[Unilateral combined lap partial nephrectomy and pyelolithotomy for ipsilateral tumor & kidney staghorn stone]

OBJECTIVE: To discuss the feasibility, safety, and effectiveness of conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone. MATERIALS AND METHODS: Retrospective multicentral comparative study. Group "Combo" was presented by patients with the mentioned combined pathology (n=15). Group "Standart" (n=69) formed from common patients who underwent standard lap partial nephrectomy for renal tumor in the absence of kidney stones. Perioperative factors and results were studied and compared. Video presentation of combined surgical technique is available at: https://youtu.be/fAfYJDvGzsU. RESULTS: Of all patients, no positive margins, no conversions to open surgery or nephrectomy & any complications Clavien >III were detected. There were no any significant differences between the two groups except for OR time (150 [120; 210] vs 130 [100; 180] min; p=0,001). Differences between indexes of WIT (16,27+/-3,8 vs 15,9+/-4,5 min; p=0,107), EBL (200 [150; 300] vs 200 [150; 300] cc; p=0,981), length of stay (7 [6;9] vs 8[6;9] days; p=0,611), intraop complications (0,00 vs 4,3%; p=0,411) and values of postop Clavien III rate (0,00 vs 4,3%; p=0,411) for "Combo" & "Standart" respectively were comparable as well as oncological outcomes. Stone-free rate for combined procedures reached 93,3%. CONCLUSION: conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone is safe and efficient alternative to 2-step treatment of this rare disease.

[Laparoscopic ileal ureteral substitution. Results of the first 40 operations].

INTRODUCTION: Despite the twenty-year history of laparoscopic ileal ureteral substitution, the literature is lacking studies reporting its outcomes, and those few are mainly case reports. Besides, they usually describe surgery from combined access, when the ileal segment resection and ileo-ileal anastomosis are performed from mini-laparotomy, and the remaining stages are done endoscopically. AIM: To conduct a multicenter retrospective analysis of our series of patients undergoing laparoscopic ileal ureteral substitution using only endoscopic access. MATERIAL AND METHODS: From 2010 to 2017, 48 ureters were replaced completely laparoscopically in 40 patients. Of them, 33 patients underwent total ureteric replacement, and the others had a subtotal ileal ureteral substitution. Video describing the operation technique is available on https://youtu.be/IeA60pSiUBE. RESULTS: The mean operating time was 335 minutes, and the estimated blood loss was 221 ml. Intraoperative complications (7.5%) were resolved during surgery. No patients required conversion to open surgery. There was no mortality. Postoperative Clavien III complications were observed in 7.5% of patients. The mean length of hospital day was 13.5 days. Functional results were followed from 6 months to 7 years. CONCLUSIONS: The presented material is the largest available in the literature, and the results, including long-term functional outcomes, demonstrate the efficacy and safety of laparoscopic technologies in the treatment of extensive strictures and obliterations of the ureter.

[Laparoscopic pyelolithotomy for staghorn kidney stones. multi-center study].

AIM: To analyze the effectiveness and safety of laparoscopic pyelolithotomy (LP) in treating staghorn stones. MATERIALS AND METHODS: A multicentre retrospective analysis of the results of LP performed from January 2004 to December 2016 was conducted. INCLUSION CRITERIA: patients with staghorn calculi K3-K4, who underwent LP as an alternative to percutaneous nephrolithotripsy. The analysis included the incidence and structure of intra- and postoperative complications, the causes of access conversion, operating time, duration of postoperative hospital stay and stone clearance. RESULTS: A total of 137 patients met the inclusion criteria, including 78 (56.93%) men. There was no mortality and access conversion. Intraoperative complications occurred in 2 (1.46%) patients. Operating time was 130 [100; 150] min, blood loss was 150 [100; 200] ml. No need for blood transfusion was observed. The cumulative rate of postoperative complications was 5.11%, stone clearance was achieved in 86.13% of observations, the duration of postoperative hospital stay was 7 [7; 11] days. CONCLUSION: In cases of dense staghorn calculi located in a large "extra-renal" pelvis and have calyceal branches equal to the diameter of their necks, laparoscopic pyelolithotomy is an alternative not only to open, but also to percutaneous surgery.

[Comparative assessment of treatments for prostate adenoma greater than 100 cm3].

AIM: To compare holmium laser enucleation of the prostate (HoLEP) and endovideosurgical (EVS) adenomectomy in the treatment of prostate adenoma. MATERIALS AND METHODS: We compared treatment results of 180 patients with prostate adenomas greater than 100 cm3 who underwent EVS adenomectomy (n=90) and laser enucleation of the prostate (n=90). The analysis included the following parameters: duration of catheterization, length of postoperative hospital stay, I-PSS score, maximum urinary flow rate measured by uroflowmetry and complications according to Clavien-Dindo grading systems. RESULTS: There were no significant differences in patient age, preoperative prostate size, glandular tissue weight, and operative time. The duration of catheterization (p=0.0008) and length of postoperative hospital stay (p<0.0001) were significantly shorter in the HoLEP group. Both groups showed a statistically significant improvement in functional performance at three months post-surgery. Complications in the HoLEP and EVS adenomectomy group occurred in 18 (20%) and 23 (25.55%) patients, respectively (p>0.99). CONCLUSION: The two methods mentioned above are widely used in the treatment of prostate adenoma. However, holmium laser enucleation of the prostate shows similar short-term functional results and complication rates compared with EVS adenomectomy for prostate adenomas greater than 100 cm3. The patients of the HoLEP group had better results regarding the duration of catheterization and length of postoperative hospital stay. Therefore, laser enucleation is the preferred surgical modality for prostate adenomas greater than 100 cm3.

[Internal drainage in cancer patients: optimizing treatment of stent-related symptoms].

INTRODUCTION: The so-called stent-related symptoms caused mainly by detrusor overactivity due to distal ("cystic") curl of the internal stent are common among patients with this type of drainage. The need for long-term stenting makes the quality of life of cancer patients one of the challenging problems of modern urology. The aim of this study was to optimize treatment of stent-related symptoms in cancer patients with internal long-term stents by complementing the treatment regimen with m-anticholinergic solifenacin. MATERIALS AND METHODS: From November 2013 to November 2015 68 cancer patients (26 males, 42 females, age 36-79 years) underwent elective internal ureteral stenting for drainage of the upper urinary tract (UUT) with special long-term stents coated with the hydrogel. The urinary tract obstruction was caused by urological (24), gynecological (26) and colorectal (18) cancers. Before deciding on urinary tract drainage, all patients were treated with radiation or chemotherapy, 28 (41.2%) patients underwent surgery, but on admission all of them had contraindications to radical surgery for different reasons. In 52 (76.5%) patients UUT stenting was performed using transurethral access, in 12 (17.6%) by percutaneous access and in another 4 (5.9%) by the combined access with patients in the supine position. Percutaneous and combined access was used in cases of impracticability (failure) of transurethral stenting. Patients in group 1 (n=32) after stent placement received standard therapy co-administered with solifenacin 5 mg daily, group 2 (n=36) - only standard therapy. The data analyzed were the technical features of the internal drainage, optimal access and registered solifenacin-related adverse events. Control examinations were scheduled once in 3 months after stent placement according to the following algorithm: ultrasound scanning, laboratory test monitoring and, if indicated, plain urography. To objectify the severity of stent-related symptoms, a survey of patients using a special questionnaire was conducted. Visual analog scale was used to measure subjectively the patients condition. RESULTS: After 12 months only 48 patients (26 from group 1 and 22 from group 2) completed the study. Follow-up examinations revealed that the patients in group 1 had significantly lower score of stent-related symptom severity and better ratings in visual analog scale. The greatest difference (1-2 points) was found in urgency and urinary frequency scores. The safety profile of solifenacin 5 mg corresponded to the findings of previous studies, there was no serious adverse events requiring discontinuation of the drug. CONCLUSIONS: Installing internal stents in UUT in cancer patients requires relevant experience in Roentgen-endoscopic operations using transurethral and percutaneous approaches and special equipment. In most cases, for preventing and eliminating supravesical obstruction in cancer patients, special internal stents for the long term placement are required. The add-on solifenacin therapy 5 mg/day resulted in almost 20% reduction in the severity of stent-related irritative symptoms and improved the quality of life in this extremely challenging category of patients.