Laparoscopic Nephrectomy with Adrenalectomy for Synchronous Adrenal Myelolipoma and Renal Cell Carcinoma.

Introduction. Adrenal myelolipomas are uncommon nonfunctioning tumors of the adrenal. Synchronous renal cell carcinomas with adrenal myelolipomas are very rare. We present the case report of adrenal myelolipoma with synchronous RCC managed laparoscopically. Case Report. A 60-year-old old gentleman presented with incidental right upper polar mass with right adrenal mass. Metastatic work-up was negative. Laparoscopic radical nephrectomy with adrenalectomy was done under general anesthesia. The biopsy report was right kidney clear cell adenocarcinoma (T1b) with right adrenal myelolipoma. Conclusion. This is the first case report of laparoscopic adrenalectomy with nephrectomy for ipsilateral synchronous renal cell carcinoma with adrenal myelolipoma.

A comparison of continuous and interrupted suturing in laparoscopic pyeloplasty.

BACKGROUND: Laparoscopic pyeloplasty is one of the most common reconstructive procedures performed by urologists. Both continuous and interrupted sutures are being practiced for ureteropelvic anastomosis. The success rate and the complications associated with the suturing technique needs evaluation. We analyzed the results from of our patients who underwent laparoscopic pyeloplasty using both techniques. OBJECTIVE: To review the outcome differences among patients undergoing laparoscopic pyeloplasty regarding suturing technique. MATERIALS AND METHODS: All patients who underwent laparoscopic, transperitoneal dismembered pyeloplasty of the primary pelviureteric obstruction were analyzed. The primary outcome was successful pyeloplasty, as assessed by the resolution of symptoms and T½<10 minutes. The secondary outcomes were the complication rate and the operative parameters. The difference in the parameters was assessed by Student t test analysis. RESULTS: Of the 107 patients we studied, 65 had interrupted suturing and 42 had continuous suturing. The success rate was not significantly different among the 2 groups. The mean suturing time, postoperative drainage volume, postoperative hospital stay, and total cost of the procedure were significantly less in the continuous suturing group. CONCLUSION: The continuous suturing technique is preferred over the interrupted suturing technique for laparoscopic pyeloplasty because the success rates are equal and the postoperative stay, suturing time, drain output, and cost of the procedure are better.

Laparoscopic undiversion in a child with sacral agenesis into augmentation cystoplasty.

INTRODUCTION: In neurogenic bladder with compromised renal function or when complex reconstruction is not preferred, ileal conduit is considered. Undiversion is performed when the patient prefers the procedure, once the renal function improves, or when complications resulting from diversion are present. CASE DESCRIPTION: We present the case of a 10-y-old boy with sacral agenesis, who underwent laparoscopic-assisted ileal conduit diversion in 2006, because he had a grossly unstable, small-capacity bladder and was not compliant with intermittent self-catheterization. At present, he preferred not to have a conduit. DISCUSSION: Laparoscopic undiversion with ileal augmentation cystoplasty was performed. The postoperative course was uneventful, and he is now on intermittent self-catheterization with healthy renal function. Laparoscopic undiversion is technically challenging, yet feasible, and is an effective option in children. To our knowledge, this is the first such case reported.

Laparoscopic diverticulocystoplasty for low compliance bladder in a child.

Low compliance bladder with a posterior urethral valve is a common association. Augmentation cystoplasty is one of the management options. We present the case report of a 4-y-old boy who presented with low compliance bladder, bladder diverticulum, right obstructive megaureter, and left grade IV reflux, 6 mo following PUV fulguration. He was managed by laparoscopic diverticulocystoplasty with right ureteric reimplantation and left detrusorrhaphy. The patient showed subjective and urodynamic improvement at 12 mo follow-up. The use of diverticulum for augmentation is advantageous, as it abides by the principle of bladder augmentation with urothelium. This is the first case report of successful use of diverticulum for laparoscopic bladder augmentation in a child.

Transmesocolic approach to laparoscopic pyeloplasty: our 8-year experience.

Open pyeloplasty is the gold standard in the treatment of congenital ureteropelvic junction obstruction. Several reports have shown that laparoscopic pyeloplasty produces comparable results. In this paper, we report a retrospective study of the transmesocolic approach to the left ureteropelvic junction obstruction in 26 patients. As colon mobilization is avoided, the field remains fairly clear. This direct approach also saves time and is least invasive. One patient was lost for follow-up, and 1 patient is awaiting a renogram. Among the remaining 24 patients, 22 patients had improved drainage (IVU or isotope renogram), and 2 of the patients had stable renal function.

Laparoscopic pyeloureterostomy: experience in three cases.

PURPOSE: To report our experience with transperitoneal laparoscopic pyeloureterostomy for duplication of the collecting system. PATIENTS AND METHODS: Since January 2003, two adult patients with incomplete duplication of ureter with ureteropelvic junction obstruction of the lower moiety and a 4-month-old male baby with complete duplication of the ureter with reflux in the lower moiety underwent transperitoneal laparoscopic pyeloureterostomy. The baby also had excision of the lower-moiety ureter. RESULTS: There was no significant intraoperative or postoperative morbidity. Follow-up imaging revealed good drainage. CONCLUSION: With increasing experience in laparoscopic reconstructive urologic procedures, laparoscopic pyeloureterostomy is a feasible option, even in infants.