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Background To evaluate the outcome and complication rate in a single institution experience using the two most commonly used techniques of ureteroenteric anastomosis, the Bricker and Wallace anastomosis. Methods A total of 137 patients underwent ileal conduit for bladder cancer. Ureters were anastomosed by two experienced surgeons, one performing a Bricker and the other, a Wallace anastomosis. Stricture was identified during clinical follow-up. Results Seventy-five patients underwent a Bricker anastomotic, and 65 received a Wallace anastomosis. The average age was 70 in both groups, males were predominant (66% Bricker, 70% Wallace). Follow up period was 36.5 months in Bricker group and 17 months in Wallace group. In both groups, the body mass index (BMI) was similar (26.1 kg/m 2 Bricker and 26.4 kg/m 2 Wallace). We observed that the stricture rate after performing the Bricker anastomosis technique was 25.3% (19/75) as compared to 7.7% (5/65) after Wallace anastomosis technique, which was statistically significant ( p  = 0.001). In the Bricker group, patients with strictures had higher BMI (28.3 vs. 25.7 kg/m 2 , p  = 0.05). On average it took 8.5 months in the Bricker group and three months in the Wallace group ( p  = 0.6) to develop stricture. Conclusions The stricture rate was significantly higher when Bricker technique was applied. Although the BMI was not different in both groups, patients with a higher BMI were more likely to develop stricture. We believe that the approach of the separate and refluxing technique of Bricker anastomosis especially in obese patients poses a higher risk for anastomotic stricture formation.

Background This study aimed to compare laparoendoscopic single-site varicocelectomy (LESSV) with multiport laparoscopic varicocelectomy (MLV) in terms of intraoperative parameters and postoperative outcomes. Methods A retrospective case–control study investigated 10 male adolescents and 89 adults who underwent either LESSV or MLV at the authors’ center. The reusable X-Cone single port was inserted transumbilically. A 5-mm 30° telescope was used together with a straight and a prebent laparoscopic instrument. The MLV procedure was performed using two 5-mm ports and one 10-mm port. Results Between January 2009 and November 2012, 20 patients underwent LESSV and 79 patients underwent MLV. The demographic data were comparable between the two groups. The mean operating time was 59.1 ± 15.5 min for LESSV and 51.2 ± 14.4 min for MLV ( P  = 0.04). In the LESSV group, no conversion to MLV was necessary. The hospital stay was 1.6 ± 0.7 days in the LESSV group versus 1.8 ± 0.5 days in the MLV group ( P  = 0.17). The postoperative pain scores did differ between the two groups. By day 2, significantly more patients in the LESSV group than in the MLV group fully recovered their normal physical activity ( P  = 0.02). Comparison of pre- and postoperative values showed relief of testicular pain and improvement of semen parameters for the majority of the patients. The overall incidence of complications was distributed equally between the two groups as follows: paresthesia of the upper thigh (8 %), wound infection (5 %), epididymitis (3 %) and hydrocele (4 %). All the patients in the LESSV group were fully satisfied with their cosmetic results compared with only 76 % of the patients in the MLV group ( P  = 0.01). Conclusions The LESSV procedure performed with the reusable X-Cone is as safe and efficient as MLV. After LESSV, the parameters measuring postoperative patient satisfaction are significantly improved. Given its reusable components, including prebent laparoscopic instruments, the X-Cone platform is a cost-effective alternative to disposable or homemade single ports.

Within the BUSTER trial, we analyzed the surgeon’s amount of experience and other parameters associated with URS procedures regarding the stone-free rate, complication rate, and operative time. Patient characteristics and surgical details on 307 URS procedures were prospectively documented according to a standardized study protocol at 14 German centers 01–04/2015. Surgeon’s experience was correlated to clinical characteristics, and its impact on the stone-free rate, complication rate, and operative time subjected to multivariate analysis. 76 (25%), 66 (21%) and 165 (54%) of 307 URS procedures were carried out by residents, young specialists, and experienced specialists (> 5 years after board certification), respectively. Median stone size was 6 mm, median operative time 35 min. A ureteral stent was placed at the end of 82% of procedures. Stone-free rate and stone-free rate including minimal residual stone fragments (adequate for spontaneous clearance) following URS were 69 and 91%, respectively. No complications were documented during the hospital stays of 89% of patients (Clavien–Dindo grade 0). According to multivariate analysis, experienced specialists achieved a 2.2-fold higher stone-free rate compared to residents (p = 0.038), but used post-URS stenting 2.6-fold more frequently (p = 0.023). Surgeon’s experience had no significant impact on the complication rate. We observed no differences in this study’s main endpoints, namely the stone-free and complication rates, between residents and young specialists, but experienced specialists’ stone-free rate was significantly higher. During this cross-sectional study, 75% of URS procedures were performed by specialists. The experienced specialists’ more than two-fold higher stone-free rate compared to residents’ justifies ongoing efforts to establish structured URS training programs.

SummaryBackgroundDespite the high utilisation of ureterorenoscopy (URS) in interventional stone treatment, there is little evidence of any link between annual hospital volume and outcome.MethodsFrom January to April 2015, data from 307 URS patients were prospectively recorded in the multicentre observational BUSTER-Trial (Benchmarks of ureterorenoscopic stone treatment-results in terms of complications, quality of life, and stone-free rates). The best threshold value for annual hospital volume with an independent effect on the outcome (measured on stone-free and complication rates) of our study group was established with logistic regression.ResultsIn 38.4% of cases of renal and 61.6% of ureteral stones, median stone size was 6 mm with an interquartile range (IQR) of 4–8 mm. The annual URS rate in the 14 participating hospitals ranged from 77 to 333 (median 144; IQR 109–208). The binary endpoint as a combination of completely stone-free or residual fragments small enough to pass spontaneously and a maximum complication severity of Clavien–Dindo grade 1 was attained in 234/252 (92.9%) cases with a hospital volume of ≥ 99 URS compared with 43/55 (78.2%) in < 99 URS (p = 0.002). Adjusted for patient-, stone- and physician-related factors, an annual hospital URS volume of ≥ 99 increases the chance of an optimum outcome (OR = 3.92; 95% CI 1.46–10.51; p = 0.007).ConclusionsAn independent effect of URS hospital volume on outcome quality in the 14 participating hospitals was demonstrated. Threshold values for annual case numbers should be scientifically established irrespective of the considered procedure.

HintergrundDie „Post-Ureteroscopic Lesion Scale“ (PULS) wurde als eine Klassifikation zur Standardisierung der iatrogenen Harnleiterläsionen während der Ureterorenoskopie (URS) vorgestellt. Mit der vorliegenden Studie sollen die praktische Anwendung und der mögliche klinische Nutzen des PULS-Scores an einem repräsentativen Patientenkollektiv überprüft werden.Material und MethodeIm Rahmen der prospektiven BUSTER-Studie (Bewertung der ureterorenoskopischen Steintherapie – Ergebnisse hinsichtlich Komplikationen, Lebensqualität und Steinfreiheitsrate) konnten Daten von 307 Patienten aus 14 deutschen Kliniken aufgezeichnet werden. Für die hier vorgestellte Arbeit wurden drei Studienhypothesen (H) überprüft: Es besteht eine hohe Übereinstimmung der unabhängig zu einander erfolgten PULS-Graduierungen von Operateur und Pflegeassistenzpersonal (H1), es gibt eine positive Korrelation der PULS-Grade mit der postoperativen Komplikationsdichte während des stationären Aufenthalts (H2), es liegt eine signifikante Übereinstimmung des postinterventionellen Harnleiterstentings mit den verursachten PULS-Graden vor (H3).ErgebnisseDas mediane Alter der Studienpatienten lag bei 54,4 („interquartile range“ [IQR] 44,4–65,84) Jahren; 65,5 % der Patienten waren männlichen Geschlechts. Die mediane Steingröße des Indexkonkrements betrug 6 (IQR, 4–8) mm, wobei 117 (38,4 %) und 188 (61,6 %) der Indexkonkremente in der Niere bzw. im Harnleiter lagen. 70 und 82,4 % erhielten ein präoperatives bzw. postoperatives Harnleiterstenting. 68,7 % der Studienpatienten waren nach einer URS komplett steinfrei, die Komplikationsrate betrug 10,8 % (dominant Grad 1 oder 2 nach Clavien-Dindo). Die PULS-Grade 0, 1, 2 und 3 nach Einschätzung des Operateurs lagen bei 40 %, 52,1 %, 6,9 % bzw. 1 %. Es bestand eine hohe Interobserver-Übereinstimmung der erfolgten Pulsgraduierungen zwischen Operateur und Pflegeassistenzpersonal (κ = 0,883, p < 0,001; H1+). Eine signifikante Korrelation zwischen dem PULS-Grad und den aufgezeichneten Komplikationen konnte nicht gefunden werden (ρ = 0,09, p = 0,881; H2−). Es bestand hingegen eine signifikante positive Korrelation zwischen dem PULS-Grad und der postoperativen Einlage eines Harnleiterstents (ρ = 0,287, p < 0,001; H3+), wobei hier beispielsweise ein PULS-Grad 1 (im Vergleich zu PULS-Grad 0) die Wahrscheinlichkeit um den Faktor 3,24 erhöhte (95 %-Konfidenzintervall 1,43–7,34, p = 0,005).SchlussfolgerungDie URS ist in der täglichen Routine ein sicheres und effektives Verfahren zur Behandlung von Konkrementen des oberen Harntrakts. Die vorliegenden „Real-world-Daten“ bestätigen die hohe Interrater-Reliabilität des PULS-Scores und dessen potentiellen Anwendernutzen hinsichtlich der Indikationsstellung zur postoperativen Harnleiterschienung. Auf der Basis des PULS-Scores sollte jetzt eine prospektiv-randomisierte Studie prüfen, inwieweit die Standardisierung einer postoperativen Harnleiterstenteinlage erfolgen kann.

A very short synthesis of the racemic cecropia hormone has been realized, utilizing a Claisen reaction. Methyl 6-hydroxy-3-methyl-7-methylene-2-trans-nonenoate, on treatment with the dimethyl ketal of 3-chloro-3-methyl-2-pentanone and a catalytic amount of 2,4-dinitrophenol, is transformed directly into methyl 11-chloro-3, 11-dimethyl-7-ethyl-10-oxo-2-trans, 6-trans-tridecadienoate. Selective reduction gives a mixture of diastereoisomeric chlorohydrins separable by chromatography. The predominant threo-chlorohydrin is transformed into the juvenile hormone.

Experimental details are reported for a previously described synthesis of cecropia juvenile hormone.Experimental details are reported for a previously described synthesis of cecropia juvenile hormone.