Laparoscopic repyeloplasty after failed open repair of ureteropelvic junction obstruction: a case-matched multi-institutional study.

OBJECTIVE: The aim of this study was to retrospectively review the experience and midterm results of laparoscopic pyeloplasty (LP) in patients with previous failed open pyeloplasty in comparison to primary LP. MATERIALS AND METHODS: Thirty-two patients who had undergone previous failed open surgery for management of ureteropelvic junction obstruction (UPJO) were reviewed. The patients underwent transperitoneal dismembered LP. All operations were performed by the same laparoscopist from March 2009 to June 2013. Surgical results were compared to 72 patients who underwent primary LP carried out by the same surgeon during the same period. RESULTS: The laparoscopic repyeloplasty group consisted of 14 men and 18 women. The mean age was 29 ± 6 years. The mean operative period was 133 ± 42 and 110 ± 57 min; the mean length of stay in hospital was 2.7 ± 2.3 and 1.3 ± 2.1 days; and the mean follow-up period was 32.4 ± 14 and 29.3 ± 11.2 months in the secondary and primary LP groups, respectively. The success rate was 90.6% for secondary LP and 94.4% for primary LP. There was no conversion in either group. The percentage of intraoperative and postoperative complications in secondary LP was 9.4% and 12.5%, respectively, compared with 0% and 5.6% in the primary LP group. CONCLUSIONS: Laparoscopic repyeloplasty is a safe and viable treatment option for secondary UPJO, with a success rate similar to that of primary repair but with longer operative time. Considerable experience in laparoscopic reconstructive procedures is a prerequisite for optimal results.

Urethroplasty for treatment of long anterior urethral stricture: buccal mucosa graft versus penile skin graft-does the stricture length matter?

PURPOSE: To investigate the surgical outcomes of dorsal onlay urethroplasty (DOU) using buccal mucosa graft (BMG) or penile skin graft (PSG) and to assess the effect of stricture length in men with anterior urethral strictures. METHODS: A prospective cohort included men with anterior urethral strictures between 2008 and 2015. Patients underwent DOU using PSG or BMG. Patients had urethrography and uroflowmetry at 0, 3, 6, 12 months, and urethroscopy when needed. Student's t test, Mann-Whitney U tests, and Pearson's Chi-square test were used for analysis. RESULTS: Sixty-nine patients (43 ± 14 year) were included, 31 received BMG, and 38 received PSG. Mean stricture length was 8 ± 3 cm, mean operative time was 145 ± 31 min, and mean follow-up was 56 ± 10 mo. Success rate was 87 % (90 % BMG vs. 84 % PSG, p = 0.4). Mean operative time was significantly shorter in PSG group (136 ± 29 min vs. 256 ± 58 min, p = 0.0005). Complications of grade I developed in 36 % (wound infection = 10 %, postvoiding dribbling = 18.8 %). Thirty of 69 patients (43 %) had strictures ≥8 cm, and 39 (57 %) had strictures <8 cm-success rate was equal for both subgroups (87 %). Mean blood loss, mean operative time, and incidence of postvoid dribbling were significantly lower in strictures <8 cm. CONCLUSION: BMG and PSG have comparable success rates in treatment of long anterior urethral strictures. Operative time is significantly longer in BMG. Long-segment strictures are associated with longer operative time, more blood loss, and more occurrence of postvoid dribbling. However, the length of the stricture has no influence on the success rate and functional outcomes of DOU.

Upper urinary tract retroperitoneoscopic surgery under epidural anesthesia: Shifting towards outpatient treatment.

OBJECTIVE: Laparoscopy for urological surgery is usually carried out under general anesthesia. However, laparoscopy under epidural anesthesia has been reported to be successful for laparoscopic cholecystectomy, hernia repair, gynecological procedures, renal biopsy and renal cyst unroofing. MATERIALS AND METHODS: From August 2011 to July 2013, 46 patients (26 male, 20 female) with a mean age of 35 years underwent retroperitoneoscopic surgery (15 nephrectomy, 21 ureterolithotomy, 10 renal cyst excision) under epidural anesthesia, performed by the same surgeon. Inclusion criteria were patients with benign upper urinary tract pathology, no history of flank operation, American Society of Anesthesiologists score I-II and body mass index less than 25. Pulse oximetry, electrocardiography, non-invasive arterial blood pressure and respiratory rate were monitored intraoperatively. The partial pressure of carbon dioxide in arterial blood and pain assessment via a visual analogue scale were assessed every 30 min. The serum cortisol level was measured to evaluate the surgical stress under epidural anesthesia. RESULTS: All operations were completed laparoscopically with no conversion to open surgery. Hypotension was observed in six patients (13%) and 16 (34.7%) experienced shoulder pain. The mean operative time was 90 min. No postoperative analgesia was given. All patients could ambulate 4 h after the operation and were discharged on the same day; the mean hospital stay was 6.5 h. CONCLUSIONS: Retroperitoneoscopy for benign upper tract pathology combined with epidural anesthesia is a feasible and an attractive method for both surgeon and patient. No postoperative pain and early recovery are the most beneficial results of this technique. Further studies, applying this technique in patients with cardiopulmonary problems, should be conducted.