Outcome and complications of laparoscopic nephrectomy in patients with previous renal surgery.

OBJECTIVE: The aim of this study was to evaluate the technical difficulties, limitations, outcome, and complications of laparoscopic nephrectomy in patients with previous ipsilateral renal surgery. MATERIALS AND METHODS: Eighteen patients with a history of epsilateral renal surgery underwent laparoscopic simple nephrectomy for benign renal disease at our center between November 2001 and March 2005. All patients were informed about the details of the laparoscopic procedure, and an informed consent was obtained that included the possibility of an emergency laparotomy. All procedures performed were carried out through a transperitoneal approach. A separate table with a laparotomy set was available in the room and ready for open conversion. RESULTS: The procedure was completed in 13 patients. Excluding the cases converted to open surgery, the operative time ranged from 120 to 210 minutes, with a mean of 170 +/- 32.9. The intraoperative blood loss ranged from 30 to 400 cc, with a mean blood loss of 100. Complications included minor visceral injury (liver) in 1 patient, minor bleeding in 2, major bleeding (open conversion) in 1, technical failure (open conversion) in 4, postoperative bleeding (reexploration) in 1, and postoperative renal bed collection in 1. CONCLUSIONS: Laparoscopic nephrectomy is an alternative to the open nephrectomy for the removal of nonfunctioning kidneys in benign diseases and results in less morbidity and a shorter hospital stay. A higher conversion to open and complication rate should be expected in patients with previous open or endoscopic renal surgery and postinflammatory conditions.

Prostate-sparing cystectomy: Potential functional advantages and objective oncological risks; a case series and review.

OBJECTIVES: Prostate-sparing cystectomy (PSC) has been debated over the last decade; our aim was to assess the functional results and to evaluate the oncological outcome after PSC, to judge the value of this technique. PATIENTS AND METHODS: Twenty-six men (median age 62 years) who were candidates for radical cystectomy were operated between 2004 and 2009 in the urology departments of Foch Hospital, Suresnes, France, and Theodor Bilharz Research Institute, Giza, Egypt. They all underwent a PSC with orthotopic bladder substitution. The functional results were assessed at 1, 3 and 6 months, with the final results evaluated at 1 year. Incontinence was classified according to pads used per day, and erectile function after PSC was assessed using the International Index of Erectile Function questionnaire. There was a strict follow-up for oncological failure, with special attention given to the remnant of the prostate and prostatic urethra. RESULTS: The final functional results were assessed at 1 year, with daytime continence achieved in 22 patients (95%) and nocturnal leak in four (13%). At 1 year, 18 patients (83%) reported having erections on sexual stimulation. The median follow-up was 43 months, with an overall incidence of recurrence of 30% and a median time to metastasis of 30 months. At 36 months, the overall survival rate was 81%, with a tumour-free survival rate of 70%. CONCLUSION: PSC was no better than standard radical cystectomy, and should only be offered to patients who prefer preservation of their sexual function and continence over appropriate tumour control.