Retroperitoneal Fibrosis with Inflammatory Aortic Aneurysm Managed by Laparoscopic Ureterolysis and Intraperitonealization of the Ureters / 대한비뇨기과학회지

Inflammatory aortic aneurysm is rare cause of retroperitoneal fibrosis with ureteral obstruction. Although the treatment options for retroperitoneal fibrosis are variable, a surgical procedure is the best choice when this condition is combined with inflammatory aortic aneurysm. We report here on our experience with laparoscopic bilateral ureterolysis and intraperitonealization of the ureters for the patient suffering with retroperitoneal fibrosis that was caused by an inflammatory aortic aneurysm.

Usefulness of Manual Reduction in Patients with Acute Scrotum / 대한비뇨기과학회지

PURPOSE: We assessed the usefulness of manual reduction in patients with an acute scrotum. MATERIALS AND METHODS: We retrospectively analyzed the data of 61 consecutive males who had undergone surgical exploration for an impression of testicular torsion, focusing on the incidence, duration of symptoms, direction of testicular torsion and results of manual reduction. Of the 61 explorations, there were 46 (75.4%) and 15 (24.6%) cases of testicular torsion and torsion of a testicular appendage, respectively. RESULTS: Of the 46 testicular torsions, the symptoms were localized to the left side in 37 and to the right side in 9. While the mean symptom duration of the 31 in the orchiectomy group (89 hours) was significantly longer than that in the 15 salvaged testes (10 hours, p=0.003), the mean degree of rotation between the two groups was not significant (p=0.196). Information on the direction of testicular rotation was available in 44 cases, with medial rotation having occurred in 31 (70.5%) and lateral rotation in 13 cases. The clinical symptoms were improved in 4 of the 20 patients in who manual reduction was attempted; residual torsion was identified in 2 patients. CONCLUSIONS: Manual detorsion, the fastest way to relieve testicular ischemia, should be performed at an early offstage following presentation. However, in attempting the manual reduction, the urologist should consider the possibility that a quarter of patients with an acute scrotum do not have testicular torsion, with 30% of testicular torsions occurring in the lateral direction. Surgical exploration remains necessary to confirm the causes of an acute scrotum and to correct any residual torsion.

Early Cardiopulmonary Changes of Retro- and Intraperitoneal Insufflation in Urologic Laparoscopic Surgery / 대한비뇨기과학회지

PURPOSE: Laparoscopic techniques are being increasingly used for retroperitoneal surgery. However, there have been few studies regarding the physiological alterations of retroperitoneal carbon dioxide (CO2) insufflation in humans. The physiological effects were compared between retroperitoneal and intraperitoneal insufflation. MATERIALS AND METHODS: Data on 66 patients who underwent laparoscopic renal (55), adrenal (10) or ureteral (1) surgery, via retroperitoneal (45) or intraperitoneal (21) approaches between July 1999 and January 2003, were collected retrospectively. The hemodynamic changes were assessed and arterial blood gas analysesis taken during an hour of insufflation, and analyzed for statistical differences. RESULTS: During the hour of CO2 insufflation, the hemodynamic parameters (heart rate, systolic blood pressure, and central venous pressure) and results of the arterial blood gas analyses (pH, PaCO2 and PaO2) indicated no significant differences between the retroperitoneal and intraperitoneal groups. The central venous pressure continued to increase in both the retroperitoneal (p=0.003) and intraperitoneal groups (p=0.005), with a similar magnitude. The increase in PaCO2 (p<0.001) and the decrease in arterial pH (p<0.001) after CO2 insufflation were significant in the retroperitoneal group. CONCLUSIONS: The physiological changes during urologic laparoscopic surgery are the same, regardless of the insufflation routes during an hour of insufflation, while the respiratory effects are relatively more pronounced with retroperitoneal insufflation. Therefore, intraperitoneal as well as retroperitoneal laparoscopic surgeries might be a safe treatment modality during an hour of insufflation when careful monitored and correction performed.