ABSTRACT
BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy (PCNL) using a small tract is controversial, and its indication is considered limited. In our center, however, we have performed Chinese minimally invasive PCNL regularly for managing upper-tract calculi. We report our experience. PATIENTS AND METHODS: Our technique is not just about using smaller instruments and tracts. Our overall approach is different from the standard PCNL. We preferred a middle caliceal puncture via the 11th rib space and also relied mainly on a strong irrigant current for stone fragment removal. We reviewed and analyzed the prospectively collected database on patients who underwent minimally invasive (MPCNL) from 2001 to 2005. RESULTS: A total of 4760 MPCNL procedures were performed in 3610 kidneys. There were 1240 staghorn stones and 85 ureteral stones. There were 14 transplanted kidneys and 27 cases of horseshoe kidneys. The average operative time was 78 minutes. The stone-free rate at postoperative day 2 was 89%. The major complication rate was 0.86%. CONCLUSION: Our experience with the Chinese MPCNL shows that it is safe and effective for managing all kinds of upper-tract calculi.
Subject(s)
Kidney Calculi/surgery , Kidney Calices , Nephrostomy, Percutaneous/methods , Ureteral Calculi/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , China , Equipment Design , Female , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures/instrumentation , Nephrostomy, Percutaneous/instrumentation , Prospective Studies , Young AdultABSTRACT
The reported incidence of bladder injury after cesarean section ranges from 0.14% to 0.94%. Most of the injuries were found intraoperatively. Delayed presentation is rare. We report a patient with bladder perforation presented with 'acute renal failure' and ascites 14 days after an uneventful cesarean section. Her clinical picture and initial presentation mimicked those of ureteric injury. Conventional cystography failed to demonstrate the bladder perforation. Computed tomography cystography clarified the diagnosis. Subsequent laparoscopic bladder repair resulted in quick and smooth recovery. This case highlights the pitfall of conventional cystography and the successful use of laparoscopy in management of this urologic condition. Literature was reviewed for this condition and its management.
Subject(s)
Acute Kidney Injury/diagnosis , Cesarean Section/adverse effects , Laparoscopy , Urinary Bladder Diseases/diagnosis , Urinary Bladder Diseases/surgery , Urinary Bladder/injuries , Adult , Diagnosis, Differential , Female , Humans , Minimally Invasive Surgical Procedures , Risk Factors , Time Factors , Urinary Bladder/pathology , Urinary Bladder/surgery , Urinary Bladder Diseases/etiologyABSTRACT
Laparoscopic adrenalectomy has become the method of choice of removal of most of adrenal lesions. This study investigated and compared the results of 2 different approaches of laparoscopic adrenalectomy, through retrospective review of 40 patients. Within this study period between 1995 and 2004, there were 20 lateral retroperitoneal and 20 lateral transperitoneal laparoscopic adrenalectomies performed. There was no significant difference in demographic variables between the 2 groups. Operative time, days to diet and ambulation, hospital stay, rate of conversion and complication did not differ significantly between the 2 approaches. No recurrence was detected upon mean follow-up period of 15.9 months. Learning curves showed gradual decrease in operation time in both approaches, reflecting maturation of techniques. In conclusion, both lateral transperitoneal and lateral retroperitoneal laparoscopic adrenalectomy are safe and effective. There is no difference in outcome between 2 approaches.
Subject(s)
Adrenalectomy/methods , Laparoscopy/methods , Adrenal Gland Neoplasms/surgery , Adult , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: Plasmakinetic vaporesection of the prostate (PKVP) using normal saline irrigation has the theoretical advantage of avoiding transurethral resection syndrome and minimizing blood loss. It may also shorten the operative time since tissue is resected instead of just vaporized. The aim of this study was to evaluate the efficiency, safety and advantages of PKVP compared with standard transurethral resection of the prostate (TURP) at a regional acute hospital. METHODS: A total of 60 consecutive men admitted from a waiting list for surgery for benign prostatic hyperplasia (BPH) were prospectively randomized to either PKVP or TURP. Peri- and postoperative outcome data at 3 months were obtained. RESULTS: The PKVP loop achieved a fast and sharp cutting action similar to that with the traditional TURP loop. Data analysis was based on 51 patients. There were no significant differences between the methods in resection time, postoperative catheterization time and hospital stay. The mean reductions in serum sodium 2 hours after PKVP and on postoperative day 1 were 0.52 mmol/L and 3.35 mmol/L, respectively, while mean reductions in haemoglobin were 0.36 g/dL and 0.24 g/dL, respectively. There was no significant difference in haemoglobin reductions between PKVP and TURP (p = 0.326 at 2 hours; p = 0.192 on day 1) and serum sodium (p = 0.757 at 2 hours; p = 0.888 on day 1). Both groups achieved comparable improvement in International Prostate Symptom Score (p = 0.862), quality-of-life score (p = 0.169) and peak flow rate (p = 0.96) at 3-month follow-up. CONCLUSION: PKVP achieved comparable results to traditional TURP and was an effective and safe procedure. However, it did not demonstrate obvious advantages over TURP in this acute regional hospital regular TURP list setting.
