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Deepak Dubey

Publications and source records attributed to Deepak Dubey.

18 recordsLinked to original sources
PubMed2006

Sigmoid vaginoplasty: long-term results.

OBJECTIVES: To evaluate the long-term results of sigmoid vaginoplasty for Mayer-Rokitansky-Kuster-Hauser syndrome. The social and psychological acceptance of the procedure is also discussed in terms of a developing country scenario. METHODS: A total of 14 patients with Mayer-Rokitansky-Kuster-Hauser syndrome were treated at our institute from January 1995 to December 2004. Sigmoid vaginoplasty was performed in all patients. The procedure was performed using a combined abdominoperineal approach. Dissection was done between the urethra and rectum to create a bed for the neovaginal colon conduit. A 10-cm segment of sigmoid colon was raised on its vascular pedicle, delivered through the abdominoperineal tunnel, and fixed to the vaginal pit incision. The patient records were reviewed for surgical technique and postoperative complications. Patients underwent a personal interview to assess the postoperative results, social acceptance of the procedure, and sexual satisfaction. RESULTS: The mean patient age at surgery was 16.8 years. The patients who underwent sigmoid vaginoplasty had good cosmetic results without the need for routine dilation or the problem of excessive mucus production. The postoperative morbidity was minimal. During a mean follow-up of 4.1 years, no stenosis or colitis was encountered. The subjective satisfaction rate with the surgical outcomes in all the patients was 8.01 on a scale of 0 to 10 (0, very disappointed to 10, satisfied). CONCLUSIONS: Sigmoid vaginoplasty is an effective treatment for patients with vaginal atresia. Timed vaginal reconstruction in these patients allows for a better quality of life and social acceptance. It also enables the patient to lead a near-normal sexual life, with high satisfaction rates.

Abnormalities, Multiple↗
PubMed2006

Is laparoscopic nephrectomy the preferred approach in xanthogranulomatous pyelonephritis?

OBJECTIVES: To report our experience with laparoscopic nephrectomy in patients with xanthogranulomatous pyelonephritis (XGP) and compare it with the open approach. XGP is an atypical and severe form of chronic renal infection. Open nephrectomy has been the procedure of choice for XGP. The laparoscopic approach has been used in cases of XGP but with increased complications and operative time. METHODS: A retrospective analysis of all the patients who underwent laparoscopic nephrectomy with a pathologic diagnosis of XGP from January 2001 to August 2005 was done. The demographic profile and data on the operative time, operative technique, blood loss, and complications were obtained. RESULTS: In all, 25 patients underwent nephrectomy with a pathologic diagnosis of XGP, 10 laparoscopically and 15 by the open approach. Laparoscopic nephrectomy for XGP was successful in 80% of the cases. The dissection of the kidney was comparatively difficult in all cases because of dense adhesions in the perirenal region and required modification of the technique. The incidence of major complications was 20% and 10% in the open and laparoscopic groups, respectively. The mean hospital stay in the laparoscopic group was 3.8 days, significantly less than that for the open nephrectomy group (8.2 days). The mean operative time in the laparoscopic group was 3.8 hours compared with 2.5 hours in the open group. CONCLUSIONS: Laparoscopy can be successfully performed in patients with a pathologic diagnosis of XGP. Although a longer operative time is required because of perinephric adhesions, the postoperative recovery is faster and cosmesis superior compared with the open approach. Modifications in the standard laparoscopic technique can be made to complete the procedure successfully and safely.

Adolescent↗
PubMed2006

Hem-o-lok clips for vascular control during laparoscopic ablative nephrectomy: a single-center experience.

BACKGROUND AND PURPOSE: Vascular control is an important step in laparoscopic nephrectomy. The various options are titanium clips, Hem-o-lok clips (Weck Closure Systems, Research Triangle Park, NC), T-knot, and stapling devices. We report our experience with the use of Hem-o-lok clips. PATIENTS AND METHODS: From January 2001 to June 2004, 246 laparoscopic ablative nephrectomies (178 simple; 68 radical) were performed at our institute for benign and malignant conditions. All patients (mean age 46.76+/-26.31 years) were evaluated by detailed history and physical examination and laboratory investigations and underwent standard transperitoneal (N=204) or retroperitoneal (N=42) nephrectomy. Venous and arterial control was obtained using Hem-o-lock clips. In cases where the clips could not be applied directly on the renal vein, various maneuvers were employed to secure the occlusion. The features compared were the number of clips used, safety, cost, and requirement for blood transfusion. RESULTS: Conversion to an open procedure was required in 36 patients (28 in the transperitoneal group and 8 in the retroperitoneal group). The mean operative time was 280+/-35 minutes and 235+/-44 minutes in the retroperitoneal and transperitoneal groups, respectively. In all cases, arterial and venous control was achieved by application of two Hem-o-lok clips on the patient side. Blood transfusion was required by 7.2% of the patients (right-side nephrectomy 4.6%; left side nephrectomy 2.6%), but none was attributable to clip-related complication. The mean postoperative hospital stay was 3.4 days. CONCLUSION: Hem-o-lok clips are a reliable and cost-effective means of achieving vascular control during laparoscopic nephrectomy.

Adult↗
PubMed2006

Urethral stricture assessment: a prospective study evaluating urethral ultrasonography and conventional radiological studies.

OBJECTIVE: To evaluate the accuracy of urethral ultrasonography (sono-urethrography, SUG) in determining the length of anterior urethral strictures, and for predicting the degree of spongiofibrosis. PATIENTS AND METHODS: In all, 52 patients with anterior urethral strictures detected on retrograde urethrography (RUG) were also examined using SUG, to assess the stricture location, length and degree of spongiofibrosis. The findings of both procedures were then compared with the operative findings. RESULTS: The mean (sd) stricture length on RUG, SUG and at surgery was 2 (0.8), 3.8 (1.4) and 3.5 (1.6) cm, respectively. The mean length on SUG was closer to that at surgery. Spongiofibrosis was detected by SUG with an overall accuracy of 42%, 56% and 83% for mild, moderate and severe degrees of fibrosis, respectively. There were no significant complications during the procedure. CONCLUSION: SUG is more accurate for evaluating the length of anterior urethral strictures than RUG, and gives additional information about spongiofibrosis.

Fibrosis↗
PubMed2005

Inferior vena cava in urology: importance of developmental abnormalities in clinical practice.

Anomalies of the inferior vena cava (IVC) have been known since 1793, when Abernethy first described a congenital, mesocaval shunt and azygous continuation of the IVC in a 10-month-old infant with polysplenia and dextrocardia. The IVC is formed by a complex process of embryogenesis during the sixth to tenth week of gestation. It forms from continuous appearance and regression of the three paired veins: posterior cardinal, subcardinal, and supracardinal. Improper completion of the developmental process may result in at least 14 anatomic anomalies, out of which the following four are usually encountered in clinical practice: duplication of the IVC, transposition or left-sided IVC, retroaortic left renal vein, and circumaortic left renal vein. It is suggested that the preoperative diagnosis of the vascular anomalies reduces the complication rate of abdominal vascular procedures. Our vast experience with approximately 400 kidney donors who were evaluated preoperatively with spiral CT scan with three-dimensional reconstruction (3D) reconfirmed this view. Thereafter, it became easier to choose the side and decide between laparoscopic vs. open approach. This prompted us to write the present article focusing on those developmental anomalies of the IVC that may be encountered by the urologist and their implication on the clinical practice.

Abnormalities, Multiple↗
PubMed2005

Vascular complications after percutaneous nephrolithotomy: are there any predictive factors?

OBJECTIVES: To evaluate the severe hemorrhagic complications of percutaneous nephrolithotomy (PNL) and their management and to analyze the predictive factors. METHODS: We retrospectively analyzed the data of 1854 patients who had undergone PNL for removal of renal calculi at our institute between 1993 and 2003. All patients were resuscitated with intravenous fluids and blood transfusions. Patients in whom bleeding did not respond to conservative means underwent angiography and subsequent embolization. Multivariate analyses were done to determine the various factors responsible for the occurrence of these lesions. RESULTS: Of the 1854 patients, 27 (1.4%), with a mean age of 38.6 years (range 19 to 63) required angiography and/or embolization for bleeding control. The mean time to the onset of hemorrhage was 8 days (range 2 to 18). Renal arteriography revealed pseudoaneurysm in 13, arteriovenous fistula in 6, a combination of both in 4, lumbar artery injury in 1, and no lesion in 3 patients. In 22 patients, successful embolization of the offending vessel was achieved and in 2 the hematuria recurred. These 2 patients underwent repeat angiography and embolization of the lesion. Metallic coils were used in 13, Gelfoam in 5, and coils and Gelfoam in 8 patients. On multivariate analysis, only stone size was the significant factor predicting for the occurrence of these vascular complications. CONCLUSIONS: Severe hematuria is a rare complication of PNL that can be successfully managed with angioembolization. Our results indicated that stone size significantly predicted for the occurrence of lesions in patients undergoing PNL for symptomatic stone disease.

Adult↗
PubMed2005

Endoscopic incision for functional bladder neck obstruction in men: long-term outcome.

OBJECTIVES: To evaluate the long-term outcomes of endoscopic bladder neck incision (BNI) for functional bladder neck obstruction. Functional and/or mechanical obstruction of the bladder neck in men causes lower urinary tract symptoms. Although alpha-blockers are the initial treatment, they often fail to alleviate the symptoms. METHODS: The records of 45 men with obstructive voiding symptoms treated between 1988 and 1996 were reviewed. The symptom score, renal parameters, urine routine microscopy, urine culture and sensitivity, uroflowmetry, voiding cystourethrography, and videourodynamic results were reviewed. Patients with a peak flow rate of less than 10 mL/s, inadequate funneling of the bladder neck, more than 40 cm H2O opening pressure with a relaxed external sphincter, a postvoid residual urine volume greater than 100 mL, no neurologic defect, and a normal urethral caliber were included. They were treated with clean intermittent catheterization and alpha-blockers. Clean intermittent catheterization was stopped when the postvoid residual urine volume was less than 50 mL. BNI was performed in patients with a poor response, noncompliance, or side effects from the alpha-blockers. Postoperatively, patients were assessed by symptom score, uroflowmetry, and postvoid residual urine volume. RESULTS: Of the 45 men, 22 responded to alpha-blockers, 5 chose clean intermittent catheterization, and 18 underwent BNI. The mean patient age was 33.42 +/- 6.56 years. The mean follow-up was 96 months (range 46 to 140). After BNI, all patients showed improvement, with the symptom score improving from 26.9 to 3.6 (P < 0.001). The peak flow rate improved from 8.5 to 19.6 mL/s (P < 0.001). This improvement persisted in more than 80% of the 18 patients. Two required a second BNI and were also doing well at the last follow-up visit. CONCLUSIONS: BNI is an effective treatment for functional bladder neck obstruction refractory to alpha-blockers and provides durable results.

Adrenergic alpha-Antagonists↗
PubMed2005

Steps to reduce operative time in laparoscopic dismembered pyeloplasty for moderate to large renal pelvis.

OBJECTIVES: To describe the steps to reduce the operative time for laparoscopic dismembered pyeloplasty in ureteropelvic junction obstruction with moderate to large hydronephrosis. METHODS: Using a transperitoneal approach and three ports, pyelotomy was done proximal to the ureteropelvic junction, and the ureter was spatulated laterally before dismembering it. Using the three suture line technique, the first suture was taken at the distal end of the spatulated ureter outside-in to the most dependent part of the pelvis inside-out and left as such. The second suture was taken at the proximal end of the ureter outside-in to the corresponding site at the posterior wall of the pelvis and then continued distally to complete the posterior suture line. A double-J stent was placed in an antegrade way. The anterior wall was completed with the first suture, taking continuous bites. The third suture line was used to close the pelvis. The operative time was recorded from placing the patient in the lateral position to the closure of the last port. RESULTS: From January 2002 to January 2004, 24 patients underwent pyeloplasty performed by a single surgeon. The mean pelvic volume was 80.4 cm3 (range 70 to 110). The mean patient age was 24.5 years (range 5 to 57). The body mass index was 22.28 kg/m2 (range 20 to 25). The mean operative time was 120.4 minutes (range 80 to 160). Minor complications were noted in 3 patients. All patients showed improvement in symptoms and drainage after a mean follow-up of 17 months (range 10 to 28). CONCLUSIONS: These steps helped to reduce the operative time to close to that of open surgery, making laparoscopic pyeloplasty a more desirable alternative.

Adolescent↗
PubMed2005

Can the need for palliative transurethral prostatic resection in patients with advanced carcinoma of the prostate be predicted?

PURPOSE: To identify the factors predicting the need for palliative transurethral resection of the prostate (channel TURP) in patients with advanced carcinoma of the prostate (CAP) receiving androgen ablation therapy. PATIENTS AND METHODS: From January 1996 to January 2004, 203 patients with advanced CAP were treated by androgen ablation. Patients presenting with retention were catheterized initially, and those (N = 12) who failed a catheter-free trial and had immediate channel TURP were excluded. The remaining 191 patients were followed every 3 months (mean 35.5 months, range 6-92 months). Patients requiring channel TURP (group 1; N = 42 [22%]) during follow-up were compared with those who did not (group 2) for predictive factors, viz. retention of urine, serum prostate specific antigen (PSA) concentration, Gleason sum, prostate size, and bony metastasis at presentation. RESULTS: Channel TURP was performed at a mean of 21 months (range 3-72 months). The mean Gleason sum in this group was 7.88, whereas it was 7.29 in group 2 (P = 0.013). Retention at presentation was significantly more common in group 1 (N = 26; 61.9%) than in group 2 (N = 46; 30.8%; P = 0.001). Patients who did not present with retention and had Gleason sums < or =7 (N = 32) did not require channel TURP. Of the 14 patients who voided successfully after a catheter-free trial but had Gleason sums of >7, 71.4% required channel TURP. Other factors were not found to be significantly different in the two groups. CONCLUSION: High Gleason sum and retention at presentation are significant factors predictors of the need for channel TURP during follow-up in patients with advanced CAP receiving androgen ablation therapy.

Aged↗
PubMed2005

Safety profile and complications of transperitoneal laparoscopic pyeloplasty: a critical analysis.

PURPOSE: To critically assess the safety profile and complications of the transperitoneal approach to laparoscopic pyeloplasty at our center. PATIENTS AND METHODS: From January 2002 to January 2004, 92 patients with a mean age of 22.78 +/- 15.15 years (range 14 months-65 years) with primary (N = 90) or secondary (N = 2) ureteropelvic junction obstruction were treated by transperitoneal laparoscopic pyeloplasty and were evaluated for this study. Renal stones were present in eight patients. A double-J stent was placed antegrade in 50 patients and in the rest through cystoscopy. All patients were followed up clinically and by renal scan. RESULTS: Of the 92 cases (93 renal units), 6 were converted to open pyeloplasty. Dismembered pyeloplasty was performed in 59, Fengerplasty in 8, and Foley Y-V-plasty in 20 units. A crossing vessel was present in 15 units (16.12%). The mean estimated blood loss was 63.6 mL (range, 30-200 mL). The mean operative time was 179.4 minutes (range 80-350 minutes). Overall, 17 patients (18.4%) had complications. Six patients had paralytic ileus and another six had increased drain output, which delayed the hospital stay to 7 days. Pyelonephritis and port-site hernia occurred in one patient each. Four patients required ancillary procedures: ureteroscopy for a migrating stent (1), percutaneous antegrade stenting (1), and SWL for residual stone (2). The mean hospital stay was 4 days (range 2-7 days). Of the 87 units (86 patients), 81 (93.3%) have shown improvement in symptoms and drainage pattern on renal scan at a mean followup of 12 (3-27) months. CONCLUSION: The transperitoneal approach to pyeloplasty is safe and effective, although patients with large stone bulk and multiple stones should be considered for an alternative approach. The double-J stent should be checked carefully for proper placement. Hemostasis of the cut margin of the renal pelvis, watertight anastomosis, and adequate drainage should also be ensured.

Adolescent↗
PubMed2005

Buccal mucosal urethroplasty for balanitis xerotica obliterans related urethral strictures: the outcome of 1 and 2-stage techniques.

PURPOSE: Balanitis xerotica obliterans (BXO) related strictures are complex and generally managed by 2-staged urethroplasty. We present our results with 1-stage dorsal onlay and 2-stage buccal mucosal urethroplasty for such strictures. MATERIALS AND METHODS: Between January 2000 and April 2004, 39 patients underwent buccal mucosal urethroplasty for BXO related anterior urethral strictures. The 25 patients with a salvageable urethral plate (group 1) were treated with 1-stage dorsal onlay urethroplasty using a cosmetic incision. The 14 patients with a severely scarred urethral plate, focally dense segments or active infection (group 2) underwent 2-stage urethroplasty. Outcomes in terms of cosmetic appearance, stricture recurrence and complications in the 2 groups were assessed. RESULTS: At a mean followup of 32.5 months (range 3 to 52) 3 patients (12%) in group 1 had recurrent stricture, of which 2 and 1 were treated with optical urethrotomy and urethral dilation, respectively. All patients had a normal slit-like meatus and none had chordee or erectile dysfunction. Four group 2 patients (28.6%) required stomal revision and 2 had glans cleft narrowing after stage 1 urethroplasty. Following stage 2, 3 patients had recurrent stricture, of whom 2 were treated with optical urethrotomy and 1 underwent repeat urethroplasty. CONCLUSIONS: In BXO related strictures with a viable urethral plate 1-stage dorsal onlay buccal mucosal urethroplasty provides excellent intermediate term results. The cosmetic incision described provides a normal, wide caliber, slit-like glans. Two-stage procedures provide satisfactory outcomes but they are associated with a higher revision rate.

Adolescent↗
PubMed2005

Can outcome of internal urethrotomy for short segment bulbar urethral stricture be predicted?

PURPOSE: We predicted the outcome of visual internal urethrotomy (VIU) by measuring the percentage of lumen narrowing at the stricture site on retrograde urethrography (RGU). MATERIALS AND METHODS: From January 1991 to June 2002 patients with primary bulbar urethral strictures who underwent VIU were selected for the study. Patients with a history of intervention, complete block of the urethral lumen and stricture greater than 2 cm were excluded from study. Urethral diameter at the area of maximum stenosis and at the normal distal urethra was measured on RGU with Vernier caliper and percentage narrowing was derived. Patients were followed 3 times monthly with symptoms, calibration and whenever required with RGU. Recurrence of symptoms, failure to self-calibrate and the need for secondary procedure were considered treatment failure. RESULTS: Complete followup data were available in 105 patients (44 grade 1 and 61 grade 2). Mean bulbar urethral stricture length was 0.86 cm. Inflammation was the cause of stricture in 83 (79%) and trauma the cause in 22 (21%) patients. In the Cox proportional hazards model only grade of narrowing had a significant impact on outcome. There were 41 cases of treatment failure in the total followup of 46 +/- 9 months. Mean recurrence-free duration +/- SD was 13 +/- 15 and 44.52 +/- 19 months in cases of treatment failure and success, respectively (p <0.0001). Mean percentage narrowing was significantly higher with treatment failure (69.9% +/- 16.1% vs 48.55% +/- 17.3%, p <0.0001). A cutoff of 74% for urethral narrowing was derived to predict the outcome with 78% probability. CONCLUSIONS: Percentage narrowing of the urethral lumen at the stricture site is a useful predictor of VIU outcome.

Adolescent↗
PubMed2005

Buccal mucosal urethroplasty: a versatile technique for all urethral segments.

OBJECTIVE: To present our experience with buccal mucosa urethroplasty for substitution of all segments of the anterior urethra, as the buccal mucosal graft (BMG) has emerged as the tissue of choice for single-stage reconstruction of bulbar urethral strictures, but its use for reconstructing meatal, pendulous and pan-urethral strictures has not been widely reported. PATIENTS AND METHODS: Between January 1998 and October 2003, 92 patients had a BMG substitution urethroplasty at our institution; 75 had a single-stage dorsal onlay BMG urethroplasty (bulbar 41, pendulous 16 and pan-urethral 18; six combined penile skin flap and BMG) and 17 (pendulous five, pan-urethral 10, bulbar two) a two-stage urethroplasty. Recurrence rates, complications and cosmetic outcomes were analysed retrospectively. RESULTS: Over a median (range) follow-up of 34 (8-72) months, 66 (88%) patients with a one-stage reconstruction (14/16 pendulous; 37/41, 90%, bulbar; 15/16 pan-urethral) remained stricture-free. The mean (range) time to recurrence was 9.4 (3-17) months. Of the nine recurrent strictures, six were managed by one-stage optical urethrotomy and three required a repeat urethroplasty. In patients who had a staged procedure, after a mean follow-up of 24.2 (9-56) months, one had complete graft loss, requiring re-grafting, five required stomal revision after stage 1, and only two (12%) developed a recurrent stricture after the two-stage urethroplasty. CONCLUSION: A one-stage dorsal onlay BMG urethroplasty provides excellent results for strictures involving any segment of the anterior urethra. The BMG appears to be the most versatile urethral substitute, as it can be successfully used for both one- and two-stage reconstruction of the entire anterior urethra.

Adolescent↗
PubMed2004

Renal hydatid cyst presenting as perinephric and iliopsoas abscess.

Hydatid disease is an infestation caused in humans by the larval forms of Taenia echinococcus. Isolated renal hydatid cyst is rare with a frequency of 2-4% of hydatid disease. Infection of hydatid cyst is a very rare condition. We describe a rare case of isolated renal hydatid cyst presenting as perinephric and iliopsoas abscess and discuss the dilemma in diagnosis and its management.

Adult↗
PubMed2003

Surgical and radiological management of renovascular hypertension in a developing country.

PURPOSE: We determined the long-term outcome of radiological and surgical intervention in young patients with renovascular hypertension. MATERIALS AND METHODS: Between 1989 and 2001, 85 patients with a mean age +/- SD of 21 +/- 10.3 years, including 59 with Takayasu's arteritis (TA) and 26 with fibromuscular dysplasia (FMD), underwent radiological (percutaneous transluminal angioplasty) or surgical treatment for renovascular hypertension due to renal artery stenosis. The technical success, complications and clinical response of each treatment were compared. RESULTS: Of the patients 29 with TA and 20 with FMD underwent a total of 56 balloon angioplasties. Technical success was achieved in 94.58 renal units with a clinical response in 41 patients (83.9%). However, the re-stenosis rate was 24.13% in TA and 10% in FMD cases. A total of 41 surgical procedures were performed in the 28 and 7 patients with TA and FMD, respectively, including aortorenal bypass with vein in 12, and with a polytetrafluoroethylene graft in 4, lienorenal bypass in 4, iliorenal bypass in 2, gastroduodenal bypass in 1, autotransplantation in 1, nephrectomy in 14 and partial nephrectomy in 2. The clinical response rate to renal revascularization procedures was 94.4%, whereas it was only 50.0% for nephrectomy/partial nephrectomy during a median followup of 42 months (range 9 to 96). CONCLUSIONS: Percutaneous transluminal angioplasty and renal revascularization provide comparable long-term results in the management of renal artery stenosis due to TA and FMD. Although it is technically complex, surgery for TA is safe and effective. However, the rate of re-stenosis following angioplasty for TA is higher compared with FMD.

Adolescent↗
PubMed2002

Urinary interleukin-8 predicts the response of standard and low dose intravesical bacillus Calmette-Guerin (modified Danish 1331 strain) for superficial bladder cancer.

PURPOSE: We determined whether the proinflammatory cytokine interleukin-8 (IL-8) can serve as a predictor for the response to standard (120 mg.) and low (40 mg.) dose intravesical bacillus Calmette-Guerin (BCG) (modified Danish 1331 strain) for managing superficial bladder cancer in patients at risk for recurrence and progression. MATERIALS AND METHODS: We randomized 26 patients with superficial bladder cancer to receive a 6-week course of standard dose 120 mg. or low dose 40 mg. intravesical BCG. Voided urine samples were collected immediately before and after (2 and 4 hours) BCG instillation. Urine samples were centrifuged at 1,500 rpm for 8 minutes and stored at -80C. IL-8 was measured using a commercial enzyme-linked immunosorbent assay. Patients were monitored for recurrence, progression and side effects of BCG treatment at 3-month intervals. RESULTS: At a median followup of 24 months (range 12 to 30), 5 and 6 patients who received a standard and low dose, respectively had disease recurrence and/or progression (nonresponders). At 4 hours after BCG mean Il-8 levels plus or minus SD were significantly higher in responders than in nonresponders (1,099.33 +/- 708.51 versus 261.82 +/- 182.66 pg./ml., p = 0.001). There was no difference at 4 hours in mean IL-8 levels in the standard and low dose groups (596.92 +/- 546 and 893 +/- 798.67 pg./ml., respectively, p = 0.28). In all patients who remained disease-free IL-8 levels were greater than 400 pg./ml. In 9 of the 11 patients with disease recurrence/progression IL-8 levels were less than 400 pg./ml. CONCLUSIONS: IL-8 secretion after the initial intravesical BCG instillation strongly correlates with the possibility of future recurrence/progression. The quantitative IL-8 response to low and standard dose intravesical BCG (Danish 1331) is similar.

BCG Vaccine↗
PubMed2002

Laparoscopy-assisted live donor nephrectomy: a modified cost-effective approach for developing countries.

BACKGROUND AND PURPOSE: Because of the prohibitive cost of laparoscopic disposable instruments such as the PneumoSleeve, Endocatch, and vascular staples, laparoscopic live-donor nephrectomy has not gained wide acceptance in many developing countries. To circumvent this problem, we have developed a cost-saving approach, which is described herein and compared with the open method. PATIENTS AND METHODS: Forty-nine patients underwent laparoscopic live-donor nephrectomy at our institute, of which two were performed by the hand-assisted technique, five by the technique described by Fabrizio et al and forty-two by our modified cost-saving laparoscopy-assisted technique (LD). The latter patients were compared with 50 patients who had a standard open donor nephrectomy (OD) through a rib-resecting (12th rib) flank incision. Our technique is similar to the procedure described by Fabrizio et al except for a 6- to 8-cm incision placed in the subcostal region to retrieve the kidney after the renal vessels are cut and ligated as in the open procedure. The costs of the various techniques at our institute were compared. RESULTS: The LD and OD groups were similar in terms of age, weight, side of nephrectomy, and number of renal vessels. The operative time was longer in the LD group than in the OD group (180.7 +/- 18 minutes v 101.5 +/- 10.4 minutes), whereas the mean intraoperative blood loss was less (85.5 +/- 21.35 v 220 +/- 22.5 mL; P < 0.001). Warm ischemia time and recipient outcomes were comparable in the two groups. Patients in the LD group had lower postoperative narcotic (tramadol hydrochloride) requirement (155.3 +/- 53.3 mg v 251.8 +/- 63.1 mg; P < 0.001) and earlier discharge from the hospital (3.14 v 5.7 days; P < 0.001). The mean expense incurred was US$175 v US$160 in the LD and OD groups, respectively. The cost of the hand-assisted and standard laparoscopic techniques was significantly higher than that of our modified technique. CONCLUSIONS: Our modified technique of laparoscopy-assisted live-donor nephrectomy avoids the use of costly disposables yet offers the advantages of lesser morbidity and small incision of LD. It is cost effective and is an alternative to open nephrectomy in the developing world.

Adult↗