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This study compared patient outcomes following irrigation applied using an automated pressure system (AP) to hand irrigation utilizing a syringe (HI) during ureteroscopy. Retrospective chart review was performed to evaluate ureteroscopy procedures without a ureteral access sheath. Procedures in which irrigation was applied by AP were compared to those with HI. Statistical analyses included chi-squared tests and Student's t tests. The AP group contained 206 procedures and the HI group, 25. The AP and HI groups were 54.9% and 36% male, respectively. Mean ages were 53.7 ± 18.9 years in the AP group and 44.0 ± 18.5 years in the HI group. Complication rates were 11.2% in the AP and 8.3% in the HI group (P > 0.99). One stone retrieval failure and one stone recurrence occurred in the HI group; one patient had residual stone in the AP group. No urinary tract infections occurred in the HI group; in the AP group, urinary tract infections occurred in 1.9% of cases. The postoperative pain incidence was equivalent (P ¼ 0.498). The AP group had one subcapsular hematoma; no calyceal ruptures occurred in either group. In conclusion, irrigation applied by an automated setup appears safe, with similar outcomes to irrigation applied with a handheld syringe.

Mantle cell lymphoma of the prostate is rare and is seldom encountered in general urologic practice. It either arises primarily from the prostate or is a result of metastatic spread from another site. This specific type of lymphoma has an aggressive course and may respond poorly to traditional chemotherapy with frequent relapses. Mantle cell lymphoma occurs in middle age or older, which is also when symptoms of benign prostatic enlargement begin in men. This overlap makes the diagnosis of lymphoma of the prostate difficult and makes the treatment more complex. We describe a case of mantle cell lymphoma of the prostate that caused significant enlargement and bladder outlet obstruction with urinary retention. The obstruction was treated with holmium laser enucleation of the prostate with good functional results. L ymphoma of the prostate is an exceedingly rare entity, with less than 200 reported cases (1). Mantle cell lymphoma (MCL) of the prostate is even less common, with only 7 reported cases (2-6). We report a case of a 59-yearold man with MCL of the prostate that was discovered after holmium laser enucleation of the prostate. CASE PRESENTATIONA 59-year-old man was referred by his primary care provider for progressive lower urinary tract symptoms. He had been treated for MCL during the prior 8 years with several clinical relapses. Initially he was treated with traditional chemotherapy, and he received chemotherapy with autologous stem cell transplantation 2 years later for disease recurrence. He did well for many years and was successfully treated with salvage bendamustine/rituximab chemotherapy 6 months prior to his prostate surgery. A follow-up computed tomography scan after this latest treatment showed complete radiographic resolution of his lymphoma.Several months after completing the most recent chemotherapy, his symptoms of nocturia, hesitancy, urgency, and frequency eventually progressed to complete urinary retention. Digital rectal exam revealed an enlarged prostate without nodules and was overall considered benign. His prostate-specifi c antigen level was 1.2 ng/mL, and gland size measured 107 cm 3 , which yielded a PSA density of 0.01 ng/mL/cm 3 . Cystoscopy demonstrated a 5 cm-long prostate with bilobar enlargement and grade 3 trabeculation of the bladder. After discussing treatment options, the patient chose to undergo holmium laser enucleation of the prostate for relief of his urinary obstruction.During his surgery, the prostate tissue was very soft and required minimal laser energy to make the incisions in the prostatic adenoma. Establishing planes was challenging, especially in the 6 o'clock groove and lateral prostatic capsular dissection. It took 60 minutes to enucleate the gland and 20 minutes to morcellate all of the tissue. Th e total weight of enucleated tissue was 189 g. After an uncomplicated recovery in the hospital, the patient improved signifi cantly and was voiding spontaneously without any residual volume on postoperative day 1.Th e resected prostate tissue was infi ltrated by a hom...

Introduction: When encountered, the ideal management of lithiasis in deceased donor kidneys is not well-defined. With advances in endourological techniques, minimally invasive treatments are becoming an increasingly viable option. We set out to describe our experience performing ex-vivo ureteroscopy on cadaveric donor kidneys, including one in which the procedure was completed on-pump. Methods: A retrospective chart review was undertaken to identify patients who had undergone ex-vivo ureteroscopy prior to cadaveric renal transplant. Four patients were identified, including one in which the procedure was done with the kidney remaining onpump. The surgical technique and subsequent data were reviewed. Results: Ex-vivo ureteroscopy was successfully completed in all four instances without intraoperative complication. All kidneys were endoscopically stone-free. Creatinine nadirs ranged from 0.8-1.4. All four patients remained stone-free at a mean followup of 13 months. Conclusions: Our series provides further evidence as to the safety and efficacy of ex-vivo ureteroscopy prior to transplantation in cadaveric renal transplants and describes a novel technique in the form of on-pump ex-vivo ureteroscopy.