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PubMed1998

Simultaneous bilateral percutaneous nephrolithotomy with subarachnoid spinal anesthesia.

We report our experience performing simultaneous bilateral percutaneous nephrolithotomy (SBPN) in four patients with large stone burdens in both kidneys. We modified the previously described approach by combining SBPN with subarachnoid Duramorph (preservative-free morphine sulfate) in an effort to decrease postoperative discomfort and shorten the duration of hospitalization. These patients (study group) were then compared with a contemporary group of four patients with similar bilateral stone burdens who underwent staged bilateral percutaneous nephrolithotomies (PCNs) (control group). The comparison showed a marked advantage in hospital stay (4.8 days for the study group v 11 days for the control group) and postoperative narcotic requirement (27.5 mg of meperidine for the study group v 533 mg for the control group). All four patients were rendered stone free. This method of treatment for large bilateral renal calculi with the addition of subarachnoid Duramorph resulted in less postoperative discomfort, less morbidity, and a more rapid recovery than staged PCN or sandwich PCN/SWL/PCN.

Adult↗

PubMed1995

Laparoscopic nephroureterectomy for upper tract transitional cell cancer: the Washington University experience.

PURPOSE: The recognized form of therapy for patients with ureteral or renal pelvis transitional cell carcinoma is total nephroureterectomy with excision of the ipsilateral periureteral cuff of bladder mucosa. We report our experience with 10 patients who underwent laparoscopic nephroureterectomy for upper tract transitional cell carcinoma through July 1994 and compare them to a contemporary group of patients undergoing open nephroureterectomy for the same disease. MATERIALS AND METHODS: A total of 10 patients undergoing laparoscopic nephroureterectomy for upper tract transitional cell carcinoma was evaluated with respect to operative time, surgical specimen weight, pathological stage, postoperative analgesia requirement, interval to resume normal oral intake, postoperative recovery and results of postoperative surveillance. Of the patients 8 who underwent open surgical nephroureterectomy during a contemporary period for the same diagnosis were evaluated for the same parameters and compared to the laparoscopic group. RESULTS: Laparoscopic nephroureterectomy averaged twice as long as open nephroureterectomy. However, the laparoscopic patients resumed oral intake sooner, required less postoperative analgesia and had a shorter hospital stay compared to the open surgical group. The laparoscopic nephroureterectomy patients returned to normal activities within less than half the time (2.8 versus 6 weeks) and completely recovered 5 times more rapidly (6 weeks versus 7.4 months). CONCLUSIONS: Laparoscopic nephroureterectomy is a feasible treatment option for patients with upper tract transitional cell carcinoma. However, 2 major drawbacks to the approach persist, that is the lengthy operative time and the need for significant laparoscopic experience on the part of the surgeon.

Aged↗