Laparoscopic retroperitoneal lymph node dissection in clinical stage I nonseminomatous germ cell tumor: a minimal invasive alternative.

OBJECTIVE: To evaluate modified laparoscopic retroperitoneal lymph node dissection (LRPLND) performed for stage I nonseminomatous germ cell tumor. METHODS: Between December 1993 and January 1996, modified unilateral laparoscopic retroperitoneal lymph node dissection was performed on 13 patients with nonseminomatous germ cell tumor of the testis. In 8 patients, the tumor was on the right side, and in 5, on the left. RESULTS: The procedure was completed in 12 patients at a mean operating time of 292 min (range: 210-400 min). The mean estimated blood loss was 250 ml. The mean hospital stay was 6.4 days. Conversion to open surgery was required in one patient because of an uncontrollable venous bleeding. No other major complications occurred. Antegrade ejaculation was preserved in 10 patients, and the last 3 patients have not yet been addressed now. CONCLUSIONS: Our results demonstrate that LRPLND is an accurate and reliable staging procedure with low morbidity, which allows quick patient discharge and rapid return to normal activity. For further evaluation, long follow-up in larger groups of patients is required.

Renal pelvis rupture after blunt abdominal trauma.

A 45-year-old male patient presented with rupture of the left renal pelvis after blunt abdominal trauma. The patient had preexisting bilateral megaureters with secondary obstruction of the pyeloureteral junction. The underlying disease was a persisting type III posterior urethral valve. Diagnosis of renal pelvis rupture and the underlying malformation was achieved sonographically and by abdominal CT scan. The left kidney was exposed at the time of admission and a pyeloplasty according to Anderson-Hynes was carried out. Secondarily the urethral valve was resected.

Radical retropubic prostatectomy: morbidity and urinary continence in 418 consecutive cases.

OBJECTIVE: To evaluate morbidity and mortality after standard retropubic radical prostatectomy with special attention to postoperative urinary continence. METHODS: Four hundred eighteen consecutive patients undergoing radical prostatectomy for treatment of localized prostatic cancer were reviewed. Both clinical and pathologic staging was assessed retrospectively according to the new TNM classification (International Union Against Cancer, 1992). Postoperative urinary continence was assessed according to the criteria of the International Continence Society. RESULTS: There were no operative deaths. Perioperative mortality was 1.2 percent, with 3 patients dying of myocardial infarction and 2 of pulmonary embolism after uneventful operations. Rectal injury, which was primarily closed, occurred in 2.9 percent. In 1 case (0.2%), reimplantation of the left ureter had to be performed. A total of 20 patients (4.7%) required reoperation: abscess 1.7 percent; postoperative hemorrhage, 1.7 percent; anastomotic urinary leakage, 1.2 percent: massive lymphocele, 0.2 percent. Complications that were treated conservatively occurred in 73 patients (17.4%): lymphocele, 6.4 percent; hemorrhage, 5.7 percent; thromboembolism, 2.6 percent; secondary wound healing, 2.6 percent. Of all patients who were followed for one year or longer, 80 percent achieved complete urinary control or reported occasional spotting only; 15 percent experienced stress incontinence grade II; and 3 percent were totally incontinent. CONCLUSIONS: Despite extensive surgical experience, our continence rates are far from the optimistic 1-3 percent incontinence rates reported in the literature. In our experience, radical retropubic prostatectomy can be performed with acceptable morbidity and without significantly affecting the quality of life in the majority of patients.