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Biomedical subjects

D M Albala

Publications and source records attributed to D M Albala.

At least 37 records · Page 2Linked to original sources
PubMed1998

Retroperitoneal and pelvic extraperitoneal laparoscopy: an international perspective.

OBJECTIVES: To assess technical preferences and current practice trends of retroperitoneal and pelvic extraperitoneal laparoscopy. METHODS: A questionnaire survey of 36 selected urologic laparoscopic centers worldwide was performed. RESULTS: Twenty-four centers (67%) responded. Overall, 3988 laparoscopic procedures were reported: transperitoneal approach (n = 2945) and retroperitoneal/extraperitoneal approach (n = 1043). Retroperitoneoscopic/extraperitoneoscopic procedures included adrenalectomy (n = 74), nephrectomy (n = 299), ureteral procedures (n = 166), pelvic lymph node dissection (n = 197), bladder neck suspension (n = 210), varix ligation (n = 91), and lumbar sympathectomy (n = 6). Mean number of total laparoscopic procedures performed in 1995 per center was 41 (range 5 to 86). Major complications occurred in 49 (4.7%) patients and included visceral complications in 26 (2.5%) patients and vascular complications in 23 (2.2%). Open conversion was performed in 69 (6.6%) patients, electively in 41 and emergently in 28 (visceral injuries, n = 16; vascular injuries, n = 1 2). Retroperitoneoscopy/extraperitoneoscopy is gaining in acceptance worldwide: in 1993, the mean estimated ratio of transperitoneal laparoscopic cases versus retroperitoneoscopic/ extraperitoneoscopic cases per center was 74:26; however, in 1996 the ratio was 49:51. CONCLUSIONS: Retroperitoneoscopy and pelvic extraperitoneoscopy are important adjuncts to the laparoscopic armamentarium in urologic surgery. The overall major complication rate associated with retroperitoneoscopy/extraperitoneoscopy was 4.7%.

Humans↗
PubMed1998

The laparoscopic cooling sheath: novel device for hypothermic preservation of kidney during temporary renal artery occlusion.

Hypothermia is commonly used to prevent ischemic renal damage during complex nephron-sparing surgical procedures requiring temporary renal artery occlusion. We developed a novel Cooling Sheath device, which is compatible with laparoscopy, to protect the kidney hypothermically during 60 minutes of temporary arterial occlusion in a laparoscopic swine model. Comparison of temperature curves and histology to control groups undergoing open slush surface cooling and laparoscopic warm ischemia for similar time periods was performed. Optimal hypothermic temperatures were reached rapidly and maintained with the use of the Cooling Sheath. Ischemic damage, present in all kidneys subjected to warm ischemia, was not found on histopathologic examination of the cooled kidneys. This new device provides hypothermic protection of the kidney during ischemia. The use of the Cooling Sheath combined with temporary arterial occlusion will allow more complex nephron-sparing renal surgery to be performed using laparoscopy.

Animals↗
PubMed1998

Complications of acucise endopyelotomy.

Endoscopic management of ureteropelvic junction (UPJ) obstruction has a success rate of 80% to 86%. We have been performing a ureteral cutting balloon procedure under fluoroscopic control (Acucise endopyelotomy) for UPJ obstruction at Loyola University Medical Center since 1991. The overall success rate in 77 patients was 78%. All patients had a preoperative intravenous urogram or a retrograde pyelogram, but none had vascular imaging studies. Acucise endopyelotomy consisted of a posterolateral incision of the UPJ and placement of an endopyelotomy or double-J stent. Foley catheter placement at the end of the procedure demonstrated significant gross hematuria in three patients (4%). All three remained hemodynamically stable but with significant drops in postprocedure hemoglobin levels, which necessitated blood transfusion. Aggressive management included angiographic studies and embolization of lower-pole branching arteries in two patients (3%). One patient stopped bleeding after being given two units of blood. None of the patients required an open exploratory procedure. Although the risk of vascular injury is low with Acucise endopyelotomy, prolonged postoperative gross hematuria does mandate investigation and observation. Angiographic embolization appears to be the therapeutic modality of choice for patients with hemorrhagic complications after an Acucise endopyelotomy.

Adolescent↗
PubMed1997

Bilateral laparoscopic adrenalectomy for adrenocorticotropic dependent Cushing's syndrome.

PURPOSE: We report our experience with bilateral laparoscopic adrenalectomy for total adrenal ablation in patients with Cushing's syndrome. MATERIALS AND METHODS: Four women (mean age 63 years) with Cushing's syndrome secondary to nonlocalized ectopic adrenocorticotropic hormone production in 3 and pituitary microadenoma after failed transsphenoidal ablation in 1 underwent bilateral transabdominal laparoscopic adrenalectomy. Preoperatively risk was III or IV according to the American Society of Anesthesiologists classification. RESULTS: In all cases bilateral laparoscopic adrenalectomy was successfully performed. Operative time ranged from 375 to 475 minutes (mean 404) and mean blood loss was 162 cc. All patients resumed oral intake on postoperative day 1, mean number of postoperative parentral narcotic doses was 2.25 and mean postoperative hospital stay was 5.75 days (range 3 to 8). Complications included an abdominal wall hematoma. All patients resumed baseline activity by postoperative day 14. CONCLUSIONS: Our experience in 4 cases of Cushing's syndrome suggests that bilateral laparoscopic adrenalectomy is a safe and effective alternative to open adrenalectomy. Further experience with this technique will likely decrease operative time, and confirm the benefit of a decreased hospital stay and convalescence.

Adrenalectomy↗
PubMed1997

A multicenter clinical trial investigating the use of a fluoroscopically controlled cutting balloon catheter for the management of ureteral and ureteropelvic junction obstruction.

PURPOSE: We assessed the efficacy of a fluoroscopically controlled cutting balloon catheter for the treatment of ureteropelvic junction and ureteral strictures. MATERIALS AND METHODS: A multicenter trial was performed that included 66 endopyelotomies and 49 endoureterotomies. To our knowledge this study represents the largest number of patients with ureteropelvic junction obstruction and ureteral strictures tested with this device to date. RESULTS: With a mean followup of 7.8 months (range 1 to 17.9) the patency rate was 77% for endopyelotomy, with 72% of the primary and 100% of the secondary ureteropelvic junction obstructions remaining patent. The endoureterotomy patients were followed for an average of 8.7 months (range 1.2 to 17.0), with a patency rate of 55%. CONCLUSIONS: A cutting balloon endoscopic incision is effective in the majority of cases, with patency rates for endopyelotomies and endoureterotomies that mirror current endourological reports using other, albeit more time intensive and more invasive, incisional techniques.

Adolescent↗
PubMed1997

Transurethral vaporization of the prostate in the treatment of bladder outlet obstruction at two university hospitals.

Transurethral vaporization of the prostate (TVAP) is a new technique for the surgical treatment of men with benign prostatic hyperplasia (BPH). The primary advantage of TVAP appears to be shortened hospitalization and less bleeding than is associated with transurethral resection of the prostate (TURP). Since February 1995, 66 consecutive men with bladder outlet obstruction (47 with persistent voiding symptoms and 19 in complete urinary retention) secondary to prostatic disease underwent TVAP at two university hospitals. TVAP was utilized in all patients regardless of prostate size. The mean length of follow-up was 3.2 months. All 19 men in complete retention were able to void adequately following surgery with a mean postvoid residual volume of 18cc and a mean International Prostate Symptom Score (I-PSS) of 7.5. In the remaining patients, the I-PSS decreased from a mean of 19.6 to 8.4. Pre- and postoperative peak urinary flow rate data were available in 17 men and increased from 9 to 18 cc/s. Limited transurethral resection of prostatic tissue at the completion of TVAP was necessary to adequately relieve bladder outlet obstruction in 18% (12/66) of patients. Hospitalization of < 24 h was needed in 68% (45/66) patients. The urinary catheter was removed within 1 day of surgery in 68% (45/66) of men as well. Seven patients required catheter replacement postoperatively due to difficulty voiding (five men) or bleeding (two men). No patient required blood transfusion. TVAP is effective in relieving bladder outlet obstruction in men with and without urinary retention. The majority of patients require brief or no hospitalization and are able to void adequately within 24 h of surgery. TVAP appears to be less effective in men with large prostate glands, and limited TURP is more frequently needed in these cases. The long-term results of TVAP will require further study.

Aged↗
PubMed1994

Cytomegalovirus prostatitis. Case report and review of the literature.

We report the case of a patient undergoing chemotherapy for multiple myeloma discovered to have cytomegalovirus prostatitis. The findings of a hypoechoic prostatic lesion on ultrasound and a slightly elevated prostatic specific antigen of 4.6 ng/ml prompted a prostate biopsy. Cytopathologic examination and immunohistochemical staining demonstrated cytomegalovirus within the prostate. This virus is a common pathogen in the immunosuppressed patient, but its presence in the male genital tract is relatively rare. No previous reports of biopsy-proven cytomegalovirus prostatitis appear in the literature. The relationship of cytomegalovirus to the prostate is discussed in detail.

Aged↗
PubMed1994

Transperitoneal nephrectomy for benign disease of the kidney: a comparison of laparoscopic and open surgical techniques.

OBJECTIVE: The objective of this study was to compare the results of laparoscopic nephrectomy for benign disease to open surgical nephrectomy for benign disease. METHODS: Twenty consecutive patients undergoing laparoscopic nephrectomy for benign disease were compared with 23 patients undergoing open surgical nephrectomy for benign disease and with 29 patients undergoing a donor nephrectomy. Data were collected in the following areas: patient age, anesthetic risk, operative time, estimated blood loss, postoperative time to resume oral intake, parenteral analgesics, oral analgesics, hospital stay, complications, and convalescence. Information was obtained through chart review, telephone interviews, and mailed questionnaires. RESULTS: Compared with open surgical nephrectomy, laparoscopic nephrectomy resulted in a statistically significant longer operative time; however, it afforded a statistically significant decrease in postoperative ileus (open group), hospital stay (both groups), oral analgesics (donor group), and convalescence (both groups). The incidence of complications was 15 percent in the laparoscopic group and 0 percent in the two open surgical groups; the majority of complications occurred during the initial seven laparoscopic procedures. CONCLUSIONS: Laparoscopic nephrectomy is a more time-consuming procedure than open surgical nephrectomy. Also, early in one's experience with this technique, the complication rate is higher than with open surgery. However, despite the newness of the technique, it results in significant benefits to the patient: decreased postoperative pain, shorter hospitalization, and more rapid convalescence.

Adult↗
PubMed1994

Laparoscopic ureteral reanastomosis using fibrin glue.

Using 10 female pigs, an open ureteral resection and suture anastomosis (5 pigs) was compared to a laparoscopic resection and a fibrin glue anastomosis (5 pigs). The fibrin glue technique was performed by laparoscopically excising a ureteral segment, placing 2 transmural sutures over a stent and sealing the anastomosis with tissue adhesive, a mixture of concentrated fibrinogen and thrombin. At 4 weeks the stent was removed. At 8 weeks, the animals underwent antegrade pyelograms and Whittaker renal pelvis perfusion test and then were sacrificed. The experimental group had 1 anastomotic breakdown; all others had patent ureters. Radiographically, both groups demonstrated mild to moderate hydroureteronephrosis. Renal pelvis perfusion tests were higher in the fibrin glue group (12.6 cm. H2O versus 3.0 cm. H2O); however, all were normal for the porcine model. Histologic evaluation demonstrated increased muscular and serosal fibrosis and inflammation in the fibrin glue group when compared with the control group. Laparoscopic ureteral reanastomosis with fibrin glue is feasible; however, further research is needed to understand its full potential in urology.

Anastomosis, Surgical↗
PubMed1994

Optimal therapy for the distal ureteral stone: extracorporeal shock wave lithotripsy versus ureteroscopy.

Extracorporeal shock wave lithotripsy (ESWL not equal to) is the optimal therapy for renal calculi less than 2 cm. in diameter and for proximal ureteral calculi. Controversy continues over the initial approach to distal ureteral calculi (that is below the bony pelvis): in situ ESWL versus ureteroscopy. Since February 1990, 76 distal ureteral calculi were treated at our institution using either in situ ESWL (Dornier HM3 ESWL with a Stryker frame modification in 27 patients or Siemen's Lithostar electromagnetic ESWL in 22) or ureteroscopy (27 patients). Patient age and stone size were similar among the groups. All ESWL treatments were performed with the patient under intravenous sedation and on an outpatient basis. Stone-free rates were 96% for the HM3 device, 84% for the Lithostar and 100% for ureteroscopy. Retreatment was required in 3 Lithostar cases (14%) and 1 HM3 case (4%). When compared to ESWL ureteroscopy for distal ureteral stones was more time-consuming, entailed routine placement of a ureteral stent, often required general anesthesia, more often led to hospitalization and doubled the convalescence period. From a cost standpoint, ESWL on an HM3 unit was a few hundred dollars more expensive than ureteroscopy. In summary, we believe that in situ ESWL provides optimal first line therapy for distal ureteral calculi, while ureteroscopy is better reserved as a salvage procedure should ESWL fail.

Adult↗
PubMed1994

Urolithiasis as a hazard of sulfonamide therapy.

We identified 40 patients (25 men and 15 women) who developed calculi composed totally or partially of sulfonamides (acetylsulfamethoxazole, sulfadiazine, and acetylsulfisoxazole) between 1980 and 1987. The incidence of sulfonamide stones is less than 1% of stones. Patient characteristics were determined from questionnaires sent to the patients and attending physicians. The majority of patients developed symptoms 1 to 4 weeks after beginning sulfonamide therapy. The bladder was the most common stone location. Obstruction of the urinary system by the acetyl derivatives of the drug is the most serious consequence of sulfonamide therapy. Early recognition of drug-related stones is essential to protect patients from recurrences, reduce the risk of renal complications, and avoid continuing ineffective therapeutic regimens.

Adolescent↗
PubMed1994

Diuretic renal scan: is it always reliable?

The differentiation between significant mechanical obstruction and nonobstructive dilation of the kidneys and ureters is fundamental to patient management. The diuretic renal scan is a useful test in this situation because it usually is reliable and reproducible and is noninvasive and objective, providing information about the function of each kidney. However, this study has given variable results in a small number of patients. We report our experience with five such patients and recommend an algorithm for evaluating patients with equivocal scan results. This report emphasizes the importance of continued follow-up and the need for periodic reevaluation of patients with unexplained urinary symptoms or persistent flank pain, even when the initial diuretic renal scan is normal.

Adolescent↗
PubMed1994

Effect of topical eutectic mixture of local anesthetics on pain response and analgesic requirement during lithotripsy procedures.

We sought to determine whether topically applied eutectic mixture of local anesthetics (EMLA) would decrease analgesic requirement during extracorporeal shock wave lithotripsy (ESWL). Fifty-nine healthy out-patients undergoing elective ESWL using an unmodified Dornier HM-3 lithotriptor were randomly assigned to receive either a topical EMLA or placebo cream applied to the skin of the flank overlying the kidney 90 min prior to the ESWL procedure. Patients were given five test shocks at each of five different energy levels: 10, 12, 15, 18, and 20 kV. Patients evaluated the average pain at each stimulus level using a visual analog scale. Overall pain scores were significantly lower in EMLA-treated patients at 18 and 20 kV (P < 0.05). EMLA cream was significantly more effective at decreasing cutaneous pain in male than in female patients. However, during the lithotripsy procedure, EMLA cream had no significant effect on the intraoperative requirement for intravenous alfentanil, hemodynamic variables, recovery times, or postoperative side effects. Although the topical application of EMLA cream produced cutaneous analgesia, these data suggest that it failed to produce any opioid-sparing effect during the immersion lithotripsy procedure.

Adult↗
PubMed1993

Retroperitoneal laparoscopic nephrectomy: laboratory and clinical experience.

Laparoscopic nephrectomy using an entirely retroperitoneal approach was performed in six anesthetized female pigs. In each animal, the kidney was localized using fluoroscopy, following which the retroperitoneum was insufflated with CO2. Subsequently, a retroperitoneal laparoscopic nephrectomy was performed in a 48-year-old man with a chronically obstructed, nonfunctioning kidney. Although the retroperitoneal approach provides excellent exposure for the dissection of the renal hilum, anatomic factors in the human limit port placement and organ entrapment and increase the risk for development of a pneumothorax.

Animals↗