[Complications from normal saline in thulium laser enucleation of the prostate]. / Komplikationen von 0,9 %iger NaCl-Spüllösungen bei der Thuliumlaserenukleation der Prostata.

Systemic fluid absorption frequently occurs during endoscopic prostatic surgery. The introduction of lasers allowed the use of normal saline (0.9% sodium chloride). We report 2 patients who developed hyperchloremic metabolic acidosis and isotonic hypervolemia during thulium laser enucleation of the prostate (ThuLEP) and required prolonged ventilation time, catecholamines, intensive care and prolonged hospitalization. A change to balanced electrolyte solutions in urology-as is already established in infusion and volume therapy-would be desirable, especially to avoid hyperchloremic metabolic acidosis.

[Treatment of Renal Artery Perforation with Covered Stent after Percutaneous Biopsy of Pancreatic Head]. / Behandlung einer Nierenarterienperforation mit gecovertem Stent nach perkutaner Pankreaskopfbiopsie.

HISTORY AND CLINICAL FINDING: In a 67-year-old female patient with upper abdominal pain, computed tomography showed a partly calcified swelling of the pancreatic head and wall thickening of the duodenum. EXAMINATIONS: Inpatient physical examination findings were normal. Laboratory showed increased pancreatic enzymes (amylase 210 U/l [Standard range: 28-100 U/l], lipase 2115 U/l [Standard range: 23-300 U/l]) and inflammation values (CRP 11.7 mg/l [Standard range: < 5.0 mg/l]), otherwise largely normal laboratory parameters. In the esophago-gastro-duodenoscopy, biopsy of swollen, partly stenosing mucous membrane areas in the duodenum was performed. DIAGNOSIS: Histology revealed partial erosive duodenitis, no evidence of a malignant tumor. If chronic calcifying pancreatitis was suspected, a sonographically guided percutaneous biopsy of the pancreatic head was performed to exclude a tumor. TREATMENT AND COURSE: Post-biopsy, the patient developed abdominal pain and temporary circulatory instability with nausea/vomiting and a drop in Hb to 7.5 g/dl [Standard range: 12.3-15.3 g/dl]. The sonographic suspicion of a retroperitoneal hematoma was confirmed by computed tomography. The cause was a haemorrhage from a renal artery perforation on the right side, which could be stopped by immediate angiographic intervention with a covered stent. CONCLUSION: After percutaneous biopsy, vascular perforation must always be considered. Computed tomography provides a reliable and quick diagnosis. Minimally invasive percutaneous insertion of a covered stent is the therapy of choice in the case of a renal artery accessible to stents.

Laparoscopic vs open retropubic intrafascial nerve-sparing radical prostatectomy: surgical and functional outcomes in 300 patients.

OBJECTIVE: To evaluate the surgical and functional outcomes in nerve-sparing laparoscopic radical prostatectomy (nsLRP) and retropubic nsRP (nsRRP). PATIENTS AND METHODS: Between January 2005 and November 2007, 150 nsLRP and 150 nsRRP were performed at our clinic. Demographic data, variables before and after surgery, and outcomes, were compared. RESULTS: The operative duration was 165 min for nsLRP and 120 min for nsRRP. Although the nsLRP group had a lower frequency of positive margins, the difference was not statistically significant. At 1 year after surgery, complete continence was reported in 97% of patients who had nsLRP and in 91% who had nsRRP (P= 0.03). At that time, 66% of patients in the nsLRP and 51% in the nsRRP group reported being able to engage in sexual intercourse (P < 0.05). There were no statistical differences in surgical trauma in both groups. CONCLUSION: Our study showed that nsLRP performed by expert surgeons results in better functional outcomes for continence and potency than for nsRRP. There was no significant difference between the surgical techniques in surgical trauma.

Bioluminescence imaging to monitor bladder cancer cell adhesion in vivo: a new approach to optimize a syngeneic, orthotopic, murine bladder cancer model.

OBJECTIVE: To improve the orthotopic murine bladder cancer model by using bioluminescent (BL) MB49 tumour cells for noninvasive in vivo monitoring of tumour growth and to examine the efficacy of integrin receptor-blocking oligopeptides on preventing tumour cell adhesion in this improved bladder cancer model. MATERIALS AND METHODS: The capacity of oligopeptide combinations to interfere with tumour cell adhesion was assessed in vivo in a syngeneic, orthotopic, murine bladder cancer model. Tumour outgrowth was monitored noninvasively by bioluminescence imaging (BLI) after administration of luciferase-expressing MB49(LUC) bladder cancer cells. The presence of tumour cells was verified histologically and immunohistochemically on paraffin wax-embedded sections of excised bladders. RESULTS: Anti-adhesive oligopeptides effectively inhibited tumour outgrowth. BLI detected tumour cells at an early stage when there were no clinical signs of cancer in any of the mice. The technique has high sensitivity in detecting tumour cell implantation, but is less reliable in assessing tumour volume in advanced-stage disease due to light attenuation in large tumours. CONCLUSIONS: Peptides targeting adhesion molecules prevent attachment of bladder cancer cells to the injured bladder wall. BLI is a sensitive method for detecting luminescent bladder cancer cells in an orthotopic mouse model.

Prospective non-randomized evaluation of four mediators of the systemic response after extraperitoneal laparoscopic and open retropubic radical prostatectomy.

OBJECTIVE: To report a prospective, controlled, non-randomized patient study to determine the systemic response to extraperitoneal laparoscopic (eLRP) and open retropubic radical prostatectomy (RRP). PATIENTS AND METHODS: In all, 403 patients who had eLRP (163) or open RRP (240) were recruited; patients in both groups had similar preoperative staging. In addition to peri-operative variables (operative duration, complications, blood loss, transfusion rate, hospitalization, catheterization), oncological data (Gleason score, pathological stage, positive margins) were also compared. The extent of the systemic response to surgery-induced tissue trauma was measured in all patients, by assessing the levels of acute-phase markers C-reactive protein (CRP), serum amyloid A (SAA), interleukin-6 (IL-6) and IL-10 before, during and after RP. RESULTS: The duration of surgery, transfusion rate, hospital stay and duration of catheterization were comparable with those in previous studies. There was an increase in IL-6, CRP and SAA but no change in IL-10, and no differences between eLRP and RRP over the entire period assessed. CONCLUSION: The invasiveness of eLRP could not be substantiated objectively based on the variables measured in this study. The surgical trauma and associated invasiveness of both methods were equivalent.

Inhibition of tumor implantation after laparoscopy by specific oligopeptides: a novel approach to adjuvant intraperitoneal therapy to prevent tumor implantation in an animal model.

OBJECTIVES: The development of intra-abdominal tumor spread and port-site metastases in urothelial cancer are still questions regarding the safety of laparoscopic methods for the resection of malignancies. Currently, the actual incidence of intra-abdominal tumor spread and port-site metastasis remains unknown. Herein, we investigated the influence of antiadhesive oligopeptides and cytotoxic agents (administered intraperitoneally) on implantation of a tumor cell suspension after laparoscopic surgery in an experimental model. METHODS: Forty C57 bl6 mice underwent laparoscopy with CO(2) insufflation and instillation of a MB 49 syngenic urothelial tumor cell suspension into the abdominal cavity. Mice were randomly allocated to one of the following groups (n=10 mice per group), and all agents were administrated intraperitoneally: (1) control (phosphate-buffered saline); (2) unspecific oligopeptides; (3) specific oligopeptides; (4) mitomycin. The mice were sacrificed 14 d after the procedure, and the peritoneal cavity and port sites examined for the presence of tumor. RESULTS: A significant reduction in tumor implantation and port-site metastases was observed in all treatment groups (specific oligopeptides and mitomycin). The oligopeptide group showed the best performance regarding body weight. CONCLUSIONS: This study suggests that tumor implantation after laparoscopic surgery and port-site metastases might be prevented by the intraperitoneal administration of specific oligopeptides or cytotoxic agents. Moreover, oligopeptides, in comparison with mitomycin, caused less weight loss of the mice.

Transperitoneal laparoscopic adrenalectomy: outline of the preoperative management, surgical approach, and outcome.

The laparoscopic approach to the adrenal gland has evolved to be the gold standard for most cases of adrenal conditions requiring surgical treatment. There is general consent about the safety, efficacy, and reproducibility of laparoscopic adrenal surgery. Compared to the open surgery, significant advantages with regard to shorter hospitalization time, decreased postoperative morbidity, improved cosmetics, and quicker convalescence are evident. The anatomic location of the adrenal gland led to the development of various approaches, including lateral transperitoneal, anterior transperitoneal, lateral retroperitoneal, posterior retroperitoneal, and even transthoracic approaches. The lateral transperitoneal approach is the technique most frequently used for laparoscopic adrenalectomy. A large operative field provides good orientation and visualization of familiar landmarks known from open surgery. In particular in the early learning curve this represents an advantage of the transperitoneal laparoscopic approach. This article describes in detail the indications, contraindications, preoperative evaluation, surgical technique, management of intraoperative complications, and outcome after lateral transperitoneal adrenalectomy.