ABSTRACT
We report on a HIV-positive patient in whom laparoscopic nephron-sparing surgery has been performed. A 47-year-old white male referred for evaluation and treatment of an asymptomatic, serendipitously discovered renal mass. The patient underwent a laparoscopic tumorectomy; indications, surgical technique and rationale are described in detail.
Subject(s)
Carcinoma, Renal Cell/surgery , HIV Seropositivity/complications , Kidney Neoplasms/surgery , Laparoscopy , Abdomen/diagnostic imaging , Carcinoma, Renal Cell/complications , Humans , Kidney Neoplasms/complications , Male , Middle Aged , Nephrectomy/methods , Tomography, X-Ray Computed , Treatment Outcome , UltrasonographyABSTRACT
PURPOSE: To demonstrate feasibility and safety of retroperitoneoscopic treatment of ureteropelvic junction obstruction. MATERIALS AND METHODS: 11 patients with symptomatic ureteropelvic junction obstruction were selected for retroperitoneoscopic pyeloplasty. Operative time ranged between 2 h 30 min and 4 h (mean 3 h 10 min); in 5 cases we had to convert to open surgery and an open pyeloplasty was performed through a minimal (6 cm) lombotomic incision. RESULTS: Follow-up IVPs were performed in all patients approximately 2-3 weeks after stent removal. In all patients, a reduction in the grade of hydronephrosis was observed. Significant improvement was noticed in 9 patients; in 2 patients a moderate improvement was observed. CONCLUSIONS: Our experience with retroperitoneoscopic treatment of ureteropelvic junction obstruction demonstrates that also with this approach it is possible to perform reconstructive procedures, with minimal complications. Technical refinements will progressively reduce the conversion rate to open surgery, even if done through minilaparotomy.
Subject(s)
Hydronephrosis/surgery , Laparoscopy/methods , Retroperitoneal Space/surgery , Ureteral Obstruction/surgery , Adolescent , Adult , Anastomosis, Surgical , Catheterization/methods , Female , Follow-Up Studies , Humans , Hydronephrosis/complications , Hydronephrosis/diagnostic imaging , Intraoperative Period , Male , Safety , Stents , Treatment Outcome , Ureter/surgery , Ureteral Obstruction/diagnostic imaging , Ureteral Obstruction/etiology , UrographyABSTRACT
Since January 1993, 10 patients with bilateral ureteral obstruction due to advanced pelvic cancers underwent videoendosurgical cutaneous ureterostomy. Five patients had prostate cancer, three had uterine cancer, and only two had bladder cancer. In five cases a bilateral laparoscopic transperitoneal procedure (LCU) was performed. In five cases a retroperitoneal laparoscopic technique (RLCU) was adopted, and only in one out of these five cases was the procedure done bilaterally. All the procedures were done under general anesthesia. The procedure was accomplished in all the cases without any intraoperative complication. Monolateral retroperitoneal laparoscopic cutaneous ureterostomy (RLCU) required 35-42 min, including the dilation time. Bilateral RLCU required extra time for changing the position of the patient. Postoperative pain was rather insignificant and did not require additional medication. Postdiversion hospital stay was 3-6 days depending on the general condition of the patient. The mean follow-up was 14.4 months.
Subject(s)
Endoscopy/methods , Retroperitoneal Space/surgery , Ureteral Obstruction/surgery , Ureterostomy/methods , Adult , Aged , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Length of Stay , Male , Middle Aged , Prostatic Neoplasms/complications , Prostatic Neoplasms/therapy , Retrospective Studies , Stents , Treatment Outcome , Ureteral Obstruction/etiology , Urinary Bladder Neoplasms/complications , Urinary Bladder Neoplasms/therapy , Uterine Neoplasms/complications , Uterine Neoplasms/therapyABSTRACT
We report our experience with the insertion of a new thermoexpansible permanent intraurethral stent, the Memotherm. We treated 49 patients, 25 with benign prostic hyperplasia (BPH), 21 with recurrent urethral strictures (2 cervicourethral and 18 bulbar and 1 of a vescicourethral anastomosis after radical prostatectomy), and 3 with sphincterotomies (2 for dyssynergia and 1 with incontinence plus stenosis). The patients' ages ranged from 24 to 84 (mean 59.7) years. In all patients, stent insertion was achieved without any operative problem. In two patients, stents were removed (one in the BPH group and one in the urethral stricture group), and at long-term follow-up, we have seen two patients with severe mucosal hyperplasia.
Subject(s)
Prostatic Hyperplasia/surgery , Stents , Urethral Stricture/surgery , Adult , Aged , Aged, 80 and over , Follow-Up Studies , Humans , Male , Middle AgedABSTRACT
Since January 1993, 9 patients with bilateral ureteral obstruction due to advanced pelvic cancers underwent videoendosurgical cutaneous ureterostomy. Five patients had prostate cancer, 3 had uterine cancer and only 1 bladder cancer. In 5 cases a bilateral laparoscopic transperitoneal procedure was performed. In 4 cases a retroperitoneal laparoscopic technique was adopted and only in 1 out of these 4 cases the procedure was done bilaterally. All the procedures were done under general anesthesia. The procedure was accomplished in all the cases without any intraoperative complication; the operative time ranged between 35 and 130 min. Postoperative pain was rather insignificant and did not require additional medication. Postdiversion hospital stay ranged from 3 to 11 days according to the general condition of the patients. The mean follow-up is 10.8 months. In conclusion, retroperitoneal laparoscopic cutaneous ureterostomy seems to be a reasonable alternative to percutaneous nephrostomy in case of bilateral ureteral obstruction due to advanced prostate or uterine cancer, provided that the clinical condition of the patient allows general anesthesia.
