Biomedical subjects

Andrei Nadu

Publications and source records attributed to Andrei Nadu.

16 recordsLinked to original sources

PubMed2006

Fascial patch technique for repair of complicated urethrovaginal fistula.

INTRODUCTION: The operative repair of urethrovaginal fistula due to tension-free vaginal tape (TVT) erosion is a challenging task, and coexisting stress urinary incontinence may complicate the situation even further. We present our technique for the repair of recurrent urethrovaginal fistula combined with stress urinary incontinence, occurring after previous removal of an eroded TVT and failed repair of the fistula. TECHNICAL CONSIDERATIONS: With the patient in the dorsal lithotomy position, an inverted U-shaped incision was cut in the anterior vaginal wall, and a vaginal flap was developed. The Martius flap from the previous repair was identified and separated from the urethra, thereby disclosing a large fistula hole on the left side of the mid-urethra. Because the periurethral tissues were very friable and attenuated, only one-layer closure of the fistula hole with these tissues was feasible. Therefore, we opted to combine a pubovaginal fascial sling with a fascial patch graft, used to reinforce the fistula site. Through a low transverse abdominal incision, a 15 x 2-cm strip of rectus fascia was harvested. A 2 x 2-cm patch of fascia was excised from the strip and transfixed to the periurethral tissues, covering the sutured fistula site. The Martius flap was repositioned over the flap, and a pubovaginal sling procedure was done. The postoperative course was uneventful, the fistula has healed, and the patient regained full continence. CONCLUSIONS: This technique can be used in complicated urethrovaginal fistula repair when the surrounding periurethral tissues have been devastated and can be combined with pubovaginal fascial sling placement.

Adult↗

PubMed2006

Renal artery occlusion during nephron-sparing surgery: retrospective review of 301 cases.

OBJECTIVES: Temporary occlusion of the renal artery during nephron-sparing surgery may facilitate complete tumor resection and reduce operative bleeding. However, it may also entail a greater risk of ischemic kidney damage. In contrast, when vascular occlusion is not applied, the risk of bleeding, as well as the risk of positive margins, may be increased. To study these issues, we retrospectively evaluated our results with nephron-sparing surgery for kidney masses using renal artery occlusion compared with patients in whom vascular occlusion was not applied. METHODS: From 1988 to 2003, 301 consecutive patients underwent nephron-sparing surgery for a kidney mass at our institutions. At the surgeons' discretion, the renal artery was temporarily occluded in 181 patients (60%) and was not in 120 (40%). RESULTS: No statistically significant differences were found between the two groups regarding blood loss, transfusion rates, and overall complication rates. The loss of the renal unit because of ischemia was noted in 2 patients (1.2%) after renal artery occlusion and in none of the nonoccluded group. Positive tumor margins were found in 5 patients (4.2%) in the nonoccluded group and in 1 patient (0.6%) in the vascular occlusion group. CONCLUSIONS: Our results suggest that although vascular occlusion during nephron-sparing surgery may increase the risk of permanent kidney damage, patients with no vascular occlusion may have a greater risk of positive tumor margins after surgery. These two factors should be taken into consideration and could be discussed with the patient when attaining informed consent.

Adolescent↗

PubMed2006

Spontaneous reduction of bladder base prolapse with gradual filling: a video-urodynamic observation.

OBJECTIVE: To report video-urodynamic observations on the effect of gradual bladder filling on the degree of bladder base prolapse while erect, as the effect of bladder fullness on the degree of bladder base descent in patients with a cystocele has rarely been addressed. PATIENTS AND METHODS: Thirty-six consecutive patients with complaints of a protruding vaginal mass due to bladder prolapse underwent video-urodynamic studies, comprised of filling and voiding cystometry with contrast material, while standing. RESULTS: During filling cystometry, in 16 of 36 patients (44%) the prolapse gradually and spontaneously reduced with increasing bladder volumes, so that at cystometric capacity the bladder base was completely reduced. Straining at cystometric capacity did not affect the bladder base position and, during voiding cystometry, the bladder base remained completely reduced. In the remaining 20 patients there was only partial reduction of the cystocele during bladder filling, i.e. the cystocele was reduced by half or less. Seven of the 16 patients with a full reduction of cystocele had concurrent uterine prolapse, compared with 15 of 20 (80%) who had only partial or no spontaneous reduction; the difference was statistically significant (P = 0.02). CONCLUSION: These video-urodynamic results suggest that when erect the degree of bladder base descent is volume-dependent, and that concomitant uterine prolapse might hinder spontaneous reduction of the cystocele.

Aged↗

PubMed2005

Laparoscopic partial nephrectomy: is it advantageous and safe to clamp the renal artery?

OBJECTIVES: To compare the outcomes of laparoscopic partial nephrectomy (LPN) performed with and without vascular clamping and to evaluate the impact of clamping on postoperative renal function. METHODS: A total of 45 patients underwent LPN, 29 with and 16 without vascular occlusion. The two groups were compared regarding complication rates, blood loss, conversion rates, operative time, mean tumor size, and incidence of positive margins. Renal function was evaluated by postoperative dimethyl mercaptosuccinic acid scans. RESULTS: The mean blood loss was lower when vascular clamping was applied (320 versus 510 mL, P <0.05) than when it was not. The conversion rates were similar (10.3% versus 12.5%), and the mean operative time was shorter in the nonclamped group (115 versus 126 minutes). Urinary leakage occurred in 2 patients, 1 from each group. The mean tumor diameter was 3.2 cm in the clamped and 1.9 cm in the nonclamped group (P <0.05). In 2 patients (12.5%) in the nonclamped and 1 patient (3.4%) in the clamped group, the surgical margins were focally positive for tumor. The mean warm ischemia time was 28 minutes, and dimercaptosuccinic acid scans performed in 18 patients showed normal ipsilateral renal function (mean relative function 48%). CONCLUSIONS: LPN without vascular clamping is feasible in selected cases. However, clamping of the artery seems to be associated with reduced blood loss and a lower incidence of positive margins. Moreover, according to the postoperative dimercaptosuccinic acid scan findings, limited warm ischemia does not seem to result in permanent renal damage. We suggest that clamping of the renal artery should be considered during LPN, even for very small, superficial tumors.

Adult↗

PubMed2005

Is frozen section analysis in nephron sparing surgery necessary? A clinicopathological study of 301 cases.

PURPOSE: One of the basic principles of nephron sparing surgery for renal cell carcinoma is resection of the tumor with normal tissue margins verified by frozen section analysis. In cases of positive tumor margins the surgeon is committed to complete the local resection or to perform radical nephrectomy. In this study we retrospectively evaluated the yield of frozen section analysis performed during nephron sparing surgeries, especially concerning compatibility with the final histological report and the long-term oncological outcome. MATERIALS AND METHODS: Between 1988 and 2003, 172 men and 129 women with a mean age of 59 years (range 16 to 83) underwent nephron sparing surgery due to suspected renal tumors. Mean tumor size was 3.56 cm (range 1 to 12.5). Frozen section analysis was routinely performed during surgery. RESULTS: Positive tumor margins in frozen section analysis were found in 2 cases (0.7%). In both cases the tumor was centrally located. Those 2 patients underwent immediate radical nephrectomy but no residual tumor was subsequently found in the radical nephrectomy specimens. Paraffin sections disclosed positive tumor margins in 4 other cases (1.3%) in whom the frozen section analysis had shown tumor negative margins. Of the 4 patients 1 underwent radical nephrectomy for tumor recurrence after 9 months. The other 3 patients showed no evidence of disease recurrence after 26, 59 and 120 months of followup. CONCLUSIONS: Our results suggest that frozen section analysis during nephron sparing surgery has minimal clinical significance and hence routine incorporation in urological practice should be reconsidered.

Adolescent↗

PubMed2005

Ventilatory and hemodynamic changes during retroperitoneal and transperitoneal laparoscopic nephrectomy: a prospective real-time comparison.

PURPOSE: Nephrectomies are currently performed via the transperitoneal or retroperitoneal laparoscopic approach. We compared the ventilatory and hemodynamic effects of these approaches. MATERIALS AND METHODS: After institutional ethics committee approval was obtained patients requiring nephrectomy in a 9-month period were prospectively allocated to the retroperitoneal (24) or transperitoneal (15) approach. All were initially ventilated in the volume controlled mode (10 ml kg tidal volume). Intraoperative fingertip, pulse derived arterial oxygen saturation less than 97%, end tidal CO2 partial pressure greater than 40 mm Hg and peak inspiratory pressure greater than 36 cm H2O necessitated changes in ventilatory parameters, as deemed necessary by the anesthetist. If tidal volume decreased greater than 25% of baseline, pressure controlled ventilation was begun instead. RESULTS: Peak inspiratory and plateau pressures increased for the transperitoneal approach by approximately 30% more than in the retroperitoneal group (p <0.05). Volume controlled ventilation was changed to pressure controlled ventilation in 8 transperitoneal vs zero retroperitoneal cases (p <0.05). Heart rate, and systolic and diastolic blood pressure increased by approximately 13% more in the transperitoneal than in the retroperitoneal group (p <0.05). CONCLUSIONS: Nephrectomy via the retroperitoneal laparoscopic approach interferes with ventilatory and hemodynamic functions less than nephrectomy via the transperitoneal approach.

Adult↗

PubMed2005

Laparoscopic nephrectomy: initial experience in Israel with 110 cases.

BACKGROUND: Data during the last decade show that laparoscopic nephrectomy is becoming an accepted and advantageous minimally invasive alternative to the open procedure. OBJECTIVE: To evaluate the efficacy, safety and reproducibility of laparoscopic nephrectomy in a series of 110 consecutive procedures. METHODS: A total of 110 patients underwent laparoscopic nephrectomy in our institution during the last 3 years. Their data were entered into a database and analyzed, including age, gender, indications for surgery, operative time, blood loss, intraoperative complications, conversion rates, and postoperative complications (defined as complications occurring up to 1 month after surgery). Histologic results and outpatient follow-up were also recorded. RESULTS: Mean age at surgery was 63 years (range 21-89 years). The indications for surgery included solid renal masses in 64 cases, non-functioning kidneys in 35, and collecting system or ureteral tumors in 11; and the procedures performed were radical nephrectomy, simple nephrectomy, or nephroureterectomy, respectively. The mean operative time was 125 minutes (range 70-310 minutes). Intraoperative complications were recorded in eight cases (7.3%), including vascular injuries of the renal artery in two, and of the renal vein, inferior vena cava and right adrenal vein in one case each. Injury of the large bowel and splenic hylus was recorded in one case and malfunction of the vascular endoGIA stapler leading to severe bleeding in one case. Nine cases were converted to open surgery (8.2%), four of them urgently due to intraoperative complications, while in another five cases conversions were elective following poor progression of the laparoscopic procedure. Comparison of the complication rate at follow-up between the initial 50 and the last 60 patients revealed no change. The conversion rate dropped significantly along the learning curve with 7 cases converted among the initial 50 patients, versus 2 in the last 60. There was no perioperative mortality. In two cases we recorded major postoperative complications, including pneumothorax treated by insertion of a thoracic drain and incarcerated inguinal hernia treated by surgery, while minor complications were seen in five patients. Histologic examination showed renal cell carcinoma pT1-T3a in 62 patients, oncocytoma in 5, transitional cell carcinoma T1G2-T3G3N1 in 10, renal sarcoma in 1, metastasis from lung tumor in 1, and end-stage kidney in the remainder. Negative margins were obtained in all cases. CONCLUSIONS: Laparoscopic nephrectomy may be currently considered a routine, safe and effective procedure associated with minimal morbidity. The conversion rate seemed to drop significantly after 50 cases. In view of the inherent benefits for patients, in terms of reduced pain level, faster recovery and improved cosmetic results, the laparoscopic approach has become the standard approach for nephrectomy in our institution.

Adult↗

PubMed2005

[The laparoscopic approach to renal tumors outcome of 121 laparoscopic radical and partial nephrectomy procedures].

BACKGROUND AND PURPOSE: We present and review a single center experience with laparoscopic renal surgery for renal cancer including laparoscopic radical and partial nephrectomy. PATIENTS AND METHODS: During the period September 2002 - January 2005, 180 patients underwent laparoscopic renal surgery at our center for several indications. A total of 121 patients underwent radical nephrectomy (76) or partial nephrectomy (45) for solid renal tumors. Their data was recorded and analyzed including age, indication for surgery, operative time, blood loss, intra- and postoperative complications, conversion rates, histological results and outpatient follow-up. RESULTS: The mean age at surgery was 65 years (range: 21-89 years). The indications for surgery were solid, enhancing renal masses. For tumors larger than 4 cm, a radical nephrectomy was performed. Tumors that were smaller than 4 cm were removed by partial nephrectomy. The mean operative time was minutes (range: 70-280 minutes) and the mean blood loss was 220 cc (range: 30-700 cc). The mean blood loss was significantly lower in the radical nephrectomy group (120 cc) than in the partial nephrectomy group (320 cc). In eight patients major intraoperative complications were noted including injury of the hilar vessels (5 cases), inferior vena cava (1 case), large bowel and spleen (one patient) and duodenum (1 case). Conversion to open surgery was needed in nine patients (7.4%), four in the radical nephrectomy and five in the partial nephrectomy group. Major postoperative complications were recorded in two patients who underwent radical nephrectomy (pneumothorax and incarcerated inguinal hernia) and in two patients who underwent partial nephrectomy (urine leakage). The pathological examination demonstrated renal cell carcinoma in 109 cases, oncocytoma in 6 cases, angiomyolipoma in 2 cases, sarcoma of the kidney and metastasis from lung cancer in one case each and a hemorrhagic cyst in one case. In all patients who underwent radical nephrectomy negative surgical margins were obtained, in three patients after partial nephrectomy the surgical margins were focally involved by tumor. The mean tumor size was 5.1 cm and 3.1 cm after radical or partial nephrectomy respectively. During follow-up, none of the patients developed local or distant recurrence. CONCLUSIONS: The laparoscopic approach to kidney cancer seems to be safe and oncologically sound. The low morbidity rate together with the inherent advantages of laparoscopic surgery make this approach attractive and we believe it should be considered the new standard of care for renal cancer.

Adult↗

PubMed2004

Endourologic procedures combined with other surgical and urologic interventions--early experience.

OBJECTIVES: To assess the feasibility of performing endourologic interventions combined with other operations during the same operative session. METHODS: Eighteen patients underwent simultaneous operations endourologically for upper urinary tract pathologic findings and other surgical and urologic indications. The operating time, technical feasibility, operative success, complications, hospital stay, and patient satisfaction were analyzed. RESULTS: The average patient age was 63 years (range 40 to 83). Five patients underwent percutaneous nephrolithotomy combined with either contralateral laparoscopic nephrectomy, contralateral open nephrectomy, radical retropubic prostatectomy, inguinal/umbilical hernia repair, transurethral resection of prostate, or cystolithotripsy. Thirteen patients underwent 15 retrograde endoscopic procedures (13 for stone disease and 2 for diagnostic purposes) that were combined with open contralateral nephrectomy, inguinal hernia repair, circumcision, closure of ileostomy, transurethral resection of bladder tumor, excision of lymphoma of thigh, drainage and sclerozation of hydrocele, or percutaneous gastrostomy. All procedures were successfully completed without complications. The average hospital stay was 5 days (range 3 to 6) in the percutaneous nephrolithotomy group and 2 days (range 1 to 5) in the retrograde endoscopic procedure group. The duration of hospitalization was related to the more complex operation; combining the procedures did not prolong it. The average follow-up was 11 months (range 3 to 24). All patients were highly satisfied because they were spared the need for more than one surgical session. CONCLUSIONS: Our results support the concept of performing simultaneous endourologic procedures and other operations during one surgical session. This approach obviates the need for repeated anesthesia, patient inconvenience, the psychological stress related to multiple operations, and reduces the total hospital stay.

Adult↗

PubMed2004

Are indications for prostatectomy in octogenarians the same as for younger men?

Prostatectomy for benign hypertrophy of the prostate is usually performed to alleviate lower urinary tract symptoms (LUTS). We assessed indications for and risks of prostatectomy in men 80 years of age and compared them to those for younger men in order to determine whether indications for prostatectomy in octogenarians are different than these for younger men. Medical records of 171 men comprised of 84 patients >80 years of age (mean 84.4) and 87 patients <65 years of age (mean 60.6) who underwent prostatectomy for benign prostate hypertrophy were reviewed. Data regarding indications for surgery, American Society of Anesthesiologists system grade, anesthesia and surgery performed, duration of hospitalization and intrahospital postoperative complications were obtained. The respective indications for surgery in the very elderly and younger patients were: urinary retention with indwelling catheter in 46 (55%) and 34 (39%) (p < 0.04), LUTS in 32 (38%) and 52 (59%) (p < 0.005), and gross hematuria in 6 (7%) and 1 (1.2%). Transurethral prostatectomy was performed in 47 elderly patients (56%) and in 30 young patients (34.5%). The other patients in each group underwent open (suprapubic prostatectomy) surgery. The overall complication rate was significantly higher in the elderly group (39% vs 22%, p < 0.05), with major complications occurring only in this group. Indications for surgery were different for octogenarians than for younger men. Morbidity and mortality rates were significantly higher among the elderly men. Age appears to be an independent risk factor for complications associated with prostatectomy.

Age Factors↗

PubMed2004

[Lower urinary tract reconstruction by augmentation cystoplasty and insertion of artificial urinary sphincter cuff only: long term follow-up].

OBJECTIVES: To review retrospectively our long-term experience with augmentation cystoplasty and simultaneously insertion of artificial urinary sphincter cuff only for lower urinary tract reconstruction in cases of mixed bladder and sphincteric dysfunction. We tried to assess the postoperative continence status, as well as the associated morbidity, focusing upon infections, urethral erosion and revision rates. PATIENTS AND METHODS: Eleven patients with urinary incontinence due to a small capacity and low compliant bladder, combined with incompetent outlet, underwent lower urinary tract reconstruction by augmentation cystoplasty and simultaneous insertion of a bladder neck sphincter cuff only (AMS, model AS-800). Mean age was 29 years (range 18-45). The etiology of voiding dysfunction was a seminal cord injury in 6 patients, myelomeningocele in 2 and spinal cord surgery in 1, bladder exstrophy (1) and pelvic trauma combined with spinal cord injury (1). RESULTS: With mean follow-up period of 115 months (range 45-141), 8 patients (73%) achieved continence on clean intermittent catheterization without any further interventions. Two patients required insertion of sphincter pump and reservoir at a second stage to achieve full continence and subsequently one was removed due to erosion (overall continence rate of 82%). In another patient, the cuff located at the level of the bladder neck has eroded and was removed. None of the patients has experienced an infection of the device in the immediate postoperative period, neither thereafter. CONCLUSIONS: Insertion of sphincter cuff only during augmentation cystoplasty may be sufficient to achieve continence in many incontinent patients who may not be cured by bladder augmentation alone. The procedure is technically easy and is not associated with increased risk of injury to the augmented bladder, neither with subsequent infectious complications.

Adolescent↗

PubMed2003

Simple model for training in the laparoscopic vesicourethral running anastomosis.

PURPOSE: To create a simple model for training in the complex technique of laparoscopic vesicourethral anastomosis after radical prostatectomy. MATERIALS AND METHODS: A model simulating the performance of a laparoscopic running urethrovesical anastomosis was fashioned using skin of a supermarket chicken set in a laparoscopic training box. A circular continuous anastomosis was performed, following exactly the technique we use in vivo for performing a vesicourethral anastomosis after laparoscopic radical prostatectomy. Details regarding the use of the right or the left needle holder, needle positioning, precise stitch position, and use of forehand or backhand stitch were strictly respected in order to reproduce the continuous stitch currently done in vivo in our department. The learning curve was analyzed in terms of the time necessary to perform the task and the quality of the anastomosis. RESULTS: The model was created and used by the junior authors during their year of fellowship in advanced laparoscopic urology. The authors had no previous experience with hands-on laparoscopic suturing but have assisted in a great number of laparoscopic radical prostatectomies. The time required for performing the anastomosis on the model declined from 75 minutes initially to 20 minutes after the trainees had performed 20 anastomoses each. After this training, it was possible to create a watertight running laparoscopic vesicourethral anastomosis in patients in a mean time of 40 minutes (range 30-55 minutes). CONCLUSION: This simple model allows the trainee in laparoscopic urology to acquire the skills necessary to perform a laparoscopic vesicourethral anastomosis, one of the most complex steps in laparoscopic radical prostatectomy, as well as to develop dexterity and facility in laparoscopic manipulation of needles, sutures, and fragile tissues.

Anastomosis, Surgical↗

PubMed2003

Immediate closure of nephrostomy tube wounds using a tissue adhesive: a novel approach following percutaneous endourological procedures.

PURPOSE: We assessed the feasibility of immediate sealing of nephrostomy tube wounds after percutaneous surgery using a tissue adhesive. MATERIALS AND METHODS: The study represents a prospective series of 27 consecutive percutaneous procedures. After nephrostographic exclusion of infrarenal urinary obstruction the nephrostomy tubes were removed and the wound edges were glued together using 2-octyl cyanoacrylate. The wound was covered by gauze to assess the efficiency of sealing and the patients were followed clinically. Another consecutive series of 20 patients who had been treated during 6 months before the current study were used for comparison. The nephrostomy wound in this group was dressed and left to close spontaneously. RESULTS: A total of 27 percutaneous procedures were performed in 25 patients with a median age of 51 years (range 9 to 77). There were 26 cases of percutaneous nephrolithotomy for an average stone burden of 32.6 mm. (range 16 to 70) and 1 pediatric case of percutaneous antegrade balloon dilation of ureteral stricture related to Cohen reimplantation. Median size of the nephrostomy tubes was 16Fr (range 12Fr to 24Fr) and they were maintained a median of 4 days (range 1 to 16) postoperatively. Urinary leakage ceased immediately after tissue adhesive application in all cases. One patient in whom renal colic developed secondary to edema of the ureteral orifice underwent temporary stenting in retrograde fashion. There were no additional complications at a median followup of 5 months (range 3 to 7). The study group had a significantly shorter hospital stay than the wound dressing group (p <0.001). CONCLUSIONS: Wound sealing following nephrostomy tube removal using 2-octyl cyanoacrylate appears to be a safe, simple and efficient method for immediate abolishment of urinary leakage. This novel approach avoids patient and medical personnel inconvenience, permitting early release from the hospital without physical and social limitations related to persistent wound urinary discharge.

Adolescent↗

PubMed2003

A simplified 5-step model for training laparoscopic urethrovesical anastomosis.

PURPOSE: We developed a training model and program aimed at improving the skills of urologists with no previous experience in laparoscopy to perform a running suture urethrovesical anastomosis as is done during laparoscopic radical prostatectomy. MATERIALS AND METHODS: Our program is performed on a pelvic trainer with a videolaparoscopic unit and consists of passage of a ligature, intracorporal knotting, intracorporal suturing, linear anastomosis and circular running suture anastomosis. The trainees performed the first 3 tasks during the initial lessons and then advanced to the 2 final tasks. At the end of each lesson time was recorded and progression curve was plotted for each participant for each task. The end point of the study was participant ability to perform an accurate circular anastomosis. Logarithmic regression analysis was used to assess the significance of progression. RESULTS: All 10 urologists who participated in this study showed a rapid and significant decrease in the time required to perform the first 3 tasks accurately. The participants were able to perform a linear anastomosis after 3 to 5 lessons and an accurate circular anastomosis after 5 to 10 lessons. CONCLUSIONS: By using this model and dividing a complicated surgical step to simplified tasks, we were able to improve trainee performance significantly in a short time. A training program for basic and advanced laparoscopic skills should be incorporated into the syllabus of urologists-in-training and available to those who wish to gain experience in laparoscopic surgery.

Anastomosis, Surgical↗

PubMed2002

Laparoscopic treatment for ureteropelvic junction obstruction.

OBJECTIVES: To assess retrospectively the subjective and objective outcomes achieved after laparoscopic treatment for ureteropelvic junction obstruction at our institutions. METHODS: Between August 1999 and July 2001, 19 patients (11 women and 8 men), with a mean age of 31.2 years (range 17 to 67), underwent laparoscopic treatment for ureteropelvic junction obstruction. Of these, 17 patients were eligible for postoperative analysis. Nine of these patients had a history of prior surgical intervention on the affected side. The patients were subjectively assessed by an analog pain scale performed before and at least 6 months after surgery. Preoperatively, patients had a diuretic renal scan to confirm the presence of obstruction. Helical computed tomography was also performed preoperatively to assess for the presence of crossing vessels. The renal scan was repeated at least 12 weeks after surgery to document the relief of obstruction objectively. RESULTS: Helical computed tomography correctly predicted the presence of crossing vessels in 12 patients (63%). The Anderson-Hynes and Fenger pyeloplasty techniques were performed in 16 and 2 patients, respectively. In 1 patient, a small crossing vein over the ureteropelvic junction was identified and divided without complications. The average operative time was 240 minutes (range 128 to 470). The blood loss was minimal, and no open conversions were required. The mean hospital stay was 2.9 days (range 2 to 7). Two postoperative complications occurred (11.7%). The average subjective follow-up was 14.4 months (range 6 to 27), and the average objective follow-up was 7.8 months (range 3 to 12). Of 17 assessable patients, 16 (94%) had subjective and objective success (postoperative improvement in analog pain score and half-life of radiotracer washout). The average split renal function improved from 34.1% to 38.5% (P <0.01). CONCLUSIONS: On the basis of our data, laparoscopic pyeloplasty has a similar success rate compared with the traditional open approach and better results than other minimally invasive techniques. Longer follow-up and further experience are needed to validate these data.

Adolescent↗

PubMed2002

Laparoscopic retroperitoneal nephrectomy for Aspergillus-infected polycystic kidney.

BACKGROUND AND PURPOSE: The management of polycystic kidney disease is mostly restricted to conservative measures. However, nephrectomy may be indicated in particular cases, especially when there are infective complications. To decrease the morbidity of the procedure, the laparoscopic approach has become appealing. We present a laparoscopic retroperitoneal approach to complicated polycystic kidney disease in a high-risk patient. CASERESPORT: We performed right retroperitoneal laparoscopic nephrectomy in a 39-year-old man who had autosomal polycystic kidney disease and had undergone heart transplantation. The immunosuppressed patient presented with severe flank pain, generalized signs of infection, and acute renal insufficiency. With the patient in the right lateral decubitus position, the retroperitoneal space was entered by the open technique, and the posterior pararenal space was developed with finger dissection. Five trocars were used. After the renal vessels had been secured and divided, the cysts were successively punctured, gradually shrinking the operative specimen. The kidney was placed in an Endo-catch and removed after morcellation, with no need to enlarge the 2-cm lumbotomy. The operating time was 80 minutes, and the hospital stay was 4 days. Histologic examination revealed a polycystic kidney with Aspergillus infection. CONCLUSION: The laparoscopic approach is a less-invasive option for removing a polycystic kidney when nephrectomy is indicated. The retroperitoneal route has the advantage of minimizing infection risks because of the absence of peritoneal opening.

Adult↗