REPEATED SCLEROTHERAPY SUCCESSFULLY TREATS A CHILD WITH IDIOPATHIC CHYLURIA: A CASE REPORT.

We describe a clinical course of idiopathic chyluria in a previously healthy 8-year-old Thai boy, with a 1-year history of cloudy white urine undergoing antibiotic treatment. The patient was investigated for the causes but they all proved negative. Cystoscopy and retrograde pyelography demonstrated a renolymphatic fistula of the right kidney. The patient was refractory to a mediumchain triglyceride-rich diet. Ultimately, sclerotherapy with 1% povidone iodine was employed twice, which resulted in a resolution of the disorder. We emphasize that chyluria, even though a very rare condition of chylous disorders, but ultimately can be initially managed by providing a medium-chain triglyceride-rich diet and is curable by sclerotharapy. Importantly, medium-chain triglyceride-rich diet can be applied to treat other types of chylous disorders.

Laparoscopic radical prostatectomy: perioperative outcomes and morbidity of 559 consecutive cases in Siriraj Hospital, Thailand.

OBJECTIVE: To evaluate perioperative outcomes and morbidity of laparoscopic radical prostatectomy in Siriraj Hospital during a 5-year experience. MATERIAL AND METHOD: Five hundred fifty nine patients who underwent laparoscopic radical prostatectomy (LRP) by seven surgeons at Siriraj Hospital between September 2004 and September 2009 were included in the study. Data of perioperative results and postoperative parameters were retrospectively evaluated. RESULTS: Mean operative time was 257 minutes SD 75 (range 125 to 680 min). The mean operative time of the first 100 cases was significantly higher than of the last 100 cases (307 ml/min SD 95 versus 223 ml/min SD 56; p-value = 0.001). Mean estimated blood loss was 779 ml SD 607 (range 40 to 6,000 ml). Of 559 patients, 148 patients (26.5%) had blood transfusions. The blood transfusion rate in the first 100 cases was significantly higher than those of the last 100 cases (36.5% versus 15%; p-value = 0.016). The median duration of catheterization time was 8 days. The mean time of drain insertion was 4.2 days SD 1.8 (range 2 to 18 days) postoperatively. Hospital stay was 8.8 days SD 7.6 (range 3 to 149 days). Overall perioperative complications rate was 17.1%. Of these patients, 13.4% were minor complication (Clavien 1, 2) and 3.7% were major complication (Clavien 3, 4). There were no mortalities. Late complication rate was 2.1%, which most of them were stricture of anastomosis. CONCLUSION: Perioperative outcomes and morbidity of LRP in a 5-year period were acceptable. Laparoscopic radical prostatectomy is technically demanding with an initially longer operative time and higher blood transfusion rate. The learning curve of the surgical team is needed to achieve good results.

Laparo-endoscopic single site (LESS) robotic radical prostatectomy in an Asian man with prostate cancer: an initial case report.

OBJECTIVE: To report the feasibility of laparo-endoscopic single site (LESS) robotic radical prostatectomy performed in Asian man. MATERIAL AND METHOD: A 71 year-old man with adenocarcinoma of prostate presented at Faculty of Medicine Siriraj Hospital, Bangkok. Prostate-specific antigen level was 16.5 ng/ml and digital rectal examination approximately showed 30 gram prostate with nodule in both lobes. No clinical metastasis was found. Leuprorelin acetate and 50 mg of bicalutamide were used for 3 months. The patient's body mass index was 22 and healthy. With the consent form signed, laparo-endoscopic single site (LESS) robotic radical prostatectomy was performed with the robot daVinci S system. RESULTS: The total operative time was 335 minutes; docking time was 12 minutes; console time was 275 minutes. The estimate blood loss was 250 ml and no blood transfusion required. No intraoperative or postoperative complication was found. Jackson drain was removed within 60 hours after surgery. The patient was discharged from the hospital within 84 hours after surgery. The urethral catheter was removed within 14 days after surgery. CONCLUSION: Laparo-endoscopic single site (LESS) robotic radical prostatectomy is feasible to be performed In the initial experience, patient selection is required.

Comparative outcome between transverse island flap onlay and tubularized incised plate for primary hypospadias repair.

OBJECTIVE: To compare the outcome of transverse island flap (TVIF) onlay with tubularized incised plate urethroplasty (TIP) in primary hypospadias repair. PATIENTS AND METHODS: We retrospectively evaluated 76 consecutive patients who underwent TVIF onlay (n = 42) and TIP (n = 36) between January 1997 and April 2006. The success rate and complications were compared according to the surgical technique and the severity of the defect (meatal position prior to surgery). RESULTS: The mean patient age at surgery was 48 (range, 9-132) months in the TVIF onlay group and 49 (range, 10-348) months in the TIP group. All patients were followed-up for at least 12 months. With mean follow-ups of 40 months and 32 months, the overall complication rates were 30.9% (13/42) and 23.5% (8/34) in the TVIF onlay group and TIP group respectively (p = 0.305). Urethrocutaneous fistula rates were 23.8% (10/42) in the TVIF onlay group compared to 14.7% (5/34) in the TIP group (p = 0.393). No complications were found in either group with distal hypospadias. In proximal hypospadias, the complication rate was 30% (6/20) in the TVIF onlay group, compared to 37.5% (6/16) in the TIP group (p = 0.751). CONCLUSION: In this study, the surgical outcomes of TVIF onlay and TIP were comparable. The TIP procedure should be preferred for distal and midshaft defects because of its simplicity and low complication rate. In proximal hypospadias repair, TVIF onlay might be better than TIP; this will be clearer once the number of patients have increased sufficiently to show statistical significance.

Outcomes of surgical treatment for upper urinary tract transitional cell carcinoma: comparison of retroperitoneoscopic and open nephroureterectomy.

OBJECTIVES: To determine the surgical and oncologic outcomes in patients who underwent retroperitoneoscopic nephroureterectomy (RNU) in comparison to standard open nephroureterectomy (ONU) for upper urinary tract transitional cell carcinoma (TCC). PATIENTS AND METHODS: From April 2001 to January 2007, 60 total nephroureterectomy were performed for upper tract TCC at Siriraj Hospital. Of the 60 patients, thirty-one were treated with RNU and open bladder cuff excision, and twenty-nine with ONU. Our data were reviewed and analyzed retrospectively. The recorded data included sex, age, history of bladder cancer, type of surgery, tumor characteristics, postoperative course, disease recurrence and progression. RESULTS: The mean operative time was longer in the RNU group than in the ONU group (258.8 versus 190.6 min; p = 0. < 001). On the other hand, the mean blood loss and the dose of parenteral analgesia (morphine sulphate) were lower in the RNU group (289.3 versus 313.7 ml and 2.05 versus 6.72 mg; p = 0.868 and p = 0.018, respectively). There were two complications in each group. No significant difference in p stage and grade in both-groups (p = 0.951, p = 0.077). One patient with RNU had lymph node involvement, three in ONU. Mean follow up was 26.4 months (range 3-72) for RNU and 27.9 months (range 3-63) for ONU. No port metastasis occurred during follow up in RNU group. Tumor recurrence developed in 11 patients (bladder recurrence in 9 patients, local recurrence in 2 patients) in the RNU group and 14 patients (bladder recurrence in 13 patients, local recurrence in 1 patient) in the ONU group. No significant difference was detected in the tumor recurrence rate between the two procedures (p = 0.2716). Distant metastases developed in 3 patients (9.7%) after RNU and 2 patients (6.9%) after ONU. The 2 year disease specific survival rate after RNU and ONU was 86.3% and 92.5%, respectively (p = 0.8227). CONCLUSION: Retroperitoneoscopic nephroureterectomy is less invasive than open surgery and is an oncological feasible operation. Thus, the results of our study supported the continued development of laparoscopic technique in the management of upper tract TCC.

Retroperitoneoscopic nephrectomy in dialysis dependent patients and comparison with open surgery.

OBJECTIVE: To evaluate the surgical outcomes and morbidity of retroperitoneoscopic nephrectomy compared with open nephrectomy for dialysis dependent patients. MATERIAL AND METHOD: Between November 2002 and August 2007, 14 hemo or peritoneal dialysis patients underwent nephrectomy or nephroureterectomy at Siriraj Hospital. Of the 14 patients, seven were treated with retroperitoneoscopic nephrectomy and seven with open nephrectomy. A retrospective review and data were carried out. The patient factors, type of surgery, perioperative outcomes and complications were analyzed. RESULTS: There was no conversion rate in the retroperitoneoscopic group. The mean estimated blood loss, analgesic requirement and time before starting oral intake were lower in the retroperitoneoscopic group (141.4 +/- 95 versus 292.8 +/- 226 ml, 5.0 +/- 4.5 versus 7.6 +/- 1.9 mg and 14.5 +/- 16.1 versus 23.1 +/- 23.3 hours, respectively). On the other hand, the mean operative time in the retroperitoneoscopic group was longer than the open group but with no significant difference (177.14 +/- 51 versus 160.71 +/- 84 min, p = 0.521). Two patients in the open group required intraoperative blood transfusion. There were two complications. One patient developed a large retroperitoneal hematoma after retroperitoneoscopic nephrectomy. Another had a perivesical collection in the open nephrectomy group. No mortality related to the procedures occurred. CONCLUSION: Retroperitoneoscopic nephrectomy should be considered as the procedure of choice for dialysis dependent patients. This has all the benefits of minimally invasive surgery such as reduced blood loss, minimal post operative pain leading to faster convalescence.

Intravesical knotting of a feeding tube used as a urinary catheter.

Urethral catheterization is a common procedure among pediatric patients. Intravesical knotting of a polyethylene feeding tube used as a urethral catheter is rare. This report described such a complication in an infant who had urethral catheterization with 5 Fr feeding tube. Removal of the catheter necessitated cystotomy. This complication is preventable if the feeding tube is inserted only as short as possible to retrieve urine.

Surgical reconstruction of exstrophy-epispadias complex: analysis of 13 patients.

BACKGROUND: Because exstrophy-epispadias complex is uncommon and satisfactory surgical reconstruction outcomes are difficult to achieve, the surgical repairs by one surgeon (PS) were analysed over a 14-year period. METHODS: Retrospective analysis was performed on 13 patients with the complex who underwent surgery between January 1986 to August 2000. Cosmesis and continence were evaluated. Complications including wound dehiscence and urethrocutaneous fistula were reported. RESULTS: Of six patients with classical exstrophy who underwent functional bladder closure, all had good cosmesis except one who had partial dehiscence. Four patients with isolated epispadias had satisfactory cosmesis. Urethrocutaneous fistula was found in one boy in the classical exstrophy group. Continence was achieved in three out of four patients who had bladder neck reconstruction. One girl whose bladder neck was severely obstructed after functional bladder closure, had continent catheterizable stoma. CONCLUSION: Functional bladder closure yielded satisfactory cosmetic outcome. Bladder neck reconstruction made the patient dry in 75% of cases.