Ureteroscopic resection of upper-tract transitional-cell carcinoma.

Technological advances have increased the applicability of endoscopic treatment for upper-tract transitional-cell carcinoma (TCC). Percutaneous and ureteroscopic tumor resection have become reasonable treatment options for patients with anatomically or functionally solitary kidneys, bilateral upper-tract tumors, significant renal insufficiency, or comorbid disease that would preclude standard open surgery. This approach also is being used increasingly on those with a normal contralateral kidney in whom nephroureterectomy and en bloc removal of the ipsilateral ureteral orifice and surrounding bladder cuff is considered the standard therapy. This paper reviews the current role of ureteroscopic management of upper-tract TCC.

Fibrin glue assisted 3-suture vasovasostomy.

PURPOSE: We report on the early results of fibrin glue assisted, 3-suture microsurgical vasovasostomy (FGV) technique in humans. MATERIALS AND METHODS: After Institutional Review Board approval, 42 patients were enrolled prospectively from October 2002 to March 2004. Patients underwent microsurgical 3-suture vasovasostomy with completion of the anastomosis with fibrin sealant. Patient and partner age, obstructive interval, female fertility status, gross appearance and presence of sperm on microscopic examination of vasal fluid, operative time, and pregnancy were noted. Semen analysis (SA) was obtained at 6 weeks, 3, 6, 9 and 12 months postoperatively. RESULTS: Of 42 patients 39 had postoperative SA. Mean followup was 6.2 months (range 1.5 to 12). Mean operative time was 79.4 minutes (range 50 to 120). The overall patency rate was 85% (33 of 39). Patency rate according to obstructive interval less than 3 years was 100%, 3 to 8 years 94%, 9 to 14 years 69% and 15 years or more was 67%. Patency rate with sperm on intraoperative SA was 96% (27 of 28) and 55% (6 of 11) with sperm absent. Nine pregnancies have been documented. CONCLUSIONS: FGV is potentially less time-consuming than standard microsurgical vasovasostomy, and may be appropriate for patients with sperm on intraoperative SA or a negative intraoperative SA, and an obstructive interval of 10 years or less. Patients without these findings should be considered for vasoepididymostomy. While the early results of FGV are promising, a larger study group with the ability to obtain longer followup is required to definitively establish equivalency to standard microsurgical vasovasostomy.

8-ply small intestinal submucosa tension-free sling: spectrum of postoperative inflammation.

PURPOSE: We report a series of postoperative inflammatory reactions of a tension-free pubourethral sling procedure using an 8-ply small intestinal submucosa (SIS) and review the literature regarding inflammatory reactions with this material in genitourinary reconstruction. MATERIALS AND METHODS: Between August 2002 and June 2003, 6 of 10 patients treated for stress urinary incontinence with 8-ply SIS had postoperative inflammatory reactions. Patients underwent a thorough evaluation, including history, physical examination and urodynamic studies, before surgical intervention. RESULTS: All patients presented with induration and erythema at the abdominal incision site(s) and pain 10 to 39 days postoperatively. Pelvic examinations were negative. In 3 patients the inflammatory reaction resolved with minimal or no intervention. Incision and drainage of a sterile abscess were required in 1 patient. Despite 7 days of prophylactic postoperative antibiotics and anti-inflammatory drugs, 2 patients had delayed inflammatory reactions. One patient had resolution with conservative treatment, while the other had an abscess that spontaneously drained. With short-term followup (mean 7 months, range 4 to 10), 8 patients are dry, 1 is improved and 1 is incontinent. CONCLUSIONS: While the results with the 8-ply SIS tension-free sling in the short term are encouraging, the additional morbidity is alarming and caution is warranted. It is essential that patients be made aware of potential risks and possible delayed presentation of morbidity with the use of this material. The human to 8-ply SIS interaction needs further investigation to ensure that long-term safety and efficacy will not be jeopardized. Until then we will continue to use other sling materials.