Use of Holmium:YAG laser to facilitate removal of intravesical foreign bodies.

BACKGROUND AND PURPOSE: Foreign bodies in the bladder present a challenge to the urologist. Previously, endoscopic extraction, with or without perineal urethrotomy, or open cystotomy were the only treatment choices. We describe a novel use of the Ho:YAG laser for the removal of intravesical foreign bodies. We further tested the laser on objects that have been reported in the literature to necessitate open cystotomy to determine their suitability for endoscopic removal. MATERIALS AND METHODS: The Ho:YAG laser is introduced through the cystoscope and used to cut large foreign bodies into a size that can be extracted through the urethra. We tested the Ho:YAG laser ex vivo on other objects that have been reported as intravesical foreign bodies. RESULTS: We removed a large complex foreign body with the laser that would otherwise have necessitated open cystotomy. No injury or sequela was observed. Many commonly reported intravesical foreign objects seem amenable to similar treatment. CONCLUSION: The Ho:YAG laser should be considered for use to facilitate removal of foreign bodies from the bladder.

Case report: bilateral hand-assisted laparoscopic nephrectomy in a patient with polycystic horseshoe kidney.

PURPOSE: To report the use of the hand-assisted laparoscopic (HAL) technique for removal of a horseshoe kidney in a patient with autosomal dominant polycystic kidney disease (ADPKD). CASE REPORT: Hospital and outpatient records were reviewed for a 65-year-old man with end-stage renal disease secondary to ADPKD who underwent HAL bilateral nephrectomy of his horseshoe kidney in preparation for kidney transplantation. The surgical method is described. It was completed successfully with an operative time of 280 minutes and an estimated blood loss of 350 mL. CONCLUSION: Bilateral HAL nephrectomy can be considered as an option for surgical removal of very large polycystic horseshoe kidneys.

Computerized tomographic angiography for renal donor evaluation leads to a higher exclusion rate.

PURPOSE: We compared the exclusion rate for potential living renal donors evaluated with computerized tomography angiography and radionuclide renal scintigraphy (renal scan) vs excretory urogram, renal scan and renal arteriography. MATERIALS AND METHODS: From March 2004 through February 2006, 603 consecutive patients were evaluated as potential living renal donors. From March 2004 through February 2005, 270 consecutive patients underwent evaluation with excretory urogram, renal scan and renal angiography (group 1). Of these patients 16 underwent computerized tomography to evaluate abnormalities detected on excretory urogram. From March 2005 through February 2006, 333 consecutive patients underwent evaluation with computerized tomography angiography and renal scan (group 2). The number of patients excluded for medical reasons and/or radiographic abnormalities was determined for the 2 groups. RESULTS: More than twice as many patients evaluated with computerized tomography were excluded. In group 1, 7% of patients (20 of 270) were excluded from donation due to radiographic findings vs 16% (53 of 333) in group 2 (p=0.0016). Of the patients 26% and 23% were excluded from renal donation for medical reasons in groups 1 and 2, respectively (p=0.5059). CONCLUSIONS: Multidetector row computerized tomography angiography increases the detection of incidental radiographic abnormalities as well as the renal donor exclusion rate. The increased sensitivity of computerized tomography angiography has created a dilemma for those determining patient eligibility for kidney donation because the clinical significance of many of these findings is unclear. Additional studies should address the significance of these incidental findings so that patients are not needlessly excluded from kidney donation.

Bilateral metastatic renal hemangiopericytoma ten years after primary intracranial lesion.

We report a case of bilateral metastatic renal hemangiopericytoma. A 37-year-old Caucasian male presented in 1993 with intracranial hemangiopericytoma. Subsequent metastatic disease noted years later include bilateral renal hemangiopericytoma 10 years after initial presentation. To our knowledge, this is only the second reported case of bilateral metastatic renal hemangiopericytoma.

Retrograde stenting for obstruction of the renal transplant ureter.

OBJECTIVES: To present our experience with retrograde stent placement and stent exchange for transplant ureteral obstruction. METHODS: A review of our renal transplant database was performed to identify all renal transplant patients who underwent attempted retrograde ureteral stenting for allograft ureteral obstruction or attempted allograft ureteral stent exchange between May 1992 and April 2004. A retrospective review was performed. RESULTS: Forty patients underwent 52 attempted retrograde ureteral stent placements, and 11 patients underwent a total of 27 attempted stent exchanges. In patients with ureteral obstruction, the most common clinical signs and symptoms were nausea, vomiting, diarrhea, abdominal pain, fever, decreased urine output, edema, and an elevated serum creatinine. Of the 52 cases of allograft ureteral obstruction and attempted retrograde ureteral stent placement, 28 (53.8%) were managed successfully with retrograde ureteral stenting. Of the 27 attempted stent exchange procedures, a successful exchange was accomplished in 23 cases (85.2%). CONCLUSIONS: Cystoscopy with retrograde allograft stent placement is a reasonable first approach to the management of transplant ureteral obstruction and is successful in more than one half of cases.

Bilateral metastatic renal hemangiopericytoma ten years after primary intracranial lesion

We report a case of bilateral metastatic renal hemangiopericytoma. A 37-year-old Caucasian male presented in 1993 with intracranial hemangiopericytoma. Subsequent metastatic disease noted years later include bilateral renal hemangiopericytoma 10 years after initial presentation. To our knowledge, this is only the second reported case of bilateral metastatic renal hemangiopericytoma.