Tubeless percutaneous nephrolithotomy with antegrade stent tether: clinical experience.

BACKGROUND AND PURPOSE: A limitation of tubeless percutaneous nephrolithotomy (PCNL) is the need for post-operative office cystoscopy to remove the ureteral stent. We developed a novel technique of intraoperative stent placement that allows removal via the flank. Herein, we report on our initial clinical experience. PATIENTS AND METHODS: Thirty consecutive patients (36 renal moieties) undergoing tubeless PCNL had ureteral stents placed at the end of the procedure with a stent tether exiting the flank incision. Patients were discharged home with the tether protected by a clear occlusive bandage. The stents were removed in the office between 3 and 12 days postoperatively by gently pulling on the tether. Patients were assessed for difficulty in removing the stent, leakage of urine from the flank, and any other postoperative complications. RESULTS: All stents could be removed from the flank using the tether. No urine leakage was noted in any patient, nor did any patient develop any complication related to stent placement or removal. Stents from several manufacturers were employed, with no difference noted. Patients reported no additional discomfort from the presence of the flank tether, and no significant pain was noted during stent removal. CONCLUSION: Utilization of the tether to remove the ureteral stent via the flank after tubeless PCNL is a feasible, safe, and cost-effective improvement on the standard tubeless PCNL technique. This modification obviates postoperative office cystoscopy, allowing easy removal of a stent.

Modification of tubeless percutaneous nephrolithotomy: anterograde stent with flank tether.

A limitation of tubeless percutaneous nephrolithotomy is the need for postoperative office cystoscopy for removal of the ureteral stent. We have developed a novel technique of intraoperative ureteral stent placement that allows for outpatient removal of the stent through the flank using the stent tether.

Bladder neck closure with lower urinary tract reconstruction: technique and long-term followup.

PURPOSE: Bladder neck closure (BNC) is an important component of reconstructive urological surgery, especially in the management of neurogenic bladder. To our knowledge we present the largest series of patients who have undergone this procedure. MATERIALS AND METHODS: A total of 39 patients with lower urinary tract (LUT) dysfunction secondary to neurogenic bladder underwent transabdominal BNC and simultaneous LUT reconstruction between 1988 and 2002. Charts were reviewed and patients were retrospectively interviewed to ascertain demographics, previous urological surgeries, perioperative data, postoperative results and complications. RESULTS: Mean postoperative followup was 36.9 months (range 7 to 173). Concomitant procedures included ileovesicostomy in 19 patients (49%), augmentation enterocystoplasty with continent cutaneous stoma in 19 (49%) and revision of a previous Mitrofanoff appendicovesicostomy in 1. The overall complication rate was 31% with a vesicourethral fistula in 6 patients (15%), of whom 4 required eventual transabdominal or transvaginal surgical correction. No other problems directly related to BNC were identified. Patients were followed by serial renal ultrasound and abdominal x-ray with upper tract maintenance seen in all patients. CONCLUSIONS: Bladder neck closure with simultaneous urinary diversion is a highly effective, well tolerated treatment for many pathological processes of the LUT. Risks for prolonged urethral leakage include high pressure systems, prior bladder neck surgery and noncompliance with catheter/drain management. These data support our belief that a high degree of success with an acceptable complication rate is attainable with careful adherence to surgical technique, proper patient selection, appropriate early postoperative management and rigid surveillance.

Urinary retention in a patient with West Nile virus.

West Nile Virus (WNV) has received much recent attention due to multiple outbreaks in North America, its insidious onset in many patients, and a wide variety of neurologic manifestations. A 45-year-old man who exhibited urinary retention as a presenting symptom of WNV infection is presented herein. We believe this to be the first reported case of a urologic sequela secondary to WNV infection.