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S Y Nakada

Publications and source records attributed to S Y Nakada.

At least 19 recordsLinked to original sources
PubMed1998

Overcoming cellular senescence in human cancer pathogenesis.

Elevation of p16, the CDKN2/p16 tumor suppressor gene (TSG) product, occurs at senescence in normal human uroepithelial cells (HUC). Immortal HUCs and bladder cancer cell lines show either alteration of p16 or pRb, the product of the retinoblastoma (RB) TSG. In addition, many human cancers show p16 or pRb alteration along with other genetic alterations that we associated with immortalization, including +20q and -3p. These observations led us to hypothesize that p16 elevation plays a critical role in senescence cell cycle arrest and that overcoming this block is an important step in tumorigenesis in vivo, as well as immortalization in vitro. Using a novel approach, we tested these hypotheses in the present study by examining p16 and pRb status in primary culture (P0) and after passage in vitro of transitional cell carcinoma (TCC) biopsies that represented both superficial bladder tumors and invasive bladder cancers. We demonstrated that all superficial TCCs showed elevated p16 after limited passage in vitro and then senesced, like normal HUCs. In contrast, all muscle invasive TCCs contained either a p16 or a pRb alteration at P0 and all spontaneously bypassed senescence (P = 0.001). Comparative genomic hybridization (CGH) was used to identify regions of chromosome loss or gain in all TCC samples. The application of a statistical model to the CGH data showed a high probability of elevated alteration rates of +20q11-q12 (0.99) and +8p22-pter (0.94) in the immortal muscle invasive TCCs, and of -9q (0.99) in the superficial TCCs. Three myoinvasive TCCs lost 3p13-p14. In this study, four of six myoinvasive TCCs also showed TP53 mutation that associated well with genome instability (P = 0.001), as previously hypothesized. Notably, TP53 mutation, which has been used as a marker of tumor progression in many human cancers, was less significant in associating with progression in this study (P = 0.04) than was p16 or pRb alteration (P = 0.001). Thus, these data support a new model in which overcoming senescence plays a critical role in human cancer pathogenesis and requires at least two genetic changes that occur in several combinations that can include either p16 or pRb loss and at least one additional alteration, such as +20q11-q12, -3p13-p14, or -8p21-pter.

Adult↗
PubMed1998

Outcomes of contemporary percutaneous nephrostolithotomy in morbidly obese patients.

PURPOSE: The surgical management of renal and ureteral calculi presents unique challenges in the obese patient. We reviewed our recent experience with percutaneous nephrostolithotomy in patients with a body mass index greater than 30. MATERIALS AND METHODS: We reviewed the records of 236 patients undergoing percutaneous nephrostolithotomy between August 1994 and March 1997 at 2 university and affiliated hospitals. Among this group 57 patients had a body mass index greater than 30 (mean plus or minus standard deviation 38.9 +/- 7.4). Renal anomalies were present in 21% of patients and more than half (56%) had co-morbidities in addition to obesity. Staghorn calculi were present in 19 patients (31.7%). In the remaining patients the mean cumulative stone size for single or multiple stones was 14.5 +/- 8.7 mm. Stone-free status after the procedure was determined by plain nephrotomograms or noncontrast computerized tomography. RESULTS: A total of 96 procedures were performed on 60 renal units (1.6 procedures per renal unit). Average operative time for the initial procedure was 181.2 +/- 91.4 minutes. Complications occurred in 8 patients (14%) and 5 (8.8%) received a blood transfusion. Average hospital stay was 4.9 +/- 3.1 days. The overall stone-free rate was 88.3%, and stone-free rate for staghorn calculi was 84.2% compared with 90.2% for nonstaghorn calculi. CONCLUSIONS: Percutaneous nephrostolithotomy in obese patients yields a stone-free rate that is comparable to that achieved in an unselected patient population. The complication rate, transfusion rate and hospital stay are also similar. Modifications to standard technique and instrumentation are sometimes necessary to perform percutaneous nephrostolithotomy in this group of patients.

Adult↗
PubMed1998

Monitoring renal cryosurgery: predictors of tissue necrosis in swine.

PURPOSE: To examine parameters for monitoring renal cryosurgery and correlate with histopathologic necrosis in a porcine model. Parameters include: 1) tissue temperature, 2) distance of tissue from the cryosurgical probe insertion site, and 3) inclusion of tissue by the visible iceball. MATERIALS AND METHODS: Following midline incision, 6 healthy kidneys from 3 domestic pigs were treated using a nitrogen-based cryosurgical system with 3.4 mm outer diameter cryoprobe. Temperatures were monitored at 6 sites in each kidney using prototype thermocouples. Gross and histologic analysis was performed on tissue harvested from each thermosensor site 24 hours postoperatively. RESULTS: All animals survived to complete the full protocol. Post-procedure bleeding was managed surgically. Histopathology revealed that complete ablation was uniformly produced at temperatures of -19.4C or lower in 13/13 tissue samples. Within 16 mm. of the probe insertion site, cells were uniformly ablated in 17/17 samples while degree of tissue death varied widely beyond this margin. Cell death was more likely found at points encompassed by the visible iceball (16/18, 89%) than those beyond it (2/18, 11%) [p <0.0001, Chi-square] while 2/18 (11%) of samples harvested from within the iceball margin were partially viable. CONCLUSIONS: Temperature monitoring using thermocouples during porcine renal cryosurgery demonstrated complete homogeneous necrosis of tissues reaching -19.4C or lower. Distance beyond 16 mm. from the cryoprobe and direct visualization of the iceball proved to be less reliable predictors of tissue necrosis. Management of bleeding post-thaw was necessary in every case.

Animals↗
PubMed1998

Retrospective analysis of the effect of crossing vessels on successful retrograde endopyelotomy outcomes using spiral computerized tomography angiography.

PURPOSE: Using spiral computerized tomography (CT) angiography, we sought to evaluate the incidence of a crossing vessel in a group of adults with primary ureteropelvic junction obstruction who had previously undergone successful retrograde endopyelotomy. MATERIALS AND METHODS: A total of 16 patients who had undergone successful Acucise balloon incision endopyelotomy for ureteropelvic junction obstruction, all with followup greater than 2 years, underwent a spiral CT angiogram with intravenous contrast material to identify those with a crossing vessel. Contrast enhanced CT was performed with dual phase technique on a Somatom-Plus-S CT scanner using prototype software. After 180-degree linear interpolation of the projection data, transaxial images of the affected kidney were reconstructed. In addition, at the time of the study all patients completed analog followup pain scales and quality of life assessment questionnaires. RESULTS: Among the 16 patients 6 (38%) had anterior or posterior crossing vessels based on spiral CT angiography. No patient had both types. By analog pain scale patients had 80% mean improvement in pain (range 63 to 100). CONCLUSIONS: In our series nearly 40% of patients with anterior or posterior crossing vessels had a long-term (greater than 2 years) successful outcome with retrograde endopyelotomy. Endopyelotomy continues to be our initial mode of therapy among adults with primary ureteropelvic junction obstruction. In our opinion the adverse influence of the crossing vessel is not sufficient to justify the added expense of preoperative angiography, spinal CT or endoluminal ultrasound.

Adult↗
PubMed1998

Endourologic therapy of bladder calculi in simultaneous kidney-pancreas transplant recipients.

OBJECTIVES: To identify the incidence and the success of endourologic therapy for symptomatic bladder-related calculi in simultaneous kidney-pancreas (SPK) transplant patients with bladder drainage. METHODS: A retrospective review of 300 SPK transplant patients with bladder drainage, treated at the University of Wisconsin, Madison from December 1985 to November 1995, is presented. A 3% incidence of bladder calculi was identified. All patients underwent cystolitholapaxy using electrohydraulic lithotripsy and endoscopic suture removal. Follow-up ranged from 15 to 86 months. RESULTS: A 100% stone-free rate was achieved after cystolitholapaxy and endoscopic suture removal. Two patients (22%) developed postprocedural urinary tract infections. No pancreaticoduodenocystotomy leaks or further complications were identified. CONCLUSIONS: SPK transplant patients with nonabsorbable sutures used for the duodenocystotomy anastomosis are at an increased risk for bladder calculi. Cystolitholapaxy with electrohydraulic lithotripsy is a safe and effective treatment for these suture-related stones.

Adult↗
PubMed1998

Laparoscopic cryosurgery of the kidney in the porcine model: an acute histological study.

OBJECTIVES: To verify histologically whether cryosurgery of the kidney can be accomplished reproducibly without injuring adjacent structures, using a combination of ultrasound and laparoscopic guidance. MATERIALS AND METHODS: Six kidneys from three domestic female farm pigs were utilized in the study. Under general anesthesia and after obtaining pneumoperitoneum, the lower pole of the kidney was mobilized laparoscopically and the ureter and adjacent bowel were protected with saline-soaked gauze. Two 3.8 mm-cryoprobes were placed percutaneously into the lower pole and cryoablation was carried out under laparoscopic and ultrasound guidance using a double-freeze technique (10-minute freeze and 5-minute thaw cycles to a probe temperature of -185 degrees C to -196 degrees C) in five kidneys (one control). The kidneys, adjacent ureter and bowel were harvested acutely, and macroscopic, histologic, and electron microscopic evaluation of all specimens was performed. RESULTS: Macroscopically, clear margins of cryodestruction corresponded with the ultrasound images of the iceball. In all five treated kidneys, reproducible cell death corresponding to visible margins of cryodestruction were verified histologically. Cell death was further corroborated by electron microscopy. Adjacent structures (ureter and bowel) were sectioned and no significant damage was noted. Blood pressure remained constant throughout the procedure. A crack in the renal parenchyma of one kidney was noted during the thaw phase; at harvest that animal was found to have an intraperitoneal hemorrhage. CONCLUSION: Combined laparoscopic and ultrasound-guided cryoablation of the lower pole of the kidney can be accomplished reproducibly in the porcine model without injury to adjacent structures.

Animals↗
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

Lower-pole caliceal stone clearance after shockwave lithotripsy, percutaneous nephrolithotomy, and flexible ureteroscopy: impact of radiographic spatial anatomy.

Spatial anatomy of the lower renal pole, as defined by the infundibulopelvic angle (LIP angle), infundibular length (IL), and infundibular width (IW), plays a significant role in the stone-free rate after shockwave lithotripsy. A wide LIP angle, a short IL, and a broad IW, individually or in combination, favor stone clearance, whereas a LIP <70 degrees, an IL >3 cm, or an IW < or =5 mm are individually unfavorable. When all three unfavorable factors or an unfavorable LIP and IL coexist, the post-SWL stone-free rate falls to 50% or less. Using these criteria, more than one fourth of our patients with a lower-pole calculus might have been better served by an initial percutaneous or perhaps ureteroscopic procedure, neither of which is significantly affected by the lower-pole spatial anatomy.

Adolescent↗
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↗
PubMed1998

Laparoscopic renal cryotherapy in swine: comparison of puncture cryotherapy preceded by arterial embolization and contact cryotherapy.

Variable results of open, percutaneous, and laparoscopic cryosurgery of the kidney have been reported. Minimally invasive approaches to lower-pole renal ablation were prospectively compared in swine: laparoscopic puncture cryoablation preceded by arterial embolization, laparoscopic contact cryosurgery, and arterial embolization alone. Eighteen kidneys in nine domestic pigs were randomized to one of three treatment groups of six organs each: (1) puncture cryotherapy preceded by selective lower-pole arterial embolization; (2) contact cryotherapy alone; and (3) arterial embolization alone. Under general anesthesia, appropriate animals underwent selective arterial embolization of the lower pole via femoral cutdown using Gelfoam pledgets. Animals randomized to cryotherapy underwent dissection of the lower pole of the kidney using a single 12-mm umbilical and two midclavicular-line ports in the lateral position. Under external ultrasound guidance, two 3-mm cryoprobes (Cryomedical Sciences, Rockville, MD) were positioned in the lower pole of the kidney, and double-freeze technique to -190 degrees C was performed using puncture or contact application. Ultrasonography was used to guide probe insertion during puncture cryotherapy only. Kidneys were harvested 11 to 14 days after the procedure. Both puncture and contact kidneys demonstrated cell death and subsequent necrosis by light microscopy and electron micrography. On average, puncture lesions were heavier than contact lesions, 19.3 g v 10.1 g (P = 0.02; unpaired t-test), whereas the kidneys were equivalent in weight: 74.1 g v 74.1 g. Puncture lesions represented 26.4% of total kidney weight v 13.5% in the contact group (P = 0.002; unpaired t-test). Only focal infarcts were identified in the embolization group. No evidence of adjacent visceral injury was identified in any of the groups, and no animal required conversion to open laparotomy. One kidney bled after contact cryotherapy, and hemostasis was achieved laparoscopically. Laparoscopic cryotherapy is reproducible and effective using either the puncture technique preceded by arterial embolization or the contact technique, without evidence of damage to adjacent structures. Contact lesions were less voluminous and more peripheral than puncture lesions. Embolization alone produces focal infarcts and focal zones of cell death.

Animals↗
PubMed1998

Hand assisted laparoscopic nephrectomy: comparison to standard laparoscopic nephrectomy.

PURPOSE: We report our initial experience with hand assisted laparoscopic nephrectomy, and compare it to our results of standard laparoscopic nephrectomy. MATERIALS AND METHODS: The results of 21 hand assisted and standard laparoscopic nephrectomies (15 simple and 4 radical nephrectomies, and 2 nephroureterectomies) were reviewed. Hand assisted laparoscopic nephrectomy was performed with a hand placed intra-abdominally using the Pneumo Sleeve,* in addition to standard laparoscopic instruments manipulated through laparoscopic ports. Standard laparoscopic nephrectomy was performed using laparoscopic instruments alone. Perioperative data were recorded and questionnaires, including visual analog pain scales, were administered prospectively to 17 of 21 cases. RESULTS: The average operative time for 13 hand assisted laparoscopic nephrectomies was 240 minutes, which was significantly less than the 325-minute average for 8 standard laparoscopic nephrectomies (p = 0.04). Major complications tended to be more frequent in the standard group (38 versus 8%, p = 0.10). Hospital stay, return to normal activity and corrected 2-week abdominal/flank pain score in the hand assisted group (3.1 days, 14 days and 0.8, respectively) were not significantly different from the standard group (3.0 days, 10 days and 0.2, respectively). CONCLUSIONS: Compared to standard laparoscopic techniques, hand assistance appears to facilitate the operative speed and safety of laparoscopic nephrectomy without sacrificing the benefits of minimally invasive surgery. Hand assistance may make laparoscopic nephrectomy more appealing to urologists without advanced laparoscopic experience, may facilitate the laparoscopic management of demanding pathological conditions and is particularly useful when intact specimens are required. Hand assistance, by improving manipulative ability and tactile sense, is helpful for select cases of laparoscopic nephrectomy.

Adolescent↗
PubMed1998

Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi.

PURPOSE: We compare the efficacy of percutaneous nephrostomy with retrograde ureteral catheterization for renal drainage in cases of obstruction and infection associated with ureteral calculi. MATERIALS AND METHODS: We randomized 42 consecutive patients presenting with obstructing ureteral calculi and clinical signs of infection (temperature greater than 38 C and/or white blood count greater than 17,000/mm.3) to drainage with percutaneous nephrostomy or retrograde ureteral catheterization. Preoperative patient and stone characteristics, procedural parameters, clinical outcomes and costs were assessed for each group. RESULTS: Urine cultures obtained at drainage were positive in 62.9% of percutaneous nephrostomy and 19.1% of retrograde ureteral catheterization patients. There was no significant difference in the time to treatment between the 2 groups. Procedural and fluoroscopy times were significantly shorter in the retrograde ureteral catheterization (32.7 and 5.1 minutes, respectively) compared with the percutaneous nephrostomy (49.2 and 7.7 minutes, respectively) group. One treatment failure occurred in the percutaneous nephrostomy group, which was successfully salvaged with retrograde ureteral catheterization. Time to normal temperature was 2.3 days in the percutaneous nephrostomy and 2.6 in the retrograde ureteral catheterization group, and time to normal white blood count was 2 days in the percutaneous nephrostomy and 1.7 days in the retrograde ureteral catheterization group (p not significant). Length of stay was 4.5 days in the percutaneous nephrostomy group compared with 3.2 days in the retrograde ureteral catheterization group (p not significant). Cost analysis revealed that retrograde ureteral catheterization was twice as costly as percutaneous nephrostomy. CONCLUSIONS: Retrograde ureteral catheterization and percutaneous nephrostomy effectively relieve obstruction and infection due to ureteral calculi. Neither modality demonstrated superiority in promoting a more rapid recovery after drainage. Percutaneous nephrostomy is less costly than retrograde ureteral catheterization. The decision of which mode of drainage to use may be based on logistical factors, surgeon preference and stone characteristics.

Adult↗
PubMed1998

Long-term outcome of caliceal diverticula following percutaneous endosurgical management.

PURPOSE: We review the morbidity and long-term outcome of percutaneous caliceal diverticulectomy and associated stone extraction. MATERIALS AND METHODS: Percutaneous caliceal diverticulectomy was performed in 19 women and 11 men (age range 20 to 58 years), of whom 26 had stones (all 15 mm. or less). The diverticula were located throughout the kidney, including the upper (11 patients), middle (15) and lower (4) calices. Percutaneous caliceal diverticulectomy included 28 direct and 2 indirect accesses (1 via a previously placed nephrostomy tract and 1 due to stones in other areas of the kidney). In all cases the stone was removed and the diverticular neck was incised or dilated. Fulguration of the diverticular walls was performed in 22 cases. Transdiverticular percutaneous renal and ureteral drainage was maintained from 2 to 7 days until a nephrostogram demonstrated no extravasation. RESULTS: The average operating room time and hospital stay were 171 minutes (range 75 to 330) and 4.1 days (range 2 to 7), respectively. Major complications occurred in 6.6% of the cases, requiring 1 blood transfusion and 1 chest tube placement, and minor complications occurred in 13.4%. There was no mortality. Followup for more than 1 year was available in 27 patients. Stone-free rate was 93% with obliteration of the diverticulum in 76% of patients. Overall, 85% of patients are asymptomatic at average followup of 3.5 years (range 1 to 7.3). CONCLUSIONS: Direct percutaneous endosurgical management provides a safe, efficacious and durable means of treating stone bearing caliceal diverticula, regardless of stone size or location of the diverticulum.

Adult↗
PubMed1998

In vitro passive sensitization of the ureter as a basis for the study of noninfectious ureteral inflammation.

PURPOSE: To develop an in vitro model of passive sensitization for the ureter for the study of noninfectious ureteral inflammation. MATERIALS AND METHODS: Human ureteral tissues were obtained from excess segments of ureters from patients undergoing donor nephrectomy. Following excision, ureters were placed in physiologic salt solution (PSS) and passively sensitized by incubating with ragweed serum from allergic donor (1 ml. serum: 4 ml. PSS) for 20 hours at room temperature. Ureteral segments were incubated with PSS only and served as non-sensitized controls (n = 4). After sensitization, excess serum was removed by serial washing with PSS without serum. Ureteral strips were then suspended in vitro for determination of tissue contraction. Contractile responses and histamine release were measured. Tissues were then exposed to antigen. To investigate the role of inflammatory mediators in tissue contraction, 4 groups of 8 sensitized ureteral segments were incubated for 1 hour with the following substances: a H1 histamine receptor antagonist (pyrilamine), an inhibitor of prostaglandin synthesis (indomethacin), an inhibitor of leukotriene synthesis (A-64077), and a control substance (DMSO). Following incubation, the tissues were exposed to antigen, and contraction and histamine release were determined. RESULTS: Sensitized ureteral segments (n = 8) responded to antigen with contraction (30% BaCl maximum; p <0.01) and histamine release (205/ng./gm. tissue) within the first 5 minutes of superfusion. Non-sensitized control segments (n = 4) did not respond. Both indomethacin and pyrilamine reduced (7-10% of BaCl maximum; p <0.05) the contractile response of sensitized ureter to antigen, whereas A-64077 did not. Analysis of the superfusate for histamine indicates that indomethacin reduced histamine release (150 ng./gm.) whereas A-64077 and pyrilamine did not (p <0.05). CONCLUSION: We have demonstrated that ureteral segments can be passively sensitized and that subsequent antigen challenge stimulates contraction and histamine release. Our findings suggest that contraction of ureteral tissue and histamine release may be utilized as an inherent bioassay indicating the activity of inflammatory mediators. In addition, these results suggest that both prostaglandins and histamine, but apparently not leukotrienes, participate in the early inflammatory response to antigen challenge of the sensitized ureter.

Antigens↗
PubMed1997

Flexible ureteroscopy: Washington University experience with the 9.3F and 7.5F flexible ureteroscopes.

PURPOSE: Recent advances in the design of flexible ureteroscopes have resulted in smaller caliber instruments. We review our experience with the smaller flexible ureteroscopes, and compare the efficacy and efficiency of the newer 7.5F to the standard 9.3F flexible instruments. MATERIALS AND METHODS: Between January 1991 and 1995, 69 male and 41 female patients (mean age 57 years, range 16 to 91) underwent 116 retrograde flexible ureteroscopic procedures for a variety of diagnostic and therapeutic indications. A 9.3F ureteroscope (group 1) was used in 71 patients and a 7.5F instrument (group 2) was used in 39. RESULTS: Patients in group 2 received sedation analgesia significantly more often than those in group 1 (56 versus 35%, p = 0.04). Active dilation of the ureteral orifice was required less often in group 2 (22.5%) than in group 1 (58%, p < or = 0.05). The total success rate for stone management, and diagnosis and/or treatment of an upper urinary tract lesion was 98.3 and 100%, respectively, in group 1, and 90 and 100%, respectively, in group 2 (p = 0.17). Of the 71 patients in group 1, 17 (24%) were treated on an outpatient basis, compared to 14 of 39 (49%) in group 2 (p = 0.16). No intraoperative or postoperative major complications were encountered in either group. Group 2 required less postoperative analgesia (p = 0.05). No ureteral stricture occurred in either group at an average followup of 9.5 months postoperatively (range 2 to 35). CONCLUSIONS: For ureteral and renal pathological conditions the 7.5F ureteroscope is as effective as the 9.3F instrument diagnostically and therapeutically. The 7.5F ureteroscope usually can be used with sedation analgesia. Also, the smaller 7.5F ureteroscope is associated with less need for active ureteral dilation, minimal postoperative discomfort and a brief hospital stay.

Adolescent↗
PubMed1997

Use of the pneumo sleeve as an adjunct in laparoscopic nephrectomy.

Having "a hand" in the abdomen when performing laparoscopic surgery offers tactile feedback, rapid finger dissection, enhanced retraction capabilities, and simplified hemostasis for the operating surgeon. We utilized the Pneumo Sleeve for technically challenging laparoscopic nephrectomies. This device may have applicability in select urologic laparoscopic operations.

Female↗