Open versus laparoscopic donor nephrectomy: perioperative parameters and graft functions.

OBJECTIVE: With the developments in laparoscopic surgery, open donor nephrectomy has been widely replaced by laparoscopic donor nephrectomy. Presented herein is the comparison of laparoscopic live donor nephrectomy (LLDN) and open live donor nephrectomy (OLDN) results performed at our institute. MATERIALS AND METHODS: Patients who underwent OLDN between July 2006 and August 2008 or LLDN between August 2008 and July 2010 were included in this retrospective age- and gender-matched case-controlled study. OLDN was performed with a 45° semi-flank position using a self-retaining retractor. LLDN operations were performed used a 90° flank position by the transperitoneal route under 12-15 mm Hg carbon dioxide (CO(2)) pressure. A Pfannenstiel incision was used in all LLDN for graft extraction. The renal artery and vein were controlled with Satinsky clamps in OLDN, whereas renal arteries were controlled with nonabsorbable polymer locking clips and renal veins with 2.5/45 mm EndoGIA vascular staplers in LLDN. RESULTS: Thirty patients underwent OLDN and 31 LLDN. The mean ages among the OLDN and LLDN patients were 44.9 ± 21.9 and 46.3 ± 18.4, respectively. There was no significant difference in mean age and gender distribution of patients between OLDN and LLDN groups by the design of the study. The OLDN group consisted of 4 (13%) right and 26 (87%) left nephrectomies; the LLDN group consisted of 3 (9%) right and 28 (91%) left nephrectomies. Mean operative time was 110 ± 18 and 101 ± 28 minutes for OLDN and LLDN, respectively (P < .05; Mann-Whitney U test). Estimated blood loss was 35 ± 15 mL among the OLDN group and 15 ± 24 mL for the LLDN group. Mean hospitalization time in the OLDN and LLDN groups were 3.8 ± 0.5 and 2.6 ± 0.6 days, respectively. There were no conversions to open surgery in the LLDN group. Mean warm ischemia time in the OLDN and LLDN groups were 140 ± 58 seconds and 203 ± 21 seconds, respectively (P < .05; Mann-Whitney U test). There was no difference in recipient serum creatinine levels at 1 week after surgery. CONCLUSION: LLDN was superior to OLDN in terms of operative time, estimated blood loss, length of hospital stay, and postoperative pain. Longer warm ischemia time in the LLDN group did not translate into worse graft function in the recipients.

Reconstruction of ureteral defects with a tubular skin graft secondarily prefabricated utilizing omentum as a carrier: an experimental study.

OBJECTIVES: This study was conducted to evaluate reconstruction of the ureter in dogs after resection of a 7-cm-long midlength segment with a vascularized tubular skin graft secondarily prefabricated utilizing omentum as a carrier. METHODS: Nine female mongrel dogs underwent surgery in which omental surface capabilities were used to create a vascularized prefabricated skin graft. After 4 weeks, all 9 dogs underwent the second surgical procedure, which included the resection of a 7-cm-long segment from the ureter and an interureteral anastomosis of the omentocutaneous cylindrical tube. At postoperative week 10, just before the third surgical procedure, intravenous urography was performed to evaluate the continuity of the treated ureter. Nephroureterectomy was also performed immediately after intravenous urography to obtain specimens for histologic analysis of the aforementioned tubular anastomosis. RESULTS: The continuity of the ureteral defect was restored with the help of the omentocutaneous cylindrical tube. There was no narrowing throughout the ureter and along the omentocutaneous cylindrical tube. Only minimal dilation occurred at the neoskin tube and at the ipsilateral collecting system. Histopathologically, there were capillary protrusions entering the skin graft from the omental vasculature. The columnar epithelium of the cutaneous cylindrical tube was completely preserved, and transitional ingrowth was present at the proximal and distal ends of the tube. CONCLUSIONS: The surgical procedure resulted in successful reconstruction of ureteral continuity by the use of a prefabricated omentocutaneous cylindrical tube in dogs.

Epidermoid carcinoma of the male urethra. Case report.

A case of voiding difficulties was investigated. Other than usual prostatic obstruction or urethral stricture, a small mass at the anterior region of the bulbous urethra was present. Detailed investigation by urethroscopy, biopsy, CT imaging and ultrasonography revealed epidermoid carcinoma of the urethra.

Endoscopic transvaginal bladder neck suspension for stress urinary incontinence.

We report the short-term results in 23 women who underwent endoscopic transvaginal bladder neck suspension for stress urinary incontinence. During follow-up for 3-14 months (mean 6 months) complete dryness was achieved in 15 (79%) of the 19 patients. Significant improvement with only minor occasional leaks after surgery was observed in 2 patients (10.5%) and the remaining 2 cases (10.5%) were failures. Four patients were lost to follow-up. No serious complication was noted. This relatively easy operation with acceptable success and morbidity rates has been found to be comparable with the other surgical techniques being used.

Novel 'soft' anticholinergic agents.

The concepts involved in the design of 'soft' drugs (drugs which, after achieving their therapeutic role, are metabolised in a predictable manner and at a controlled rate to non-toxic moieties) have been further applied in the case of atropine. Selected aliphatic and cycloaliphatic esters of a hypothetical, inactive acidic metabolite of atropine were designed and found to have atropine-like activity, and to revert to the inactive metabolite in rat liver homogenates. Peak anticholinergic activity, measured by the degree of antagonism of carbachol-induced spasms of guinea pig ileum strips, was observed when the esters contained a quaternary group. The in vitro stability of the esters was determined in human plasma, in pH 12 buffer solution, and in rat liver homogenate; the fastest rate of hydrolysis occurred in rat liver homogenate, and least sterically hindered esters degraded more rapidly than hindered esters. Synthesis of the esters was achieved in two stages. Phenylmalonic acid and the appropriate alcohol gave phenylmalonic acid monoesters, which, after reaction with tropine, afforded the required diesters. The tertiary amine group on the tropine moiety of the diesters then allowed the preparation of quaternary derivatives.