Objectives The aim of this study was to compare the perioperative outcomes of open (OPN) and laparoscopic (LPN) partial nephrectomy in obese and non-obese patients. Methods We analyzed records for a ...cohort of 56 patients (28 obese and 28 non-obese) who underwent OPN, as well as 112 (56 obese and 56 non-obese) who underwent LPN. Results Obese patients undergoing OPN had increased operative time (285.9 ± 69.7 versus 195.2 ± 59.8 minutes), blood loss (484.5 ± 272.1 versus 391.7 ± 308.6 mL), clamp time (44.4 ± 12.8 versus 28.2 ± 10.5 minutes), intraoperative complications (14.3% versus 1.8%), postoperative complications (35.7% versus 17.9%), and hospital stay (6.4 ± 2.8 versus 3.2 ± 2.2 days) than those undergoing LPN. Comparison of obese versus non-obese patients who underwent LPN revealed similar perioperative outcomes, with the exception of a greater blood loss in the obese patient cohort (391.7 ± 308.6 versus 280.9 ± 202.1 mL). Finally, in comparing perioperative data among non-obese patients who underwent OPN versus LPN, those who underwent LPN were found to have improved operative times (248.9 ± 45.0 versus 181.1 ± 62.4 minutes), less blood loss (412.4 ± 274.6 versus 280.9 ± 202.1 mL), fewer intraoperative complications (21.4% versus 1.8%), and shorter length of hospital stay (6.3 ± 2.8 versus 3.2 ± 1.6 days). Conclusions Laparoscopic partial nephrectomy has significantly better perioperative outcomes than open partial nephrectomy in both the obese and non-obese populations.
Transmesenteric Laparoscopic Pyeloplasty Romero, Frederico R.; Wagner, Andrew A.; Trapp, Claudemir ...
The Journal of urology,
12/2006, Letnik:
176, Številka:
6
Journal Article
Recenzirano
Traditionally transperitoneal laparoscopic access to ureteropelvic junction obstruction has been performed in retrocolic fashion. We assessed transmesenteric laparoscopic pyeloplasty to correct ...ureteropelvic junction obstruction and compared results to those in patients undergoing traditional retrocolic laparoscopic pyeloplasty.
Between August 1999 and July 2005, 188 consecutive transperitoneal laparoscopic pyeloplasties were performed at our institution. A total of 18 patients underwent a transmesenteric approach and 170 underwent the classic retrocolic approach. Patient selection for the transmesenteric approach was at surgeon discretion with the inclusion criterion of recognition of the renal pelvis and/or ureter through the descending colonic mesentery.
Compared to patients undergoing traditional retrocolic procedure the transmesenteric approach was more commonly applied in younger individuals and males, and for pathological conditions on the left side and malrotated kidneys. The transmesenteric approach lowered operative time by a mean of 22.5% and decreased hospital stay by 19.2%. The patency success rate was 100% at a mean followup of 18.6 months for the transmesenteric approach and 94.1% at a mean followup of 22 months for the retrocolic approach.
In a select group of patients transmesenteric pyeloplasty may represent a more rapid alternative to the transperitoneal retrocolic approach and speed convalescence with similar success rates.
Leiomyomas are benign mesenchymal tumors that rarely occur in the kidney. We present the reports of three renal leiomyomas diagnosed and treated at our institution during the past 10 years. On the ...basis of our experience, preoperative diagnosis may be possible through image-guided percutaneous biopsy, and conservative treatment with either expectant management or minimally invasive nephron-sparing surgery should always be considered.
Objectives To address the incidence of local recurrence and port site metastasis in patients who underwent laparoscopic radical nephroureterectomy (RNU) for upper tract transitional cell carcinoma ...(TCC). Methods Between August 1993 and February 2006 116 laparoscopic RNU were performed in 115 patients at our institution. A traditional open excision, a laparoscopic stapler resection or a different approach was used for the management of the distal ureter in 76, 27, and 11 cases, respectively. Clinical follow-up as well as perioperative and pathologic data were retrospectively collected. Results Perioperative and pathologic data were available in all 116 cases. Clinical outcomes were available in 107 patients with a mean follow-up of 30.5 months (range 1 to 148). Six patients (5.6%) had a local recurrence develop, including 1 patient with port site metastasis (0.9%) at an average of 5.7 months. In 2 of these patients, violation of the ipsilateral urinary tract was noted perioperatively. Conclusions We report, in this large single-center series of laparoscopic RNU, a low incidence of local recurrence. Our results confirm that a laparoscopic approach to upper tract TCC does not result in a clinically significant increased risk of tumor spillage provided that principles of oncologic surgery are followed.
OBJECTIVE
To review the trends in the operative management of renal tumours over a 14‐year period at a university hospital, as the therapeutic options available for treating renal tumours have ...increased over the past decade.
PATIENTS AND METHODS
The study was a retrospective chart review of 1621 consecutive patients undergoing treatment for renal tumours from January 1991 to March 2005. The characteristics assessed included patient demographics, tumour size, operative duration and treatment.
RESULTS
During the study period, 624 (38.6%) open, 883 (54.6%) laparoscopic and 111 (6.7%) percutaneous approaches were performed. The number of renal tumours treated increased annually, as did the use of minimally invasive techniques (93.4% in 2005). Conversely, the number of open surgical treatments used declined both absolutely and proportionally. Over the study period, for tumours of ≤ 4 cm, laparoscopic partial nephrectomy was the most common approach (41.0%). Percutaneous ablation has also made an impact as a treatment method for small tumours (13.8% in 2005). For tumours of >7 cm, open radical nephrectomy (ORN) was the most common method of treatment over all years. However, since 2002, laparoscopic radical nephrectomy (LRN) surgery has been increasingly used over ORN for treating this tumour group (73% LRN vs 19.2% ORN in 2004).
CONCLUSION
The available treatment options for renal tumours have increased significantly since the early 1990s. At a university hospital in which there are physicians with a specific interest in minimally invasive surgery and ablative treatments, minimally invasive approaches have become the standard treatment.
Crossed renal ectopia is a rare congenital malformation. We report a case of renal cell carcinoma in a 51-year-old man with right-to-left crossed fused renal ectopia. The patient was treated with ...ultrasound-guided laparoscopic heminephrectomy. Postoperative three-dimensional computed tomography showed normal perfusion of the remaining part of the kidney, with good excretion of contrast from both units of the cross-fused kidney.
To evaluate the safety and oncologic efficacy of extravesical laparoscopic stapling of the distal ureter and bladder cuff during nephroureterectomy for pelvicaliceal transitional-cell carcinoma ...(TCC).
Patients with primary pelvicaliceal TCC and no history of TCC of the bladder or ureter who underwent extravesical laparoscopic control of the bladder cuff were compared with a similar group of patients submitted to the open transvesical approach. Operative results and oncologic outcomes were compared.
Operative time, estimate blood loss, length of hospital stay, rate of positive margins, and postoperative complications were not statistically different in the two groups of patients. With an average of almost 4 years of follow-up, the laparoscopic approach to the bladder cuff was associated with an increase in the overall rate of recurrence and a shorter recurrence-free survival, although these differences were not statistically significant. Rates of local and bladder recurrence and distant metastases were similar.
Laparoscopic stapling of the bladder cuff has oncologic efficacy and outcomes similar to those of the open transvesical approach. However, the laparoscopic procedure may carry a higher risk of recurrence and a shorter recurrence-free interval than the open transvesical approach.
To assess the early reinstatement of continuous ambulatory peritoneal dialysis (CAPD) after transperitoneal radical nephrectomy.
The medical records of the 3 patients who were using CAPD before ...laparoscopic radical nephrectomy were retrospectively reviewed. All 3 were reinstated on CAPD during the second postoperative week.
In these 3 patients, the mean hospital stay was 6 days (range 3 to 9), and CAPD was reinitiated 12.7 days (range 10 to 14) after laparoscopic surgery. During the interim between surgery and reinstituting CAPD, all 3 patients underwent hemodialysis (HD) in the hospital and were discharged to local outpatient HD centers. No difficulties were associated with the transition to CAPD, and no complications had occurred after the reinstatement of regular CAPD regimens at a mean follow-up of 11 months (range 10 to 13) in this group of patients.
The results of this study have shown that CAPD can be reinstated within 2 weeks of laparoscopic transperitoneal radical nephrectomy without short-term complications.
To evaluate the preferred position used by Brazilian Urologists to perform DRE, the position that Brazilian patients prefer or think it is less embarrassing to have a DRE, and to evaluate the results ...of DRE with patients in left lateral decubitus, modified lithotomy, standing-up, or the physician will have them place their elbows on the table and squat down slightly.
Brazilian Urologists were contacted by e-mail, and 200 patients answered a questionnaire while undergoing prostate cancer screening.
The preferred position was modified lithotomy position reported by 63.4% of Urologists, and left lateral position reported by 42.7% of the patients. Total DRE time was lower in the standing-up position. Pain and urinary urgency scores were similar regardless of the position used, and bowel urgency score was higher in patients squatting down. Patients were similar in terms of age and PSA level, but there was a significant difference between the standard deviations of estimated prostate weight in left lateral position. There were no differences in prostate asymmetry, positive DRE, or incomplete palpation of the prostate rates among different examination positions.
Despite individual subjective preferences, a faster examination time in the standing-up position, and higher bowel urgency scores in patients with their elbows placed on the table and squatting down slightly, there were similar rates of prostate asymmetry, positive DRE, and incomplete palpation of the prostate, and comparable patient tolerability among different examination techniques.
The prostate exam Romero, Frederico R; Romero, Antonio W; Filho, Thadeu Brenny ...
Health education journal,
03/2012, Letnik:
71, Številka:
2
Journal Article
Recenzirano
Objective: To help students, residents, and general practitioners to improve the technique, skills, and reproducibility of their prostate examination.
Methods: We developed a comprehensive guideline ...outlining prostate anatomy, indications, patient preparation, positioning, technique, findings, and limitations of this ancient art of urological evaluation.
Results: The prostate exam was the first diagnostic test used for prostate cancer screening and other urological conditions. Although several alternative procedures have been developed in the past century, the prostate exam is still an important part of genital–pelvic evaluation because of its simplicity, cost and time effectiveness, and relatively minimal patient discomfort experienced.
Conclusion: With an aging population and increasing incidence of prostate diseases, it is imperative that healthcare professionals possess the knowledge, skills, and attitudes to make the prostate exam a routine part of a complete physical examination.
PDF
