Retroperitoneal laparoscopic nephroureterectomy with distal and intramural ureter resection for a tuberculous non - functional kidney

ABSTRACT Objective: To evaluate the safety and feasibility of total retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection for a tuberculous nonfunctional kidney. Materials and Methods: A total of 27 individuals diagnosed with unilateral nonfunctional kidney secondary to tuberculosis were treated between June 2011 and June 2015. All patients had normal renal function on the contralateral side and underwent the standard four-drug anti-tuberculosis treatment for at least four weeks before surgery. Total retroperitoneal laparoscopic nephroureterectomy was performed in all patients, and the urinary-bladder junction of distal ureter was managed using different auto-suture techniques. Results: Nineteen male and 8 female patients with an average age of 47.3 years (range, 36-64 years) underwent surgery. All the operations were successfully performed without conversion. The median operative time was 109.3 min (range, 75-138 min), the median blood loss was 157.5 mL (range, 70-250 mL), and the median hospitalization time was 3.7 days (range, 3-6 days). No serious perioperative complications occurred. Anti-tuberculosis chemotherapy was prescribed to all patients, with the entire course of treatment lasting six months. No recurrence of tuberculosis of the bladder or the contralateral kidney was observed during the median follow-up period of 26.7 months (range, 6-54 months). Conclusion: Retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection is a safe and feasible approach for the treatment of tuberculous non-functional kidneys.

Laparoscopic nephrectomy outside gerota fascia and en bloc ligation of the renal hilum for management of inflammatory renal diseases

ABSTRACT Objectives This study aims to improve laparoscopic nephrectomy techniques for inflammatory renal diseases (IRD) and to reduce complications. Materials and Methods Thirty-three patients underwent laparoscopic nephrectomy for IRD, with a method of outside Gerota fascia dissection and en-bloc ligation and division of the renal pedicle. Operative time, blood loss, complications, analgesia requirement, post-operative recovery of intestinal function and hospital stay were recorded. The degrees of perinephric adhesion were classified based on the observation during operation and post-operative dissection of the specimen, and the association of different types of adhesion with the difficulty of the procedures was examined. Results Among 33 cases, three were converted to hand-assisted laparoscopy, and one was converted to open surgery. Mean operative time was 99.6±29.2min, and blood loss was 75.2±83.5 mL. Postoperative recovery time of intestinal function was 1.6±0.7 days and average hospital stay was 4.8±1.4 days. By classification and comparison of the perinephric adhesions, whether inflammation extending beyond Gerota fascia or involving renal hilum was found to be not only an important factor influencing the operative time and blood loss, but also the main reason for conversion to hand-assisted laparoscopy or open surgery. Conclusions In laparoscopic nephrectomy, outside Gerota fascia dissection of the kidney and en-bloc ligation of the renal pedicle using EndoGIA could reduce the difficulty of procedure and operative time, with satisfactory safety and reliability. Inflammation and adhesion extending beyond Gerota fascia or involving renal hilum is an important predictor of the difficulty related to laparoscopic nephrectomy for IRD.

Retroperitoneal Laparoscopic Nephroureterectomy for Tuberculous Nonfunctioning Kidneys: a single-center experience

Purpose To present our surgical techniques and experiences of retroperitoneal laparoscopic nephroureterectomy for the treatment of tuberculous nonfunctioning kidneys. Materials and Methods From March 2005 to March 2013, a total of 51 patients with tuberculous nonfunctioning kidney underwent retroperitoneal laparoscopic nephroureterectomy at our medical center. The techniques included early control of renal vessels and dissection of the diseased kidney along the underlying layer outside the Gerato’s fascia. The distal ureter was dissected through a Gibson incision and the entire specimen was removed en bloc from the incision. Patient demographics, perioperative characteristics and laboratory parameters as well as postoperative outcome were retrospectively reviewed. Results Retroperitoneal laparoscopic nephroureterectomy was successfully performed in 50 patients, whereas one case required conversion to open surgery due to non-progression of dissection. The mean operating time was 123.0 minutes (107-160 minutes) and the mean estimated blood loss was 134 mL (80-650 mL).The mean postoperative hospital stay was 3.6 days (3-5days) and the mean return to normal activity was 11.6 days (10-14days). Most intra-operative and post-operative complications were minor complications and can be managed conservatively. After 68 months (12-96 months) follow-up, the outcome was satisfactory, and ureteral stump syndrome did not occur. Conclusions Retroperitoneal laparoscopic nephroureterectomy as a minimally invasive treatment option is feasible for treatment of tuberculous nonfunctioning kidneys. .

Tuberculosis renal en el lactante / Renal tuberculosis in infants

Se presenta un paciente varón, de 23 días de vida, con un cuadro de insuficiencia renal por válvulas de la uretra posterior y reflujo vésico uretreal secundario grado IV bilateral. Se le realizó una derivación urinaria, que consistió en una ureteroscopía cutánea bilateral, con rápida mejoría de la función renal. A los 3 meses de edad, presentó una masa renal derecha dura, que hizo sospechar un tumor.La imagen pielográfica era de un riñón en esponja.A los 16 meses, previo a la desderivación se realiza biopsia renal, que informa tuberculosis.Este diagnóstico es infrecuente en niños.Su tratamiento médico fue satisfactorio

Complicaciones urológicas en el riñón en herradura / Urologic complications of horseshoe kidney

Se analisan en ésta revisión aspectos clínicos y terapéuticos en 24 pacientes portadores de un riñón en herradura asociado a complicaciones urológicas. Estas fueron: litiasis en 15 casos (62,5%0, hidronefrosis en 8 (33,3%) y tuberculosis renal en 1 (4,2%). En los casos de litiasis urinaria el tratamiento fué quirúrgico en 10 pacientes, con mínima morbilidad postoperatoria. De los pacientes portadores de una hidronefrosis 6 fueron operados, realizando una pieloplastía en 5 y una heminefrectomía en 1. En 2 de éstos pacientes fué necesario realizar una nefrectomía tardía del hemiriñón operado por fracaso de la plastía pieloureteral. En el paciente con una tuberculosis se practicó una nefrectomía del hemiriñón no funcionante, asociado a tratamiento quimioterápico. El riñón en herradura es la anomalía más frecuente de fusión renal, con una incidencia estimada de 0,25% en la población general. Esta malformación no predispone a patología renal y constituye generalmente un hallazgo radiológico

Lesiones retractiles intrarrenales por tuberculosis: patología y tratamiento / Intrarrenal retractile lesions of tuberculosis origin: pathology and treatment

Se presenta experiencia en lesiones tuberculosas retráctiles intrarrenales que causan obstrucción indirecta y ectasia de grupos caliciarios no lesionados. Se destaca la patogenia de las lesiones, su importancia en el diagnóstico de tuberculosis renal y en la planificación de una cirugía conservadora peculiar. Se discuten detalles de técnicas quirúrgicas