Laparoscopic nephrectomy for the management of renal medullary carcinoma in a child.

Renal medullary carcinoma is a lethal subtype of renal cancer that afflicts patients with sickle-cell hemoglobinopathies. Here we present the case of a 13-year-old boy with renal medullary carcinoma who is the first, to our knowledge, to be managed using a planned laparoscopic radical nephrectomy.

Safety and efficacy of synchronous percutaneous nephrostolithotomy and contralateral ureterorenoscopy for bilateral calculi.

Herein we describe the technique and review the medical records of 26 patients who underwent percutaneous nephrostolithotomy (PCNL) and simultaneous contralateral retrograde ureterorenoscopy (URS) for bilateral urolithiasis of discordant sizes at our institution. Preoperative factors, operative time, change in hemoglobin, change in serum creatinine, stone free, and efficacy rates after a single procedure were analyzed retrospectively. The total efficacy rate--defined as residual calculus of 4 mm or less--was 92.3%. A second look PCNL or URS was used to target any residual calculi; 5 of the 26 (19%) patients required further therapy following the initial intervention. All cases that required a second look were ultimately rendered stone-free. No preoperative factor was statistically significant with respect to treatment failures. In terms of complications, temporary, acute renal insufficiency occurred in 2 patients, (7.7%) and the duration was transient. Performing synchronous PCNL and contralateral retrograde URS is efficient, safe, and not more dramatically lengthy in terms of operative time or morbid in terms of complications when compared to a traditional unilateral percutaneous procedure. In this approach, management of bilateral urolithiasis in one operative procedure is practical and efficacious. The approach allows patients to return to normal activity within the same time period as those having a unilateral approach and to be free of stone without a need for a second, staged procedure.

Issue of prostate gland size, laparoscopic radical prostatectomy, and continence revisited.

OBJECTIVES: To evaluate the influence of prostate gland size on the perioperative, pathologic, and continence outcomes after laparoscopic radical prostatectomy (LRP). METHODS: 144 LRPs for which 18-month continence data were available were performed by a single surgeon, and were retrospectively reviewed. Patients were divided initially into two groups based on final prostate gland size: group 1 (weight less than 50 g) and group 2 (weight 50 g or more). Group 2 patients were stratified into group IIa (weight 50 to 70 g) and Group IIb (weight 70 g or more) to further examine the effect of gland size on continence. RESULTS: Larger glands had higher mean prostate-specific antigen (P <0.05) but among groups there were no significant differences in patient age, Gleason sum, pathological stage, operative time, intraoperative blood loss, or positive margin rate. We noted a significant difference in mean time to recovery of continence for patients with small glands versus large glands: group 1 (8.2 months), group 2 (9.9 months), group IIa (8.5 months), and group IIb (13.8 months) (P <0.05). CONCLUSIONS: Prostate gland size had no effect on perioperative outcomes. However, recovery of postoperative continence can be delayed in patients with large prostates.

Outcome of percutaneous surgery stratified according to body mass index and kidney stone size.

OBJECTIVE: To stratify outcome and morbidity of percutaneous nephrostolithotomy (PCNL) with regard to body mass index (BMI) and kidney stone burden. METHODS: The charts of 148 patients who underwent PCNL procedures were reviewed retrospectively. Hospital stay, blood loss, maximal temperature during inpatient stay, and stone-free outcomes were evaluated. Patients were divided into 3 groups depending on their BMIs: <25 kg/m, 25 to 29.9 kg/m, and >30 kg/m. Kidney stone burden was measured in terms of square area in millimeters, as measured by retrospective review of computerized tomography scans. Preoperative computerized tomography scan for measurement of stone burden was available for only 85 patients who are included in the study. Analysis of variance for a single variable was performed with regard to the values of the hospital stay, postoperative maximal temperature, and hemoglobin change. RESULTS: Of the 85 patients, 37 (43.5%) were obese or morbidly obese (BMI, >30 kg/m), 33 (38.8%) were overweight (BMI, 25 to 29.9 kg/m), and 15 (17.7%) were within or below their ideal weight (BMI, <25 kg/m). No statistically significant difference among the 3 groups was seen for stone-free rate, postoperative fever, or change in hemoglobin when stratified by BMI alone or by BMI and kidney stone burden. However, significantly longer length of stay for the group with BMI <25 kg/m was observed when stratifying either by BMI alone (P=0.01) or by BMI and kidney stone burden (P=0.03). CONCLUSIONS: In this retrospective review of patients with kidney stones undergoing PCNL, the stone-free outcome and associated morbidity of PCNL (except for the length of hospital stay) is independent of both patients' BMI and stone burden when stratifying by commonly defined parameters.

Laparoscopic nephrectomy for a nonfunctioning pelvic kidney in preparation for renal transplantation.

Pelvic kidneys pose a problem for any planned surgical intervention given their anomalous blood supply. Although minimally invasive approaches have been described for the management of benign conditions, only a handful of reports have described the use of laparoscopy for removal of ectopic or fused kidneys. We describe the laparoscopic removal of a symptomatic pelvic kidney in a patient before renal transplantation.