Large impacted upper ureteral calculi: A comparative study between retrograde ureterolithotripsy and percutaneous antegrade ureterolithotripsy in the modified lateral position.

CONTEXT: The treatment for patients with large impacted proximal ureteral stone remains controversial, especially at institutions with limited resources. AIM: The aim of this study is to compare and to evaluate the outcome and complications of two main treatment procedures for impacted proximal ureteral calculi, retrograde ureterolithotripsy (URS), and percutaneous antegrade ureterolithotripsy (Perc-URS). SETTINGS AND DESIGN: Our inclusion criteria were solitary, radiopaque calculi, >15 mm in size in a functioning renal unit. Only those patients in whom the attempt at passing a guidewire or catheter beyond the calculus failed were included in this study. PATIENTS AND METHODS: Between January 2007 and July 2011, a total of 52 patients (13 women and 39 men) with large impacted upper-ureteral calculi >15 mm and meeting the inclusion criteria were selected. Of these, Perc-URS was done in 22 patients (group 1) while retrograde ureteroscopy was performed in 30 patients (group 2). We analyzed operative time, incidence of complications during and after surgery, the number of postoperative recovery days, median total costs associated per patient per procedure, and the stone-free rate immediately after 5 days and after 1 month. STATISTICAL ANALYSIS USED: Bivariate analysis used the Student t-test and the Mann-Whitney test to compare two means and Chi-square and Fisher's exact tests to compare two percentages. The significance level was set at 0.05. RESULTS: The mean age was 42.3 years (range 22-69). The mean stone sizes (mm) were 34 ± 1.2 and 29.3 ± 1.8 mm in group 1 and 2, respectively. In the Perc-URS group, 21 patients (95.45%) had complete calculus clearance through a single tract in one session of percutaneous surgery, whereas in the URS group, only 20 patients (66.7%) had complete stone clearance (P = 0.007). The mean operative time was higher in the Perc-URS group compared to group 2 (66.5 ± 21.7 vs. 52.13 ± 17.3 min, respectively; P = 0.013). Complications encountered in group 1 included transient postoperative fever (2 pts) and simple urine outflow (2 pts). Ten patients (33%) of group 2 experienced failure: Migration to the kidney (3 pts), ureteral perforation (2 pts), tortuosity of the ureter (2 pts), and epithelial polyps (2 patients). Group 1 patients had an average visual analog (VAS) pain score of 47 mm compared with 31 mm in group 2 patients. The mean hospital stay (days) in group 1 was higher than the group 2 (2.27 ± 0.8 vs. 1.67 ± 0.6, respectively; P = 0.01). The mean analgesia requirement for group 1 (paracetamol chlorhydrate + codeine 12 ± 3 g) was significantly more compared with group B (6.8 ± 2 g) (P < 0.01). The difference in average blood loss between the two groups was not statistically significant. Total costs was slightly higher in group 1 but the difference was not statistically significant between the two groups (15000 vs. 13400 MDH respectively; P > 0.05). After 1 month, the stone free-rate remained higher in group 1 (95.5% vs. 66.7%, respectively; P = 0.012). CONCLUSIONS: In our series, Perc-URS is a safe and efficient treatment option for proximal ureteral stone, especially when the stone size is superior to 15 mm with the presence of moderate or severe hydronephrosis.

Inguinal bladder hernia: four case analyses.

A study of four cases presenting as inguinal bladder hernia was performed based on a review of the clinical presentation, circumstances of diagnostics, and surgical management. The mean age of patients was 66.5 years. Presenting symptoms included lower urinary tract symptoms (LUTS; three cases) and decrease in scrotal size after voiding (one case). The diagnostic circumstances were incidental finding during investigation for urethral stricture (one case), preoperative discovery on the basis of decrease in scrotal size after voiding (one case), perioperative discovery during standard herniorrhaphy (one case), and peritoneal effusion secondary to bladder injury in the early postoperative period. All patients were managed successfully by replacement of the bladder in its original position and inguinal herniorrhaphy, the Lichtenstein technique (two cases), Shouldice repair (one case), or modified Bassini repair (one case) through the same inguinal incision. For one patient, bladder injury was diagnosed at the time of inguinal herniorrhaphy and repair was promptly made. For another, bladder injury was discovered only at surgical abdominal exploration. Surgical repair led to the resolution of signs and urologic symptoms in all but one patient who needed medical therapy for residual LUTS. An awareness of this possibility on the part of general surgeons should guide preoperative evaluation and therapy appropriately. Even if the preoperative diagnosis is missed, a perioperative diagnosis is crucial to avoid bladder injury during surgery.

"Knot stent": an unusual cause of acute renal failure in solitary kidney.

The insertion of indwelling ureteric stents is a routine procedure in urology practice. Complications secondary to the insertion of these stents have also increased, such as stent encrustation, stent fragmentation, stone formation, and recurrent urinary tract infections. Knot formation within the renal pelvis or in the coiled portion of the ureteral stent is an extremely rare condition, with less than 15 cases reported in literature. The authors report a rare case of knotted stent, complicated by an obstructive acute renal failure and urosepsis, in a patient with a solitary functioning kidney.

Transurethral transvesical endoscopic management of a retrovesical hydatid cyst.

We present a technique of transurethral transvesical endoscopic management of an intraperitoneal retrovesical hydatid cyst. Cystoscopy is performed using a 20.8F nephroscope. The cyst is punctured using an 18-gauge, 36-cm needle through the nephroscope operating channel. Saline (20%) is used as scolicidal agent. After balloon tract dilation, the nephroscope is introduced into the cyst, and the hydatid material is evacuated.

A more "conventional" way to perform percutaneous endopyeloplasty: a feasibility study.

OBJECTIVE: Percutaneous endopyeloplasty is a horizontal suturing of the endopyelotomy incision via a unique percutaneous tract. We present a feasibility study of our technique of percutaneous endopyeloplasty using a conventional suture with a laparoscopic needle holder via the nephroscope. MATERIALS AND METHODS: A longitudinal endopyelotomy incision is performed through a 24-Fr working sheath placed via an upper calyx. Then an initial suture is placed, approximating the endopyelotomy incision distal and proximal apex, using a conventional absorbable 13-mm needle suture with a lengthened 3.5-mm pediatric laparoscopic needle holder, via the nephroscope. If possible, an additional 2 sutures are eventually placed, 1 on either side of the initial midline suture. RESULTS: Percutaneous endopyeloplasty, using a conventional suture with a pediatric laparoscopic needle holder via a nephroscope, is technically possible, reproducible, and effective, and was performed in 10 consecutive patients. The tissue approximation provides a fast, full thickness ureteral healing. Endopyelotomy horizontal suturing leads to a wider caliber reconstruction of the ureteropelvic junction. CONCLUSION: Percutaneous endopyeloplasty is a promising technique. Our procedure for endopyeloplasty is technically feasible and effective, with little need for highly specialized equipment. However, further technical experience and longer follow-up in a larger group of patients are necessary for more development of this technique.

La NLPC en décubitus dorsal modifié : notre expérience.

UNLABELLED: RéSUMé: INTRODUCTION ET OBJECTIF :: La NLPC est conventionnellement réalisée en décubitus ventral. Cette position présente de nombreux inconvénients. Notre objectif était d'évaluer de façon prospective le caractère sûr et efficace de la NLPC en position de décubitus dorsal modifié (DDM). MATéRIEL ET MéTHODES :: Entre novembre 2004 et janvier 2010, 159 NLPC ont été réalisées en DDM. Le patient a été mis en décubitus dorsal avec un billot sous le flanc permettant une rotation de 45 degrés du côté opposé. Une position de lithotomie modifiée était associée si un double accès antérograde et rétrograde simultané était nécessaire. Après ponction rénale, la dilatation a été faite selon la technique « one shot ¼ ou en utilisant les dilatateurs d'Alken. Les caractéristiques des patients et des calculs, la durée opératoire, le séjour hospitalier, les complications et le taux d'absence de calculs résiduels (« stone free ¼) ont été analysés. RéSULTATS :: L'âge moyen des patients était de 47 ± 13,1 ans (22-70). Vingt-et-un patients avaient des ATCD de chirurgie rénale du même côté. Vingt-six patients avaient un rein unique anatomique ou fonctionnel. Un patient avait un rein en fer à cheval et deux patients avaient une malrotation rénale. Le diamètre moyen des calculs était de 3,4 ± 1,9 cm (1,3-5,4) et 20 patients avaient des calculs coralliformes. Dix patients avaient des calculs urétéraux et ont eu une urétéroscopie simultanée. La durée moyenne de l'intervention était de 60 ± 29 min. Deux interventions ont été interrompues en raison d'un saignement important. Trois cas de fièvre postopératoire et 2 cas de fistule urinaire traités par sonde en double J ont été notés. Aucune plaie vasculaire ou viscérale n'a été rapportée ni de plaie pleuropulmonaire. Huit patients ont eu une seconde séance de NLPC durant la même hospitalisation. Après trois mois le taux d'absence de calculs résiduels était de 91,8 %. CONCLUSION: La NLPC en DDM a permis de traiter de façon sûre et efficace les calculs rénaux. Elle a offert plusieurs avantages : facilité d'installation et non-nécessité de changer la position, pas de compression thoracique, moins de contraintes anesthésiques, réduction du risque de plaie colique et possibilité d'accès simultané antérograde et rétrograde.

[Laparoscopic kidney release for refractory chyluria]. / Néphrolyse laparoscopique pour chylurie réfractaire.

Chyluria is a rare disease outside of parasite endemic zones. The treatment of severe forms is surgical. Reno-lymphatic disconnection is the reference procedure, with long-term success rates of 99%. This operation performed via a lumbar incision can also be performed by retroperitoneal or transperitoneal laparoscopy. The advantages of this minimally invasive incision are those classically reported in the literature.

[Ductal adenocarcinoma of the prostate: case report and review of the literature]. / Adénocarcinome ductal de la prostate.

Ductal adenocarcinoma is a histological variant of prostate cancer. The authors report the case of a 53-year-old man, in whom the tumour was revealed by acute urinary retention and haematuria. In the light of this case and a review of the recent literature, the authors discuss the histological, clinical and therapeutic aspects of this rare entity.

[Genital self-mutilation. Report of 3 cases]. / L'automutilation génitale: à propos de 3 cas.

Self-mutilation, a very unusual situation in routine urology, is a rare phenomenon. It is generally observed in a psychotic context, but can be secondary to drug or alcohol abuse. Treatment and management vary according to the severity of the lesions, the time to presentation and the patient's mental state. The authors report 3 cases of self-mutilation, including 1 case of penis amputation, 1 case of strangulation by a metal ring and 1 case of bilateral castration. In the light of these cases and a review of the recent literature, the authors analyse the various psychiatric medicolegal and urological aspects of this deliberate self-injury.

[Unusual clinical presentations of tumours of the renal pelvis. Report of two cases ]. / Tumeurs pyéliques à révélation inhabituelle: à propos de 2 cas.

Chronic irritation induced by stones and urinary stasis can be responsible for squamous and sometimes glandular metaplasia of the urothelial epithelium with secondary carcinomatous transformation. The authors report two cases of tumour of the renal pelvis associated with stone pyonephrosis in one case and ureteropelvic junction syndrome in the other.

[Lumboscopic treatment of simple renal cysts: initial experience with 17 cases]. / Traitement lomboscopique des kystes simples du rein: expérience initiale à propos de 17 cas.

OBJECTIVE: To evaluate the feasibility of lumboscopic treatment of simple renal cysts. MATERIAL AND METHODS: From January 1999 to January 2002, 17 patients with a mean age of 40 years were operated for symptomatic renal cysts via a retroperitoneal approach. All patients were evaluated by preoperative ultrasonography and CT. A Bosniak type I cyst was diagnosed in 10 cases and a Bosniak type II cyst was diagnosed in 7 cases. The mean cyst diameter was 7 cm (range: 5 to 15 cm). RESULTS: All patients were operated via an exclusively retroperitoneal approach. The mean operating time was 50 min (range: 40 mm-120 mm). The estimated mean blood loss was 80 cc. No conversion was necessary and the mean length of hospital stay was 1.5 days. All cysts were histologically benign. All 17 patients are asymptomatic (mean follow-up = 11 months) with no radiological signs of recurrence. CONCLUSION: Lumboscopic treatment of simple renal cysts appears to be a feasible, safe, effective and satisfactory technique in terms of morbidity, operating time, complications and blood loss.

[Pseudotumor form of urinary tuberculosis]. / Forme pseudotumorale d'une tuberculose urinaire.

Urogenital tuberculosis is an increasingly frequent serious disease. The diagnosis is often delayed due to the marked clinical polymorphism, leading to serious sequelae. The diagnosis of typical forms is easy, but some forms are misleading and can lead to an incorrect diagnosis. The authors report a pseudoneoplastic form of urogenital tuberculosis in a young patient that was initially diagnosed as lymphoma. In the light of this case and a review of the literature, the authors emphasize the diagnostic difficulties of these forms and the treatment modalities.