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Background Penile strangulation is an uncommon urological emergency that requires prompt intervention to avoid potentially serious sequelae including loss of the distal penis secondary to ischemia and subsequent gangrene. We present a case report of a patient who presented to the hospital with penile strangulation injury of 10-hour duration secondary to the presence of a thick hexagonal steel nut. This case is presented in accordance with Consensus Surgical Case Report guidelines. Case presentation A 24-year-old Vietnamese man presented to the emergency room with urinary retention and decreased penile sensation following a 10-hour history of penile strangulation due to the presence of a thick hexagonal steel nut that he had placed around the shaft of the penis for the purpose of sexual enhancement during masturbation. The hexagonal nut was tightly entrapping the penile shaft, resulting in edema, congestion, and swelling of the distal 5 cm of the phallus. Given the thickness of the foreign body as well as the degree of penile swelling, we were unable to remove the hexagonal nut using traditional methods of alleviating penile strangulation injuries. Following consultation with a dental colleague, a dental diamond drill handpiece was utilized to cut the foreign body without injury to the underlying penile skin. Subsequent follow-up in clinic demonstrated no significant urinary or sexual sequalae from this episode. Conclusion We report a case of penile strangulation requiring novel instrumentation and collaboration for successful treatment.

Background: This study aims to assess safety and efficacy of introducing robotic-assisted laparoscopic donor nephrectomy (RALDN) to the standard retroperitoneal endoscopic living donor nephrectomy (RELDN). Methods: Data were collected prospectively from 124 consecutive living kidney donors (93 for RELDN subgroup and 31 for RALDN subgroup) from February 2018 to December 2020. Donor baseline demographics, perioperative outcomes and recipient outcomes were recorded, and these parameters were compared between the two subgroups before and after propensity-score matching.Results: For the entire group, mean age was 51.1±9.1 years; 42.7% were males; mean body mass index was 22.7±2.4 kg/m 2 ; and there were 109 left kidneys (88%). The following data of RELDN and RALDN was respectively recorded: operative time (213±43 vs. 216±39 minutes, P=0.721), warm ischemic time (4.7±1.2 vs. 4.9±1.4 minutes, P=0.399), postoperative complications (5.4% vs. 6.5%, P=1), hemoglobin (g/L) drop (9.4±7.2 vs. 9.7±6.6, P=0.836), donor blood creatinine at 1 month (1.17±0.25 vs. 1.12±0.25 mg/ dL, P=0.325) and at 6 month (1.15±0.23 vs. 1.13±0.24 mg/dL, P=0.734). In post-propensity score matched analyses, there was significant differences between the two groups including opioid use after surgery (48.4% vs. 16.1%, P=0.014) and postoperative hospital stays (2.7±1.5 vs. 3.8±2.2 day, P=0.02). Conclusions: RALDN could be safely introduced into a living donor program experienced in laparoscopic donor nephrectomy.

Objectives: To assess the safety and efficacy of introducing robotic-assisted laparoscopic donor nephrectomy (RALDN) to the standard retroperitoneal endoscopic donor nephrectomy (REDN). Methods: Data were collected prospectively from 124 consecutive living kidney donors (93 for REDN subgroup and 31 for RALDN subgroup) from February 2018 to December 2020. Donor baseline demographics, perioperative outcomes and recipient outcomes were recorded, and these parameters were compared between the two subgroups before and after propensity-score matching. Results: Mean age was 51.1 AE 9.1 years; 42.7% were males; mean body mass index was 22.7 AE 2.4; and there were 109 (88%) left kidneys. The following data of REDN and RALDN was, respectively, recorded: operative time (213 AE 43 versus 216 AE 39 min, p = 0.721), warm ischemic time (4.7 AE 1.2 versus 4.9 AE 1.4 min, p = 0.399), postoperative complications (5.4% versus 6.5%, p = 1), haemoglobin (g/L) drop (9.4 AE 7.2 versus 9.7 AE 6.6, p = 0.836), blood creatinine at 6 month (1.15 AE 0.23 versus 1.13 AE 0.24 mg/dL, p = 0.734) and at 1 year (1.09 AE 0.22 versus 1.17 AE 0.28 mg/dL, p = 0.591). In postpropensity score matched analyses, there was no significant differences between the two groups including intraoperative and postoperative complications. Conclusions: RALDN could be safely introduced into a living donor program experienced in laparoscopic donor nephrectomy. The outcomes of our study comparing these minimally invasive techniques are mostly similar in terms of intraoperative and postoperative outcomes for kidney donors.Abbreviations: ASA American society of anesthesiologists; BMI body mass index; eGFR estimated glomerular filtration rate; HLA Human Leukocyte Antigens; RALDN Robotic-assisted laparoscopic donor nephrectomy; REDN Retroperitoneal endoscopic donor nephrectomy; SCr serum creatinine.Bold values are p-value less than 0.05 and are considered statistically significant.