Retroperitoneal and pelvic extraperitoneal laparoscopy: an international perspective.

OBJECTIVES: To assess technical preferences and current practice trends of retroperitoneal and pelvic extraperitoneal laparoscopy. METHODS: A questionnaire survey of 36 selected urologic laparoscopic centers worldwide was performed. RESULTS: Twenty-four centers (67%) responded. Overall, 3988 laparoscopic procedures were reported: transperitoneal approach (n = 2945) and retroperitoneal/extraperitoneal approach (n = 1043). Retroperitoneoscopic/extraperitoneoscopic procedures included adrenalectomy (n = 74), nephrectomy (n = 299), ureteral procedures (n = 166), pelvic lymph node dissection (n = 197), bladder neck suspension (n = 210), varix ligation (n = 91), and lumbar sympathectomy (n = 6). Mean number of total laparoscopic procedures performed in 1995 per center was 41 (range 5 to 86). Major complications occurred in 49 (4.7%) patients and included visceral complications in 26 (2.5%) patients and vascular complications in 23 (2.2%). Open conversion was performed in 69 (6.6%) patients, electively in 41 and emergently in 28 (visceral injuries, n = 16; vascular injuries, n = 1 2). Retroperitoneoscopy/extraperitoneoscopy is gaining in acceptance worldwide: in 1993, the mean estimated ratio of transperitoneal laparoscopic cases versus retroperitoneoscopic/ extraperitoneoscopic cases per center was 74:26; however, in 1996 the ratio was 49:51. CONCLUSIONS: Retroperitoneoscopy and pelvic extraperitoneoscopy are important adjuncts to the laparoscopic armamentarium in urologic surgery. The overall major complication rate associated with retroperitoneoscopy/extraperitoneoscopy was 4.7%.

Prostatic cancer: role of color Doppler imaging in transrectal sonography.

OBJECTIVE: The aim of this study was to assess the roles of transrectal color Doppler and gray-scale sonography in revealing prostatic cancer, using biopsy as the reference standard. SUBJECTS AND METHODS: Two hundred fifty-six patients referred for urologic studies underwent transrectal sonography using gray-scale and color Doppler scanning. All abnormal areas shown on gray-scale or color Doppler sonography or both were targeted and biopsies were performed. The patients also underwent random sextant biopsies. All biopsies were individually correlated with histopathologic findings and all results were analyzed. RESULTS: Cancer was found on biopsy in 100 patients (39%), and equivocal sonographic results or prostatic intraepithelial neoplasia was found in 22 other patients (9%). In 16 of the patients in whom cancer was detected, the tumors were correctly revealed only with color Doppler sonography. These 16 patients had a mean Gleason score of 6.4 (range, 5-8). Biopsy findings in these 16 patients showed eight patients with extensive lesions, three with moderate lesions, and five with minimal lesions. However, in nine other patients with cancer (9% of cancers detected), both gray-scale and color Doppler sonography failed to reveal lesions that were found on sextant biopsy. An analysis showed that, although highly sensitive, color Doppler sonography was somewhat less specific than gray-scale sonography. CONCLUSION: Color Doppler sonography should become a routine part of transrectal sonography of the prostate gland to improve detection and targeting of lesions. The practice of performing random sextant biopsies should also continue.

Patch grafting the renal pelvis and ureteropelvic junction. A comparative study in pigs using lyophilized dura mater and free peritoneum.

Lyophilized dura mater (Lyodura) and autogenous free peritoneum were compared in the replacement of the partially resected renal pelvis and uretero-pelvic junction (UPJ) in the pig. The Lyodura and peritoneum grafts were both progressively resorbed, and replaced by fibroblasts which formed a mature scar lined by transitional epithelium, but without smooth muscle regeneration. Lyodura was found to be superior to free peritoneum with a longer time before resorption of the graft, less intense inflammatory reaction, absence of metaplastic bone formation, less risk of urine leak and greater ease of surgical manipulation.

The treatment of uric acid calculi with extracorporeal shock wave lithotripsy.

A review of the first 1000 patients treated with extracorporeal shock wave lithotripsy (ESWL) at UCLA revealed 21 patients with uric acid renal or ureteric calculi. Using the combination of ESWL and oral urinary alkalinisation, 16/21 patients (76%) were stone-free at follow-up 3 months later and 19 patients were stone-free at 5 months. ESWL and urinary alkalinisation are complementary methods for the non-invasive treatment of uric acid renal calculi.

Rupture of renal angiomyolipoma.

Spontaneous rupture of renal angiomyolipoma is a rare, but life threatening condition. A case is reported which illustrates the role of computerized tomography in the diagnosis and management of this condition. Rupture of these benign lesions should be managed initially with blood transfusion and angiographic embolization if haemorrhage continues. In cases where surgery is necessary, a kidney-sparing technique should be performed when possible, such as enucleation of the lesion or partial nephrectomy.

Bilateral renal metastases from squamous cell carcinoma of the anus.

We report a case of bilateral renal metastases from squamous cell carcinoma of the anus. The patient underwent sequential bilateral radical nephrectomy, and has remained free of disease and in good health on dialysis for more than 8 months.