ABSTRACT
PURPOSE: The data on laparoscopic nephrectomy in Mansoura Urology & Nephrology Center were reviewed to identify the preoperative findings that may predict the need for conversion to open surgery. PATIENTS AND METHODS: One hundred sixty-three patients were subjected to transperitoneal laparoscopic nephrectomy, while 82 underwent retroperitoneal laparoscopic nephrectomy for benign renal diseases. The preoperative demographic data and laboratory and radiologic findings of these patients were correlated with failure rate of the laparoscopic procedure. RESULTS: The overall failure rate was 10.4% and 11% for the transperitoneal and retroperitoneal approach, respectively. Positive urine culture, renographic clearance of the removed kidney (>10 ml/min), and learning curve were independently associated with a greater risk of failure in patients undergoing transperitoneal nephrectomy. For the retroperitoneal approach, a positive urine culture, renographic clearance (> or =10 ml/min), and large kidney showed statistical significance. CONCLUSION: Preoperative data could be used as a predictor of laparoscopic nephrectomy outcome in patients with benign renal diseases. A more experienced surgeon should be selected for risky cases, bearing in mind the greater potential for early conversion to open surgery.
Subject(s)
Laparoscopy , Nephrectomy , Adult , Female , Humans , Intraoperative Complications , Laparoscopy/methods , Male , Middle Aged , Nephrectomy/methods , Postoperative Complications , Risk FactorsABSTRACT
OBJECTIVE: To describe the technique and report our experience of laparoscopic nephrectomy. PATIENTS AND METHODS: Between August 1992 and December 1993, 106 patients underwent laparoscopic nephrectomy at the Mansoura Urology and Nephrology Center. RESULTS: Of the 106 patients, laparoscopic nephrectomy was performed successfully in 97 cases. Conversion to an open procedure was necessary in the remaining nine patients. CONCLUSION: For a selected group of patients, laparoscopic nephrectomy is a feasible and safe technique. The length of hospital stay and convalescence is short and return to work is rapid.
Subject(s)
Kidney Diseases/surgery , Laparoscopy/methods , Nephrectomy/methods , Adolescent , Adult , Aged , Female , Humans , Laparoscopy/adverse effects , Length of Stay , Male , Middle Aged , Nephrectomy/adverse effects , Time FactorsABSTRACT
Between August 1992 and April 1993, 60 patients underwent laparoscopic nephrectomy in our institution for benign disease (35 hydronephrosis, 20 chronic pyelonephritis, 4 end-stage kidney, 1 renal hypoplasia). Conversion to open surgery was needed in six cases to overcome intraoperative bleeding or perirenal adhesions. The mean operative time was 3.5 +/- 1.3 hours, and the mean hospital stay was 3.2 +/- 2.1 days. No deaths occurred, but significant complications were encountered in four cases in the form of pulmonary embolism, a large hematoma, postoperative bleeding, and colonic perforation. Laparoscopic nephrectomy is a safe and effective alternative to open nephrectomy for benign renal conditions.
Subject(s)
Laparoscopy/methods , Nephrectomy/methods , Adolescent , Adult , Female , Humans , Kidney Diseases/surgery , Laparoscopy/adverse effects , Length of Stay , Male , Middle Aged , Nephrectomy/adverse effects , Time Factors , Treatment OutcomeABSTRACT
We report on the accidental division of the ureter of a transplanted kidney during laparoscopic marsupialization of a symptomatic lymphocele into the peritoneal cavity. Identification of the lymphocele was difficult because of a thick layer of overlying periperitoneal fibrolipomatous tissue. The complication was identified intraoperatively and stented reanastomosis of the divided ureter was performed. Postoperative course was uneventful. To avoid accidental injury to the transplanted ureter during laparoscopic drainage of lymphocele, we recommend that a ureteral catheter be inserted.
Subject(s)
Drainage/methods , Intraoperative Complications , Kidney Transplantation , Laparoscopy , Lymphocele/surgery , Surgical Wound Dehiscence/etiology , Ureter/transplantation , Humans , Kidney Transplantation/adverse effects , Lymphocele/etiology , Male , Middle AgedABSTRACT
Over a period of 5 consecutive years, 1039 renal units were treated by percutaneous nephrolithotripsy for stone disease of the kidney. The success rate was 93.7%. Residual stones remained in 4.2% of patients and in 2.1% we failed to remove the stones. The complication rate was 17.8%. Complications were treated conservatively in most cases but nephrectomy was required on one occasion to control severe bleeding. The average hospital stay was 6.9 days. Follow-up of 339 renal units (333 patients), for a minimum of 60 months, revealed minor late sequelae such as pelviureteric junction obstruction in 1 patient (0.3%) and post-catheterisation strictures of the anterior urethra in 4 (1.2%). Stone recurrence was observed in 9.1% of patients. Percutaneous nephrolithotripsy is an effective, safe treatment for renal stones with minimal late sequelae and is still required even in the era of extracorporeal shock wave lithotripsy.
Subject(s)
Kidney Calculi/therapy , Lithotripsy/methods , Adolescent , Adult , Aged , Child , Female , Follow-Up Studies , Humans , Kidney Calculi/diagnostic imaging , Length of Stay , Lithotripsy/adverse effects , Male , Middle Aged , Radiography , Recurrence , Renal Artery/diagnostic imaging , Treatment OutcomeABSTRACT
Over a 1-year period, rigid ureteroscopy has been used to retrieve ureteric calculi in 120 patients. The technical details, causes of failure and the complications are described. An initial success rate of 78% was obtained. It was concluded that ureteroscopy should replace blind procedures for the extraction of ureteric stones.
Subject(s)
Ureteral Calculi/therapy , Adult , Aged , Endoscopy , Female , Humans , Male , Middle Aged , Radiography , Ureter , Ureteral Calculi/diagnostic imagingABSTRACT
The prophylactic effect of maltose tetrapalmitate (MTP), a newly developed non specific immunoadjuvant in preventing or delaying bladder cancer induction by N-[4(5-nitro-2-furyl)-2-thiazolyl] formamide (FANFT) or in reducing the growth rate of the induced tumor was compared to other well-known immunoadjuvants (BCG, C. parvum, levamisole and pyran copolymer). The evaluation of the prophylactic role of immunoadjuvants demonstrated that MTP, levamisole and C. parvum were the most effective in prolonging animal survival. MTP was found superior to either of them in reducing the tumor size. The development of lung metastasis was lower in the group receiving MTP or C. parvum. Next, MTP was studied for its therapeutic effect against primary FANFT induced tumor. The subcutaneous (s.c.) and oral routes of MTP administration and their combination with intravesical route were tried. Combinations of intravesical with s.c. or oral MTP were most effective in reducing tumor size, obtaining lower metastases along with greater mononuclear lymphocyte infiltration in the primary tumor.
Subject(s)
Adjuvants, Immunologic/therapeutic use , Glycolipids/therapeutic use , Urinary Bladder Neoplasms/therapy , Animals , BCG Vaccine/therapeutic use , Bacterial Vaccines/therapeutic use , FANFT , Female , Immunotherapy , Levamisole/therapeutic use , Propionibacterium acnes/immunology , Pyran Copolymer/therapeutic use , Rats , Rats, Inbred F344 , Urinary Bladder Neoplasms/chemically induced , Urinary Bladder Neoplasms/pathologyABSTRACT
Our 14-year experience with the use of isolated ileal segments for replacement of the bilharzial ureter is analyzed retrospectively. Of 52 patients subjected to this procedure followup data were available for 38, in whom 52 ureters were repaired. The results generally were unsatisfactory: the morbidity and mortality rates were high and the percentage of functional improvement was low. The risk was higher for patients with low creatinine clearance. Therefore, we recommend that this operation be avoided when possible. If the operation is unavoidable, tapering of the ileal segment with antireflux ileovesical anastomosis may improve the outcome. Further clinical study must be done.
Subject(s)
Ileum/transplantation , Schistosomiasis/complications , Ureteral Obstruction/surgery , Adult , Female , Humans , Male , Retrospective Studies , Ureteral Obstruction/etiology , Urinary DiversionABSTRACT
The effectivenss of maltose tetrapalmitate (MTP) as an antitumour immune adjuvant was verified by its comparison with other known immunopotentiators, namely BCG, Corynebacterium parvum, levamisole and pyran copolymer. Copenhagen x Fisher 344/CRBL F1 hybrid male rats inoculated s.c. with the Dunning R3327A prostatic adenocarcinoma were used as the test system. All animals treated with immunoadjuvants showed a delay in tumour appearance and inhibition of early tumour growth. MTP was found to be the most effective, followed by levamisole, BCG, pyran copolymer and C. parvum in order of decreasing efficacy. Intratumoral treatment of small or large s.c. tumours with BCG, MTP and C. parvum was ineffective in our cases. However, this treatment was effective with MTP and BCG if they were used against a differentiated form of R3327 tumour. MTP and levamisole were found to be equally effective when given orally in drinking water. Experiments involving surgical excision of tumours followed by MTP therapy in two s.c. implanted animal tumour models (viz. a poorly immunogenic ascites mammary carcinoma 13762 in Fisher 344/CRBL rats, and an SV40 virus-induced sarcoma of low immunogenicity in Syrian hamster) showed beneficial effects of MTP on local tumour recurrence and tumour growth. Pre- and postoperative MTP treatment was at least as effective as postoperative MTP treatment alone.
