Laparoscopic surgery for renal stones: is it indicated in the modern endourology era?

Purpose: To report the outcomes of laparoscopic surgery combined with endourological assistance for the treatment of renal stones in patients with associated anomalies of the urinary tract. To discuss the role of laparoscopy in kidney stone disease. Materials and Methods: Thirteen patients with renal stones and concomitant urinary anomalies underwent laparoscopic stone surgery combined with ancillary endourological assistance as needed. Their data were analyzed retrospectively including stone burden, associated malformations, perioperative complications and outcomes. Results: Encountered anomalies included ureteropelvic junction obstruction, horseshoe kidney, ectopic pelvic kidney, fussed-crossed ectopic kidney, and double collecting system. Treatment included laparoscopic pyeloplasty, pyelolithotomy, and nephrolithotomy combined with flexible nephroscopy and stone retrieval. Intraoperative complications were lost stones in the abdomen diagnosed in two patients during follow up. Mean number of stones removed was 12 (range 3 to 214). Stone free status was 77 percent (10/13) and 100 percent after one ancillary treatment in the remaining patients. One patient had a postoperative urinary leak managed conservatively. Laparoscopic pyeloplasty was successful in all patients according to clinical and dynamic renal scan parameters. Conclusions: In carefully selected patients, laparoscopic and endourological techniques can be successfully combined in a one procedure solution that deals with complex stone disease and repairs underlying urinary anomalies.

Neonatal Urologic Urgencies: Early Detection and Management / 대한비뇨기과학회지

Neonatal urologic urgencies are any genitourinary condition during the 1st month of life that jeopardizes the gonads, the kidneys, or the life of the infant if there is a delay in either diagnosis or treatment. Since 1991, we have experienced 41 cases of neonatal urologic urgencies. Of 41 cases, 23 were detected prenatally. Male to female distribution was 29 to 12. The initial symptoms or signs at presentation were antenatal hydronephrosis in 21, fever in 10, scrotal mass in 5. The rest 5 were 1 abdominal mass, 1 cystic adrenal mass, 1 absence of kidney, 1 abnormal micturition and 1 jaundice. The final diagnosis were 1 neuroblastoma, 2 multicystic dysplastic kidney, 1 multicystic dysplastic kidney and contralateral UPJO, 2 unilateral transient hydronephrosis, 3 bilateral transient hydronephrosis, 1 unilateral renal hypoplasia and contralateral hydronephrosis, 1 unilateral and 2 bilateral UPJO, 1 renal agenesis, 5 complete duplicate ureter, 3 primary megaureter, 1 unilateral UVJ0, 2 unilateral and 9 bilateral VUR, 1 PUV, 1 congenital megalourethra with bilateral hydronephrosis, 1 acute epididymitis, 3 torsion of spermatic cord, 1 cystic teratoma. Surgical treatment was performed in 26 and conservative management in 15. Since it has been reported 2/3 of all infant deaths occur during the 1st year of life, especially most are during the neonatal period, we believe it is crucial that urologists be involved in the care of newly born infants and be alert to the clues of underlying genitourinary abnormalities or diseases because the least easily recognizable urologic abnormality may be the one that requires the most immediate attention in the neonate.