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The clinical data of 10 patients with prostate abscess admitted to our hospital were retrospectively analyzed. Summarize its diagnosis and treatment characteristics and its clinical efficacy. Prostatic abscess can generally be effectively controlled by timely, adequate and effective antibiotic treatment and active control of comorbidities. Prostate abscess deroofing might be an effective treatment for patients with the failure of conservative antibiotic treatment.
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A 39 year old gentleman complained of right upper abdominal pain. Ultrasonography revealed cholelithiasis with a cystic space occupying lesion in liver of around 14 cm. Computed tomograpy of whole abdomen was done which revealed a cystic lesion of 14.1×10.6×12.4 cm dimensions in right lobe of liver suggestive of simple cyst. Laparoscopic cholecystectomy was done along with de-roofing of cyst wall, bile leak was noted from a tiny orifice which was found communicating with biliary system by intraoperative cholangiography. Primary closure of opening done by suturing laparoscopically. Patient did well postoperatively and followed for 2 years with no complications and/or recurrence.A 39 year old gentleman complained of right upper abdominal pain. Ultrasonography revealed cholelithiasis with a cystic space occupying lesion in liver of around 14 cm. Computed tomograpy of whole abdomen was done which revealed a cystic lesion of 14.1×10.6×12.4 cm dimensions in right lobe of liver suggestive of simple cyst. Laparoscopic cholecystectomy was done along with deroofing of cyst wall, bile leak was noted from a tiny orifice which was found communicating with biliary system by intraop cholangiography. Primary closure of opening done by suturing laparoscopically. Patient did well postoperatively and followed for 2 years with no complications and/or recurrence. A 39 year old gentleman complained of right upper abdominal pain. Ultrasonography revealed cholelithiasis with acystic space occupying lesion in liver of around 14 cm. Computed tomograpy of whole abdomen was done whichrevealed a cystic lesion of 14.1×10.6×12.4 cm dimensions in right lobe of liver suggestive of simple cyst. Laparoscopiccholecystectomy was done along with de-roofing of cyst wall, bile leak was noted from a tiny orifice which was foundcommunicating with biliary system by intraoperative cholangiography. Primary closure of opening done by suturinglaparoscopically. Patient did well postoperatively and followed for 2 years with no complications and/or recurrence.
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Objective To study the efficacy of the deroofing-fixation operation for postoperative recurrent simple hepatic cysts (RSHC).Methods 21 patients who developed postoperative RSHC underwent the deroofing-fixation operation at the First Affiliated Hospital,Henan University of Science & Technology from August 2012 to August 2016.The data were analyzed retrospectively.Results The recurrent sites varied and included S6,7 (n=9),S7 (n=5),S8 (n=3) and S7,8 (n=4).The first operations for all these patients were either laparoscopic fenestration or windowing decompression.The recurrence time ranged from 4 to 13 months (average 6 months) after the first operation.All these patients were reoperated using the deroofing-fixation method,i.e.taparotomy,cyst deroofing and cyst edge fixation to the right hepatorenal ligament (n =9),or to the hepatic falciform ligament (n =12).All these patients were followed up for 11 to 60 months after the reoperation,and no recurrence was found.Conclusion The deroofing-fixation is an efficacious operation for post-operative RSHC.
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Objective To assess the safety and efficacy of a novel technology referred to as percutaneous ureteroscopic laser deroofing in the management of renal cysts.Methods From November 2014 to August 2016,59 patients having surgical indications with renal cysts were enrolled and evaluated by ultrasound and CT scan.Of all the 59 patients,36 were males and 23 were females.Their mean age was 46 years (ranging 35-64 years).41 patients complained about the reported flank and abdominal pain.18 patients were found by imaging examination.Their mean diameter of cyst was 6.3cm(ranging 4.9-9.1cm).In regards to the 59 patients,include 6 patients suffered with parapelvic cysts and 4 patients suffered with renal cyst complicated with ipsilateral renal calculi.Their mean stone surface area was 5.7 cm2 (ranging 3.4-9.8 cm2).All of the patients received combined spinal and epidural analgesia or paravertebral nerve block anesthesia.Patients were placed in the prone position for percutaneous puncture and tract dilation.Under ultrasound guidance,an eighteen gauge needle was placed inside the cyst cavity percutaneously,a metal guidewire was introduced followed by sequential dilation up to F26-28.9.8F rigid ureteroscope was inserted through the Amplazt access sheath and advanced into the cyst cavity.Then sheath and ureteroscope both returned to the exterior cyst together.Cyst wall was dissociated from perirenal adipose tissue by used ureteroscope.A majority of the collapsed cyst wall was grasped and gently pulled towards the Amplazt sheath interior using grasping forceps and incised using either Thulium (Power 40 ～50W) or Holmium laser(Power 60 ～70W) and was taken for pathological examination.Nephrostomy tube was left in place for 2-3 days and removed before discharge.For parapelvic cysts patients,ureter stent was inserted into the renal pelvis i n the dorsal lithotomy position firstly.Patients were then placed in the prone position for percutaneous puncture and tract dilation.Laser was used to incise cyst wall towards identified pelvis to create a permanent communication between the cyst and adjacent renal collecting system.F6 double-J stent was inserted into the cyst cavity at the end to prevent auto-closure for at most two months.F22 nephrostomy tube was left in renal pelvis for two weeks.For renal cyst complicated with ipsilateral renal calculi patients,a puncture was created targeting the stone through the cyst,after fragmenting and extracting the stone,the same laser was used to deroof the cyst.More than 50％ reduction in cyst volume was considered a success.The perioperative complications,hospitalization days and the effective rate of surgery were evaluated.Results All operations were conducted without intraoperative complications such as bleeding,urinary leakage or injury of the renal parenchyma and the adjacent organs.The hospital stay after the surgery was 2-4 days (mean 2.5 days).After 3-12 months follow-up (mean 8.1 months),patients underwent imaging examinations.42 out of 59 cases were completely resolved,15 were reduced to less than 50％,the total effective rate for the operation is 96.6％ (57/59).4 patients with ipsilateral renal calculi were completely clear.However,two cases failed probably due to incomplete resection and follow treated with laparoscopic renal cyst deroofing.Conclusions Percutaneous ureteroscopy renal cyst laser deroofing is a safe,effective,less invasive,which can be performed in any endourological center without the need of special instruments and training.
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ABSTRACTINTRODUCTION:Hydatidosis is the result of infection with the larval stages of some species of the genus Echinococcus. Treatment approaches for hydatid cysts include the use of albendazole, surgery, and/or medico-surgical procedures. The choice of the therapeutic surgical approach depends on the cyst number and localization, surgeon expertise, and presence of complications. The present study aimed to compare the outcomes of the following therapeutic approaches for the treatment of hepatic hydatid cysts: pericystectomy; the puncture, aspiration, injection, and reaspiration (PAIR) technique; and the PAIR technique followed by deroofing, evacuation of cysts, and omentoplasty.METHODS:The 54 patients were divided into 3 groups: Group I (14 patients) who underwent pericystectomy, Group II (23 patients) who underwent the PAIR technique, and Group III (17 patients) who underwent the PAIR technique followed by deroofing and omentoplasty. The diagnosis of hydatid cysts was based on serological testing using enzyme-linked immunosorbent assay, abdominal ultrasound, and parasitological examination of the cyst contents. Morbidity, mortality, length of hospital stay, recurrence, and postoperative complications were evaluated.RESULTS:Postoperative bleeding, infection, and recurrence were reported in Groups I and II; Group III did not experience postoperative infection and had shorter hospital stays. Recurrence and postoperative complications did not occur in Group III.CONCLUSIONS:The partial surgical procedure with deroofing, evacuation of the cysts, and omentoplasty, as performed in the present study, is recommended as a safe and effective method for elimination of the entire parasite with minimal possibility for intra-peritoneal spillage.