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1.
Prog Urol ; 19(1): 21-6, 2009 Jan.
Article in French | MEDLINE | ID: mdl-19135638

ABSTRACT

PURPOSE: We studied the efficiency and the morbidity of endoscopic removal of kidney stones during laparoscopic removal of ureteral stone. MATERIAL AND METHODS: Six patients presenting with an ureteral stone resisting to ESWL and four patients presenting with an UPJ obstruction were studied. Every patient had one to five associated kidney stones. The patients were operated with transperitoneal laparoscopic ureterolithotomy or pyeloplasty. An endoscopy of the upper urinary tract was realized during the same operating time through laparoscopic access. A flexible ureteroscope (five cases) or semi-flexible ureteroscope (one case) were used after ureterolithotomy. A fibroscope (four cases) was used before pyeloplasty. The endoscope was introduced through the port of the iliac fossa and the stones were extracted with a basket grasper. The patients were followed by abdominal plain film 12 weeks after surgery, by IPV six weeks after surgery and then annually with abdominal plain film and ultrasound. RESULTS: No operative complication arose. Nine of 10 patients had a complete extraction of the kidney stones (one patient had an extraction only of four out of five kidney stones). No damage of any endoscope was observed. At a minimum follow-up of 18 months, no fistula nor stenosis of the ureter was diagnosed. CONCLUSION: Endoscopic removal of kidney stones through laparoscopic access of the upper urinary tract is effective, sure and reproducible. Such procedure requires experience in laparoscopy and endoscopy of the upper urinary tract. The evaluation of this procedure must be pursued.


Subject(s)
Kidney Calculi/surgery , Laparoscopy , Ureteroscopy , Adult , Aged , Feasibility Studies , Female , Humans , Kidney Pelvis , Laparoscopy/methods , Male , Middle Aged , Ureter , Ureteroscopy/methods , Young Adult
2.
J Urol ; 180(5): 2106-9, 2008 Nov.
Article in English | MEDLINE | ID: mdl-18804233

ABSTRACT

PURPOSE: Renal cell carcinoma in a renal graft is a rare condition whose incidence will increase in the future. To our knowledge no standardized treatment has been established for this disease. We performed a prospective study of nephron sparing surgery for small renal cell carcinoma in renal grafts. MATERIALS AND METHODS: From January 2002 to December 2006, 2,050 renal graft recipients were followed at our transplantation center. Of these patients 7 were diagnosed with histologically confirmed renal cell carcinoma in the renal graft, 5 of whom presented with T1a renal cell carcinoma and prospectively underwent nephron sparing surgery. RESULTS: Five patients with 15 to 30 mm (median 20) renal cell carcinoma were included in the study and were treated with nephron sparing surgery. Median operative time was 110 minutes (range 60 to 150). Blood loss was less than 200 ml in each case. All tumors were pT1aN0M0 with negative margins. No postoperative complications were observed (hemorrhage, urinary fistulas, renal failure). Preoperative immunosuppressive treatment was not modified postoperatively. At 3 months after nephron sparing surgery and at a mean of 17.4 months of followup (range 5 to 54) no significant impairment of renal function or recurrence was observed. CONCLUSIONS: Nephron sparing surgery is a safe and efficient procedure for the treatment of renal cell carcinoma in renal grafts, resulting in the preservation of renal function and in short-term cancer control.


Subject(s)
Carcinoma, Renal Cell/surgery , Graft Rejection/surgery , Kidney Neoplasms/surgery , Kidney Transplantation/adverse effects , Nephrectomy/methods , Adult , Biopsy, Needle , Carcinoma, Renal Cell/mortality , Carcinoma, Renal Cell/pathology , Feasibility Studies , Female , Follow-Up Studies , Graft Rejection/pathology , Graft Survival , Humans , Immunohistochemistry , Kidney Neoplasms/mortality , Kidney Neoplasms/pathology , Kidney Transplantation/methods , Male , Middle Aged , Neoplasm Staging , Nephrons/surgery , Prospective Studies , Reoperation , Risk Assessment , Survival Rate , Time Factors , Tissue Donors , Transplantation, Homologous/adverse effects , Treatment Outcome
3.
Ann Urol (Paris) ; 40(6): 368-94, 2006 Dec.
Article in French | MEDLINE | ID: mdl-17214236

ABSTRACT

Orthotopic urinary reservoir using a bowel segment has become the most favoured form of diversion after radical cystectomy. Ideal neobladder has to (i) store the urine with a low pressure bladder substitute, (ii) protect the upper urinary tract and (iii) provide a better quality of life enabling volitional voiding. A lot of techniques have bee described to construct a reservoir, however, all of them are based on the principle of intestinal loop detubulation. Many intestinal segments have been used, but ileum seems to be preferred in Europe. The upper urinary tract is mainly protected by a low neobladder pressure, rather than an additional antireflux flap-valve-type implantation technique which may increase the risk of uretero-enteric stricture. No significant difference in functional outcome can be observed among the several techniques. In selected cases, orthotopic bladder replacement is well tolerated and feasible and appears to be the gold standard after cystectomy.


Subject(s)
Cystectomy , Plastic Surgery Procedures/methods , Urinary Diversion/methods , Urinary Reservoirs, Continent , Feasibility Studies , Humans , Male , Quality of Life , Treatment Outcome , Urinary Bladder Neoplasms/surgery
4.
Ann Urol (Paris) ; 40 Suppl 3: S72-6, 2006 Nov.
Article in French | MEDLINE | ID: mdl-17366859

ABSTRACT

Radiofrequency and cryoablation are both minimally invasive techniques applied to the treatment of renal cell carcinoma. These techniques allow in situ destruction of neoplasm. Although cryotherapy is the most studied, radiofrequency is the most currently used technique. Indications mostly accepted as elective indication are the less than 4 cm in diameter exophytic tumors. Radiofrequency and cryoablation can also be proposed in patients with solitary kidney, multiple bilateral tumors and patients with contraindication for surgical resection. The radiofrequency parietal tract can be coagulated at the time of radiofrequency electrode withdrawal reducing the rare risk of parietal tumor dissemination. Preliminary oncological results in exophytic small renal tumors are promising with only few complications. A longer follow-up is however mandatory to better define the place of these two new technologies in the treatment of renal cancer.


Subject(s)
Catheter Ablation , Cryosurgery , Kidney Neoplasms/surgery , Humans
5.
Ann Urol (Paris) ; 38(4): 180-5, 2004 Aug.
Article in French | MEDLINE | ID: mdl-15485157

ABSTRACT

Surgery is the gold standard of hydrocele treatment; it is indicated in case of functional disorders. The two principal techniques are Lord's plication procedure, and excision. Main complications consist in potential haematoma and injury to epididymis, vas deferens or cord structures. Two other techniques exist, but with limited indications: fenestration which puts in contact the sac with lymph-rich subcutaneous tissues, and sclerotherapy.


Subject(s)
Postoperative Complications , Testicular Hydrocele/surgery , Urologic Surgical Procedures, Male/methods , Adult , Genitalia, Male/injuries , Hematoma/etiology , Humans , Male , Sclerotherapy , Testicular Hydrocele/therapy
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