Laparascopic heminephrectomy in horseshoe kidney: a case report.

We present a case of laparoscopic transperitoneal heminephrectomy involving a large renal cell carcinoma of 7 cm centrally located on the left side of a horseshoe kidney in a 48 years old male patient detected by ultrasound scan and CT scan.

Chylous ascites following laparoscopic adrenalectomy: case report and literature review.

We report a case of chylous ascites developing the first post-operative day after laparoscopic adrenalectomy. The early initiation of treatment with total parenteral nutrition and somatostatin analog led to rapid resolution of the ascites. To the best of our knowledge, this is the first case of chylous ascites after laparoscopic adrenalectomy and we report it to stress the need for greater awareness and attention (meticulous dissection, permanent use of hemoclips and/or suture ligatures instead of electrocautery) even for simpler laparoscopic urologic procedures.

Evolving transurethral resection of the prostate: enucleation-resection of the prostate.

BACKGROUND AND PURPOSE: Enucleation-transurethral resection of the prostate (e-TURP) is our evolution of the conventional TURP. The aim of this study was to report our experience with e-TURP for the endoscopic management of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: The e-TURP combines the basic steps of classic TURP with the technique of holmium laser enucleation of the prostate (HoLEP) but using only the bipolar resector. The charts of 64 patients who underwent e-TURP for BPH in our department between October 2005 and October 2009 were retrospectively studied. RESULTS: The mean resected tissue weight was 27.21 g, and the mean operative time was 75.7 min. The mean decreases in hemoglobin and serum sodium levels were 1.63 g/dL and 0.55 mEq/L, respectively. Mean catheter duration was 2.53 days, and the mean total hospitalization time was 3.75 days. There was a significant improvement in urinary peak flow rate (Qmax) 2 months postoperatively (P = 0.009718), as well as a significant decrease in the International Prostate Symptom Score during the same period (P < 0.0001). No major complications were observed, and the rates for early and late complications were 10% and 5%, respectively, at 14.75-month mean follow-up. CONCLUSION: The e-TURP seems to be a safe and effective method for the endoscopic management of BPH. Further investigation with randomized trials is needed on this matter.

Laparoscopic nephron sparing surgery: a multi-institutional European survey of 592 cases.

Laparoscopic Nephron Sparing Surgery (LNSS) is a technically challenging procedure. Technical aspects and the outcome of LNSS are investigated. A total of 592 LNSS procedures were collected from 12 Centres, either in extraperitoneal or transperitoneal fashion. Mean tumor size was 2.2 cm. Eight centers reported on tumor position for a total of 407 cases with 338 exophytic tumors (83%) and 69 deep lesions (17%). Four centers, accounting for 185 cases, did not report on tumor position. All the centers performed their LNSS by clamping the hilum. The warm ischemia time was < 30 min in all the centers. The positive margin rate was 2% (12/592). Hemostatic agents and/or sealant or tissue glues were used in 86% of cases (511/592). Types of sealants used included: gelatine matrix (Floseal), fibrin gel (Tissucol), bovine serum albumin (BioGlue) and cianacrylate (Glubran). Two Centres never used sealants, one center used only sealants without suturing and 9 centers used a combination of sealants and bolstering-sutures. The intraoperative open conversion rate was 3.5% (21/592). Postoperative complications included bleeding in 15/592 (2.5%) and urine leak in 13/592 (2.1%). No tumor seeding was reported. LNSS has similar results of open partial nephrectomy. The use of hemostatic agents and/or sealants or tissue glues during LNSS is largely diffuse in European centers and may be an effective add on reducing bleeding and urine leakage when used in combination with bolstering-suturing.

"Capio" for laparoscopic radical prostatectomy: a useful device.

Vesico-urethral anastomosis is a technically challenging part of the laparoscopic radical prostatectomy. Our aim was to simplify the anastomosis-step by adopting a new device "Capio" (Boston Scientific), already known in open surgery, together with "Alesix" (Applied), a device used in hand assisted laparoscopy.

Laparoscopic transperitoneal adrenalectomy for adrenocortical oncocytoma.

A middle aged male patient (39 year old) presented with right renal pain. During evaluation a small renal stone was found in the right kidney, and a mass 6 cm in diameter related to the upper pole of the left kidney was discovered. An endocrinologic evaluation was negative and a laparoscopic transperitoneal adrenalectomy was performed. Final pathology was adrenocortical oncocytoma with malignant potential.

Laparoscopic excision of a retroperitoneal cystic lymphangioma: an insidious case.

Cystic lymphangioma is a rare, benign malformation of the lymphatic system. In this paper, we describe a rare case of a retroperitoneal cystic lymphangioma in a 25-year-old woman.

Use of haemostatic agents and glues during laparoscopic partial nephrectomy: a multi-institutional survey from the United States and Europe of 1347 cases.

OBJECTIVES: Laparoscopic partial nephrectomy (LPN) is a technically challenging procedure for the management of renal tumours. Major complications of LPN include bleeding and urine leakage. Haemostatic agents (HAs) and/or glues may reduce haemorrhage and urine leakage. We sought to examine the current practice patterns for urologists performing LPN with regard to HA use and its relationship with bleeding and urine leakage. MATERIALS AND METHODS: A survey was sent via e-mail to urologists currently performing LPN in centres in the United States and Europe. We queried the indications for HA/glue usage, type of HAs/glues used, and whether concomitant suturing/bolstering was performed. In addition, the total number of LPNs performed, laparoscopic tools used to resect the tumour, tumour size, and tumour position were queried. RESULTS: Surveys suitable for analysis were received from 18 centres (n=1347 cases). HAs and/or glues were used in 1042 (77.4%) cases. Mean tumour size was 2.8cm, with 79% of the tumours being defined as exophytic and 21% deep. The HAs and glues used included gelatin matrix thrombin (FloSeal), fibrin gel (Tisseel), bovine serum albumin (BioGlue), cyanoacrylate glue (Glubran), oxidized regenerated cellulose (Surgicel), or combinations of these. Sixteen centres performed concomitant suturing/bolstering. The overall postoperative bleeding requiring transfusion and urine leakage rates were 2.7% and 1.9%, respectively. CONCLUSIONS: The use of HAs and/or glues is routine in most centres performing LPN. The overall haemorrhage and urine leakage rates are low following LPN. More studies are needed to assess the potential role of HAs and/or glues in LPN.

Congenital ureteropelvic junction obstruction: definition and therapy.

Congenital ureteropelvic junction (UPJ) obstruction is a well recognized pathology. It typically occurs due to the presence of an aperistaltic segment of the ureter, very frequently aggravated by a strangling vessel defined by different authors as "anomalous", "aberrant" or "crossing". An embryologic review of the development of the kidney, ureter and renal vessels reveals that such definitions are etiologically inadequate since such vessels almost always run anterior to the UPJ and therefore in reality are not anomalous or aberrant. It would be, therefore, more appropriate to speak of a "vascular bar" rather that congenital vascular anomaly. A series of 23 patients treated by a laparoscopic technique (15 using the Anderson-Hynes pyeloplasty, 4 Fenger's technique, 3 a simple ureterolysis, 1 necessitating a conversion to open procedure (due to bleeding) are presented. An inferior polar vessel was found in 15 cases and this was running anterior to the UPJ in 14. The mean operative time was 235 min., while the mean hospital stay 7 (3-15) days. The mean follow-up was 47.7 months. Twenty-one pts. (95.5%) were symptom-free with imaging studies confirming relief from obstruction.

Treatment of benign prostatic hyperplasia with water-induced thermotherapy: experience of a single institution.

PURPOSE: To evaluate the efficacy of and tolerance for water-induced thermotherapy (WIT). PATIENTS AND METHODS: Between June 1998 and December 1999, 50 patients were treated with WIT protocol. The patients were divided in two groups according to the achieved treatment temperature and the volume of the inflated treatment balloon. In Group 1, the treatment temperature was set at 60 degrees C, and the treatment balloon was inflated to 50F. In Group II, 29 patients were treated with a temperature of 62 degrees C, and the treatment balloon was inflated to a maximum of 60F. RESULTS: In Group I, the catheter was permanently removed in eight of the nine patients who had previously had permanent indwelling bladder catheters (88.8%). The average Qmax was 11.5 mL/sec; the quality of life (QoL) index was 1.3, and the International Prostate Symptom Score (IPSS) was 6.2. The remaining five patients were not catheter dependent prior to WIT. Three of these patients (60%) demonstrated Qmax improvements from 11.7 to 17.1 mL/sec. In Group II, 11 of the 15 patients (73.3%) who had been catheter dependent resumed spontaneous micturition with a Qmax of 10.7 mL/sec and an IPSS of 8.5. CONCLUSION: Water-induced thermotherapy can be performed easily on an outpatient basis under local anesthesia. It is well tolerated by most patients, and the early results are encouraging.