Laparoscopic bilateral native nephrectomies with simultaneous kidney transplantation.

UNLABELLED: Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Extirpation of polycystic kidneys for various medical reasons has been performed using many different approaches in attempts to limit morbidity from such a large operation. In indicated patients, it has usually been offered in a staged approach with renal transplantation to avoid graft complications. We published the first case of simultaneous laparoscopic bilateral native nephrectomy with kidney transplant in 2008. The present study shows our continued experience with offering this minimally invasive, single surgery alternative. The results are comparable to a staged laparoscopic approach with significantly shorter total hospital stay and one recovery for the patient and his/her family. OBJECTIVE: • To analyse the perioperative outcomes of native bilateral laparoscopic nephrectomy (BLN) with simultaneous kidney transplantation. PATIENTS AND METHODS: • From November 2000 to April 2011, 37 patients were seen for renal failure secondary to autosomal-dominant polycystic kidney disease (ADPKD) and underwent renal transplant with native nephrectomies at a single tertiary academic centre. • In all, 15 patients underwent BLN for ADPKD followed by simultaneous kidney transplantation. • The other 22 patients underwent BLN for ADPKD with kidney transplant performed at a separate setting. • Demographic data, perioperative outcomes, complications regardless of need for intervention, and graft function were analysed in both groups. RESULTS: • The combined surgery was completed without intraoperative complication in all cases. • The median total operative duration was 372 min, estimated blood loss was 300 mL with two patients requiring transfusion, and the median (range) hospital stay was 5 (3-7) days. • All patients had immediate graft function with additional relief of compressive symptoms. • In comparison to our staged cohort, the simultaneous group had a significantly shorter total hospital stay. • All other outcomes and complication rates were comparable. CONCLUSION: • In ADPKD, a less invasive laparoscopic approach for native nephrectomies with simultaneous renal transplant offers comparable morbidity without graft compromise and the convenience of one operation and one recovery for the patient.

Testicular Metastasis From Prostatic Adenocarcinoma Presenting as Recurrent Epididymo-orchitis.

OBJECTIVE: To present a rare case of testicular metastasis from prostatic adenocarcinoma origin and to provide a meaningful discussion of currently available supporting literature. MATERIALS AND METHODS: Pertinent health information was obtained by retrospective analysis of hospital electronic medical records. RESULTS: A 93-year-old man with history of castration-resistant prostatic adenocarcinoma presented with recurrent episodes of epididymo-orchitis with initial symptoms responsive to oral antibiotics. Further investigation with testicular ultrasound revealed two 1-cm cystic lesions in the right testicle, one complex in nature, with bilateral mild-to-moderate hydroceles. Repeat ultrasound confirmed growth of lesions to 1.4 and 1.6 cm, respectively. Patient underwent bilateral orchiectomy with resultant symptomatic resolution. Surgical pathology returned with an isolated right testicular parenchyma infiltrated by adenocarcinoma from a primary prostatic neoplasm. Follow-up at 2 and 8 weeks postoperatively revealed prostate-specific antigen levels of 2.60 ng/mL and 4.14 ng/mL, and with no further complaints of pain. CONCLUSION: The most commonly documented sites for metastasis from a prostatic carcinoma origin are to regional lymph nodes and bone, followed by the lungs, liver, and adrenal glands. However, patients with a history of prostate cancer presenting with recurrent symptoms of epididymo-orchitis should have a high suspicion for testicular metastasis. Treatment with bilateral orchiectomy offers patients the possibility for both favorable symptomatic and oncologic outcomes.