Laparoscopic renal biopsy: a 9-year experience.

OBJECTIVES: To present our experience and outcome of consecutive laparoscopic renal biopsy over a 9-year period, as renal biopsy remains an important diagnostic procedure for evaluating proteinuria, haematuria and renal failure, but when percutaneous biopsy is contraindicated, a laparoscopic biopsy is an attractive option because it is minimally invasive. PATIENTS AND METHODS: Seventy-four patients (29 male, 45 female, mean age 45 years, range 3-79) had a laparoscopic renal biopsy taken for various indications, e.g. morbid obesity, solitary kidney, coagulopathy, failed percutaneous biopsy, high location of the kidney and poor visualization with ultrasonography. The kidney was approached via a laparoscopic retroperitoneal route using a two-port technique, with the patient in the flank position. After identifying the kidney, one to five cortical biopsies were obtained with cup-biopsy forceps. RESULTS: Adequate tissue was obtained in 96% of the patients; the mean (range) operative duration was 123 (9-261) min and the estimated blood loss 67 (5-2000) mL. Forty-three patients were discharged within 24 h. Complications occurred in 10 patients, with significant bleeding in three. One patient died after surgery, secondary to a perforated peptic ulcer while on high-dose steroid therapy. CONCLUSION: Laparoscopic renal biopsy is a safe and effective alternative to open renal biopsy for patients in whom percutaneous biopsy is not feasible. It offers the advantage of obtaining cortical biopsies and achieving haemostasis under direct vision. Adequate renal tissue is obtained in most cases. Recovery and convalescence are short for most patients.

Laparoscopic ureteral reimplantation for ureteral lesion secondary to transvaginal ultrasonography for oocyte retrieval.

Transvaginal ultrasound-guided follicular puncture for oocyte retrieval is a highly efficient and minimally invasive method for assisted reproductive techniques. Complications related to this procedure are rare. We report the case of a ureteral stricture secondary to ultrasound-guided follicular puncture for oocyte retrieval that was corrected by a laparoscopic approach. This approach can minimize postoperative pain, the length of hospitalization, and the period of convalescence and should be considered a minimally invasive option in the management of this rare complication of oocyte retrieval.

Primary localized amyloidosis of the ureter.

Primary amyloidosis is a rare condition that can involve the urinary tract. These lesions can occur anywhere in the collecting system and are often mistaken clinically for malignancies. We report a case of localized ureteral amyloidosis. Our treatment consisted of a conservative approach with local resection.

The laparoscopic Boari flap.

PURPOSE: Laparoscopic management of ureteral pathologies, such as ureteropelvic junction obstruction, ureteral calculi and retroperitoneal fibrosis, has proved to be highly effective. We present our initial experience with the laparoscopic Boari flap in regard to feasibility, safety and short-term results. MATERIALS AND METHODS: Three patients who presented with distal ureteral obstruction underwent preoperative radiographic evaluation, including excretory urography, computerized tomography and retrograde pyelography, that showed upper urinary tract dilatation at the site of obstruction. The contralateral upper urinary tract was normal in all cases. Ureteroureterostomy and ureteroneocystostomy was not feasible because of stricture length and a laparoscopic Boari flap procedure was performed. Renal function, symptom improvement and radiological studies, including excretory urography and cystography, were assessed 3 and 6 months postoperatively. RESULTS: All procedures were successfully performed without any intraoperative complications or need for open conversion. Excretory urography showed good drainage with no obstruction of urine flow and all patients had grade I vesicoureteral reflux on cystography. CONCLUSIONS: The laparoscopic Boari flap is feasible using currently available laparoscopic suturing techniques. Longer followup and larger series of patients are necessary to provide data comparable to that of the open approach.

Laparoscopic treatment of retroperitoneal fibrosis: report of two cases and review of the literature.

OBJECTIVES: We present the results of treatment by laparoscopy of two patients with retroperitoneal fibrosis and review the literature since 1992, when the first case of this disease that was treated using laparoscopy was published. We also discuss the contemporary alternatives of clinical treatment with corticosteroids and tamoxifen. CASE REPORT: Two female patients, one with idiopathic retroperitoneal fibrosis, and other with retroperitoneal fibrosis associated with Riedel's thyroiditis, were treated using laparoscopic surgery. Both cases had bilateral pelvic ureteral obstruction and were treated using the same technique: transperitoneal laparoscopy, medial mobilization of both colons, liberation of both ureters from the fibrosis, and intraperitonealisation of the ureters. Double-J catheters were inserted before the operations and removed 3 weeks after the procedures. The first patient underwent intraperitonealisation of both ureters in a single procedure. The other had 2 different surgical procedures because of technical difficulties during the first operation. Both patients were followed for more than 1 year and recovered completely from the renal insufficiency. One of them still has occasional vague lumbar pain. There were no abnormalities in the intravenous pyelography in either case. CONCLUSIONS: Surgical correction of retroperitoneal fibrosis, when indicated, should be attempted using laparoscopy. If possible, bilateral ureterolysis and intraperitonealisation of both ureters should be performed in the same operation.

Splenic rupture and abscess after extracorporeal shock wave lithotripsy.

Extracorporeal shock wave lithotripsy (ESWL) is the first choice for the treatment of most urinary stones. Complications of ESWL can be separated into two groups: those related to the administration of the shock waves and those related to fragmentation and elimination of the stone's particles. We report a rare case of splenic trauma followed by abscess after ESWL.