure for radical management of inguinal nodes in patients with penile squamous cell carcinoma. J Urol 2007;177:953-7;discussion 958.

16. Velasquez EF, Melamed J, Barreto JE, Aguero F, Cubilla AL. Sarcomatoid carcinoma of the penis. A clinicopathologic study of 15 cases. Am J Surg Pathol 2005;29:1152-8.

17. Master V, Ogan K, Kooby D, Hsiao W, Delman K. Leg endoscopic groin lymphadenectomy (LEG procedure): step-by-step approach to a straightforward technique. Eur Urol 2009;56:821-8.
VE Corona Montes, T Machado, C Fraga, T Piéchaud
Surgical intervention
5 years ago
2838 views
78 likes
0 comments
11:31
Video endoscopic inguinal lymphadenectomy (VEIL) for penile cancer
This video reports the endoscopic technique used for the dissection of inguinal lymph nodes as complementary treatment for penile cancer.
Laparoscopic surgery has been used in iliac and retroperitoneal lymph nodes approaches, as well as for inguinal nodes dissection (video endoscopic) with fewer sequels and faster recuperation, according to conventional surgery indications.
This technique is indicated in patients presenting with penile cancer, in the following situations:
- after local treatment;
- when there is a lymph node mass less than 4cm;
- when mobile palpable lymph nodes appear in the postoperative follow-up;
- when there are risk factors for the development of inguinal metastasis (clinical stage > T1 or information regarding the initial biopsy such as histological grade > 1, lymphatic or vascular invasion).
This operation is performed bilaterally once.
This technique duplicates the conventional technique principles, promoting a radical resection of inguinal lymph nodes, regarding the reduction of surgical morbidity.
The video demonstrates that this procedure is feasible and safe with encouraging results.
References:

1. Bevan-Thomas R, Slaton JW, Pettaway CA: Contemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the M.D. Anderson Cancer Center Experience. J Urol 2002;167:1638-42.

2. Barnholtz-Sloan JS, Maldonado JL, Pow-Sang J, Giuliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol 2007;25:361-7.

3. Bishoff JA, Lackland AF, Basler JW, Teichman JM, Thompson IM: Endoscopy subcutaneous modified inguinal lymph node dissection (ESMIL) for squamous cell carcinoma of the penis. J Urol 2003:169;Suppl 4:78.

4. Dardour JC, Ktorza T: Endoscopic deep periorbital lifting: study and results based on 50 consecutive cases. Aesthetic Plast Surg 2000;24:292-8.

5. D’Ancona CA, de Lucena RG, Querne FA, Martins MH, Denardi F, Netto NR Jr: Long-term follow-up of penile carcinoma treated with penectomy and bilateral modified inguinal lymphadenectomy. J Urol 2004;172:498-501;discussion 501.

6. Folliguet TA, Le Bret E, Moneta A, Musumeci S, Laborde F: Endoscopic saphenous vein harvesting versus ‘open’ technique. A prospective study. Eur J Cardiothorac Surg 1998;13:662-6.

7. Horenblas S. Lymphadenectomy for squamous cell carcinoma of the penis. Part 2: the role and technique of lymph node dissection. BJU Int 2001;88:473-83.

8. Hungerhuber E, Schlenken B, Karl A, et al. Risk stratification in penile carcinoma: 25-year experience with surgical inguinal lymph node staging. Urology 2006;68:621-5.

9. Leijte JA, Kroon BK, Valdés Olmos RA, Nieweg OE, Horenblas S. Reliability and safety of current dynamic sentinel node biopsy for penile carcinoma. Eur Urol 2007;52:170-7.

10. Machado MT, Tavares A, Molina Jr WR, Zambon JP, Forsetto Jr P, Juliano RV, Wroclawski ER: Comparative study between videoendoscopic radical inguinal lymphadenectomy (VEIL) and standard open lymphadenectomy for penile cancer: preliminary surgical and oncological results. J Urol 2005;173:226, Abst 834.

11. Ornellas AA, Seixas AL, Marota A, Wisnescky A, Campos F, de Moraes JR. Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol 1994;151:1244-9.

12. Hegarty PK, Dinney CP, Pettaway CA. Controversies in Ilioinguinal lymphadenectomy. Urol Clin North Am 2010;37:421-34.

13. Protzel C, Alcaraz A, Horenblas S, Pizzocaro G, Zlotta A, Hakenberg OW. Lymphadenectomy in the surgical management of penile cancer. Eur Urol 2009;55:1075-88.

14. Sotelo R, Sánchez-Salas R, Carmona O, Garcia A, Mariano M, Neiva G, Trujillo G, Novoa J, Cornejo F, Finelli A. Endoscopic lymphadenectomy for penile carcinoma. J Endourol 2007;21:364-7;discussion 367.

15. Tobias-Machado M, Tavares A, Ornellas AA, Molina WR Jr, Juliano RV, Wroclawski ER. Video endoscopic inguinal lymphadenectomy: a new minimally invasive procedure for radical management of inguinal nodes in patients with penile squamous cell carcinoma. J Urol 2007;177:953-7;discussion 958.

16. Velasquez EF, Melamed J, Barreto JE, Aguero F, Cubilla AL. Sarcomatoid carcinoma of the penis. A clinicopathologic study of 15 cases. Am J Surg Pathol 2005;29:1152-8.

17. Master V, Ogan K, Kooby D, Hsiao W, Delman K. Leg endoscopic groin lymphadenectomy (LEG procedure): step-by-step approach to a straightforward technique. Eur Urol 2009;56:821-8.