V Mirciulescu | PubMed Health

PubMed2001

Endoscopic classification and endourologic therapy in proximal incomplete ureteral duplication pathology.

OBJECTIVE: To assess whether patients with proximal incomplete ureteral duplication (PIUD) had functional or anatomical Y junction zone pathology. In such cases, stasis and infection, with or without associated renal scarring, are often found. The results after minimally invasive treatment (retrograde endoincision of ureteral stenosis, localized on one limb) can be evaluated. PATIENTS AND METHODS: In a retrospective analysis of 807 ureteroscopies, we found 29 cases with PIUD pathology dating from July 1996 to March 1999. The investigative protocol involved: intravenous pyelography (IVP) with delayed films, voiding cystourethrogram, and duplex Doppler renal ultrasonography (DDRU) for the resistive index. We used semirigid ureteroscopes (7.5 and 8.5 french) and the Storz cold knife/scissor. The mean follow-up period was 17 months (range 5-33 months). RESULTS: In 22 cases (76%) we found functional obstruction of the Y junction region and in 7 cases (24%) a ureteral stricture shorter than 1 cm of lower or upper limbs. We described four particular morphologies of the Y junction zone: double-barrelled (wide bifid limbs) with larger Y junction, lateral insertion, punctiform insertion and valvular insertion of one of the limbs. The first type is associated with functional obstruction and the others are characteristic of anatomic obstruction. After retrograde cold endoincision, normal PIUD was found in 85% of cases. CONCLUSIONS: Pathological aspects of PIUD may pose interesting problems in diagnosis and therapy. Endoscopic particularities of the Y junction zone could be correlated with IVP and DDRU. Retrograde endoureterotomy appears to be an effective minimally invasive procedure for treatment of anatomical obstruction where the ureteral stenosis of one limb is shorter than 1 cm.

Adult↗

PubMedDate not supplied

[Preliminary data on our laparoscopy experience in urinary pathology].

We studied laparoscopic urological procedures in 14 cases between July 1995 and October 1996. We applied retroperitoneal lomboscopic technique for 2 cases with symptomatic renal cyst (over 500 ml) and laparoscopic retroperitoneal lymphadenectomy in 12 cases (adenocarcinoma of the prostate-5 cases, pT2-3bMo, Gleason score between 3-9, PSA between 11-46 ng/ml and invasive bladder tumors-7 cases, pT2-3bMoG2-3). For the renal cyst we used extraperitoneal approach and for the pelvic lymph nodes we used in 8 cases intraperitoneal approach and in 4 cases extraperitoneal approach (patients with multiple prior abdominal surgeries). Lymph node tissue was present in 11 cases. For the bladder tumors we did first iliac lymph nodes dissection and for the prostate adenocarcinoma we did first obturator lymph nodes dissection. We didn't describe complications. For our patients it was 3 days long hospitalization. So, we consider that laparoscopic lymphadenectomy is essential for evaluation of the patients with prostate adenocarcinoma having markedly elevated prostate specific antigen, high Gleason grade, large clinical burden of tumor. For the invasive bladder tumors, radical cystectomy and especially bladder replacement surgery need absolutely evaluation of regional lymph nodes. For the symptomatic renal cysts (over 500 ml) laparoscopic surgery is with very good results, minimally invasive.

Adenocarcinoma↗