Laparoscopic donor nephrectomy in unusual venous anatomy - donor and recepient implications

ABSTRACT Objectives Laparoscopic donor nephrectomy is now a commonly performed procedure in most of renal transplantation centers. However, the suitability of laparoscopy for donors with abnormal venous anatomy is still a subject of debate. Materials and methods Between August 2007 and August 2014, 243 laparoscopic donor nephrectomies were performed in our institution. All donors were evaluated with preoperative three-dimensional spiral computed tomography (CT) angiography Thirteen (5.35%) donors had a left renal vein anomaly. A retrospective analysis was performed to collect donor and recipient demographics and perioperative data. Results Four donors had a type I retroaortic vein, seven had type II retroaortic vein and a circumaortic vein was seen in three donors. The mean operative time was 114±11 minutes and mean warm ischemia time was 202±12 seconds. The mean blood loss was 52.7±18.4mL and no donor required blood transfusion. Mean recipient creatinine at the time of discharge was 1.15±0.18mg/dL, and creatinine at six months and one year follow-up was 1.12±0.13mg/dL and 1.2±0.14mg/dL, respectively. There were no significant differences in operative time, blood loss, warm ischemia time, donor hospital stay or recipient creatinine at 6 months follow-up, following laparoscopic donor nephrectomy in patients with or without left renal vein anomalies. Conclusion Preoperative delineation of venous anatomy using CT angiography is as important as arterial anatomy. Laparoscopic donor nephrectomy is safe and feasible in patients with retroaortic or circumaortic renal vein with good recipient outcome.

Evaluation of Jordan's meatoplasty for the treatment of fossa navicularis strictures. A retrospective study.

INTRODUCTION: Fossa navicular strictures can be a challenging problem for reconstructive urologists in which there is a need to achieve good cosmetic results along with a consistent stream. Our aim was to retrospectively evaluate the outcome of Jordan meatoplasty in the management of fossa navicularis strictures. MATERIAL AND METHODS: A total of 25 patients who underwent Jordan meatoplasty for the management of fossa navicularis strictures between 2011 and 2016 were retrospectively reviewed. All patients were evaluated with uroflometry. Preoperative retrograde urethrogram was performed in all patients to exclude proximal urethral strictures. The operative details including operative time were analyzed. All patients were evaluated for urinary pattern changes, irritative voiding symptoms and with uroflometry at the end of three months. Hypospadias objective score evaluation (HOSE) was applied at the end of three months for the evaluation of cosmetic outcome. RESULTS: The mean age of patients was 64 years and the mean operative time was 42 minutes. The mean follow up period was 30 months. The mean post-operative peak urine flow rate at three months after removal of the catheter was 18 ml per second. The meatus was slit shaped in 84%. Only 12% of patients complained of splay of urine at the end of three months. 96% of patients were stricture free, with one patient developing a recurrence at 12 months of follow up which was managed by urethral dilatation. CONCLUSIONS: Jordan meatoplasty is a feasible and easily reproducible technique for the management of distal penile strictures.

Laparoscopic donor nephrectomy in unusual venous anatomy - donor and recepient implications.

OBJECTIVES: Laparoscopic donor nephrectomy is now a commonly performed procedure in most of renal transplantation centers. However, the suitability of laparoscopy for donors with abnormal venous anatomy is still a subject of debate. MATERIALS AND METHODS: Between August 2007 and August 2014, 243 laparoscopic donor nephrectomies were performed in our institution. All donors were evaluated with preoperative three-dimensional spiral computed tomography (CT) angiography Thirteen (5.35%) donors had a left renal vein anomaly. A retrospective analysis was performed to collect donor and recipient demographics and perioperative data. RESULTS: Four donors had a type I retroaortic vein, seven had type II retroaortic vein and a circumaortic vein was seen in three donors. The mean operative time was 114±11 minutes and mean warm ischemia time was 202±12 seconds. The mean blood loss was 52.7±18.4mL and no donor required blood transfusion. Mean recipient creatinine at the time of discharge was 1.15±0.18mg/dL, and creatinine at six months and one year follow-up was 1.12±0.13mg/dL and 1.2±0.14mg/dL, respectively. There were no significant differences in operative time, blood loss, warm ischemia time, donor hospital stay or recipient creatinine at 6 months follow-up, following laparoscopic donor nephrectomy in patients with or without left renal vein anomalies. CONCLUSION: Preoperative delineation of venous anatomy using CT angiography is as important as arterial anatomy. Laparoscopic donor nephrectomy is safe and feasible in patients with retroaortic or circumaortic renal vein with good recipient outcome.

Management of recurrent anterior urethral strictures following buccal mucosal graft-urethroplasty: A single center experience.

OBJECTIVE: To describe the safety, feasibility and outcome of redo buccal mucosal graft urethroplasty in patients presenting with recurrent anterior urethral stricture following previous failed BMG urethroplasty. MATERIALS AND METHODS: This was a retrospective chart review of 21 patients with recurrent anterior urethral stricture after buccal mucosal graft urethroplasty, who underwent redo urethroplasty at our institute between January 2008 to January 2014. All patients underwent preoperative evaluation in the form of uroflowmetry, RGU, sonourethrogram and urethroscopy. Among patients with isolated bulbar urethral stricture, who had previously undergone ventral onlay, redo dorsal onlay BMG urethroplasty was done and vice versa (9+8 patients). Three patients, who had previously undergone Kulkarni-Barbagli urethroplasty, underwent dorsal free graft urethroplasty by ventral sagittal urethrotomy approach. One patient who had previously undergone urethroplasty by ASOPA technique underwent 2-stage Bracka repair. Catheter removal was done on 21(st) postoperative day. Follow-up consisted of uroflow, PVR and AUA-SS. Failure was defined as requirement of any post operative procedure. RESULTS: Idiopathic urethral strictures constituted the predominant etiology. Eleven patients presented with stricture recurrence involving the entire grafted area, while the remaining 10 patients had fibrotic ring like strictures at the proximal/distal graft-urethral anastomotic sites. The success rate of redo surgery was 85.7% at a mean follow-up of 41.8 months (range: 1 yr-6 yrs). Among the 18 patients who required no intervention during the follow-up period, the graft survival was longer compared to their initial time to failure. CONCLUSION: Redo buccal mucosal graft urethroplasty is safe and feasible with good intermediate term outcomes.

A simplified laparoscopic approach to repair vesicovaginal fistula: the M.S. Ramaiah technique.

OBJECTIVE: To describe a simplified laparoscopic approach for the management of vesicovaginal fistula (VVF), with the specific aim of decreasing laparoscopic intracorporeal suturing and to highlight our results with this simplified approach. MATERIALS AND METHODS: A retrospective chart review was carried out to all patients who underwent VVF repair at our institute by the "simplified laparoscopic approach" between January 2011 and August 2014. Preoperative evaluation consisted of intravenous urography, micturating cystography, and cystoscopy. Patients with malignant fistulas, history of pelvic irradiation, or co-existent ureteric fistulas were excluded. The procedure consisted of an initial cystoscopy to intubate bilateral ureteric orifices with ureteric catheter, as well as the fistula with a ureteric catheter of different color. A 3-port technique was used. The simplified laparoscopic approach consisted of limited cystotomy, single-layer bladder closure with 3-0 V-Loc barbed suture and omental patch over the vaginal opening. RESULTS: A total of 22 patients were included in the analysis. Mean interval before surgery was 2.5 months. One patient had previous failed transvaginal repair. Transvaginal hysterectomy for benign uterine pathology constituted the predominant etiology of VVF in this series. Mean fistula size was 7 mm. Mean operative time was 75 minutes. All patients were continent at catheter removal at postoperative day 14 and remained symptom free in the follow-up period. CONCLUSION: The simplified laparoscopic approach of VVF repair produces excellent results with minimal morbidity.

Magnetic resonance spectroscopy imaging-directed transrectal ultrasound biopsy increases prostate cancer detection in men with prostate-specific antigen between 4-10 ng/mL and normal digital rectal examination.

OBJECTIVES: To evaluate the ability of magnetic resonance spectroscopic imaging to improve prostate cancer detection rate. METHODS: A retrospective analysis was carried out of 278 men with prostate-specific antigen in the range of 4-10 ng/mL and normal digital rectal examination who underwent transrectal ultrasound-guided prostate biopsy. Outcomes were compared between men who had a standard biopsy versus those who also underwent a prebiopsy magnetic resonance spectroscopic imaging. Men with an abnormal voxel on magnetic resonance spectroscopic imaging had standard transrectal ultrasound biopsies plus biopsies directed to the abnormal voxels. RESULTS: The study group (n = 140) and control group (n = 138) were similar in baseline parameters, such as mean age, prostate size and mean prostate-specific antigen. The overall cancer detection in the magnetic resonance spectroscopic imaging positive group (24.4%) was more than double that of the control group (10.1%). On comparing the magnetic resonance spectroscopic imaging results with the transrectal ultrasound biopsy findings, magnetic resonance spectroscopic imaging had 95.6% sensitivity, 41.9% specificity, a positive predictive value of 24.4%, a negative predictive value of 98% and an accuracy of 51.4%. CONCLUSIONS: Magnetic resonance spectroscopic imaging-directed transrectal ultrasound biopsy increases the cancer detection rate compared with standard transrectal ultrasound biopsy in patients with normal digital rectal examination and elevated prostate-specific antigen in the range of 4-10 ng/mL.

Dislodged dormia basket.

This is the first reported case of a Dormia basket being dislodged outside the ureter into the retroperitoneum during intracorporeal lithotripsy.

Congenital giant hydroureter presenting as abdominal mass in an infant.

Herein we present a case of a 7-month-old baby girl, with left single system ectopic ureter, in whom the ureter was dilated to such an extent that it presented as an abdominal mass. Diagnosis was established by means of computed tomography. Work up was completed with renal scan and micturating cystourethrography. The patient was operated and left nephorureterectomy was performed. Hydroureter has to be considered in differential diagnosis of abdominal mass in an infant.