ABSTRACT
Aim: The open simple nephrectomy is associated with significant mobidity and laparoscopic nephrectomy is now becoming the standared of care in many centers. In this study we will try to evaluate the actual results of laparoscpic nephrectomy for benign renal lesions in comparison to open nephrectomy
Methods: 17 patients were divided into 2 groups in a non-randomized trial. 8 patients 5 males and 3 females, aged 19-56 underwent open simple nephrectomy. 9 patients, 3 males and 6 females, aged 16-53, underwent laparoscopic simple nephrectomy [3 retroperitoneal and 6 transperitoneal]
Results: In spite of the high conversion rate [4 out of 9 cases] the laparoscopic simple nephrectomy was superior to the open technique in terms of intraoperative complications [0 versus 2 patients who needed blood transfusion and another with pleural injury], duration of analgesia requirements [2 versus 4.5 days post operative], starting oral feeding [1 versus 3 days post operative], wound infection [0 versus 2 cases], hospital stay [3 versus 7.5 days] and time for full recovery [22 versus 40 days] The superiority of the laparoscopic simple nephrectomy in terms of analgesia requirement, post operative oral feeding, hospital stay and time for complete recovery were all statistically significant
Conclusion: In spite of this being a preliminary experience of the Urology Department started in association with the General Surgery Department in TBRI, laparoscopic simple nephrectomy was not only found to be a safe procedure but also other all parameters were in favor of the laparoscopic versus the open simple nephrectomy. The conversion rate was expectedly high but it is not until the learning curve peaks up before the true rate appear and properly judged
ABSTRACT
To evaluate diagnostic and therapeutic uses of ureteroscopy [URS] in upper urinary tract filling defects. Fourty patients with upper urinary tract filling defects underwent Ureterorenoscopy [URS], their age ranged from 38 to 83 years [Mean 68 yrs]. Clinical presentation included: gross hematuria [20 cases], flank pain [13 cases], microscopic hematuria [5 case], and fever [2 cases]. Radiological studies [intravenous urography and/or retrograde urography], revealed filling defects in the renal pelvis [4 cases], upper ureter [16 cases], middle ureter [one cases], and lower ureter [19 cases]. Introduction of ureteroscopy was done without preliminary ureteral dilation in 60% of the cases. The procedure was completed in 38 cases and aborted in 2 cases because of inability to engage the ureter [one case], and perforation with extravasations [one case]. Diagnosis was established by direct endoscopic visualization in 26.3% of patients while 57.9% of patient's required additional biopsy. These procedures revealed that 34.2% of patients had malignant urothelial tumors, 18.4% had radiolucent stones. Benign ureteral polyps were found in 10.5% of patients, ureteritrs cystica in 7.9%, blood clots in 7.9% and papillary necrosis in 5.3% of patients. No abnormalities were detected in 6 patients [15.8%] by URS, further angiography's identified vascular anomaly in only one patient. In conclusion, URS proved to be of value in dealing with upper urinary tract filling defects. This procedure, whenever the lesion is accessible, can add in diagnosis and treatment of the underlying lesion causing a pelvic or ureteric filling defect. URS can disclose the nature of these lesions, and extensive surgery can be avoided