THE USE OF BOWEL FOR BILATERAL URETER SUBSTITUTION: A CASE REPORT AND REVIEW OF LITERATURE.

Intestinal ureteral replacement remains a useful procedure for complex ureteral reconstruction. Bilateral ureteral substitution is more complicated procedure. There are some different methods of ureteroplasty. In our case we used Libertino modification. In this case we have examined safety and efficacy of this procedure, surgical outcome and impact on renal function. Our results were compared to literature findings. November 2013 year 52 years female patient underwent bilateral ureter replacement using the ileal segment of bowel. Exclusion criteria were elevated serum creatinine above to - 1.8 mg/dl, inflammatory bowel syndrome. Preoperatively we prepared patient with antibiotic therapy. Post-surgery was examined level of serum creatinine, dilatation of upper urinary tract, hematocrits, biochemical analysis, urinary tract infection, postoperative complications, and clinical outcomes. Follow-up protocol was carried out for up to 18 month. There were no intra-operative or postoperative mortality or significant complications in our case. There was no significant blood loss during operation. Blood transfusion was - 230ml. There was minor by-effect in the form of mucus production and there was needful oral treatment with bladder irrigation. During follow up, no excess metabolic abnormalities were encountered. Renal function was normal without any evidence of urinary obstruction. Urinary tract infection was only non-etiologic mean. According to our case and revive of literature ureteric substitution with ileal segment is a safe technique with a positive outcome. It uses of any kind ureteric injury: iatrogenic or idiopathic; unilateral or bilateral. It is not associated with excess mucus metabolic abnormalities and preserved renal function without urinary tract infection or obstruction.

Transplanting kidneys with small renal masses: a new source of renal allografts.

The number of publications on transplanting kidneys with small renal masses is steadily growing. There are several transplant centers worldwide with organized programs of transplanting such kidneys. Nevertheless, despite growing number of reports this practice remains controversial. The existing guidelines for kidney transplantation give controversial recommendations concerning transplantation of the kidneys with renal masses. There are arguments in favour as well as against this policy. Importance of the subject is emphasized by calculations showing that about 3000 kidneys with tumors could be transplanted in the United States annually. Based on the results reported in the literature the risk of occurrence of de novo graft tumor is extremely low and varies from 0.24% to 0.46%. A risk of getting a transmitted cancer is even lower and reported as 0.015-0.2%. The patient and graft survival rates of these kidneys are comparable to that of the standard criteria deceased and living transplant. More studies with higher number of patients are needed to prove the functional and oncological safety of this practice.

Results of radical cystectomy with Mainz pouch II diversion (single institution experience).

Evaluation of the peri- and postoperative morbidity in patients who underwent radical cystectomy and sigma-rectum pouch (Mainz pouch II) diversion with curative intent for invasive bladder cancer. We've reviewed 320 patients with invasive bladder cancer who underwnt radical cystectomy with lymphadenectomy and urinary diversion in our clinic from 1988 to 2011. In 134 (41.9%) patients Mainz pouch II diversion was performed. The results and complication rates have been analyzed in these patients. Intraoperaive injury of the rectum occurred in 2 (1.5%) patient, early complications were found in 40 (29.9%) and late complications in - 5 (3.7%) patients. Oral alkalization was necessary in 30 (22.4%) cases. 9 (6.7%) patients were hospitalized because of severe acidosis. Acute pyelonephritis developed in 8 (5.9%) patients. Hydronephrosis developed in 15 (11.2%) cases. In 7 (5.2%) patients dilatation of upper urinary tract was bilateral and in 8 (5.9%) - unilateral. In 4 (2.9%) patients stricture of the ureteral anastomosis was diagnosed. All patients were dry at day time. Only three (2.2%) patients (2 male and 1 female) needed pads at night time. All of these three patients were above 70 years old. Two patients underwent surgical intervention for interintestinal abscess. One patient was operated because of mechanical bowel obstruction 2 month after surgery. Perioperative mortality was 3.7%. Mainz Pouch II has a low morbidity and mortality rates. This form of diversion is method of choice for patients in whom the urethra cannot be used. In selected cases Mainz Pouch II is alternative to other types of continent diversion.

[Radical perineal prostatectomy--surgical technique, first results].

Prostate cancer is the most common malignancy in men and the second leading cause of cancer death. Radical prostatectomy is the most effective treatment for localized prostate cancer. With increasing use of minimally invasive treatment methods, clinical outcomes are becoming important assessment tools to compare one option to another. Perineal prostatectomy is modified to incorporate contemporary surgical ideas, including preservation of cavernosal nerve bundles, sphincteric urethra at the prostatic apex, and the bladder neck. During 2001-2004 in National Centre of Urology radical perineal prostatectomy was performed in 9 patients. The mean age of the patients was 64 years (range: 53-71 years). All operations were carried out with curative purpose for the treatment of localized prostate cancer. In all cases prostate specific antigen (PSA) was <10 ng/ml, Gleason score<7. There were analyzed operative time, volume of blood transfusions, duration of hospital stay, peri-operative complications, pre and postoperative potency and urinary continence. The distribution of pT categories was: pT2a-2 (22.2%); pT2b-5 (55.6%); pT3a-1 (11.1%); pT3b-1 (11.1%). The mean operative time was 130 minutes (range 95-180 minutes). The middling volume of blood transfusion per patient was 427 ml. At 12 months incontinence was manifested in 1 (11.1%) patient. Postoperative potency was reached in one case. Margins were positive in 2 (22.2%) cases. In both cases was manifested biochemical relapse. One of these patients died after 32 month from surgery. According our results 3-year tumor specific survival was in 7 (77.8%) patients. Radical perineal prostatectomy is an excellent alternative approach for radical surgery in the treatment of early prostate cancer. This method of prostatectomy is able to achieve complete cancer resection while preserving urinary and sexual function in the majority of men presenting with clinically localized prostate cancer. The simplicity and minimally invasive nature of this procedure contribute to a short recovery and low overall cost of therapy. The radical perineal prostatectomy is a cost-efficient, outcome-effective minimally invasive method of treating men with localized prostate cancer.

[Extended lymphadenectomy in radical cystectomy: margins, scope, methodology].

Radical cystectomy with pelvic lymphadenectomy is a gold standard for treatment of muscle-invasive urinary bladder cancer. However, therapeutic and prognostic value of pelvic lymphadenectomy is still controversial. Recent studies have demonstrated a better prognosis after extended lymphadenectomy. A multicenter study was made to standardize an extended lymphadenectomy procedure. We examined prospectively the total number of lymph nodes removed from various sites, number and location of positive nodes and its relation to location of primary tumors in the urinary bladder. Thirty five radical cystectomies with extended lymphadenectomy were performed for the treatment of invasive bladder cancer in National Urology Center in 1999-2004. The margins of extended lymphadenectomy were: cranial level of a.mesenterica inferior; lateral--n.n. genitofemoralis; caudal-fossa obturatoria. A total amount of removed lymph nodes comprised 1081, mean 34.2 +/- 8.1 lymph node per patient (range from 10 to 58). Fourteen patients (40.0%) were node positive (69 nodes). According to N category: N1--6 patients; N2--7 patients. Six patients had lymph node metastases up to the aortic bifurcation. In 6 cases a positive node was found on the contralateral side. Thus, we recommend extended radical lymphadenectomy for all patients undergoing radical cystectomy for bladder cancer.