Comparison of renal function of patients after tumor nephrectomy versus donor nephrectomy: Long term outcome using a propensity score matching analysis.

Objective: To compare long-term incidence rate of chronic kidney disease (CKD) in patients after tumor nephrectomy (TN) and donor nephrectomy (DN) and to evaluate risk factors for developing CKD. Materials and methods: Data from 1048 patients who performed TN (552) and DN (496) between 2000 and 2018 at Siriraj hospital were retrospectively analyzed. We obtained 106 patients for each group after using a 1:1 propensity score matching by age and preoperative glomerular filtration rate (GFR). The incidence rate of CKD and risk factors for CKD stage ≥3 were evaluated. Results: There were no differences in incidence of CKD between TN (26.4 %) and DN group (24.5 %) with median follow-up time of 4.95 and 6.05 years (p = 0.308). There were no differences in mean GFR postoperatively at up to ten years follow-up (p = 0.378). The GFR at last follow-up was 71.15 and 68.1 ml/min/1.73 m2 in TN and DN groups (p = 0.172). The TN showed more proteinuria than DN group but not for postoperative hypertension. The multivariate analysis showed age 47 years (p = 0.012) and preoperative GFR 100 (p = 0.001) as a risk factor for developing CKD after nephrectomy but not for type for nephrectomy (p = 0.753). Conclusion: The risk of developing CKD in patients after tumor nephrectomy was the same as in living kidney donors who were matched by age and preoperative GFR. Age over 47 years and preoperative GFR <100 of patients should be considered risk factors for developing CKD in patients choosing nephrectomy as the treatment of choice.

Perioperative factors and 30-day major complications following radical cystectomy: A single-center study in Thailand.

Objective: This study aims to evaluate the prevalence of early postoperative complications of radical cystectomy, using standardized reporting methodology to assess perioperative characteristics and determine risk factors for major complications. Materials and methods: A retrospective study included 254 consecutive bladder cancer patients undergoing RC between 2012 and 2020 at a urological cancer referral center. Postoperative complications within 30 days were recorded and graded according to the Clavien-Dindo classification (CDC). The study examined risk factors, including novel inflammatory-nutrition biomarkers and perioperative serum chloride. Results: Total complications were observed in 135 (53 %). Of these, 47 (18.5 %) were high grade (CDC ≥ 3). Wound dehiscence was the most common complication, occurring in 14 (5.5 %) patients. Independent risk factors for major complications included an age-adjusted Charlson comorbidity index (ACCI) > 4 and thrombocytopenia (odds ratio [OR] 3.67 and OR 8.69). Preoperative platelet counts < 220,000/µL and albumin < 3 mg/dL were independent risk factors for wound dehiscence (OR 3.91 and OR 4.72). Additionally, postoperative hypochloremia was a risk factor for major complications (OR 13.71), while novel serum biomarkers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory response index (SIRI), and prognostic nutritional index (PNI) were not associated with early major complications. Conclusion: Patients who have multiple comorbidities are at a greater risk of developing major complications after undergoing RC. Our result suggests that preoperative platelet counts and serum albumin levels are associated with wound dehiscence.

Anterior quadratus lumborum block provided superior pain control and reduced opioid consumption in kidney transplantation: A randomized controlled trial.

BACKGROUND: The research aimed to assess the effectiveness of inside-out anterior quadratus lumborum (QL3) block and local wound infiltration in managing postoperative pain and total morphine dosage following kidney transplantation. METHODS: In this prospective, randomized, double-blind study; 46 end-stage renal disease patients undergoing kidney transplantation were randomly allocated into 2 groups: a QL group (n = 23) receiving 20 mL of 0.25% bupivacaine using the ultrasound-assisted inside-out technique before wound closure, while the local wound infiltration (LA) group (n = 23) receiving the same dose around the surgical wound and drain at the time of skin closure. The primary outcome measure was the numerical pain rating scale, with secondary outcomes including amount of morphine consumption at various postoperative time points (2nd, 4th, 6th, 12th, 18th and 24th hours). RESULTS: Patients in the QL group had significantly lower numerical rating scale scores at the 2nd and 4th hours, both at rest and during movement (P < .05). Although pain scores at rest and during movement at later time points were lower in the QL group compared to the LA group, these differences were not statistically significant. Cumulative morphine consumption at postoperative 4th, 6th, 12th, 18th and 24th hours was significantly lower in the QL group (P < .05). No patients experienced complications from the QL3 block. CONCLUSION: Ultrasound-assisted inside-out QL3 block significantly reduced postoperative pain levels at the 2nd and 4th hours, both at rest and during movement, and led to a reduction in cumulative morphine consumption from the 4th hour postoperatively, and persisting throughout the 24-hour period.

In vitro Comparison of the Mechanical and Optical Characteristics of 5 Disposable Flexible Ureteroscopes.

INTRODUCTION: Disposable (single-use) flexible ureteroscopes are alternatives to reusable ureteroscopes. With their superior surgical efficacy and safety in the presence of upper urinary calculi, disposable ureteroscopes aim to overcome the main limitations of conventional reusable ureteroscopes. However, studies on the performance of the most recently developed models of single-use flexible ureteroscopes are scarce. This study aimed to compare the in vitro performance of several recently introduced, single-use, flexible ureteroscopes. METHODS: Five disposable flexible ureteroscopes were tested in vitro to evaluate their mechanical and optical characteristics. To this end, their degrees of deflection, irrigation flow rates, and image qualities were investigated. The models examined were Innovex US31-B12, OTU-100RR, Redpine RP-U-C12, Sciavita SUV-2A-B, and Seplou URS3016E. Their performance was also compared with that of a reusable flexible ureteroscope, Olympus URV-F. RESULTS: The OTU device had the highest degrees of deflection and the smallest loop diameter of the disposable ureteroscopes. The single-use ureteroscopes had identical image resolutions at a distance of 1 cm. The Innovex and Redpine devices had the best color representation. CONCLUSIONS: Of the tested disposable ureteroscopes, the OTU device had the best mechanical attributes, given its small loop diameter, high deflection angles, and low irrigation flow loss. As to their optical properties, the resolutions of all 5 single-use models were identical at an image distance of 1 cm.

Survival benefits after radical nephrectomy and IVC thrombectomy of renal cell carcinoma patients with inferior vena cava thrombus.

Objective: The role of tumor thrombus as a predictor of survival in patients with renal cell carcinoma (RCC) is controversial. This study aims to evaluate surgical and oncological outcomes after surgery in RCC with inferior vena cava (IVC) tumor thrombus patients. Materials and methods: A total of 58 patients (2002-2019) underwent radical nephrectomy and IVC thrombectomy at our institute, were retrospectively reviewed. Kaplan-Meier analysis was utilized to compare survival benefits between cohorts and Cox-regression to evaluate potential predictors of patient survival. Results: There were 5(8.6%), 21(36.2%), 23(39.7%) and 9 (15.5%) patients with tumor thrombus level I, II, III and IV respectively. The major complications (Clavien 3-5) were observed in 15 patients (25.8%) and 12 patients (80%) were patients with high thrombus level (III-IV). There was 9%mortality (5patients): 2 intraoperatively and 3 postoperatively. Median follow-up was 15 months (IQR:5-41). Two-year overall survival (OS) was 80% and 75% in all patients and pN0M0 cohort, respectively. There was significant difference in OS among each IVC thrombus level cohort (p < 0.02). Two-year OS of metastatic RCC patients was 67% and not significantly different when compared to non-metastatic cohort (p = 0.12). On multivariate analysis, only sarcomatoid dedifferentiation was associated with OS(p = 0.04). Disease-free survival was not significantly different among thrombus-level cohorts (p = 0.65). Conclusions: Our study suggested that surgical treatment for RCC with IVC thrombus provided substantial OS outcomes. Although survival was significantly reduced with higher IVC thrombus level cohort, the level of thrombus itself was not an independent factor. Only sarcomatoid dedifferentiation was a predictor for reduced OS after radical nephrectomy and tumor thrombectomy. Meticulous patient selection and prompt counselling are substantial step for the operation.

Color Doppler Guided in Early Renal Allograft Biopsy: A Safer and Non-Inferior Technique.

BACKGROUND: This study compared a novel technique for renal allograft biopsy, color Doppler ultrasound-guided biopsy (CDUS-Bx), with routine ultrasound-guided biopsy (RUS-Bx). METHODS: A retrospective review was conducted on 111 patients, with 42 undergoing CDUS-Bx and 69 undergoing RUS-Bx. Urologists used an 18-gauge automatic spring-loaded biopsy needle for all procedures. CDUS-Bx tissue collection was guided by identifying renal vessels with color Doppler mode. RESULTS: Overall, the adequacy rate was 90.1%, with a higher number of glomeruli obtained in the CDUS-Bx group (25.6 ± 10.3 vs. 20.6 ± 11.3, P = .008). Acute tubular necrosis was the most frequent pathological diagnosis, with a higher prevalence in the CDUS-Bx group (69% vs 40.6%). T cell-mediated rejection had a lower incidence in the CDUS-Bx group (4.8% vs 21.7%), and antibody-mediated rejection was comparable between the 2 groups. The most common complication was microscopic hematuria, which was significantly less frequent in the CDUS-Bx group (48.7% vs 70.1%, P = .028), but there was no significant difference in the rate of gross hematuria between CDUS-Bx and RUS-Bx (11.9% vs 11.6%, P = .961). The number of cores was the only predictor of adequate biopsy, with a 93.2% adequacy rate after 3 cores of allograft biopsy. Multivariate analysis revealed that only the guiding type, CDUS-Bx, was associated with less microscopic hematuria (adjusted odds ratio 0.325, P = .018). CONCLUSIONS: Color Doppler ultrasound-guided biopsy had comparable tissue adequacy to RUS-Bx, with a lower incidence of microscopic hematuria. These findings suggest that CDUS-Bx may be a safe and effective alternative to RUS-Bx for allograft biopsy.

Surgical outcomes of patients who underwent retrograde intrarenal surgery using a ureteral access sheath to manage kidney stones sized 1-2 cm compared between patients who did and did not undergo preoperative ureteral stenting.

Objective: To investigate the surgical outcomes of patients who underwent retrograde intrarenal surgery (RIRS) using a ureteral access sheath (UAS) to manage kidney stones sized 1-2 cm compared between patients who did and did not undergo preoperative ureteral prestenting. Materials and methods: This retrospective cohort study included 166 patients (aged ≥18 years) who underwent RIRS at Siriraj Hospital (Bangkok, Thailand) during February 2015-February 2020. All patients had renal calculi (stone size: 1-2 cm) located within the pelvicalyceal system. 80 and 86 patients were allocated to the prestent and non-prestent groups, respectively. Patient baseline characteristics, renal stone details, operative equipment, stone-free rate (SFR) at 2 weeks and 6 months, and perioperative complications were compared between groups. Results: All patient baseline characteristics were similar between groups. At 2 weeks after surgery, the overall SFR was 65.1%, and the SFRs in the prestent and non-prestent groups were 73.4% and 59.5%, respectively (p = 0.09). At 6 months after surgery, the overall SFR was 80.1%, and the SFRs in the prestent and non-prestent groups were 90.7% and 79.3%, respectively (p = 0.08). The incidence of perioperative complications was not significantly different between groups. Conclusions: There was no significant difference in the SFR between the presenting and non-prestenting groups at both the 2-week and 6-month postoperative time points. There was also no significant difference in intraoperative and postoperative complications between groups. The SFR was higher at 6 months than at 2 weeks in both groups with no additional procedure.

Late Distal Ureteral Stricture in Internal Hemipelvectomy Without Bone Reconstruction: A Case Report.

We report the case of a patient with Ewing sarcoma involving the right pelvis in a 14-year-old girl who had multicycles of neo-adjuvant chemotherapy and preoperative radiation therapy. She underwent an internal hemipelvectomy type I resection, according to Enneking and Dunham's classification without bony reconstruction. There was no intra- and perioperative complication. The patient has good function and needs no gait aids. She can walk with equinus foot compensated for leg shortening 5 centimeters and without a shoe-lift. There is no sign of disease relapse. However, she developed late ureteral stricture at 8-year postoperatively and was successfully treated with a ureteral stent.

The effect of laser fiber on the damage of the working channel of a flexible ureteroscope.

INTRODUCTION: Flexible ureteroscopy involves expensive equipment that is expensive to repair. This study aimed to investigate the effects of cleavage by various tools on the laser fiber tip and to determine the extent of damage incurred to the laser passing through the working channel and firing at different degrees of deflection. MATERIALS AND METHODS: We investigated the effect of cleavage on Lumenis Slimline reusable fibers (272 and 365 µm) as performed by four cleavage tools: a scribe pen, a surgical blade, suture scissors, and ceramic scissors. Following cleavage, we recorded the pattern of light dispersion and power output. The laser fibers passed through the working channel at various. RESULTS: The ceramic scissors provided the best pattern of light dispersion and the highest power output. The suture scissors provided unacceptable levels of light dispersion. The 272 µm fiber was able to pass through the working channel at 30 and 45 degrees of deflection. The 365 µm laser fiber was only able to pass through the working channel at 30 degrees of deflection. There was no breakage of the laser fiber at any of the degrees of deflection evaluated. CONCLUSIONS: Analysis showed that the ceramic scissors were the best tool for cleaving Lumenis Slimline reusable fibers and that suture scissors were unacceptable. We also found that the deflection angle that causes damage to the working channel by laser insertion is dependent on both the size of the laser fiber and the degree of bending. Firing the laser during scope deflection could be performed safely at any degree of deflection, even with a high laser power of 40 W for a duration of 30 s.

Factors Impacting Stone-Free Rate After Retrograde Intrarenal Surgery for Calyceal Diverticular Calculi.

OBJECTIVE: To evaluate the outcomes of retrograde intrarenal surgery (RIRS) treatment of calyceal diverticular calculi and identify the associated factors affecting post-operative stone-free rate. MATERIALS AND METHODS: From August 2015 to May 2019, data of 32 patients with calyceal diverticular calculi who were treated by RIRS in a Siriraj Hospital were retrospectively studied. All operations were performed by the same surgeon using flexible ureterorenoscopy (f-URS) and holmium YAG laser lithotripsy. Calyceal diverticula were identified by our refluxing technique and from the collected demographic, diverticular and stone data. Operative outcomes were retrospectively evaluated. Data were analysed to identify the factors associated with stone-free outcomes. Stone-free was defined as no residual stones remaining after surgery. RESULTS: Mean age of the patients was 55.7 years. Stone locations were non-lower pole in 81.2% of cases and lower pole for the remaining 18.8% of cases. Median stone size was 1.2 cm with three as the median number of stones per patient. Calcium oxalate was the most common stone composition (56.3%). Positions of the diverticulum were anterior calyx (34.4%) and posterior calyx (50%), while the remainder were undetermined (incomplete data). Average length of the diverticular neck was 0.4 cm. Mean operative time was 46 minutes and mean hospital stay was 2.9 days. Complications included fever in three patients (9.3%) and sepsis in two patients (6.3%), with overall post-operative stone-free rate at 75%. Factors significantly affecting stone-free status were stone size (P=0.003) and length of diverticular neck (P=0.038). Multivariate analysis determined that only stone size had a statistically significant effect on post-operative stone-free status (P=0.015). Cut off point for stone size that increased the chances of a post-operative stone-free outcome was less than 1.5 cm, as determined by the ROC curve. CONCLUSION: RIRS was found to be an effective and safe treatment option for the removal of calyceal diverticular calculi. Stone size of less than 1.5 cm offered a better chance of post-operative stone-free condition.

The Application of Retrograde Intrarenal Surgery to Remove a Single Large Kidney Stone During Pregnancy.

PURPOSE: To report the application and outcome of retrograde intrarenal surgery (RIRS) to remove a large kidney stone during pregnancy. PATIENT AND METHODS: A 30-year-old woman presented with an infected kidney stone (3 cm in size) at 4 weeks of pregnancy. We decided to remove the stone due to the possibility of obstruction and infection and chose to carry out this procedure by RIRS. In order to avoid complications associated with anesthetic, the surgery was carried out after the infection had cleared and when the patient had entered the second trimester of pregnancy. First, we used an ureteral access sheath and semi-rigid ureteroscopy to evaluate the ureteral lumen. We confirmed that the ureteral access sheath had been positioned appropriately by direct visualization with a flexible ureterorenoscope. The procedure was then carried out with a radiation-free protocol and without fluoroscopy. Ho-YAG laser lithotripsy was used to fragment the stones, and these fragments were then removed in a stone basket. The patient required three sessions of RIRS to remove the stone in its entirety; during this time, the patient was 18-29 weeks into her pregnancy. During each session, we removed approximately 30% of the stone. The patient developed fever after the first operation but responded fully to antibiotics. There were no perioperative complications, and the patient only remained in hospital for 3 days. The male infant was delivered by caesarian section at 37 weeks of pregnancy without any health complications. RESULTS AND CONCLUSION: We successfully removed a large kidney stone from a pregnant patient using an ureteral access sheath and RIRS without fluoroscopy. There were no complications indicating that this procedure can be carried out safely during pregnancy.

The correlation between demographic factors and upper urinary tract stone composition in the Thai population.

OBJECTIVE: To identify the correlation between demographic factors and upper urinary tract stone composition in the Thai population. METHOD: A retrospective observational study of first-time upper urinary tract stone former patients aged over 18 years who underwent stone surgery was performed in a tertiary referral university hospital from January 2013 to May 2018. Collected data included demographic information and stone composition information, which were analysed by the Fourier Transform-Infrared Spectroscopy (FTIR) method. The correlation between the demographic factors and major upper urinary tract stone composition was analysed using Fisher's exact test. RESULTS: A total of 480 patients were included in this study. The stones were 319 (66.5%) renal calculi and 161 (33.5%) ureteric calculi. There were 248 (51.7%) single composition stones and 232 (48.3%) mixed composition stones. The major stone compositions were 288 (60.0%) calcium oxalate (CaOx), 125 (26.0%) calcium phosphate (CaP), 40 (8.3%) uric acid (UA), 19 (4.0%) magnesium ammonium phosphate (MAP), five (1.0%) cystine, and three (0.6%) ammonium hydrogen urate (AHU). Gender was correlated with the major stone composition. In females, a correlation was found between the major stone composition and age, diabetes mellitus (DM), and glomerular filtration rate (GFR). The study showed no significant correlation between the major stone composition and dyslipidemia (DLP), hypertension (HT), gout, and body mass index (BMI) in both genders. CONCLUSION: Gender, age, DM, and GFR were the factors affecting the stone composition.

Vaporizing Effect of the Popcorn Technique for Laser Lithotripsy: Comparing the Different Settings of High Energy in a Caliceal Model.

Objective: To assess the effectiveness of laser lithotripsy in different holmium:yttrium aluminum garnet (Ho-YAG) laser settings with a wide range of energies, frequencies, and power. Materials and Methods: Two types of phantom stones were utilized, including soft stone, which mimics uric acid stone, and hard stone, which mimics calcium oxalate monohydrate stone. The stones were made into a round shape measuring 10 mm in diameter. The lithotripsy settings were 1 J × 20 Hz, 2 J × 10 Hz, 1.5 J × 20 Hz, 3 J × 10 Hz, and 2 J × 20 Hz. The lithotripsy was conducted in a caliceal model with a 2-mm filter. All stone vanishing from the artificial calix was an end point of the experiment. All fragments that passed through the filter of each setting were dried and weighed to calculate the vaporizing effect as well as to compare among the different settings. Laser fiber degradation was compared by using these settings. Results: Disintegration efficiency was determined by time consumption and the amount of vaporized stone. The best time consumption was 8 min 51 sec for 2 J × 20 Hz for hard stone and 5 min 13 sec for this setting for soft stone. The most vaporizing effect for hard stone was 92.19% for 2 J × 20 Hz and 87.30% for this setting for soft stone. The most fiber tip degradation was 28 mm for 3 J × 10 Hz for hard stone and 4 mm for 1.5 J × 20 Hz for soft stone. Conclusion: The study revealed that the best setting for hard stone was 2 J × 20 Hz, which was the fastest for achieving maximum vaporization, whereas fiber degeneration was comparable to others. For soft stone, there was no difference among the settings.

Characterization of renal stone composition by using fast kilovoltage switching dual-energy computed tomography compared to laboratory stone analysis: a pilot study.

PURPOSE: To prospectively examine the diagnostic performance of fast kilovoltage switching dual-energy computed tomography (DECT) in characterization of in vivo renal stone composition compared with postoperative stone analysis. METHODS: Consecutive consenting patients scheduled for endoscopic kidney stone surgery in a tertiary referral hospital from June 2015 to January 2016 were enrolled. Patients were preoperatively scanned with single-source, fast kilovoltage switching DECT. Stone compositions were determined regarding the effective atomic number measurements. Results of the stone compositions from DECT were compared to postoperative infrared spectroscopy stone analysis as the standard reference. RESULTS: For the 39 patients enrolled in the study, DECT was able to detect uric acid stone with sensitivity of 88.9% and specificity of 100%. There was 100% positive predictive value, 96.8% negative predictive value, and 97.4% accuracy. For non-contrast CT scan, sensitivity was 88.9%, specificity was 96.7%, positive predictive value was 88.9%, negative predictive value was 96.7%, and accuracy was 94.8%. Of the 39 samples examined, 21 (54%) were single composition, whereas 18 (46%) were combined. Single composition stones were correctly characterized by DECT in 100% (8/8) for uric acid. Whereas the result of uric acid stone containing stone discrimination in mixed composition was not so good with Zeff alone, iodine imaging can compensated this fault. CONCLUSIONS: DECT provides excellent accuracy in characterizing uric acid stone compositions. With the addition of iodine image, all of uric acid-containing stones can be determined by the DECT.

The Impact of Arterial Clamping Technique in Robot-Assisted Partial Nephrectomy on Renal Function and Surgical Outcomes: Six-Year Experience at Siriraj Hospital, Thailand.

INTRODUCTION: Robot-assisted partial nephrectomy (RAPN) with different arterial clamping techniques has increasingly been performed to avoid ischemic injury to nephron. However, postoperative renal function remains controversial. We determine the impact of each renal arterial clamping on surgical and renal outcomes after RAPN. MATERIALS AND METHODS: Patients who underwent RAPN at Siriraj Hospital from 2010 to 2016 were retrospectively reviewed and stratified into 3 cohorts: main-clamp (MAC), selective-clamp, and off-clamp. RESULTS: Main, selective, and off-clamping were performed in 27, 38, and 12, respectively. Median tumor size and Radius, Exophytic or endophytic, Nearness to collecting system or sinus, Anterior or posterior, and Location relative to polar lines (RENAL) score were 3 cm and 7, respectively. Longer operative time was observed in MAC (p = 0.002) although estimated blood loss, transfusion rate, and complication were comparable. Warm ischemia time was not different between cohorts. However, number of patients with prolonged ischemia time in MAC were greater (p ≤ 0.01). All margins were negative. Median postoperative and latest glomerular filtration rate reduction were 3.8 and 5.3 mL/min/1.73 m2, respectively without significant difference between cohorts. On multivariable analysis, hypertension independently associated with reduced renal function preserved (p = 0.03). Median follow-up was 18 months. CONCLUSIONS: Our study is the first to report surgical and renal functional outcomes after RAPN in Southeast-Asian population. Based on our experience, clamping techniques does not impact on renal functions and complication rate was low even in small-volume center.

Accuracy of preoperative urinary symptoms, urinalysis, computed tomography and cystoscopic findings for the diagnosis of urinary bladder invasion in patients with colorectal cancer.

BACKGROUND: To determine the accuracy of preoperative urinary symptoms, urinalysis, computed tomography (CT) and cystoscopic findings for the diagnosis of urinary bladder invasion in patients with colorectal cancer. MATERIALS AND METHODS: Records of patients with colorectal cancer and a suspicion of bladder invasion, who underwent tumor resection with partial or total cystectomy between 2002 and 2013 at the Faculty of Medicine Siriraj Hospital, were reviewed. Correlations between preoperative urinary symptoms, urinalysis, cystoscopic finding, CT imaging and final pathological reports were analyzed. RESULTS: This study included 90 eligible cases (71% male). The most common site of primary colorectal cancer was the sigmoid colon (44%), followed by the rectum (33%). Final pathological reports showed definite bladder invasion in 53 cases (59%). Significant features for predicting definite tumor invasion were gross hematuria (OR 13.6, sensitivity 39%, specificity 73%), and visible tumor during cystoscopy (OR 5.33, sensitivity 50%, specificity 84%). Predictive signs in CT imaging were gross tumor invasion (OR 7.07, sensitivity 89%, specificity 46%), abnormal enhancing mass at bladder wall (OR 4.09, sensitivity 68%, specificity 66%), irregular bladder mucosa (OR 3.53, sensitivity 70%, specificity 60% ), and loss of perivesical fat plane (OR 3.17, sensitivity 81%, specificity 43%). However, urinary analysis and other urinary tract symptoms were poor predictors of bladder involvement. CONCLUSIONS: The present study demonstrated that the most relevant preoperative predictors of definite bladder invasion in patients with colorectal cancer are gross hematuria, a visible tumor during cystoscopy, and abnormal CT findings.

Laparoscopic appendectomy: results of a new technique for stump management.

OBJECTIVE: The purpose of the present study was to review a new laparoscopic technique for treatment of appendicitis. An earlier pilot study indicated the safety of the technique in addition to saved time and cost. MATERIAL AND METHOD: The electronic records were analyzed on appendix surgeries performed at our hospital between January 1, 2007 and December 31, 2011. RESULTS: The 91 patients who had an appendiceal stump closure using clips (viz., the Hem-o-lock clip) had a significantly shorter surgery and hospitalization than those whose appendiceal stump was closed using the standard loop strap (Endo-loop). CONCLUSION: The complications between groups were not significantly different and were treated in both groups using conservative management.

Laparoscopic vesicovaginal fistula repair: a novel approach.

BACKGROUND: Vesicovaginal fistula (VVF) is a common consequence of gynecologic procedures. Treatments include transabdominal, transvaginal and laparoscopic surgery. New methods for laparoscopic VVF repair aim to improve treatment outcomes and reduce post-operative complications. OBJECTIVE: To report a novel approach for laparoscopic VVF repair. MATERIAL AND METHOD: Medical records were reviewed of 5 patients who underwent a novel approach for laparoscopic VVF repair for benign fistula between October 2008 and December 2010. None had previously undergone operative repair Preoperative cystoscopy revealed supratrigonal VVFs in all patients. Each patient was placed in the lithotomy position and four or five trocars used. Cystoscopy combined with laparoscopy was performed to identify the site of the fistula. Limited cystotomy was done and the fistula tract excised. The bladder and vagina were closed independently and the omentum interposed between them. RESULTS: All cases were successfully managed using the laparoscopic technique. The respective mean operative time and length of hospital stay was 229 min (range, 150-300) and mean 4.4 days (range, 4-6). All patients were able to take food and drink within a day of surgery. The post-procedural cystogram showed no leakage. The urethral catheter was removed after 24.4 days (range, 18-34 days). CONCLUSION: Laparoscopic transperitoneal repair of VVF is a feasible and safe technique, Cystoscopy combined with laparoscopy simplifies limited cystotomy.

Quality of life after donor nephrectomy for living donor kidney transplantation at Srinagarind Hospital.

OBJECTIVE: To determine the quality of life (QoL) of donors who have undergone nephrectomy for living donor kidney transplantation at Srinagarind Hospital, using the Thai version of the Short-Form, 36-item, health survey (SF-36). MATERIAL AND METHOD: The SF-36 questionnaires were sent by mail to 93 living donors who underwent nephrectomy between Jan 1, 1990 and Dec 31, 2008. The first part collected demographic data and the donor/recipient relationship, the second surveyed QoL, and the third asked about decision-making, donation-related stress and feedback. RESULTS: Forty-nine questionnaires were returned completed (30 women; 19 men: mean age 44.2 +/- 9.5 (range, 28-65) years). Thirty-one participants (61%) were siblings of the recipients. The QoL scores were not significantly different from the general Thai population; albeit nominally higher for mental health and social function. Upon reflection, only 5 (10%) had second thoughts. CONCLUSION: Donor nephrectomy did not affect QoL; thus, from that perspective living kidney transplantation is a suitable procedure for donors.

Laparoscopic simple nephrectomy: perioperative outcomes at Srinagarind Hospital.

BACKGROUND: Laparoscopic urology is a minimally invasive alternative to open surgery, especially laparoscopic simple nephrectomy for benign disease such as KUB stone. OBJECTIVE: To evaluate the efficacy and perioperative outcomes of laparoscopic simple nephrectomy at Srinagarind Hospital. MATERIAL AND METHOD: Analyzed the demographic and perioperative data of 78 consecutive patients who underwent laparoscopic simple nephrectomy. RESULTS: Mean age was 54.1. The indications included non-functioning kidney (64) and infection (14). Surgery averaged 118.37 minutes. In 38 and 40 respective cases, a transperitoneal and retroperitoneal approach was used. Intraoperative complications (13; 16.7%) included 10 bleeding, 2 diaphragmatic injuries and 1 pancreatic injury. Six cases (10.3%) were converted to open surgery: 5 for massive adhesion and 1 for uncontrolled bleeding. Mean estimated blood loss was 170.99 ml. Post-operative complications included: 8 cases of prolonged ileus and 5 wound infections. Mean post-operative analgesia was 14.0 mg morphine: mean pain score at post-operative day 1 6.20. Mean time to oral intake was 1.48 days, and post-operative period 4.63 days. Retroperitoneal access was associated with: shorter operative time (103.83 vs. 133.68 minutes, p = 0.008); a better result vis-a-vis post-operative ileus (1 vs. 7, p = 0.021); and shorter time to oral intake than transperitoneal route (1.20 vs. 1.79 days, p = 0.004). CONCLUSION: Vis-a-vis reducing pain, faster recovery and improved cosmetics laparoscopic nephrectomy by a skilled surgeon via retroperitoneal approach is preferred for benign diseases.