Renal cell carcinoma of native kidney in renal transplant recipients.

OBJECTIVE: To evaluate the prevalence, prognosis and possible risk factors of renal cell carcinoma (RCC) of the native kidney in renal transplant recipients. PATIENTS AND METHODS: We retrospectively re-examined the follow-up data of 373 consecutive renal transplant recipients at our institution between August 1993 and September 2004. We collected the data of all de novo RCC of the native kidney in the current analysis. RESULTS: Of the 373 patients examined, 12 tumours of the native kidney were diagnosed in 10 individuals. The mean ages at transplantation and diagnosis were 33 and 45.8 years, respectively. Thirteen malignancies were discovered fortuitously. Among the renal ultrasonograms there were two false-negative results. The mean tumour size was 21 mm. Nephrectomy was performed in all cases. Among the 12 kidney malignancies, there were five conventional RCCs and seven papillary RCCs. Half of all tumours were Furhman Grade 3 lesions, and pT1aN0M0 tumours also accounted for all malignancies in the current cohort. One of the 10 patients died, from progression of metastases 6 years after diagnosis. One patient had a local recurrence 2 years after diagnosis. The other eight patients were alive with no evidence of disease at the time of the current report. No significant relationship was detected between RCC occurrence and clinical patient characteristics. CONCLUSIONS: There appears to be a greater risk of RCC of the native kidney in patients with end-stage renal disease. The present results suggest that an annual examination of the native kidney before and after renal transplantation is essential.

Laparoscopic excision of seminal vesicle cyst revealed by obstruction urinary symptoms.

Primary diseases of the seminal vesicle are rare. Most seminal vesicle cysts are congenital, and two-thirds are associated with renal dysplasia or agenesis and ectopic ureter opening into the seminal vesicle. Acquired cysts may be due to genitourinary infections, surgical prostate resection or ejaculatory duct lithiasis. We report a case of video laparoscopic ablation of seminal vesicle cysts.

Impact on active scope deflection and irrigation flow of all endoscopic working tools during flexible ureteroscopy.

OBJECTIVE: Flexible ureteroscopy is nowadays an alternative effective option for treatment of upper urinary tract stones, especially in the lower renal pole. Access in this case is often limited by active deflection capabilities of the instrument which is always deteriorated by the passage of different tools through the working channel. Insertion of them limits also the irrigation flow and so that the visibility. These deteriorations vary largely following the tool inserted. We performed an in vitro evaluation of deterioration of active deflection, possibility of tool insertion in maximal active deflection and irrigation flow in 6 different flexible ureteroscopes with almost all of tools available. METHODS: A total of 546 measures of maximal deflection, test of passage of tools in maximal deflection and measures of irrigation flow passage through the working channel were made on 6 different ureteroscopes, the ACMI DUR-8, the ACMI DUR-8 "Elite", the Karl Storz 11274 AA, the Karl Storz 11278 AU1 "Flex-X", the Wolf 7325.172 and the Olympus URF/P-3 without any tool inserted and with 22 different tools (14 extraction devices and 8 lithotripsy probes). RESULTS: Larger caliber tools resulted in more deflection degradation than smaller ones but it is more evident in case of use of non-nitinol tools instead of the nitinol ones. Generally lithotripsy probes affected active deflection more than nitinol extractions tools but different brand laser fibres present different results. Usually 1.6 and 1.9F electro hydraulic probes offer a slightly better deflection than does the 200micro laser fibre. Ballistic shock probes are so stiff that can not be used for treating lower renal pole stones. CONCLUSIONS: An array of different instruments are nowadays available for upper renal endoscopic treatment but they differ largely on stiffness and on obstruction to irrigation flow. Laser probes are very problematic to insert in the already deflected instruments, something that is less evident with the EHL probes and the smaller nitinol extraction tools. Irrigation flow is inversely proportional to the diameter of the tool inserted. Tools with a diameter of 3 French or more block totally the flow.

[Flexible double active deflection ureterorenoscopy]. / Urétérorénoscope souple à double déflexion active. Expérience initiale.

INTRODUCTION AND OBJECTIVE: Secondary deflection of a flexible ureterorenoscope (FUR) is a passive mechanism, which can only be performed under certain anatomical conditions. The objective of this study was to present a new double active deflection FUR and to assess its value based on our initial experience. MATERIAL AND METHODS: From October 2002 to February 2003, we performed flexible retrograde ureterorenoscopy in 30 consecutive patients (34 renal units) using a double active deflection FUR (ACMI DUR 8 Elite). Bilateral ureterorenoscopy was performed during the same operating time in four patients. Ureterorenoscopy was diagnostic for 9 patients (macroscopic haematuria, urinary tract tumour), and therapeutic for 21 patients (stones, urinary tract tumour, ureteropelvic junction stenosis with stone). The value of double deflection as well as the efficacy and morbidity of the technique were evaluated. RESULTS: The main indication for flexible ureterorenoscopy was the treatment of urinary stones (73.6%), followed by the diagnosis of macroscopic haematuria and urinary tract tumours (26.4%). Ureteric dilatation was necessary in 38.3% of cases. The use of active secondary deflection was essential in 20% of cases (7/34) for complete investigation of the pyelocaliceal cavities. Access to the lower calices was not possible in one patient with a left pelvic kidney. 19 patients with urinary stones had no fragments (79.2%) at the end of the operation, while 4 had residual fragments in the lower calices. The global success rate for all operations was 85% (29/34). Two patients developed acute pyelonephritis during the 48 hours after the procedure and another two patients experienced acute renal colic. CONCLUSIONS: Our study confirms the data of the literature on flexible ureterorenoscopy in terms of indications and efficacy. The URS DUR 8 Elite allowed complete exploration of the pyelocaliceal cavities in more than 97% of cases. The use of active secondary deflection was unnecessary for the majority of patients (80%), but it represents a major technical progress which should be taken into account in the design of future flexible ureterorenoscopes.