Transperitoneal Laparoscopic Pyelopyelostomy for Retrocaval Ureter without Excision of the Retrocaval Segment: Experience on Three Cases.

Introduction. Retrocaval ureter is a rare congenital anomaly. Open surgery was the classic treatment for this condition. Laparoscopy is currently an admitted procedure to treat many urological diseases. The objective of our study is to present our experience and discuss the safety and the feasibility of transperitoneal laparoscopic pyelopyelostomy for treatment of retrocaval ureter (RCU). Materials and Methods. Three symptomatic patients underwent laparoscopic repair for RCU in our department. The diagnosis was suspected on the computed tomography scan (CT) and confirmed on ascending pyelography. After placement of a JJ stent, and, using the transperitoneal approach, the retro peritoneum was exposed; the ureter was identified in both sides of the vena cava. The retrocaval segment was entirely mobilized and pulled from behind of the vena cava after section of renal pelvis. A pyelopyelostomy was done in a normal anatomic position. Results. All operations were achieved laparoscopically without conversion to open surgery. The mean operative time was 140 minutes (110-190). No intraoperative complication occurred. Blood loss was less than 50 mL in all patients. The mean hospital stay was 5 days (4-6 days). All patients were symptom-free after surgery and had reduction of hydronephrosis in control imagery. Conclusion. Laparoscopy seems safe, feasible, and reproducible in managing retrocaval ureter.

Ureteral stenting after uncomplicated ureteroscopy for distal ureteral stones: a randomized, controlled trial.

Objectives. We compared outcome and complications after uncomplicated ureteroscopic treatment of distal ureteral calculi with or without the use of ureteral stents. Materials and Methods. 117 patients, prospectively divided into three groups to receive a double j stent (group 1, 42 patients), ureteral stent (group 2, 37 patients), or no stent (group 3, 38 patients), underwent ureteroscopic treatment of distal ureteral calculi. Stone characteristics, operative time, postoperative pain, lower urinary tract symptoms (LUTS), analgesia need, rehospitalization, stone-free rate, and late postoperative complications were all studied. Results. There were no significant differences in preoperative data. There was no significant difference between the three groups regarding hematuria, fever, flank pain, urinary tract infection, and rehospitalisation. At 48 hours and 1 week, frequency/urgency and dysuria were significantly less in the nonstented group. When comparing group 1 and group 3, patients with double j stents had statistically significantly more bladder pain (P = 0.003), frequency/urgency (P = 0.002), dysuria (P = 0.001), and need of analgesics (P = 0.001). All patients who underwent imaging postoperatively were without evidence of obstruction or ureteral stricture. Conclusions. Uncomplicated ureteroscopy for distal ureteral calculi without intraoperative ureteral dilation can safely be performed without placement of a ureteral stent.

Genital self-amputation or the Klingsor syndrome: Successful non-microsurgical penile replantation.

Self-mutilations of the external genitals in psychiatric patients also known as Klingsor syndrome is a rare urologic trauma. Men with religious conflicts, low self-esteem, unresolved transsexual issues and feelings of guilt are the most vulnerable. This condition requires immediate surgical intervention. Currently replantation involves meticulous microsurgery and has become the primary method for managing these patients. In this paper, we report a case of self amputation of penis in a patient with a psychiatric history significant for schizopfrenia. Because of the unavailability of a microscope in our department, a non-microsurgical replantation without microscopic magnification was attempted. After surgery, normal appearance and function including a good normal voiding, sensation, and erections were observed.

Percutaneous endoscopic nephropexy with a percutaneous suture passed through the kidney.

OBJECTIVES: To report a technique of percutaneous endoscopic nephropexy, using a polyglactin suture passed through the kidney, in patients with nephroptosis. PATIENTS AND METHODS: Four women presenting with symptomatic right nephroptosis underwent a percutaneous endoscopic nephropexy. An upper-pole calyx was accessed percutaneously and a 24-F working sheath was placed. Another needle access was made through a lower-pole calyx and a #2 polyglactin suture was passed into the renal pelvis. It was then pulled out through the upper-pole tract using the nephroscope. A retroperitoneoscopy was performed and the tip of the nephroscope was used to cause nephrolysis. After inserting the nephrostomy tube the polyglactin suture was passed into the subcutaneous tissue and then tied without too much tension, to avoid cutting the parenchyma. RESULTS: The operative duration was 33 min and the hospital stay after surgery was 3.5 days. The nephrostomy catheter was removed 5 days after surgery. There were no complications, especially no haemorrhagic, infectious, lithiasic or thoracic complications. The four patients were relieved of their initial symptoms, with a mean follow-up of 28 months. Ultrasonography and/or intravenous urography showed the kidney at a higher location with the patient standing. CONCLUSIONS: This technique combines the nephrostomy tract used in percutaneous techniques with the suture and nephrolysis used in laparoscopic techniques. Moreover, this procedure seems to be safe, with satisfactory anatomical and clinical results and a lower morbidity. However, a larger series will be necessary to establish its long-term morbidity and success rate.

[US-guided transrectal drainage of prostatic abscesses]. / Aspiration échoguidée transrectale des abcès prostatiques.

Prostatic abscess is rare and most commonly occurs as a complication of acute prostatitis. Because of the wider use of antibiotics, the clinical presentation is becoming less typical. Diagnosis is useful for diagnosis. Based on a review of 3 cases, the authors report their experience with US-guided transrectal drainage of prostatic abscesses and review other therapeutic options.

[Three years results of transvaginal cystocele repair with polypropylene mesh using a tension-free technique]. / Resultados a los tres años de la reparación de un cistocele transvaginal con malla de propileno usando una técnica sin tensión.

OBJECTIVES: To evaluate the long term efficacy and safety of transvaginal implantation of a non-resorbable synthetic prosthesis (Gynemesh) for the treatment of cystocele using transvaginal free tension technique. MATERIALS AND METHODS: Prospective study of patients that have been submitted to correction of cystocele between April 2004 and July 2007. A prolene mesh was cut to an appropriate size to cover the whole cystocele leaving two tabs on each side. The two tabs of the mesh were then placed in paravaginal spaces, tension free, without stitches. Mesh was used in 31 patients. All patients had a symptomatic cystocele >or= 2 according to Baden-Walker halfway classification. Patients were reviewed initially at 1 and 3 month and then every 6 months. RESULTS: The mean age of the patients was 58 years (range: 47-70 years). Mean parity was 5.8 (range 1-11), and mean weight was 75 kg (range 60-82Kg). All women were postmenopausal. The operation was combined with vaginal hysterectomy in 2 patients, Posterior colporraphy in 2 patients, Perineorrhaphy in 1 patient, Sacrospinous fixation in 2 patients, transobturator tape for stress urinary incontinence in 7 women. Average time of surgery was 23 minutes for cystocele. There were no major complications, such as trauma to the bladder, urethra, bowels, or large vessels in the patient group treated. There was no immediate postoperative complications (up to 7 days) recorded. No hematoma or infection was observed in the operative area. Mesh erosion was detected in one patient. It was treated by excision of the eroded part of the mesh. Mean follow-up was 36.4 months (18 to 52 months). Using our definition of success based on both anatomic and functional outcomes, the overall cure rate was 74.19% (asymptomatic with no or grade 1 cystocele). The improvement rate (asymptomatic with a grade 2 cystocele) was 19.35% and the overall failure rate (symptomatic or with a grade 3 or 4 cystocele) was only 6.4% (2 women). DISCUSSION AND CONCLUSIONS: The interposition of a sub-vesical transversal tension-free polypropylene mesh by the vaginal route seems to be an excellent procedure in the definitive surgical treatment of anterior vaginal wall prolapse. This procedure is simple, mini-invasive, reproducible and efficient with low morbidity and good tolerance. The results seem to be stable after three years of follow up.

Resultados a los tres años de la reparación de un cistocele transvaginal con malla de propileno usando una técnica sin tensión / Three years results of transvaginal cystocele repair with polypropylene mesh using a tension-free technique

Objetivos: evaluar la eficacia y la seguridad a largo plazo de la implantación transvaginal de una prótesis sintética no absorbible (Gynemesh(R)) para el tratamiento del cistocele mediante una técnica vaginal sin tensión. Materiales y métodos: estudio prospectivo de pacientes sometidas a corrección de un cistocele entre abril de 2004 y julio de 2007. Se cortaba una malla de propileno al tamaño adecuado para cubrir todo el cistocele, dejando dos lengüetas a cada lado. Las dos lengüetas de la malla se colocaban después en los espacios paravaginales sin tensión ni suturas. Se utilizó la malla en 31 pacientes. Todas ellas tenían un cistocele sintomático de grado ≥ 2, según la clasificación del punto medio de Baden-Walker. Se les revisaba inicialmente al cabo de uno y tres meses, y después cada 6 meses. Resultados: la edad media de las pacientes era de 58 años (límites: 47-70 años). La paridad media era de 5,8 (límites: 1-11) y el peso medio de 75 kg (límites: 60-82 kg). Todas las mujeres eran posmenopáusicas. La operación se combinó con histerectomía vaginal en dos pacientes, colporrafia posterior en dos, perineorrafia en una, fijación sacroespinosa en dos y cinta transobturadora para incontinencia urinaria de esfuerzo en 7 mujeres. La duración media de la cirugía del cistocele fue de 23 minutos. En el grupo de pacientes tratadas no hubo complicaciones importantes como traumatismo de vejiga, uretra, intestino o grandes vasos. No se registraron complicaciones en el postoperatorio inmediato (hasta los 7 días). No se observó hematoma ni infección en la zona quirúrgica. En una paciente se detectó erosión de la malla, que se trató mediante extirpación de la parte erosionada de la misma. El seguimiento medio fue de 36,4 meses (de 18 a 52). Según nuestra definición de éxito, basada en los resultados anatómico y funcional, la tasa de curación global fue del 74,19% (asintomática sin cistocele o con cistocele de grado 1). La tasa de pacientes con mejoría (asintomáticas con cistocele de grado 2) fue del 19,35% y la de fracasos globales (sintomáticas o con cistocele de grado 3 o 4) de sólo el 6,4% (dos mujeres). Comentario y conclusiones: la interposición de una malla de polipropileno subvesical transversal, sin tensión, por la vía vaginal, parece ser un procedimiento excelente para el tratamiento quirúrgico definitivo del prolapso de la pared vaginal anterior. Se trata de un procedimiento simple, poco invasivo, reproducible y eficiente con baja morbilidad y bien tolerado. Los resultados parecen mantenerse estables a los tres años de seguimiento(AU)

Objectives: To evaluate the long term efficacy and safety of transvaginal implantation of a non-resorbable synthetic prosthesis (Gynemesh(R)) for the treatment of cystocele using transvaginal free tension technique. Materials and methods: Prospective study of patients that have been submitted to correction of cystocele between April 2004 and July 2007. A prolene mesh was cut to an appropriate size to cover the whole cystocele leaving two tabs on each side. The two tabs of the mesh were then placed in paravaginal spaces, tension free, without stitches. Mesh was used in 31 patients. All patients had a symptomatic cystocele ≥ 2 according to Baden-Walker halfway classification. Patients were reviewed initially at 1and 3 month and then every 6 months. Results: The mean age of the patients was 58 years (range: 47–70 years). Mean parity was 5.8 (range 1-11), and mean weight was 75 kg (range 60-82Kg). All women were postmenopausal. The operation was combined with vaginal hysterectomy in 2 patients, Posterior colporraphy in 2 patients, Perineorrhaphy in 1 patient, Sacrospinous fixation in 2 patients, transobturator tape for stress urinary incontinence in 7 women. Average time of surgery was 23 minutes for cystocele. There were no major complications, such as trauma to the bladder, urethra, bowels, or large vessels in the patient group treated. There was no immediate postoperative complications (up to 7 days) recorded. No hematoma or infection was observed in the operative area. Mesh erosion was detected in one patient. It was treated by excision of the eroded part of the mesh. Mean follow-up was 36.4 months (18 to 52 months). Using our definition of success based on both anatomic and functional outcomes, the overall cure rate was 74.19% (asymptomatic with no or grade 1 cystocele). The improvement rate (asymptomatic with a grade 2 cystocele) was 19.35% and the overall failure rate (symptomatic or with a grade 3 or 4 cystocele) was only 6.4% (2 women). Discussion and conclusions: The interposition of a sub-vesical transversal tension-free polypropylene mesh by the vaginal route seems to be an excellent procedure in the definitive surgical treatment of anterior vaginalwall prolapse. This procedure is simple, mini-invasive, reproducible and efficient with low morbidity and good tolerance. The results seem to be stable after three years of follow up(AU)

[Role of polyvidone-iodine ablation in the management of symptomatic renal cysts]. / Place de la ponction-sclérothérapie à la polyvidone-iodine dans le traitement des kystes rénaux simples symptomatiques.

OBJECTIVE: To assess prospectively the results of percutaneous sclerotherapy with povidone-iodine of symptomatic renal cysts in adults. METHODS: Fifty two patients were included in this study from august 2004 to november 2006. The operative indication was: pain (41 cases), urinary tract compression (8 cases), and very large cyst (3 cases). The preoperative assessment (site and dimensions of the cyst) always included ultrasonography. CT scan, for morphological assessment, was performed in 39 cases. RESULTS: The mean age of patients was 63 years (47-75 years). The mean diameter was 76 mm. The cysts were punctured in all the cases directly under local anaesthesia and guided by sonography. The procedure was very well tolerated in every case, with external drainage for 72 hours. Clinical regression was complete in 48 cases (92%), with total ultrasonographic disappearing of the cysts in 31 cases (60%) with a mean follow-up of 14 months (3-29 months). CONCLUSION: Percutaneous sclerotherapy with povidone-iodine is a safe, effective and reproducible treatment of symptomatic renal cysts in adults.