Significance of muscularis mucosae in metastasis involvement of urinary bladder transitional cell carcinoma.

OBJECTIVE: To assess the significance of muscularis mucosae involvement in metastasis of urinary bladder transitional cell carcinoma. MATERIAL AND METHOD: This was a retrospective cohort study of superficial urothelial carcinoma (transitional cell carcinoma). Histopathology and patient records of 192 patients were collected from 1990 to 2004. There were 115 males and 77 females, their age ranged from 43 to 83 years old with an average of 60 +/- 5 years. One hundred cases did not invade muscularis mucosae layer (group A) and 92 cases invaded the muscularis mucosae layer (group B). The histopathology of biopsy or cystectomy specimens for recurrence, progression of the disease and the number of vessels above and below the muscularis mucosae layer of bladder cancer specimens were compared by light microscopic examination with Hematoxylin and Eosin (H&E) and followed by immunoperoxidase desmin stain. RESULTS: The amount per high power field of the blood and lymphatic vessels below muscularis mucosae layer, 9 (6-12), was significantly higher than that above muscularis mucosae layer, 7 (5-10) (p < 0.05). The cancer high grade (grade 3) in group B had also significantly higher percentage than that in group A, 30.4:5.0 (p < 0.05). Moreover, the recurrent rate (recurrent > 2) in group B had also a significantly higher percentage than that in group A, 21.4:4.0 (p < 0.05). CONCLUSION: The present study has confirmed previous findings that not all muscularis mucosae layers (about 50%) were found in the biopsy specimens. The findings of superficial urothelial cancer (no invasion to muscularis propria) invading the muscularis mucosae are a warning sign for invasive tumor that needs more aggressive treatment.

Laparoscopic renal surgery: Ramathibodi Hospital experience.

OBJECTIVE: To report the authors' early experience of laparoscopic renal surgery for benign and malignant renal conditions. MATERIAL AND METHOD: Laparoscopic renal surgery was performed on 24 patients with benign and malignant renal conditions between July 2004 and February 2005. The patient characteristics and perioperative data including operative time, blood loss, analgesic requirement, complications, duration of postoperative drain removal, length of hospital stay, and duration to return to normal activity were all recorded. RESULTS: Laparoscopic simple nephrectomy was performed in 15 patients with nonfunctioning benign renal conditions. Three operations of hand-assisted laparoscopic radical nephrectomy and one of partial nephrectomy were performed for large and small renal cell carcinoma, respectively. Transitional cell carcinomas were managed by retroperitoneoscopic nephrectomy or hand-assisted approach in 3 cases. For a case of severe inflammatory renal condition, hand-assisted approach was used for treatment. Laparoscopic renal cyst decortication was performed in one case. In the laparoscopic simple nephrectomy group, the mean operative time was 126 +/- 38.3 minutes. The median (range) estimated blood loss was 100 (50-500) mL, and one patient required conversion to open surgery because of renal vein injury. In three cases of hand-assisted laparoscopic radical nephrectomy, the operation time was 315, 325 and 150 minutes and the operative blood loss was 500, 1000 and 200 ml, respectively. In cases of hand-assisted laparoscopic partial nephrectomy, the operation time and the operative blood loss were 220 minutes and 350 ml, respectively. In three cases of transitional cell carcinoma, the operation time was 120, 140 and 150 minutes and the operative blood loss was 100, 150 and 150 ml. The surgical margins of all resected specimens for malignant tumors were negative and no major complication was recorded Simple renal cyst decortication was successfully performed within 90 minutes of operation time and bleeding 50 ml. In cases of severe inflammatory renal condition performed by hand-assisted approach, the operative time was 250 minutes and the operative blood loss was 250 ml. CONCLUSION: Laparoscopic renal surgery is a safe and efficacious approach for resection of benign nonfunctioning kidneys and malignant renal tumors.

Comparative study of renal function between standard and modified anatrophic nephrolithotomy by radionuclide renal scans.

OBJECTIVE: To compare the changes in renal function after surgery between standard and modified anatrophic nephrolithotomy using the technetium 99m-DTPA renal scan in patients with complex staghorn calculi. MATERIAL AND METHOD: From July 2001 to March 2002, standard anatrophic nephrolithotomy (sANL) was performed in 7 patients with complex staghorn calculi and modified anatrophic nephrolithotomy (mANL) was performed in another group of 8 patients with the same condition. Preoperative and postoperative renal function were assessed by technetium 99m-DTPA renal scan. RESULTS: Mean patient age was 41 years in the sANL group and 45 years in the mANL group. Male to female ratio was 4:3 in the sANL group and 5:3 in the mANL group. Median operative time was 205 minutes in the sANL group compare with 180 minutes in the mANL group (P = 0.03). Median estimated blood loss was 300 ml. in the sANL group and 275 ml. in the mANL group (P = 0.17). Median percent reduction of GFR on the operated kidney was 9.13 (-30.03 to -3.15) in the sANL group and 27.25 (-41.81 to -1.55) in the mANL group (P = 0.13). Residual small stone was seen in one patient of the sANL group and ESWL was performed for stone fragmentation. There were no serious short-term complications. CONCLUSION: The average operative time of sANL was longer than mANL however, sANL preserved more renal function than mANL. This study suggested that sANL should be the procedure of choice in patients who have compromised renal function.