PubMed Health⌕ Search

Biomedical subjects

R S Figenshau

Publications and source records attributed to R S Figenshau.

At least 19 recordsLinked to original sources
PubMed2001

Dual-organ ablative surgery using a hand-assisted laparoscopic technique. A report of four cases.

In clinical situations where more than one procedure is required, a properly positioned hand-assist device can be used to obviate the need for two large incisions. We present four cases of hand-assisted laparoscopic nephrectomy combined with a simultaneous second organ extraction. Each of the four primary procedures, as well as one of the four secondary procedures, was performed using a hand-assisted laparoscopic technique. In two cases, the secondary procedure was performed with an open surgical technique through the hand-assist incision. For the remaining secondary procedure, we used a laparoscopically assisted technique.

Aged↗
PubMed2001

Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for management of distal ureteral calculi.

PURPOSE: We compared the efficacy of shock wave lithotripsy and ureteroscopy for treatment of distal ureteral calculi. MATERIALS AND METHODS: A total of 64 patients with solitary, radiopaque distal ureteral calculi 15 mm. or less in largest diameter were randomized to treatment with shock wave lithotripsy (32) using an HM3 lithotriptor (Dornier MedTech, Kennesaw, Georgia) or ureteroscopy (32). Patient and stone characteristics, treatment parameters, clinical outcomes, patient satisfaction and cost were assessed for each group. RESULTS: The 2 groups were comparable in regard to patient age, sex, body mass index, stone size, degree of hydronephrosis and time to treatment. Procedural and operating room times were statistically significantly shorter for the shock wave lithotripsy compared to the ureteroscopy group (34 and 72 versus 65 and 97 minutes, respectively). In addition, 94% of patients who underwent shock wave lithotripsy versus 75% who underwent ureteroscopy were discharged home the day of procedure. At a mean followup of 21 and 24 days for shock wave lithotripsy and ureteroscopy, respectively, 91% of patients in each group had undergone imaging with a plain abdominal radiograph, and all studies showed resolution of the target stone. Minor complications occurred in 9% and 25% of the shock wave lithotripsy and ureteroscopy groups, respectively (p value was not significant). No ureteral perforation or stricture occurred in the ureteroscopy group. Postoperative flank pain and dysuria were more severe in the ureteroscopy than shock wave lithotripsy group, although the differences were not statistically significant. Patient satisfaction was high, including 94% for shock wave lithotripsy and 87% for ureteroscopy (p value not significant). Cost favored ureteroscopy by $1,255 if outpatient treatment for both modalities was assumed. CONCLUSIONS: Ureteroscopy and shock wave lithotripsy were associated with high success and low complication rates. However, shock wave lithotripsy required significantly less operating time, was more often performed on an outpatient basis, and showed a trend towards less flank pain and dysuria, fewer complications and quicker convalescence. Patient satisfaction was uniformly high in both groups. Although ureteroscopy and shock wave lithotripsy are highly effective for treatment of distal ureteral stones, we believe that HM3 shock wave lithotripsy, albeit slightly more costly, is preferable to manipulation with ureteroscopy since it is equally efficacious, more efficient and less morbid.

Adult↗
PubMed2000

Concomitant laparoscopic hand-assisted radical nephrectomy and open radical prostatectomy using a single lower midline incision.

The hand-assist technique offers the urologic surgeon several advantages. The technique provides the novice laparoscopist a logical segue into minimally invasive surgery by literally allowing one hand to remain in the realm of open surgery. Hand-assist access affords the laparoscopist the use of tactile sensation and blunt manual dissection and retraction. We describe an additional benefit of the hand-assist technique. In clinical situations in which more than one procedure is required, a properly positioned hand-assist device will avoid the need for two large incisions. We present simultaneous hand-assisted laparoscopic radical nephrectomy and open radical prostatectomy performed through a single midline incision.

Abdominal Muscles↗
PubMed1998

Endourologic options for management of ureteropelvic junction obstruction in the pediatric patient.

Endourologic intervention is becoming a more widely accepted modality in the management of pediatric UPJ obstruction. The authors present five factors that are important in selecting patients that will lead to a successful treatment and outline techniques for antegrade and retrograde endopyelotomy and balloon dilation. This article also reviews the recent literature on endourologic interventions in the management of pediatric UPJ obstruction. The authors conclude that pediatric endopyelotomy has an 86% success rate and should be offered as treatment for select pediatric patients with UPJ obstruction.

Adolescent↗
PubMed1998

Endoscopic creation of reflux in the pig.

Vesicoureteral reflux (VUR) in the animal model for experimental purposes can be created either by open transvesical or endoscopic techniques. The concept of reflux creation is the same for both techniques: incision of the roof of the intramural portion of the ureter at the 12 o'clock position. The open method has the disadvantages of requiring a cystotomy and a lengthy healing period prior to initiating a study, thereby incurring additional expense and the problem of introducing several confounding factors. The open method is unreliable because of the resolution of reflux over time. Herein, we present a simple transurethral endoscopic technique for creating VUR in pigs. This technique was successful in producing persistent Grade II or III reflux in 94% of the incised ureters.

Animals↗
PubMed1998

Renal medullary carcinoma.

PURPOSE: Renal medullary carcinoma is a rare and extremely aggressive neoplasm that almost always develops in young patients with sickle cell trait. To our knowledge all cases to date have been metastatic at surgical resection. Pathological examination reveals an aggressive tumor mainly involving the renal medulla with a varied morphology. The prognosis is dismal. Mean survival from the time of resection is 15 weeks (range 2 to 52). The disease course has not been altered by surgery, radiotherapy or various regimens of chemotherapeutic agents. MATERIALS AND METHODS: We add to the literature our experience treating renal medullary carcinoma in 2 cases and review the existing literature on this disease. RESULTS: Both patients whom we treated died of the disease, as have the other 35 patients described in the literature. CONCLUSIONS: A high index of suspicion may lead to earlier diagnosis and treatment, and survival of patients with renal medullary carcinoma.

Adult↗
PubMed1996

Pediatric endopyelotomy: the Washington University experience.

PURPOSE: Endopyelotomy has gained acceptance as minimally invasive therapy for ureteropelvic junction obstruction in adults. Its role in the treatment of pediatric ureteropelvic junction obstruction remains controversial. We report our experience with antegrade endopyelotomy for treating pediatric ureteropelvic junction obstruction. MATERIALS AND METHODS: A total of 17 patients 3 months to 17 years old underwent endopyelotomy as primary treatment for ureteropelvic junction obstruction (8) and after failed open pyeloplasty with secondary endopyelotomy performed a mean of 12 weeks after open pyeloplasty (9). Standard antegrade percutaneous techniques were used. Electrosurgical incision of the ureteropelvic junction at a posterolateral orientation was done in each case. Internal ureteral stents remained in place for 4 to 6 weeks postoperatively. RESULTS: In 5 of the 8 patients (62%) treated primarily the outcome was successful at a mean followup of 38 months (range 25 to 53). Failures occurred at 6 weeks, 3 months. In all 9 patients treated secondarily outcomes were successful at a mean followup of 59 months (range 16 to 110). CONCLUSIONS: Endopyelotomy as primary treatment of pediatric ureteropelvic junction obstruction remains controversial but it may be appropriate in select cases. On the other hand, endopyelotomy is safe and effective for pediatric patients in whom open pyeloplasty fails.

Adolescent↗
PubMed1996

Ureterolysis for extrinsic ureteral obstruction: a comparison of laparoscopic and open surgical techniques.

PURPOSE: We evaluated the role of laparoscopy in the management of extrinsic ureteral obstruction due to benign retroperitoneal fibrosis or ovarian pathology. The results of laparoscopic ureterolysis were compared to those of a contemporary series of open ureterolysis performed for the same pathological conditions. MATERIALS AND METHODS: We compared 6 patients undergoing unilateral laparoscopic ureterolysis for extrinsic ureteral obstruction to 7 undergoing open unilateral ureterolysis for similar pathological conditions. Patient demographic, operative, and early and late postoperative data were collected. RESULTS: Laparoscopic ureterolysis was associated with less intraoperative blood loss and need for parenteral pain medications, and significantly shorter hospital stay and convalescence than open surgery. Although there were no intraoperative or postoperative complications in the laparoscopy group, 1 patient in the open surgery group had an intraoperative ureteral avulsion and 4 had minor postoperative complications (blood transfusion, ileus and/or wound cellulitis). Operative time was longer in the laparoscopy group (255 versus 232 minutes). Subjective followup with an analog pain scale and/or telephone interview showed improvement in all patients in the laparoscopy group and all 6 contacted in the open surgery group. Likewise, excretory urography and/or renal scan showed improved renal function and relief of obstruction in all patients. CONCLUSIONS: Laparoscopic unilateral ureterolysis for extrinsic ureteral obstruction is a less morbid, yet equally effective procedure with several clinical advantages over conventional open surgical ureterolysis.

Adolescent↗
PubMed1996

Laparoscopic bladder seromyotomy: laboratory experience.

Twelve female microminipigs with normal bladder capacity underwent laparoscopic bladder seromyotomy. Three other female microminipigs were added to the study as controls. Urodynamic studies and cystograms were performed preoperatively and at 2 and 4 months after a laparoscopic bladder seromyotomy. Histologic studies of the treated bladders were performed when the animals were euthanized at 4 months. The operation was completed in all 12 test animals. There was no significant difference in bladder capacity or leak-point pressure between the 12 seromyotomy and the 3 control bladders at any time point. Histologically, over the seromyotomy site, the urothelium remained intact; however, the muscularis was attenuated, and a thin layer of fibrotic tissue replaced the normal serosal covering of the bladder. Laparoscopic bladder seromyotomy can be performed reliably in the porcine animal model. Not surprisingly, no significant changes in bladder capacity or bladder compliance were seen in our study of normal bladders. An animal model of a neuropathic contracted bladder is needed to assess more accurately the physiological impact of laparoscopic seromyotomy.

Animals↗
PubMed1996

Comparison of acucise endopyelotomy and endoballoon rupture for management of secondary proximal ureteral stricture in the porcine model.

At this point in time, endopyelotomy is first-line therapy for both primary and secondary adult ureteropelvic junction obstruction (UPJO) in many medical centers. However, the potential, albeit small, for significant bleeding with any endoincision of the UPJ has sparked interest in the simple, less morbid technique of endoballoon rupture. To date, no comparative data are available on the effectiveness of these two techniques. Thirty female minipigs were randomized to cutting balloon (Acucise) endopyelotomy (AEP) (N = 13), endoballoon rupture (EBR) (N = 13), or a control arm (N = 4). Following baseline retrograde pyelogram (RPG) and diuretic renogram (DRG), a secondary proximal ureteral stricture was created by laparoscopic ligation of the UPJ. After 8 weeks, AEP or EBR was performed in each of the study pigs. In 16 pigs (8 AEP, 8 EBR), a 7F 22-cm ureteral stent was placed (chronic arm). After 6 weeks, the stent was removed, and a second RPG and DRG were performed. Three months post-treatment, after RPG and DRG, the renal units were harvested, and histologic sections of the affected UPJ, contralateral normal ureter, and ipsilateral kidney were examined. Ten pigs (5 AEP, 5 EBR) underwent harvest immediately after treatment (acute arm). The four control animals remained untreated. At 8 weeks, all minipigs had obstructive findings on RPG and DRG. All UPJs could be treated but one, which had an impassable stricture; there were no perioperative complications. In the acute arm, all UPJs were patent. All five AEP ureters had evidence of an uneven cut and cautery effect. Of the EBR ureters, two had smooth tears and three had ragged tears, and none had evidence of cautery effect. In the chronic arm, 3 months after either AEP or EBR, all minipigs had a patent UPJ, yet only 5 of 16 had an improved 1 1/2 by DRG. Histologic sections of the affected UPJs from 20 minipigs in the chronic arm (8 AEP, 8 EBR, 4 controls) were indistinguishable among the three groups; each revealed significant periureteral fibrosis and chronic inflammation with a mainly unremarkable muscular layer. However, histologic sections of 25 treated kidneys, including both acute and chronic animals (13 AEP, 12 EBR), revealed endstage renal disease (N = 10), chronic inflammatory changes (N = 7), or normal tissue (N = 8). Again, there was no trend favoring either AEP and EBR. In summary, in this laboratory study, we could detect no difference in outcome between an incisional endopyelotomy and an endoballoon rupture for treating secondary UPJO.

Animals↗
PubMed1996

The unintubated ureterotomy endourologically revisited.

PURPOSE: The duration of stenting after endoureterotomy is a controversial issue. An even more basic question, however, is whether stent placement is needed at all. We performed a porcine study to address this question. METHODS: A unilateral midureteral stricture was created in 20 minipigs. Six weeks later, 15 pigs underwent endoureterotomy. In 10 animals, a 7F ureteral stent was placed for 1 week. Five pigs remained unstented. Three months later, all 20 ureters were studied radiographically and were harvested. RESULTS: Three of 5 control animals and 2 of 10 stented animals has strictures. In the unstented study group, all 5 animals had a nonobstructing dilation at the site of endoureterotomy. This was corroborated by a normal furosemide washout renal scan in all 3 animals so tested. CONCLUSIONS: The result of unstented endoureterotomy in the porcine model suggests that, after endoureterotomy of secondary midureteral strictures, stenting may be unnecessary.

Animals↗
PubMed1996

Comparative clinical study of port-closure techniques following laparoscopic surgery.

BACKGROUND: Recently, a number of laparoscopic port-closure techniques have been reported to avoid the complications associated with the port closure after laparoscopic surgery. To evaluate these port-closure techniques, we compared seven new laparoscopic port-closure techniques with the standard technique of a hand-sutured closure. STUDY DESIGN: In a prospective, randomized study, 95, 12-mm port sites in 32 patients undergoing transperitoneal laparoscopic procedures were randomized to one of eight different port-site closure techniques. The port-closure techniques included: the Carter-Thomason Needle-Point Suture Passer, Maciol suture needle set, eXit Disposable Puncture Closure device, Endoclose suture carrier, Tahoe Surgical Instruments Ligature device, a long 14-gauge angiocatheter with looped polypropylene suture, Lowsley retractor with hand-sutured closure, and the standard technique of hand-sutured closure. We evaluated the time, the security, and the auxiliary instrumentation required for each closure. RESULTS: Of the port-closure techniques, the Carter-Thomason device was faster overall, resulted in fewer port-closure-related complications and provided a leak proof closure. CONCLUSIONS: The Carter-Thomason device is our preferred method for the closure of port sites after laparoscopic surgery.

Female↗
PubMed1995

Laparoscopic retropubic auto-augmentation of the bladder.

The small capacity or contracted bladder is a difficult management problem. The goal of bladder augmentation is to create a storage structure with an adequate capacity and low pressure. Bladder auto-augmentation creates a large bladder diverticulum by partially excising the detrusor muscle. We report our initial experience with an extraperitoneal approach to laparoscopic auto-augmentation in a patient with a small contracted bladder. This is a technically feasible operation but longer clinical followup is necessary to determine its durability in the management of the small contracted bladder.

Adult↗
PubMed1994

Laparoscopic pneumoperitoneum: impact of body habitus.

The purpose of this study was to determine the relationships among pneumoperitoneum pressure, CO2 insufflation volume, and patient height, weight, and body mass index. Forty-one male patients undergoing laparoscopic urologic procedures prospectively had a record made of the delivered volume of CO2 during insufflation to attain intraabdominal pressures of 5, 10, 15, 20, 25, and 30 mm Hg. The relationship of the delivered volume of CO2 insufflated and the intraabdominal pressure was compared statistically to the patient height, weight, and body mass index. In addition, six domestic female pigs underwent pneumoperitoneum, and the abdominal volume was calculated for intraabdominal pressures of 0, 5, 10, 15, 20, 25, and 30 mm Hg. Four different commercially available 10-mm trocars were tested for force required for placement at intraabdominal pressures of 15 and 30 mm Hg. There was a direct relationship between delivered volume of CO2 insufflated and the pneumoperitoneum pressure. There was no significant relationship between the delivered volume of CO2 insufflated at a given intraabdominal pressure and the patient height, weight, or body mass index. During insufflation, 94% of the abdominal volume is achieved by insufflating to 15 mm Hg. There is no significant difference in the force required for insertion of different ports at 15 mm vs 30 mm Hg pressure. Increasing the abdominal pressure to 30 mm Hg provides a 50% increase in the volume of CO2 insufflated vs a standard 15 mm Hg pneumoperitoneum. However, this additional volume does not significantly change the actual abdominal volume or diminish the pressure necessary to insert a trocar.

Abdomen↗
PubMed1993

Effect of stent duration on ureteral healing following endoureterotomy in an animal model.

Ureteral strictures were created in 18 minipigs. Six weeks after stricture inducement, endourologic incision with a balloon cutting device was performed and a 7 F internal polyurethane stent was placed. After this step, 14 pigs remained in the study and were randomized into three different groups depending upon the time when the stent was removed: 1, 3 or 6 weeks. Twelve weeks after stricture incision, the pigs were killed, the status of the incised ureteral segment was evaluated histologically, and a healing score was determined. There were no statistically significant overall differences among the mean values of the overall healing score throughout the three different groups. However, when the one-week and the six-week groups (p < .05) were compared with respect to strictures requiring more than one incision due to stricture length greater than 2 centimeters, a more favorable outcome occurred in the 1 week group. Based on these findings it may be reasonable to remove ureteral stents as early as 1 week after endoureterotomy and endopyelotomy.

Animals↗