Sutureless nephron-sparing surgery: use of albumin glutaraldehyde tissue adhesive (BioGlue).

OBJECTIVES: To determine the feasibility of using serum albumin glutaraldehyde tissue adhesive (BioGlue) to achieve hemostasis and prevent urine leakage during nephron-sparing surgery (NSS). METHODS: From February 1993 to April 2005, 174 NSS operations were performed for renal cell carcinoma at our institute. A total of 143 patients underwent NSS with the traditional suturing technique (suture group) and 31 patients underwent a sutureless BioGlue sealing-only procedure (BioGlue group). We compared the two groups for clinical and tumor characteristics and surgical outcome. RESULTS: The patient and tumor characteristics were similar in both groups. The average maximal tumor diameter was 4.21 cm (range 2.2 to 7) for the suture group and 3.67 cm (range 2 to 6.8) for the BioGlue group. The use of BioGlue reduced the mean warm ischemic time by 8.8 minutes (17.2 versus 26 minutes, P = 0.002). The mean estimated blood loss was 45.1 mL in the BioGlue group and 111.7 mL in the suture group (P = 0.001). Blood transfusion was required in 1 patient (3.2%) of the BioGlue group and 24 (17%) in the suture group (P = 0.014). None of the patients treated with BioGlue developed urinary fistula compared with three (2%) in the suture group. CONCLUSIONS: Albumin glutaraldehyde tissue adhesive (BioGlue) alone provided adequate hemostasis during NSS, significantly decreasing the blood loss and transfusion rate, as well as the renal ischemic and operative times. BioGlue was easy to use and safe for sealing the kidney during partial nephrectomy. Future prospective clinical trials are necessary to validate its role during renal surgery.

Nephroureterectomy through a single lumbar incision combined with endoscopic incision of a bladder cuff.

Nephroureterectomy is the accepted approach in treating upper urinary tract carcinoma. We present a modification of transurethral resection of the intramural ureter, using endoscopic incision of a bladder cuff around the ureteral ostium as the first step in performing nephroureterectomy through a single lumbar incision.

Treatment of a recurrent bulbar urethral stricture after Urolume wallstent implantation with a second inner Urethrospiral-2 urethral stent.

Although the Urolume wallstent has been proven to be effective in the treatment of bulbar urethral strictures, in some instances obstruction may recur. We present a patient in whom recurrent stricture after wallstent implantation was managed by insertion of a second inner Porges Urethrospiral-2 stent inside the first one.

Fracture of the penis: results of an immediate surgical approach.

Fracture of the penis is a rare and probably under-reported entity. We present 7 patients with this type of trauma. All the patients were treated operatively immediately on presentation with good morphologic and functional results. The diagnosis and treatment of this unusual type of injury are discussed.

The persisting mesonephric duct syndrome in a neonate with agenesis of the corpus callosum.

Agenesis of the corpus callosum is a rare condition, often associated with craniofacial, skeletal and genitourinary abnormalities. We report on a male newborn in whom all of these organ systems were affected. The genitourinary anomaly consisted of vaso-ureteral fusion accompanied by renal, ureteral, vesical, ductal and genital malformations. The diagnostic approach and management of this unusual case are described and the literature is reviewed.

The use of ceftriaxone in the prevention of urinary tract infection in patients undergoing transurethral resection of the prostate (TUR-P).

We evaluated 101 patients undergoing transurethral resection of the prostate in this open randomized study in which 51 received antibiotic prophylaxis and 50 did not (control group). In those patients receiving antibiotics, ceftriaxone 1 g was administered intravenously within 1 h before transurethral prostatectomy and a second dose was given 3-4 days postoperatively, within 1 h before the suprapubic catheter was removed. The groups had similar clinical and demographic characteristics. During the 28-day study period, bacteriuria appeared in six ceftriaxone-treated patients and in 20 control patients (p < 0.005). On days 3-4 after the resection, only two patients who had received ceftriaxone had bacteriuria compared with 14 in the control group (p < 0.005). In addition, the incidence and duration of fever and length of hospitalization were shorter in the patients treated with ceftriaxone. In conclusion, these results support the use of prophylactic antibiotics in transurethral prostatectomy, even in patients at low risk of developing bacteriuria.

The incidence of urinary tract infection in patients without bacteriuria who underwent extracorporeal shock wave lithotripsy.

The incidence and severity of urinary tract infections in 145 patients with renal calculi undergoing extracorporeal shock wave lithotripsy (ESWL*) who were catheterized for a short period without evidence of bacteriuria and/or infected stones evaluated. The patients were followed clinically and bacteriologically 1 and 14 days after the procedure. Bacteriuria was observed in 7 of the 145 patients (4.8%): in 5 patients 24 hours after ESWL and in 2 patients 2 weeks later. Of these patients 2 were symptomatic but only 1 had fever. No patient was hospitalized. We found no correlation between bacteriuria and the number or size of the stones. We conclude that the incidence of bacteriuria in catheterized patients who underwent ESWL without urinary tract infection is low and the use of antibiotics in these patients is probably not indicated.

Hydronephrosis due to fibroepithelial ureteral polyp in a child.

The case of a 5-year-old girl, complaining of left abdominal and flank pain, is reported. The excretory urogram and retrograde pyelography showed an obstruction located at the left upper ureter with hydronephrosis. Exploration revealed a small ureteral polyp obstructing the lumen. The polyp along with the short segment of the ureter was resected. Diagnostic and therapeutic considerations are discussed.

Intubated ureterotomy for ureteral obstruction following radiotherapy and radical hysterectomy. Case report.

A woman suffering from carcinoma of the cervix went through radical hysterectomy and radiotherapy. The treatment was complicated by obstruction of the lower left ureter which was dealt with by transureteroureterostomy. Eighteen months later she was admitted with severe stricture of the common pelvic ureter and massive retroperitoneal fibrosis. The afflicted ureteral segment was successfully reformed by intubated ureterotomy.

Obstructive renal failure and pleural effusion caused by the gravid uterus.

Acute renal failure due to ureteral obstruction by the gravid uterus is considered to be a rare complication of late pregnancy. Pleural effusion caused by urinary tract obstruction is also extremely uncommon. This presentation reports what is believed to be the first case in which both these complications appeared at the same time in a pregnant patient.

Biopsy of ureteral tumor in patient with ileal conduit.

A patient with ileal conduit and recent dilation of the left upper collecting system had flexible fiberoptic endoscopy of the ileal loop. The entire lumen of the intestinal conduit and the ureteroileal anastomosis were visualized. In addition retrograde pyelography and direct vision biopsy of a tumor in the ureter were performed.