Computed tomography appearance of Hem-o-lok clips in patients who have undergone laparoscopic nephrectomy or nephroureterectomy.

BACKGROUND AND OBJECTIVES: Hem-o-lok clips are safe and reliable for controlling the renal vasculature. We retrospectively evaluated the CT appearance of Hem-o-lok clips in patients who had undergone laparoscopic radical nephrectomy (LRN) or nephroureterectomy (LRU) as well as their appearance on ex vivo CT scans. METHODS: Between January 2006 and December 2006, 19 patients underwent LRN or LRU, and their CT images were reviewed within 5 postoperative months. The Hem-o-lok clips were radiopaque in all of the patients' CT images, and their radiodensity value was 222 Hounsfield Units (HU). To confirm that Hem-o-lok clips are radiopaque on CT images, an ex vivo CT scan was performed. RESULTS: We confirmed that these clips are radiopaque on CT images and that they have a radiodensity of 223 HU. CONCLUSION: We conclude that the Hem-o-lok clips are radiopaque on CT images. It is important for urologists and radiologists to be aware of the CT appearance of Hem-o-lok clips when following up patients who have undergone LRN or LRU.

Retroperitoneoscopic pyeloplasty with concomitant neophropexy for a ureteropelvic junction obstruction in combination with nephroptosis.

INTRODUCTION AND OBJECTIVES: We herein describe our technique for retroperitoneoscopic pyeloplasty with concomitant nephropexy in patients with a ureteropelvic junction (UPJ) obstruction in combination with nephroptosis. METHODS: We performed this operation on three female patients with a right UPJ obstruction and nephroptosis diagnosed by intravenous urography, retrograde pyelography, computed tomography and an isotopic renogram. All patients underwent the insertion of a ureteral stent before laparoscopy, and they were placed in the flank position. A four-port, balloon-dissecting, retroperitoneal laparoscopic approach was used. Gerota's fascia was incised and the perirenal fat was completely dissected from the kidney. A UPJ obstruction was identified and pyeloplasty was performed using Anderson-Hynes dismembered anastomosis. Next, kidney fixation to the abdominal wall was performed by rows of renal capsular 2-0 nylon sutures which were secured to the quadratus lumborum fascia. All procedures were performed retroperitoneoscopically. RESULTS: The median operative time was 350 min with a range from 204 to 414 min. The median estimated blood loss was 50 ml with a range from 10 to 200 ml. The postoperative hospital stay was 6 days. There were no postoperative complications. The ureteral stent was removed at 6 weeks after surgery. Postoperative urography revealed a complete resolution of hydronephrosis in all cases with one complete resolution and two cases with an improvement of nephroptosis. All patients had a complete resolution of their symptoms. CONCLUSIONS: Retroperitoneoscopic pyeloplasty with concomitant nephropexy seems to be a feasible, effective and minimally invasive procedure for treating UPJ obstruction in combination with nephroptosis.

Usefulness of Ureteropyeloscopy for diagnosis of upper urinary tract tumors.

BACKGROUND: Upper urinary tract tumors have historically been diagnosed using urinary cytology examination and radiography. As the technique and instrumentation of ureteroscopic inspection and biopsy have advanced, ureteroscopic examination has become more routine. We studied the applicability and safety of using ureteropyeloscopy to diagnose upper urinary tract tumors. PATIENTS AND METHODS: Between January 1994 and October 1999, 50 patients at Kobe University Hospital underwent ureteropyeloscopy for suspected upper urinary tract tumors. RESULTS: The sensitivity values of radiography, urinary cytology, and ureteroscopy were 96%, 60%, and 92%, respectively. The specificity values of the three procedures examination were 12%, 84%, and 88%, respectively. No major complications or dissemination of malignant cells were evident. CONCLUSION: Ureteroscopic examination is a safe, sensitive, and specific means of detecting upper urinary tract tumors.

[Laparoscopic radical prostatectomy: initial 17 case report].

PURPOSE: We report our early experience of laparoscopic radical prostatectomy for clinically localized prostatic cancer. MATERIAL AND METHOD: Between April and December 2000, 17 patients with clinical stage T1c to T2b prostatic cancer underwent laparoscopic radical prostatectomy. The median age was 70.9 year old, the median preoperative PSA and the median Gleason score of biopsy specimens was 7.1 ng/ml, 6, respectively. We followed the operation technique from the "Montsouris technique". Briefly, we used five trocars (two 10-mm and three 5-mm trocars) and the operation was performed transperitoneally. Pelvic lymph node dissection was performed in only one patient (case 3). Urethrovesical anastomosis was performed with 6 to 9 interrupted 3-0 absorbable sutures. RESULTS: No conversion to open surgery or reoperation was required in all cases. Median operation time was 450 minutes (range 290 to 750) and median intraoperative bleeding (including urine) was 600 ml (range 100 to 3,135). Only one case (case 3) needed homologous blood transfusion. Median postoperative Foley catheterization period was 9 days (range 5 to 19). Intraoperative complications related to operation procedure were one rectal injury and three vesical injuries, which were treated by absorbable suturing laparoscopically. Major complication was one complete A-V block (case 3) who was required a transient discontinuance of the procedure. Surgical margins were negative in 13 cases. Postoperative pathological evaluation was one pT0, five pT2a, seven pT2b and four pT3a. PSA value decreased less than 0.2 ng/ml after surgery in all patients. Although six months have passed after the surgery in only 4 patients, all of them were fully continent. CONCLUSION: Although the operation time is still longer than that of conventional open procedures, intraoperative magnified vision allows a more precise and safer dissection, especially for apical dissection. We believe that operative time will decrease with more experience. These results show that laparoscopic radical prostatectomy can be an acceptable treatment option for localized prostatic cancer.

Laparoscopic removal of gonads in a Turner's syndrome mosaic female patient with isodicentric Y chromosome.

We report a case of laparoscopic adnexectomy in a prepubertal girl with an isodicentric Y chromosome and mosaic Turner's syndrome. This is the second reported case of laparoscopic adnexectomy in such patients.

[Laparoscopic resection of retroperitoneal tumors: report of two cases].

Here we report two rare cases of retroperitoneal tumors which were found incidentally and resected laparoscopically. Case 1; A 43-year-old woman presented with general fatigue and revealed liver dysfunction. Although the initial diagnosis with computed tomography (CT) was left non-functioning adrenal tumor, it was proven as a retroperitoneal tumor adjacent to the left adrenal gland by laparoscopic examination. The tumor was resected laparoscopically and diagnosed histopathologically as a solitary retroperitoneal neurofibroma. Case 2; A 68-year-old man was being followed for a renal stone and a perirenal tumor was found by CT. It was resected laparoscopically and diagnosed as a mature retroperitoneal teratoma by histopathological examination. We conclude that laparoscopic resection is useful for the retroperitoneal tumors as well as for adrenal tumors.

Long-term experience with orthotopic reconstruction of the lower urinary tract in women.

PURPOSE: We investigated the long-term outcome of orthotopic neobladders in women. MATERIALS AND METHODS: At our institutions 8 women have undergone lower urinary tract reconstruction with an orthotopic neobladder and have been followed for more than 4 years. After urethral sparing cystectomy the neobladder was constructed and connected to the native urethra. Late complications were analyzed, and voiding function was evaluated by a pressure flow micturition study and bead-chain cystourethrography. RESULTS: No late complications related to the surgery were noted. Of the 8 patients 7 were completely dry day and night. Four patients with ileal neobladder required clean intermittent catheterization, and hypercontinence might have been caused by downward migration of the neobladder and reduced neobladder pressure at voiding. No recurrence in the native urethra was noted, and all patients were satisfied postoperatively. CONCLUSIONS: These results of orthotopic neobladder in women are encouraging. Overall patient satisfaction was excellent. An international collaborative study is necessary to achieve the number of patients required to determine the ideal orthotopic neobladder for women.

[Endoscopic ureteroureterostomy for a complete obstructed ureter: a case report].

We report a case in which the completely obstructed ureter was successfully treated by endourological procedure. The patient was a 66-year-old male who had been admitted for panperitonitis caused by diverticulitis perforation of the sigmoid colon. About one month later, leakage of both stool and urine and left hydronephrosis were observed. Therefore, left percutaneous nephrostomy was performed and the artificial anus was created. Radiographic examination showed about 1 cm defect on the lower one-third of the left ureter. (1st Operation) A 9.5 Fr. rigid ureteroscope was inserted into the left ureter transurethrally and a 7.5 Fr. flexible ureteroscope was inserted percutaneously. Antegrade puncture using a stiff end of a 0.038-inch guidewire into the obstructed segment was failed. Then, we bit off the obliterated tissue with a biopsy forceps transurethrally towards the light from the flexible scope, and a 12 Fr. double-J stent was indwell. (2nd Operation) Eight weeks after the first operation, a 12 Fr. ureteroresectoscope was inserted transurethrally. Full-thickness cold-knife incision of the re-established ureter was failed, however. (3rd Operation) Two weeks after the second operation, a 12.5 Fr. ureteroscope was inserted transurethrally, and a full-thickness incision in the lateral position of the re-established ureter was successfully made by KTP-laser. Then, a 12 Fr. endopyelotomy stent was placed. (Result) Six weeks after the third operation, the stent was removed and DIP revealed the improvement in hydronephrosis. The patient presented no recurrence at 2-year follow up.

[Uretero-external iliac artery fistula: a case report].

We report a case of uretero-external iliac artery fistula. A 60-year-old female was referred to our hospital complaining of intermittent gross macrohematuria. She had undergone radical hysterectomy, radiation therapy and chemotherapy for advanced cervical cancer 2 years ago. The patient had a 7 Fr ureteral double-J stent for left hydronephrosis. Retrograde urography showed a filling defect (8 mm in diameter) of the left ureter. A contrast-enhanced computed tomographic scan showed left hydronephrosis and hydroureter but no evidence of fistula formation or extravasation. A pelvic arteriography revealed a pseudoaneurysm of the left external iliac artery at the crosspoint between the left ureter and the iliac artery. Surgical repair of the left uretero-external arterial fistula was successfully performed as well as left nephroureterectomy. The possibility of fistula formation between ureter and artery should be kept in mind in patients with long-term indwelling ureteral stents and history of radiation therapy.

Percutaneous treatment of transitional cell carcinoma of the upper urinary tract.

BACKGROUND: We evaluated the long-term effect of percutaneous resection in 2 Japanese patients with transitional cell carcinoma of the renal pelvis, and reviewed the medical literature on similar patients, to determine the appropriate indications for percutaneous treatment of transitional cell carcinoma in the upper urinary tract. RESULTS: Indications for endoscopic resection in the 2 patients were renal insufficiency and unsuitability for major open surgery. The patients had no recurrence during follow-up. Seven previous reports described percutaneous resection of upper urinary tract transitional cell carcinoma in 82 patients. Although 72.6% of the patients were successfully treated by percutaneous resection, half of the patients with grade 3 carcinoma developed recurrence. CONCLUSION: These results, together with those of the 7 published reports, suggest that percutaneous resection should be limited to selected patients with low-grade transitional cell carcinoma.

[Laparoscopic approach to idiopathic retroperitoneal fibrosis].

A 49-year-old male patient underwent an exploratory laparoscopy for a lumbosacral prevertebral mass which caused right hydronephrosis by extrinsic ureteral stricture. The diagnosis of idiopathic retroperitoneal fibrosis (IRPF) was made by the laparoscopic biopsy. We then proceeded to perform successfully laparoscopic ureterolysis and intraperitonealization of the ureter on the patient. Laparoscopic approach provides a less invasive alternative in diagnosis and treatment of the patient with IRPF.

[Urinary hCG beta-core fragment as a tumor marker for bladder cancer].

Human chorionic gonadotropin (hCG) is a highly specific tumor marker or trophoblastic neoplasms. Also in patients with non-trophoblastic tumors, hCG beta-related material has been frequently demonstrated in their urine. This material was termed beta-core fragment (beta-CF) since it is recognized by hCG beta-core directed antisera but not by hCG beta-carboxyterminal peptide (CTP) directed antisera. We measured the concentration of beta-CF in the urinary samples from patients with urothelial tumors and studied its clinical usefulness as a tumor marker. The concentration of beta-CF was expressed as ng/mg of creatinine in the urine and the cut-off value was 0.1 ng/mg.Cr. Thirty (61.2%) of 49 patients with bladder carcinoma had raised beta-CF levels and the positive rates were dependent upon pathological grade (25.0, 33.3 and 82.8% at G1, G2 and G3, respectively). The elevated urinary beta-CF were also detected in 5 of 7 patients with upper urinary tract carcinoma. However, there was no elevated urinary beta-CF level in prostate carcinoma. Serial determination in 13 patients with elevated beta-CF level prior to therapy showed that 12 patients had decreased concentrations after successful treatment, but 1 patient with persistently elevated urinary beta-CF level after treatment subsequently relapsed. The determination of urinary beta-CF may provide a useful tool in identifying and monitoring the response to treatment in patients with carcinomas of the bladder and the upper urinary tract.

[Spontaneous thrombosis of the pampiniform plexus--case report].

Spontaneous thrombosis of the pampiniform plexus is a extremely rare condition, with only 9 cases reported in the literature. We report here a case of this entity and demonstrate that surgical exploration should be indicated to rule out some of these other conditions, such as a tumor of the intrascrotal component, acute scrotum or inguinal herniation.

[Colon bladder replacement after total cystectomy].

Although ileal conduit diversion is widely accepted in the treatment of the patients undergoing radical cystectomy, many patients would prefer other alternatives which allow continence. and urination through the urethra. We describe a new procedure in which a segment of detuburalized right colon is used as a continent reservoir. Eight patients, 7 after radical cystectomy for bladder cancer and one after total exenteration for rectal cancer, have undergone colon bladder replacement. New created bladder had a capacity of 300 to 600 ml. All patients could pass urine through the urethra but one is on self-catheterization. Five of the 8 patients had no residual urine. Three months after operations 4 were totally continent and 3 were satisfactorily dry during daytime but slightly enuretic. Excretory urography showed no abnormalities in their upper urinary tract. Considering the "quality of life' of a patient, this procedure can be an ideal option for selected patients.

[A case of ureteral stenosis caused by ureteral endometriosis].

A case of ureteral endometriosis is reported A 42-year-old woman visited our clinic on December 3, 1985, with the complaint of right lumbago. Intravenous pyelography showed right hydronephrosis and retrograde pyelography revealed ureteral stenosis at 11 cm from right ureteral orifice and 2 cm long. Primary right ureter tumor was suspected. The operation was performed on January 16, 1986 and revealed periureteral mass. The mass was removed with ureter and ureteroureterostomy was performed. The pathological diagnosis was extrinsic ureteral endometriosis. Ureteral endometriosis has rarely been described and only 17 cases have been reported previously in Japan.

[A case of renal cell carcinoma of horseshoe kidney that produced AFP and caused hypercalcemia].

A very rare case of renal cell carcinoma of the horseshoe kidney that produced AFP and caused hypercalcemia is reported. The relationship between this renal cell carcinoma and hypercalcemia was obvious, but the mechanism of hypercalcemia was not revealed. The presence of AFP in cancer cells was demonstrated using the "ABC" method.