Mini-Flank incision assisted laparoscopy versus transperitoneal laparoscopy for dismembered pyeloplasty

To define the impact of the combined approach on the minimally invasive style of laparoscopic approach. From July 2005 to September 2007, 21 patients with unilateral primary pelvi-ureteric junction [PUJ] obstruction underwent Anderson Hynes pyeloplasty. Patients were divided into two groups. Group 1: consisted of 11 patients who had combined transperitoneal laparoscopic approach and then mini-open approach. The surgical procedure was divided into two steps: laparoscopic dissection of the renal pelvis and proximal ureter and then accomplishing the pyeloplasty through mini-flank [5 cm], muscle splitting incision which was planned under laparoscopic guidance to be accurately overlaying the PUJ. Group 2: consisted of 10 patients who underwent the whole procedure through laparoscopic approach. Perioperative records and postoperative assessment were compared between the two groups. The mean operating time [135 versus 189 min] and Analgesic requirement [90 versus 36 mg, morphine equivalent] were significantly different between group 1 and 2, respectively. There was no intraoperative complication in both groups and the postoperative complications were minor and similar in both groups [10%]. Postoperatively, time to resume the full activity was significantly different between the groups 1 and 2, at 2 weeks [54.0 versus 80%, respectively] however, it was similar [100%] at 4 weeks. Postoperative, assessment of the all patients, based on IVU and diuretic renogram at 3 and 6 months, were similar in both groups. Dismembered pyeloplasty through a combined approach save time and ensures high quality of anastomosis while maintaining the minimally invasive fashion of laparoscopic approach

Complications and functional results of standard orthotopic diversion: studer`s pouch

Objective: The purpose of this study was to evaluate early and late complications, reservoir functional outcome, continence status and upper tract functional throughout the follow up after Studer ileal neobladder

Patients and methods: Thirty two patients were included in this study and followed at a regular interval of three months for one year postoperatively. Early and late complications, urinary continence and upper tract configuration and function were evaluated. Patients were assessed by interviews and history taking, voiding diary, continence questionnaire, abdominopelvic ultrasound, IVU and urodynamic study

Results: No postoperative mortality. Early and late postoperative complications rates were 28.1% and 12.5% respectively. Out of 32 patients, febrile urinary tract infection occurred in 4 patients, prolonged urinary leakeage in 2 patients, unilateral hydronephrosis in 3 patients, urethroileal stricture in 3 patients, and metabolic acidosis in one patient. The mean functional pouch capacity increased over time from 298 +/- 65ml at 3month postoperatively to 423 +/- 93 at 9 month of follow up and became fixed thereafter. The mean post voiding residual urine estimated by ultrasound was 46 +/- 18 at 6 month of follow up. All patients underwent urodynamic evaluation at 6 and 12 month postoperative. The maximal pouch capacity was 395 +/- 75 ml with the pouch pressure at maximal capacity was 30 +/- 6 cm water at 6 month postoperative with similar value at 12 month and thereafter. Continence status improved over time, meanwhile the night time continence rate was lower than daytime, unsatisfactory night continence who need more than one pad per night was recorded in 12.5% then reduced to 3.1% at 6 month and 12 month postoperative respectively .IVU at 6 month show no upper tract ectasia or dilatation in all patients through out next follow up period

Conclusion: Studer ileal neobladder is easy and satisfactory surgical technique of orthotropic urinary diversion. It provides an acceptable rate of postoperative complications with good functional reservoir outcome and continence status while preserving upper tract function