Laparoscopic donor nephrectomy: effects of learning curve on surgical outcomes.

UNLABELLED: Our objective was to determine the effect of an experienced laparoscopic surgeon's learning curve with laparoscopic donor nephrectomy (LDN) on patient outcome and graft function. MATERIALS AND METHODS: Retrospective review of the medical records of the initial 73 consecutive LDN patients and corresponding transplant recipients was performed. All of the LDN were performed by a single, experienced laparoscopic surgeon (C.P.S.). The method of LDN was slightly different between the groups. RESULTS: Patients were divided into early and late groups with 37 and 36 patients, respectively. There was no statistically significant difference in mean estimated blood loss (245 +/- 671.2 vs 84.7 +/- 63.9 mL), warm ischemia time (159.7 +/- 66.3 vs 150.8 +/- 63.0 seconds), postoperative creatinine levels (1.34 +/- 0.24 vs 1.29 +/- 0.26 mg/dL,), recipient mean creatinine level at 1 month (1.57 +/- .98 vs 1.53 +/- 0.46 mg/dL), and hospital stay (2.49 +/- 0.87 vs 2.47 +/- 0.56 days) between the early and late groups. However, the difference in mean operative time between early and late groups was statistically significant (255.2 +/- 42.4 vs. 209.1 +/- 30.8 minutes, P < .05). In addition, there were 8 (21.6%) vs 4 (11.1%) instances of slow graft function and 3 (8.1%) vs 0 instances of delayed graft function among the recipients in early group versus the late group. There were four (10.8%) vs two (5.6%) minor complications among donors of the early and late groups, respectively. CONCLUSION: There is a significant decrease in operating time and incidence of delayed graft function following the first 37 patients who underwent LDN by an experienced laparoscopist. Improvement in operative technique decreased operative time and improved perioperative graft function as evidenced by decreased slow graft function and delayed graft function in the late group.

Ileal conduit perforation-iatrogenic injury and conservative management.

The ileal conduit was popularized by Bricker in the 1950s. Since then, surveillance of the upper urinary tract has been accomplished with intravenous urography, ultrasonography, or loopography. Loopography is used as an imaging modality at our institution because of its safety and avoidance of intravenous contrast. We report the first case of an iatrogenic rupture of an ileal conduit during loopography.

The intravesical potassium sensitivity test and urodynamics: implications in a large cohort of patients with lower urinary tract symptoms.

PURPOSE: Bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH) is the most common diagnosis in older men with lower urinary tract symptoms. However, these symptoms also can occur with interstitial cystitis. We determine whether the potassium sensitivity test is useful for distinguishing BPH from possible intersitial cystitis in patients with lower urinary tract symptoms. We also test the hypothesis that patients with these symptoms who have a positive test will have urodynamic findings consistent with the diagnosis of interstitial cystitis. MATERIALS AND METHODS: The potassium sensitivity test was performed in 526 (95%) males and 25 (5%) females with lower urinary tract symptoms undergoing urodynamic testing. Urodynamic parameters in the positive and negative potassium sensitivity test groups were compared. % RESULTS: Of the patients 16% (89 of 551) had a positive potassium sensitivity test. Compared with patients who had a negative test, those who had a positive test were younger (61 versus 64 years, p = 0.03), had urgency at significantly lower volumes (108 versus 182 cc, p <0.0001), lower bladder capacity (343 versus 436 cc, p <0.0001) and lower post-void residual (49 versus 95 cc, respectively, p <0.001). Urodynamic parameters in the 24% (6 of 25) of women who had a positive potassium sensitivity test were similar to those in men who also had a positive test. CONCLUSIONS: Urodynamic findings in patients with lower urinary tract symptoms who have a positive potassium sensitivity test are significantly different from those in patients who have a negative test, and are similar to those findings characteristic of interstitial cystitis. Interstitial cystitis should be considered in patients with lower urinary tract symptoms who have a positive test. The potassium sensitivity and urodynamic tests may be a useful combination for screening men with lower urinary tract symptoms to identify those symptoms that may be due to interstitial cystitis versus BPH.

Ureteral obstruction in a transplant kidney caused by an ovarian tumor.

Ureteral obstruction in the transplant recipient can provide a diagnostic challenge. We report a case of ureteral obstruction 5 years after cadaveric renal transplantation due to an ovarian tumor. Magnetic resonance imaging provided essential anatomic information that eventually led to the diagnosis. To our knowledge, this is the first reported case of ureteral obstruction in a transplant kidney caused by an ovarian tumor.

Symptomatic renal angiomyolipoma: report of 8 cases, 2 with spontaneous rupture.

Of the 97 patients with symptomatic renal angiomyolipoma not associated with tuberous sclerosis reported in the literature 13 have presented with a clinical picture of shock because of spontaneous rupture and massive retroperitoneal hemorrhage. Eight new patients with symptomatic renal angiomyolipomas are described, 2 of whom presented with an acute abdomen. Renal angiomyolipomas are essentially benign tumors. Several angiographic and pyelographic characteristics have been described but none appears to be unequivocally diagnostic. Because of the inability to make a precise preoperative diagnosis and the possibility of massive hemorrhage, nephrectomy is indicated in patients with such unilateral solid tumors in the absence of the tuberous sclerosis complex.