Robot-assisted minimally invasive surgery has become a routine surgical option for the treatment of prostate cancer. Despite its technical advancements, the da Vinci(®) Surgical System still lacks haptic feedback to the surgeon, resulting in a maximally applied compressive force by the robotic needle driver during every grasping maneuver. Without this perceptional sense of touch and grip control, repetitive robotic needle driver manipulation may unknowingly lead to irreparable damage to fine sutures used during delicate anastomotic repairs. For robotic prostatectomy, any such loss of integrity can potentially lead to premature breakdown of the urethrovesical anastomosis and urine extravasation, especially important for a less-than-perfectly fashioned anastomotic repair. Although it has already been established that overhandling of sutures using handheld laparoscopic instruments can lead to reduced suture strength, it has not been established to what extent this may occur after robotic surgical procedures. We present analytical data and analyses concerning the failure strength of fine sutures commonly used for urethrovesical anastomotic repair during robotic prostatectomy, after repetitive robotic needle driver manipulation. When compared with noncompromised monofilament suture controls, the average maximal failure force after repetitive robotic manipulation was significantly reduced by 35% (p < 0.0001). Similarly, the average maximal failure force of braided sutures was significantly reduced after repetitive robotic manipulation by 3% (p = 0.009). This work demonstrates that significant reductions in monofilament and braided suture strength integrity can occur after customary repetitive manipulation by robotic needle drivers in an ex vivo model, with further research warranted in the in vivo setting.

Penile fractures are classically described as presenting with rapid detumescence of an erection associated with blunt trauma. This clinical finding is due to a tear in the tunica albuginea surrounding the corpora cavernosum. We, however, present the case of a patient who presented with a 'classical' penile fracture but was found on surgical exploration to only have an isolated corpus spongiosum injury.

The relatively low total cost, ready material availability, and ease of construction make this trainer an appropriate option for the training of residents in laparoscopic procedures.

The significant and frequent morbidity of post-procedural urinary tract infections has resulted in both the American Urological Association and European Association of Urology developing guidelines and recommendations. The difficulty with any guideline is the practical application to the office setting. The goal is to effectively and safely evaluate and treat patients by efficient and cost-sensitive means. By creating an algorithm to aid in the application of the guidelines, the clinician can identify the high-risk patient and potentially reduce post-procedural urinary tract infections in an efficient and cost-effective manner.