- Email: [email protected]
THE PULLEY SYSTEM: A LAPAROSCOPIC TESTIS RETRACTION AID
THE JOURNAL OF UROLOGY®
384
pediatric patients, and was not feasible in patients with thickened abdominal walls. Dismembered pyeloplasties were performed with running absorbable suture in both populations. In pediatric patients, a ureteral stent was passed in an antegrade fashion over a guidewire through an accessory port, while adult patients had previous cystoscopic placement of ureteral stents. Adult patients usually had a drain postoperatively, while pediatric patients did not. CONCLUSIONS: Robotic-assisted laparoscopic pyeloplasty for UPJO in the adult and pediatric populations usually involve differences in technique that accounts for anatomic differences in these 2 populations. A comparison of techniques provides an opportunity for review of the basis behind the differences in techniques. Source of Funding: None
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
patients had symptomatic urinary duplication anomalies. Demographic, operative and post-operative data was collected prospectively. RESULTS: The median age was 5 years (range 4 - 15). In all patients, a preoperative stent was attempted, and this was successful in 6/7 patients. One patient required intra-operative antegrade stent placement. In 4 patients an, upper to lower ureterostomy was performed for an ectopic ureter or ureterocele. In the remaining 3 patients, a lower to upper uretero-ureterosotomy was performed to treat symptomatic vesicoureteral reflux. Distal ureterectomy was carried out in all patients. Median estimated blood loss was 10 mL (range 5 - 100). All patients were discharged home within 24 hours of surgery. CONCLUSIONS: Robotic uretero-ureterostomy is a viable option for treating urinary tract duplication anomalies in pediatric patients. Source of Funding: None
V1073 PEDIATRIC ROBOT ASSISTED LAPAROSCOPIC URETEROCALYCOSTOMY Derek J Matoka*, Jennifer A Hagerty, Bruce W Lindgren, Chicago, IL INTRODUCTION AND OBJECTIVES: Robot assisted laparoscopic pyeloplasty is an effective option in the management of pediatric ureteropelvic junction (UPJ) obstruction. However, aberrant anatomy or extensive scarring may not allow one to proceed with the standard minimally invasive approach. To our knowledge, we describe the first pediatric robot assisted laparoscopic ureterocalycostomy. METHODS: A 12-month old male underwent an open pyeloplasty at 5 months of age for management of a UPJ obstruction. The postoperative course was complicated by a large retroperitoneal hematoma. Follow-up ultrasound demonstrated progression of hydronephrosis with significant parenchymal thinning and a small renal pelvis. MAG-3 renography was notable for persistent high-grade obstruction. Minimally invasive, transperitoneal surgical intervention was planned. The decision to proceed with a ureterocalycostomy was based on the degree of scarring in proximity to the renal hilum, the small intrarenal pelvis identified on ultrasound and the significant calyceal dilation with associated severely thinned parenchyma. Gerota’s fascia overlying the inferior portion of the kidney was opened and excised to provide exposure to this thinned parenchyma. The ureter was mobilized, transected and then spatulated along its lateral aspect. The calyceal opening was created with attention toward sufficient parenchymal excision of the most dependent lower pole calyx. Anastomosis of the spatulated ureter to the calyx was performed using interrupted 4-0 monocryl sutures. Care was taken to include full thickness parenchyma with renal capsule, collecting system and ureter in each stitch. RESULTS: The post-operative course was without surgical complications. He did develop mild hypertension that contributed to his delay in discharge to home until post-operative day number three. Radiographic follow-up at 6 weeks has shown improvement in the hydronephrosis on the ultrasound and improved function on a MAG 3 renal scan. CONCLUSIONS: In conclusion, similar to open ureterocalycostomy, robotic ureterocalycostomy is a technically feasible reasonable alternative for reestablishing drainage of the upper urinary tract in appropriately selected patients. Source of Funding: None
V1074 ROBOTIC URETEROURETEROSTOMY FOR UPPER URINARY TRACT DUPLICATION ANOMALIES Alok Shrivastava*, Louis S Krane, Fred Muhletaler, Rajesh Laungani, Mani Menon, Jack S Elder, Detroit, MI INTRODUCTION AND OBJECTIVES: We demonstrate our technique of robotic uretero-ureterostomy to treat duplication anomalies in pediatric patients and report our early experience. METHODS: The technique of left upper to lower moiety ureteroureterostomy with excision of the distal ureter is demonstrated. Since October 2007, robotic uretero-ureterostomy via a transperitoneal approach was performed in 7 patients by a single surgeon. All of these
V1075 ROBOTIC PYELOLITHOTOMY: A MINIMALLY INVASIVE APPROACH FOR TREATMENT OF RENAL CALCULI IN YOUNG CHILDREN Alok Shrivastava*, Louis S Krane, Rajesh Laungani, Mani Menon, Jack S Elder, Detroit, MI INTRODUCTION AND OBJECTIVES: Robot assisted pyelolithotomy has been reported in adolescent patients. We demonstrate a technique of robot assisted pyelolithotomy in young patients and report our early experience. METHODS: Robotic pyelolithotomy via a transperitoneal approach was performed in 3 patients by a single surgeon. Demographic, operative and post-operative data was collected prospectively. RESULTS: Ages patients were 4 months, 4 years and 7 years. All three procedures were performed for left sided calculi. In two patients, the calculus was located in the renal pelvis, while in the other the stone was in an inferior calyx. Operative time ranged from 72 to 161 minutes. Estimated blood loss was 10,5 and 35 ml respectively. Two patients were discharged 24 hours following surgery, however the 4 month old patient had a post-operative ileus which was treated conservatively, and he was discharged 72 hours following the procedure. CONCLUSIONS: Robotic pyelolithotomy presents a viable option for management of renal calculi in children. This procedure can be performed with minimal morbidity and safely even in children younger than one year. Source of Funding: None
V1076 THE PULLEY SYSTEM: A LAPAROSCOPIC TESTIS RETRACTION AID Richard S Hurwitz*, Los Angeles, CA INTRODUCTION AND OBJECTIVES: The “Pulley system” is a laparoscopic testis retraction aid that is particularly helpful during a 2nd stage Fowler-Stephens orchidopexy. This retraction system frees up both instruments allowing for a very careful disection of the vas pedicle. It also prevents testis and epididymal trauma from the grasper that typically retracts the testis and ties up one of the operating instruments. In addition it stabilizes the testis and prevents inadvertent torsion of the pedicle. METHODS: The pulley system is demonstrated in the second stage laparoscopic orchidopexy of a three-year-old boy who had a previous first stage right Fowler-Stephens orchidopexy. The video clearly shows how to set up the pulley system and how it facilitates the second stage procedure. RESULTS: The pulley system has made the second stage orchidopexy easier and safer to perform. CONCLUSIONS: The pulley system provides excellent intraabdominal retraction, allowing both instruments to be used for the dissection. In addition it decreases testis handling and potential trauma from a grasping instrument and it stabilizes the orientation of the testis, preventing inadvertent torsion during the dissection and during transfer to the scrotum.
THE JOURNAL OF UROLOGY®
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
Source of Funding: None
V1077
385
History of Urology Forum Monday, April 27, 2009
1:00 pm - 5:30 pm
SCROTOPLASTY IN SCROTAL AGENESIS Christopher G Wicher*, David A Hadley, Patrick C Cartwright, Siam N Oottamasathien, Salt Lake City, UT INTRODUCTION AND OBJECTIVES: Scrotal Agenesis is an extremely rare anomaly with only a handful of case reports in the literature. METHODS: We present a patient with an UPJ obstruction, absence of the scrotum and undescended testicles that was noted during extensive workup for Genitopatellar syndrome. Genitopatellar syndrome encompasses a multitude of abnormalities, including: absent patella, imperforate anus, agenesis of the corpus callosum, hydronephrosis, and scrotal hypoplasia. RESULTS: The patient was followed until 6 months of age when adequate penile skin was available for repair. He was then taken back to the operating room for a complex scrotoplasty. After degloving the penis, a ventral penile U-shaped flap and a dorsal buttonhole pedicle were used for a neo scrotum. We elected to stage the procedure, with the 2nd stage entailing bilateral orchiopexy. CONCLUSIONS: We believe this video provides a unique learning opportunity to better understand the important steps in this very rare anomaly. Source of Funding: None
V1078 INLAY-ONLAY URETHROPLASTY IN SEVERE HYPOSPADIAS Nenad Djakovic*, Alev Oeztuerk, Regina Stredele, Joanne NyarangiDix, Axel Haferkamp, Jesco Pfitzenmaier, Sascha Pahernik, Stephan Buse, Markus Hohenfellner, Heidelberg, Germany INTRODUCTION AND OBJECTIVES: Severe forms of hypospadias are usually associated with chordee and short or even absent urethral plate that result in a small and curved penis. In this case, the urethral plate should be divided for penile straightening and lengthening. In such cases the missing urethral plate needs to be augmented. METHODS: We present the case of a 14 month old boy with a perineal hypospadias, a 90° ventral penile curvature and a bifid scrotum. After completion of penile degloving, artificial erection reveals a severe ventral penile curvature.The short urethral plate is mobilised in the plane of Buck´s-Facia. The urethral plate is divided at the coronal level. The dorsal neurovascular bundle is carefully mobilised in the plane of Buck´sLayer. With another artificial erection, the point of the maximal curvature is revealed and the intended correction marked with an Ellis-Clump. In order to straighten the penis, the marked area is incised longitudinally and sutured transversally. Renewed erection demonstrates the straightened penis. The distance between the original hypospadic meatus and the distal end of the divided urethral plate shows a 4cm gap that needs to be bridged. Buccal mucosa is harvested from the inner cheek and brought to the ventral aspect of the penis to be used as an inlay graft to fill in the gap of the missing urethral plate. After complete fixation of the buccal mucosa, the inlay is quilted to the tunica albuginea. Dorsal penile and preputial skin was used for creating the longitudinal island flap. The island flap is transposed ventrally with the buttonhole technique to be used as the onlay flap. The glanular wings are trimmed and the glans reconstructed. The bifid scrotum is corrected in the same session. RESULTS: A severe hypospadias was corrected as a one-stageprocedure. CONCLUSIONS: Combined longitudinal island skin flap and buccal mucosa graft could be a good choice for urethral reconstruction in most severe hypospadias repairs. Source of Funding: None
1079 ‘FIAT LUX’: LET THERE BE LIGHT! THE CONTRIBUTION OF HAROLD HOPKINS TO MODERN DAY UROLOGY Pardeep Kumar*, Tahir R Bhat, Shikohe Masood, Gillingham Kent, United Kingdom INTRODUCTION AND OBJECTIVES: The desire to look inside the human body to diagnose disease dates back to the time of Hippocrates with his description of rectal speculum. The nineteenth century saw the development of the endoscope, making this desire a reality. Harold Hopkins brilliant work on optics was instrumental in the development of modern endoscopy and is a true milestone in the development of minimally invasive surgery. METHODS: A systematic search of online and published material was conducted including original articles and papers. RESULTS: Harold Horace Hopkins was born in Leicester UK in 1918, the son of a small baker. Despite initial reluctance, he read science and mathematics in which he excelled and went on to obtain a scholarship to Leicester University where he graduated in 1939. He initially joined the army where his brilliance in the field of optics was first noticed. He was transferred to an optical firm called Taylor and Hobson as a lens designer. His first major contribution was development of a zoom lens in 1948 which was used at Lords cricket ground London to broadcast a cricket test match. He went on to develop a flexible instrument capable of light transmission and collection, work published in Nature in 1954. This major breakthrough led to the development of the flexible endoscopes in use today. In 1957 he was approached by a Liverpool urologist to develop a better cystoscope so that photographs of inside of bladder can be taken. The answer was the rod lens system. His work resulted in far better light and image transmission than was ever before possible. He offered this system to several American and British companies who did not show any interest in it. A German manufacturer, Karl Storz, recognised the potential of Hopkins’ work and combined the rod lens system with his ‘cold light’ and transformed his small company into the international one, we know today. Hopkins received many prestigious awards and was nominated for the Nobel Prize. He was a gifted linguist and musician as well as keen wine drinker! He died at the age of 77. CONCLUSIONS: Minimally invasive surgery accounts for up to 80% of all interventions in the field of operative urology. Hopkins was a genius whose inventions revolutionised diagnostic and therapeutic endoscopy. His contribution to modern urology cannot be underestimated. Source of Funding: None
1080 WINE AND HONEY: THE OLDEST OF MEDICINES Jennifer B Gordetsky*, Karin Westesson, Jeanne O’Brien, Ronald Rabinowitz, Rochester, NY INTRODUCTION AND OBJECTIVES: Wine and honey are some of the oldest documented medicinal remedies dating back thousands of years and crossing multiple cultures. We will explore the medicinal uses of wine and honey, with a focus on the treatment of genito-urinary disease, starting with the ancient civilizations of Egypt and India. We will then work our way forward in time to include the medical theories and remedies of wine and honey present in Greek, Rome and Arabic medicine. Our review continues onto the middle ages and finally evaluates the medicinal properties of wine and honey as we understand them in our current scientific paradigm and its specific application to urology. METHODS: A review of the literature was completed looking at the medical theories and medicinal uses of wine and honey from ancient civilization to the present. RESULTS: Wine and honey has been used in the treatment of
384
pediatric patients, and was not feasible in patients with thickened abdominal walls. Dismembered pyeloplasties were performed with running absorbable suture in both populations. In pediatric patients, a ureteral stent was passed in an antegrade fashion over a guidewire through an accessory port, while adult patients had previous cystoscopic placement of ureteral stents. Adult patients usually had a drain postoperatively, while pediatric patients did not. CONCLUSIONS: Robotic-assisted laparoscopic pyeloplasty for UPJO in the adult and pediatric populations usually involve differences in technique that accounts for anatomic differences in these 2 populations. A comparison of techniques provides an opportunity for review of the basis behind the differences in techniques. Source of Funding: None
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
patients had symptomatic urinary duplication anomalies. Demographic, operative and post-operative data was collected prospectively. RESULTS: The median age was 5 years (range 4 - 15). In all patients, a preoperative stent was attempted, and this was successful in 6/7 patients. One patient required intra-operative antegrade stent placement. In 4 patients an, upper to lower ureterostomy was performed for an ectopic ureter or ureterocele. In the remaining 3 patients, a lower to upper uretero-ureterosotomy was performed to treat symptomatic vesicoureteral reflux. Distal ureterectomy was carried out in all patients. Median estimated blood loss was 10 mL (range 5 - 100). All patients were discharged home within 24 hours of surgery. CONCLUSIONS: Robotic uretero-ureterostomy is a viable option for treating urinary tract duplication anomalies in pediatric patients. Source of Funding: None
V1073 PEDIATRIC ROBOT ASSISTED LAPAROSCOPIC URETEROCALYCOSTOMY Derek J Matoka*, Jennifer A Hagerty, Bruce W Lindgren, Chicago, IL INTRODUCTION AND OBJECTIVES: Robot assisted laparoscopic pyeloplasty is an effective option in the management of pediatric ureteropelvic junction (UPJ) obstruction. However, aberrant anatomy or extensive scarring may not allow one to proceed with the standard minimally invasive approach. To our knowledge, we describe the first pediatric robot assisted laparoscopic ureterocalycostomy. METHODS: A 12-month old male underwent an open pyeloplasty at 5 months of age for management of a UPJ obstruction. The postoperative course was complicated by a large retroperitoneal hematoma. Follow-up ultrasound demonstrated progression of hydronephrosis with significant parenchymal thinning and a small renal pelvis. MAG-3 renography was notable for persistent high-grade obstruction. Minimally invasive, transperitoneal surgical intervention was planned. The decision to proceed with a ureterocalycostomy was based on the degree of scarring in proximity to the renal hilum, the small intrarenal pelvis identified on ultrasound and the significant calyceal dilation with associated severely thinned parenchyma. Gerota’s fascia overlying the inferior portion of the kidney was opened and excised to provide exposure to this thinned parenchyma. The ureter was mobilized, transected and then spatulated along its lateral aspect. The calyceal opening was created with attention toward sufficient parenchymal excision of the most dependent lower pole calyx. Anastomosis of the spatulated ureter to the calyx was performed using interrupted 4-0 monocryl sutures. Care was taken to include full thickness parenchyma with renal capsule, collecting system and ureter in each stitch. RESULTS: The post-operative course was without surgical complications. He did develop mild hypertension that contributed to his delay in discharge to home until post-operative day number three. Radiographic follow-up at 6 weeks has shown improvement in the hydronephrosis on the ultrasound and improved function on a MAG 3 renal scan. CONCLUSIONS: In conclusion, similar to open ureterocalycostomy, robotic ureterocalycostomy is a technically feasible reasonable alternative for reestablishing drainage of the upper urinary tract in appropriately selected patients. Source of Funding: None
V1074 ROBOTIC URETEROURETEROSTOMY FOR UPPER URINARY TRACT DUPLICATION ANOMALIES Alok Shrivastava*, Louis S Krane, Fred Muhletaler, Rajesh Laungani, Mani Menon, Jack S Elder, Detroit, MI INTRODUCTION AND OBJECTIVES: We demonstrate our technique of robotic uretero-ureterostomy to treat duplication anomalies in pediatric patients and report our early experience. METHODS: The technique of left upper to lower moiety ureteroureterostomy with excision of the distal ureter is demonstrated. Since October 2007, robotic uretero-ureterostomy via a transperitoneal approach was performed in 7 patients by a single surgeon. All of these
V1075 ROBOTIC PYELOLITHOTOMY: A MINIMALLY INVASIVE APPROACH FOR TREATMENT OF RENAL CALCULI IN YOUNG CHILDREN Alok Shrivastava*, Louis S Krane, Rajesh Laungani, Mani Menon, Jack S Elder, Detroit, MI INTRODUCTION AND OBJECTIVES: Robot assisted pyelolithotomy has been reported in adolescent patients. We demonstrate a technique of robot assisted pyelolithotomy in young patients and report our early experience. METHODS: Robotic pyelolithotomy via a transperitoneal approach was performed in 3 patients by a single surgeon. Demographic, operative and post-operative data was collected prospectively. RESULTS: Ages patients were 4 months, 4 years and 7 years. All three procedures were performed for left sided calculi. In two patients, the calculus was located in the renal pelvis, while in the other the stone was in an inferior calyx. Operative time ranged from 72 to 161 minutes. Estimated blood loss was 10,5 and 35 ml respectively. Two patients were discharged 24 hours following surgery, however the 4 month old patient had a post-operative ileus which was treated conservatively, and he was discharged 72 hours following the procedure. CONCLUSIONS: Robotic pyelolithotomy presents a viable option for management of renal calculi in children. This procedure can be performed with minimal morbidity and safely even in children younger than one year. Source of Funding: None
V1076 THE PULLEY SYSTEM: A LAPAROSCOPIC TESTIS RETRACTION AID Richard S Hurwitz*, Los Angeles, CA INTRODUCTION AND OBJECTIVES: The “Pulley system” is a laparoscopic testis retraction aid that is particularly helpful during a 2nd stage Fowler-Stephens orchidopexy. This retraction system frees up both instruments allowing for a very careful disection of the vas pedicle. It also prevents testis and epididymal trauma from the grasper that typically retracts the testis and ties up one of the operating instruments. In addition it stabilizes the testis and prevents inadvertent torsion of the pedicle. METHODS: The pulley system is demonstrated in the second stage laparoscopic orchidopexy of a three-year-old boy who had a previous first stage right Fowler-Stephens orchidopexy. The video clearly shows how to set up the pulley system and how it facilitates the second stage procedure. RESULTS: The pulley system has made the second stage orchidopexy easier and safer to perform. CONCLUSIONS: The pulley system provides excellent intraabdominal retraction, allowing both instruments to be used for the dissection. In addition it decreases testis handling and potential trauma from a grasping instrument and it stabilizes the orientation of the testis, preventing inadvertent torsion during the dissection and during transfer to the scrotum.
THE JOURNAL OF UROLOGY®
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
Source of Funding: None
V1077
385
History of Urology Forum Monday, April 27, 2009
1:00 pm - 5:30 pm
SCROTOPLASTY IN SCROTAL AGENESIS Christopher G Wicher*, David A Hadley, Patrick C Cartwright, Siam N Oottamasathien, Salt Lake City, UT INTRODUCTION AND OBJECTIVES: Scrotal Agenesis is an extremely rare anomaly with only a handful of case reports in the literature. METHODS: We present a patient with an UPJ obstruction, absence of the scrotum and undescended testicles that was noted during extensive workup for Genitopatellar syndrome. Genitopatellar syndrome encompasses a multitude of abnormalities, including: absent patella, imperforate anus, agenesis of the corpus callosum, hydronephrosis, and scrotal hypoplasia. RESULTS: The patient was followed until 6 months of age when adequate penile skin was available for repair. He was then taken back to the operating room for a complex scrotoplasty. After degloving the penis, a ventral penile U-shaped flap and a dorsal buttonhole pedicle were used for a neo scrotum. We elected to stage the procedure, with the 2nd stage entailing bilateral orchiopexy. CONCLUSIONS: We believe this video provides a unique learning opportunity to better understand the important steps in this very rare anomaly. Source of Funding: None
V1078 INLAY-ONLAY URETHROPLASTY IN SEVERE HYPOSPADIAS Nenad Djakovic*, Alev Oeztuerk, Regina Stredele, Joanne NyarangiDix, Axel Haferkamp, Jesco Pfitzenmaier, Sascha Pahernik, Stephan Buse, Markus Hohenfellner, Heidelberg, Germany INTRODUCTION AND OBJECTIVES: Severe forms of hypospadias are usually associated with chordee and short or even absent urethral plate that result in a small and curved penis. In this case, the urethral plate should be divided for penile straightening and lengthening. In such cases the missing urethral plate needs to be augmented. METHODS: We present the case of a 14 month old boy with a perineal hypospadias, a 90° ventral penile curvature and a bifid scrotum. After completion of penile degloving, artificial erection reveals a severe ventral penile curvature.The short urethral plate is mobilised in the plane of Buck´s-Facia. The urethral plate is divided at the coronal level. The dorsal neurovascular bundle is carefully mobilised in the plane of Buck´sLayer. With another artificial erection, the point of the maximal curvature is revealed and the intended correction marked with an Ellis-Clump. In order to straighten the penis, the marked area is incised longitudinally and sutured transversally. Renewed erection demonstrates the straightened penis. The distance between the original hypospadic meatus and the distal end of the divided urethral plate shows a 4cm gap that needs to be bridged. Buccal mucosa is harvested from the inner cheek and brought to the ventral aspect of the penis to be used as an inlay graft to fill in the gap of the missing urethral plate. After complete fixation of the buccal mucosa, the inlay is quilted to the tunica albuginea. Dorsal penile and preputial skin was used for creating the longitudinal island flap. The island flap is transposed ventrally with the buttonhole technique to be used as the onlay flap. The glanular wings are trimmed and the glans reconstructed. The bifid scrotum is corrected in the same session. RESULTS: A severe hypospadias was corrected as a one-stageprocedure. CONCLUSIONS: Combined longitudinal island skin flap and buccal mucosa graft could be a good choice for urethral reconstruction in most severe hypospadias repairs. Source of Funding: None
1079 ‘FIAT LUX’: LET THERE BE LIGHT! THE CONTRIBUTION OF HAROLD HOPKINS TO MODERN DAY UROLOGY Pardeep Kumar*, Tahir R Bhat, Shikohe Masood, Gillingham Kent, United Kingdom INTRODUCTION AND OBJECTIVES: The desire to look inside the human body to diagnose disease dates back to the time of Hippocrates with his description of rectal speculum. The nineteenth century saw the development of the endoscope, making this desire a reality. Harold Hopkins brilliant work on optics was instrumental in the development of modern endoscopy and is a true milestone in the development of minimally invasive surgery. METHODS: A systematic search of online and published material was conducted including original articles and papers. RESULTS: Harold Horace Hopkins was born in Leicester UK in 1918, the son of a small baker. Despite initial reluctance, he read science and mathematics in which he excelled and went on to obtain a scholarship to Leicester University where he graduated in 1939. He initially joined the army where his brilliance in the field of optics was first noticed. He was transferred to an optical firm called Taylor and Hobson as a lens designer. His first major contribution was development of a zoom lens in 1948 which was used at Lords cricket ground London to broadcast a cricket test match. He went on to develop a flexible instrument capable of light transmission and collection, work published in Nature in 1954. This major breakthrough led to the development of the flexible endoscopes in use today. In 1957 he was approached by a Liverpool urologist to develop a better cystoscope so that photographs of inside of bladder can be taken. The answer was the rod lens system. His work resulted in far better light and image transmission than was ever before possible. He offered this system to several American and British companies who did not show any interest in it. A German manufacturer, Karl Storz, recognised the potential of Hopkins’ work and combined the rod lens system with his ‘cold light’ and transformed his small company into the international one, we know today. Hopkins received many prestigious awards and was nominated for the Nobel Prize. He was a gifted linguist and musician as well as keen wine drinker! He died at the age of 77. CONCLUSIONS: Minimally invasive surgery accounts for up to 80% of all interventions in the field of operative urology. Hopkins was a genius whose inventions revolutionised diagnostic and therapeutic endoscopy. His contribution to modern urology cannot be underestimated. Source of Funding: None
1080 WINE AND HONEY: THE OLDEST OF MEDICINES Jennifer B Gordetsky*, Karin Westesson, Jeanne O’Brien, Ronald Rabinowitz, Rochester, NY INTRODUCTION AND OBJECTIVES: Wine and honey are some of the oldest documented medicinal remedies dating back thousands of years and crossing multiple cultures. We will explore the medicinal uses of wine and honey, with a focus on the treatment of genito-urinary disease, starting with the ancient civilizations of Egypt and India. We will then work our way forward in time to include the medical theories and remedies of wine and honey present in Greek, Rome and Arabic medicine. Our review continues onto the middle ages and finally evaluates the medicinal properties of wine and honey as we understand them in our current scientific paradigm and its specific application to urology. METHODS: A review of the literature was completed looking at the medical theories and medicinal uses of wine and honey from ancient civilization to the present. RESULTS: Wine and honey has been used in the treatment of