Controversial cases in endourology.
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Child↗
Biomedical subjects
Simon V Bariol
Publications and source records attributed to Simon V Bariol.
Laparoscopic suturing: effect of instrument handling on suture strength.
BACKGROUND AND PURPOSE: In open surgery, handling of suture at any position other than the end is discouraged because of evidence that handling deforms and weakens the material. The limited operative field of laparoscopic surgery necessitates repeated instrument handling of suture, and the effect of such handling has not been investigated. We assessed the effect of trauma imposed on various suture materials by laparoscopic needle holders and forceps. Also, the ideal suturing technique (interrupted v continuous) according to the physical characteristics of the suture material and the optimal length for laparoscopic sutures were determined. MATERIALS AND METHODS: Sutures of 2-0 and 3-0 polyglactin 910 and 2-0 poliglecaprone 25 were tested. Controlled damage was inflicted by grasping the suture for 1 second between the jaws of either toothed laparoscopic grasping forceps or a laparoscopic needle holder at a pressure of 45 MPa. Blind physical testing was then performed using a computer-controlled tensile testing system. The length and proportion of suture extension prior to breaking and the tensile strength were measured. Samples of undamaged and controlled damaged specimens, before and after breakage, were examined by scanning electron microscopy (SEM). RESULTS: The mean percentage extension in the control group was 46.3 mm for 3-0 Monocryl, 26.3 mm for 3-0 Vicryl, and 28.1 mm for 2-0 Vicryl. The mean tensile strengths were 47.9 N, 42.4 N, and 70.4 N for 3-0 Monocryl and 3-0 and 2-0 Vicryl, respectively. The 3-0 Monocryl and 3-0 Vicryl had significantly reduced tensile strength after damage compared with control sutures, whereas 3-0 Vicryl and 2-0 Vicryl had significantly impaired extension. After infliction of controlled damage with laparoscopic needle holders, the percent extension of damaged sutures was significantly less than that of undamaged sutures. Tensile strength was significantly lower for 3-0 Vicryl and 3-0 Monocryl after damage than before. The handling of Monocryl by laparoscopic needle holders and graspers produced punched-out defects and scratch marks, respectively. A number of damaged 2-0 and 3-0 Vicryl samples from the laparoscopic needle holder group showed disruption or unravelling of the braided filaments. CONCLUSION: We expect that our results underestimate the potential effect on suture strength and extension inflicted by laparoscopic suturing. The exact length of suture material cannot be recommended from the findings. However, interrupted sutures should be preferred, particularly for long suture lines. In addition, the findings support the use of laparoscopic graspers in preference to needle holders. The combination of a grasper in one hand and needle holder in the other is ideal. Finally, urologists initially embarking on laparoscopic reconstruction must take meticulous care in their suturing technique and, in particular, the number of times and force with which the suture is grasped.
Dioxanes↗
Bone formation in the urinary tract: case report.
A case of osseous metaplasia of the ureter presenting as a small upper-ureteral calculus is reported. This rare phenomenon may represent an unusual nucleus for stone formation in the urinary tract. The etiology of this condition is uncertain; we speculate that trauma to the ureter may stimulate osseous metaplasia.
Diagnosis, Differential↗
Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study.
PURPOSE: Urosepsis due to manipulation during percutaneous nephrolithotomy (PCNL) can be catastrophic despite prophylactic antibiotic coverage, and negative midstream urine culture and sensitivity testing (C&S). It has been postulated that bacteria in the stone may be responsible for systemic infection. In this prospective study we determined the correlation between different sites of urine sampling, including stones, and also ascertained which is more predictive of urosepsis. MATERIAL AND METHODS: All patients undergoing PCNL who fulfilled our selection criteria were recruited. The samples collected were 1) midstream urine and bladder urine at cystoscopy, 2) renal pelvic urine collected at percutaneous puncture of the pelvicaliceal system and 3) extracted and later fragmented stones. They were sent immediately for C&S. Patients were monitored for systemic inflammatory response syndrome (SIRS). RESULTS: A total of 54 procedures were suitable for analysis. Midstream urine C&S was positive in 11.1% of cases, stone C&S was positive in 35.2% and pelvic C&S was positive in 20.4% (p = 0.009). Pelvic urine C&S predicted infected stones better than bladder urine C&S. Of the patients 37% had SIRS and 3 experienced septic shock. Patients with infected stones or pelvic urine were found to be at a relative risk for urosepsis that was at least 4 times greater (p = 0.0009). Bladder urine did not predict SIRS. Stone C&S had the highest positive predictive value of 0.7. Preoperative hydronephrosis correlated with infected pelvic urine. No patients with urosepsis had positive blood C&S. CONCLUSIONS: The results of this study suggest that positive stone C&S and pelvic urine C&S are better predictors of potential urosepsis than bladder urine. Therefore, routine collection of these specimens is recommended.
Adult↗
What is the best imaging for stone management?
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Flank Pain↗
A comparison of the pathology of transitional cell carcinoma of the bladder and upper urinary tract.
OBJECTIVE: To clarify the histopathological patterns of upper and lower urinary tract transitional cell carcinomas (TCCs), as previous reports suggest that upper urinary tract TCCs have a greater tendency towards high-grade disease than bladder TCCs, of which most are low-grade and low-stage tumours. PATIENTS AND METHODS: All patients presenting with TCC of bladder or upper urinary tract between February 1991 and December 2001 at one institution were identified. Further patient information was obtained from the hospital database and case-note review. RESULTS: In all, 164 patients with upper urinary tract TCC and 2197 with bladder TCC were identified. There was a correlation between grade and stage of both upper urinary tract and bladder TCCs. 35% of the upper tract TCCs were classified as grade 2 and 44% as grade 3, while for bladder TCCs, 31% of lesions were classified as grade 2 and 35% as grade 3 (P = 0.003). Of the upper urinary tract lesions 33% were stage pT2-T4, compared with only 20% of bladder TCCs (P = 0.001). CONCLUSIONS: Upper urinary tract TCC is a higher grade and stage disease than bladder cancer, a finding that emphasizes the need for aggressive treatment of upper urinary tract TCC. If endourological management of upper urinary tract TCC is considered, histopathological determination of tumour grade before treatment is essential.
Aged↗
Oncological control following laparoscopic nephroureterectomy: 7-year outcome.
PURPOSE: Proof of the oncological safety of laparoscopic nephroureterectomy (LNU) relies on truly long-term outcome being at least equivalent to that of open surgery. We compared the long-term oncological outcome of laparoscopic versus open nephroureterectomy (ONU) in patients with upper tract transitional cell carcinoma (TCC). MATERIALS AND METHODS: Between April 1992 and January 1999, 26 LNUs and 42 ONUs were performed at our hospital for suspected upper tract TCC. Hospital medical records were retrospectively reviewed to assess preoperative staging, pathology and followup. RESULTS: There were 4 patients excluded from study (1 who underwent LNU and 3 ONU) since the histological diagnosis was other than TCC. Median followup for the laparoscopic and open groups was 101 and 96 months, respectively. There was local recurrence in 2 patients (8%) after LNU and in 6 patients (15.4%, p = 0.3) after ONU. TCC recurred in the contralateral kidney or ureter in 2 LNU cases (8%) and 1 ONU case (2.6%, p = 0.3). There was bladder recurrence in 7 patients (28%) following LNU compared with 15 patients (42%, p = 0.2) after open nephroureterectomy. The 1 and 5-year metastasis-free survival rates were 80% and 72% for LNU compared with 87.2% and 82.1% for ONU (p = 0.33 and 0.26). Upper tract tumor grade and stage influenced the incidence of metastatic and contralateral disease, but not the incidence of local or bladder recurrence. CONCLUSIONS: In the surgical management of upper tract TCC, the laparoscopic approach does not affect long-term oncological control. Tumor stage and grade are important prognostic factors in the development of metastases and cancer specific mortality.
Adult↗
Simple technique for identifying the linea alba in lower abdominal incisions.
BACKGROUND: Identification of the true midline in infra-umbilical longitudinal incisions is often difficult. Traditional methods of identification can be unreliable. METHODS: An alternative technique for identifying the linea alba, based on the attachments of the median umbilical ligament, is presented. RESULTS: The technique is both reliable and reproducible in identifying the midline. CONCLUSION: This technique is recommended as a means of avoiding muscle incision and facilitating wound closure.
Abdominal Wall↗
Intracorporeal ribbon gauze in laparoscopic surgery.
Good haemostasis optimizes laparoscopic visibility and performance. The use of suction reduces pneumoperitoneum and collapses the operative space, and the resulting fall in intra-abdominal pressure can increase the rate of bleeding. Therefore, other methods of improving laparoscopic visibility need to be investigated. In the present report we describe the effectiveness of a 20-40-cm length of 3-inch ribbon dressing gauze when introduced into the peritoneal cavity via a 10-12 mm laparoscopic port. Current results indicate that intracorporeal ribbon gauze can be used successfully during laparoscopic procedures as a suction filter, to assist haemostasis, to facilitate dissection and to provide atraumatic organ retraction.
Bandages↗