A case of laparoscopic ureteric reimplantation in a solitary urinary system.

Ureteric strictures can be caused by traumatic pelvic surgery, urolithiasis and instrumentation. There are various treatment options for ureteric stricture, including laparoscopic ureteric reimplantation. A 56-year-old female with a history of chronic left pelviureteric junction obstruction presented with urosepsis secondary to right-sided urolithiasis. The patient had a left nephrectomy and developed right-sided ureteric stricture following repeated ureteroscopy to manage her stone disease. The treatment with ureteric stenting was unsuccessful. Here we present a case on the feasibility of laparoscopic reimplantation for ureteric stricture in a solitary kidney to preserve renal function and avoid further ureteroscopy or nephrostomies.

Use of optical dilating trocar for initial access during extraperitoneal laparoscopic radical prostatectomy.

BACKGROUND AND PURPOSE: For fully extraperitoneal laparoscopic radical prostatectomy, open port placement is standard. This takes quite some time, so with the availability of trocars that combine optical control and radial dilation, an easier and faster technique was tested. PATIENTS AND METHODS: In 70 consecutive cases, preperitoneal space creation was attempted with only a 1-cm skin incision, developing further access using an optical dilating trocar with a laparoscope. Open preparation of the subcutaneous fat and incision of the anterior rectus fascia was not necessary. RESULTS: Access was successful on the first attempt in 67 cases. The time from the first skin incision to an established preperitoneal space was <10 minutes. CONCLUSIONS: We believe this technique offers an easier, faster, and safe way to introduce the first port for extraperitoneal laparoscopic radical prostatectomy.

Ureteric embolization: an alternative treatment strategy for urinary fistulae complicating advanced pelvic malignancy.

OBJECTIVE: To report experience with a minimally invasive technique for palliation of urinary fistula/incontinence complicating advanced pelvic malignancy or its treatment. PATIENTS AND METHODS: We used ureteric embolization with permanent nephrostomy drainage in eight renal units in five patients for palliation of symptoms. All procedures were done under local anaesthesia as day-case procedures. Nephrostomy tubes were changed at regular intervals on an outpatient basis. Embolization was repeated when required. RESULTS: The follow-up was 2-84 months; four patients died from the underlying malignancy during the follow-up. All patients were continent and had effective palliation of their symptoms. Two patients required repeat embolization. There were no embolization-related complications. CONCLUSIONS: Ureteric embolization is a safe and effective minimally invasive palliative treatment option in urinary fistulae or incontinence complicating advanced pelvic malignancy.