Efficacy of Laparoscopic Renal Cyst Marsupialization for Patients Suffering with Simple Renal Cyst / 대한비뇨기과학회지

PURPOSE: We wanted to evaluate the efficacy of transperitoneal laparoscopic renal cyst decortication for treating patients with symptomatic renal cysts. MATERIALS AND METHODS: From January 2000 to July 2006, 57 patients with symptomatic renal cysts underwent transperitoneal laparoscopic renal cyst decortication. The mean age of the patients was 56.0 years old (29-77) and the male to female ratio was 1:1.2. The mean size of the renal cysts was 6.6cm (range: 4-11). The laterality of the renal cyst was on the left side in 31 cases, the right side in 11 and it was bilateral in 15. The location of the cysts was at the upper pole in 23 cases, at the middle pole in 13 cases and at the lower pole in 21 cases. All the procedures were performed via the transperitoneal approach. The preoperative and postoperative data were collected retrospectively. The mean follow-up period was 44.1 months (range: 3.2-66.2). RESULTS: The mean operation time was 68.3 minutes (range: 35-280) and the mean blood loss was 42.1cc (range: 30-150). With the mean follow-up of 44.1 months, 52 patients were asymptomatic and 5 patients were still symptomatic. For follow-up, abdominal ultrasonography was performed for 53 of 57 cases and computed tomography (CT) was performed in the others. The success rate was 94.7% (54/57) and the complication rate was 7.0% (4/57). CONCLUSIONS: Laparoscopic renal cyst decortication in patients with symptomatic renal cysts via the transperitoneal approach seems to be an effective procedure to achieve symptomatic relief with minimal morbidity and an acceptable long-term success rate.

Unusual Metastasis in Renal Cell Carcinoma / 대한비뇨기과학회지

Approximately one-third of all patients with renal cell carcinoma have metastasis at the time of diagnosis. Metastatic lesions of renal cell carcinoma are most commonly seen in the lung, and they are frequently seen in the bone and liver. However, spleen and rectal metastases are extremely rare. A 63-year-old man had undergone left radical nephrectomy for renal cell carcinoma. About 22 months later, computed tomography revealed multiple enhanced masses in the spleen. Spleen metastasis was suspected and splenectomy was then performed. One year later, the patient visited with complaints of voiding difficulty. A huge pelvic mass was detected by performing prostate ultrasonography and MRI. The mass was 13cm in diameter and it was between the rectum and the prostate. Removal of the pelvic mass and lower anterior resection with end colostomy was done. Histologically, the resected specimens were diagnosed as metastases from the renal cell cancer. Herein, we report on a case of metachronous splenic and rectal metastasis from renal cell carcinoma.

Laparoscopic Nephroureterectomy in Patient with an Upper Urinary Tract Transitional Cell Carcinoma: Safety and Efficacy / 대한비뇨기과학회지

PURPOSE: To evaluate the safety and efficacy of a laparoscopic nephroureterectomy in patients with a transitional cell carcinoma of the renal pelvis and ureter. MATERIALS AND METHODS: All patients underwent a nephroureterectomy for an upper tract transitional cell carcinoma. Of these, 23 and 22 underwent a laparoscopic nephroureterectomy (LNU) and open nephroureterectomy (ONU), respectively, between January 2002 and June 2006. After the nephrectomy had been performed, a 5-6cm modified Gibson incision was created to allow dissection of the lower ureter and bladder cuff, and extraction of the intact specimen. A retrospective analysis was performed on the operating time, blood loss, analgesic requirement, ambulation time, interval to resume oral intake, hospital stay, complications and follow-up results for both groups. RESULTS: The LNU was superior to the ONU with regard to the mean operation time; 275 (190-390) versus 258 (180-400) (p=0.259), blood loss; 188 (130-250) versus 488ml (350-750) (p<0.05), ambulation time; 2.5 versus 3.3 days (p<0.05), interval to resume oral intake 2.1 versus 2.8 days (p<0.05), and hospital stay; 8.3 versus 11.1 days (p<0.05). Complications developed in 4 and 5 of the LNU and ONU patients, respectively, but all were resolved with conservative management. The mean follow-up duration of the LNU and ONU groups were 29 versus 14 months, respectively. CONCLUSIONS: Based on our experience, a laparoscopic nephroureterectomy is better tolerated with respect to pain, has less blood loss, shorter hospital stays, ambulation time and time to oral intake. LNU is safe for an upper tract transitional cell carcinoma, and is also an efficacious alternative to open surgery. However, a long-term follow-up will be warranted to ascertain accurate oncologic data.