Laparoscopic partial nephrectomy for renal tumours: early experience in Singapore general hospital

<p><b>INTRODUCTION</b>To review the perioperative and short-term outcome of all laparoscopic partial nephrectomies (LPN) performed in a single institution.</p><p><b>MATERIALS AND METHODS</b>Thirteen consecutive patients who underwent LPN since the beginning of the programme in March 2002 to January 2008 were enrolled. Demographic, perioperative and follow-up data were retrospectively collected. Transperitoneal approach was used in all cases, and vascular control was achieved with the use of a laparoscopic Satinsky clamp or vascular tape. The tumour was excised using cold scissors. Transected intrarenal vessels were suture ligated and the parenchymal defect was closed primarily with absorbable suture over a bolster.</p><p><b>RESULTS</b>Thirteen patients underwent a total of 14 LPN. The median age of patients was 60 years (range, 41 to 77). The mean tumour size was 24 +/- 11.4 (2SD) mm. The mean operative time was 228 +/- 129 (2SD) minutes and median warm ischaemia time was 35 minutes (range, 24 to 68). Postoperatively, serum haemoglobin level decreased by a mean of 1.4 +/- 2.5 (2SD) gm/dL and serum creatinine increased by a mean of 22.5 +/- 25.8 (2SD) micromol/L. Twelve out of 13 (92%) patients achieved their baseline serum creatinine level within 1 month postoperatively. There was 1 open conversion (7%), and 2 patients (14%) required blood transfusion perioperatively. Two patients (14%) had transient fever postoperatively due to basal atelectasis. No other complications were encountered. Median patient hospital stay was 4 days (range, 2 to 10). Eleven out of 14 (79%) of the tumours were renal cell carcinoma (RCC). At a median follow-up of 12 months (range, 6 to 53), all except 1 patient with RCC were disease-free.</p><p><b>CONCLUSIONS</b>Our experience has shown that laparoscopic partial nephrectomy is a safe, feasible technique in our centre for patients with small exophytic renal tumours. Patients can be discharged early with preservation of renal function and good early cancer control.</p>

Intramuscular gentamicin improves the efficacy of ciprofloxacin as an antibiotic prophylaxis for transrectal prostate biopsy

<p><b>INTRODUCTION</b>Infection-related complications after transrectal ultrasound guided prostatic biopsy (TRPB) could be life threatening. Our centre observed sepsis after TRPB despite prophylactic oral ciprofloxacin. We reviewed all cases of post-TRPB sepsis with their bacteriology and evaluated if the addition of intramuscular (I/M) gentamicin to standard prophylaxis before TRPB could reduce its incidence.</p><p><b>MATERIALS AND METHODS</b>In a single urological centre, we performed an interventional study that compared a prospective group with retrospective control. The latter is known as the "cipro-only" group included consecutive patients who underwent TRPB between 1 September 2003 and 31 August 2004. The addition of I/M gentamicin 80 mg half an hour before TRPB started on 1 September 2004. All subsequent patients who underwent TRPB until 31 August 2005 were included in the "cipro+genta" group. Patients who did not receive the studied antibiotics were excluded.</p><p><b>RESULTS</b>There were 374 patients in the "cipro+genta" group and 367 patients in the "cipro-only" group with comparable profiles. There were 12 cases of post-TRPB sepsis in the "cipro-only" group and 5 cases in the "cipro+genta" group. Ciprofloxacin-resistant Escherichia coli (E. coli) was the only pathogen isolated in both groups. In the "cipro-only" group, 9 patients had positive blood cultures and 8 were sensitive to gentamicin. In the "cipro+genta" group, the only positive E. coli was gentamicin-resistant. One patient in the "cipro+genta" group was admitted to the intensive care unit with septicaemia.</p><p><b>CONCLUSION</b>The addition of I/M gentamicin to oral ciprofloxacin is a safe and effective prophylactic antibiotic regime in reducing the incidence of post-TRPB sepsis.</p>

Clinical research about balloon dilation before incision for patients with ureteric stricture / 中华外科杂志

<p><b>OBJECTIVE</b>To study the use about balloon dilatation before incision for the patients with ureteric stricture.</p><p><b>METHODS</b>Sixteen patients with ureteric stricture were included in our study. The cases were reviewed retrospectively with regards to the etiological factor, the site of stricture, symptom and diagnosis. Six patients with ureteric stricture were dilated with balloon before incision using Ho YAG laser. Ten patients with ureteric stricture were dilated with rigid ureteroscope before incision using Ho YAG laser. The double "J" stent was kept for 4-6 weeks after operation. All the patients were followed up by ultrasound, BUN and creatinine. Complete success is defined as symptomatic improvement, resolution of hydronephrosis and absence of ureteric stricture 3 months after removal of the double "J" stent. If the hydronephrosis and ureteric stricture did not deteriorate, and symptom improved after stent removal, it was considered as improvement. Failure is defined as deterioration of hydronephrosis and symptoms upon removal of double "J" stent.</p><p><b>RESULTS</b>The length of stenosis was from 0.8 to 1.4 cm. Three patients failed to improve after initial dilatation with rigid ureteroscope, but were later successfully dilated using balloon. All the patients who were treated using balloon dilatation were successful. The operative time of balloon dilatation was shorter than that of dilatation by rigid ureteroscope (P < 0.05). However, the cost of balloon dilatation was higher (P < 0.05). The period of follow-up was 3-28 months. None of the patients had any complications. There were 2 cases of recurrent stricture in patients who underwent ureteroscopic dilatation.</p><p><b>CONCLUSIONS</b>Despite a higher cost, balloon dilatation followed by laser incision for ureteric stricture is safe and effective. This technique may be used for selected patients.</p>