Internal versus external ureteric stents for uretero-ileal anastomosis after laparoscopic radical cystectomy with orthotopic neobladder: A prospective comparative study.

OBJECTIVE: To prospectively compare the use of external ureteric stents with internal JJ stenting of the uretero-ileal anastomosis in patients undergoing laparoscopic radical cystectomy (LRC) with a Y-shaped ileal orthotopic neobladder (ON). PATIENTS AND METHODS: The study included 69 patients undergoing LRC with ON. Patients were grouped according to the type of uretero-ileal stents used. An external ureteric stent was used in Group A (33 patients) and a JJ stent was used in Group B (36). We prospectively compared the duration of hospital stay, the incidence of short- and intermediate-term complications in the two study groups. RESULTS: The mean (SD) follow-up periods were 29.18 (3.94) and 28.19 (3.37) months for patients in Groups A and B, respectively. Perioperative patient characteristics were comparable in the two study groups. The use of JJ stenting was associated with a shorter hospital stay compared with external stenting, at a mean (SD) of 14.63 (3.74) and 6.8 (3.03) days in Groups A and B, respectively (P < 0.001). The incidence of urinary leakage was comparable in the two study groups, at 6.1% in Group A vs 8.3% in Group B (P = 1.0). Strictures of the uretero-ileal anastomosis occurred in two patients (6%) in Group A and confirmed by intravenous urography. All strictures were treated with antegrade JJ fixation. CONCLUSION: JJ stents could be used as an effective alternative to external ureteric stents to support the uretero-ileal anastomosis. JJ stenting is associated with a shorter hospital stay and similar complication rates compared with external stenting in patients undergoing LRC with ON.

Holmium laser enucleation of the prostate: initial report of the first 230 Egyptian cases performed in a single center.

OBJECTIVES: To report our experience with the first 230 cases of holmium laser enucleation of the prostate (HoLEP) performed in a single center. METHODS: A total of 230 cases of HoLEP were performed between June 2007 and June 2008. Mean age of patients was 69.8 +/- 10.3 years, and 21.3% of patients were either on anticoagulant or antiplatelet treatment. There was no limit for prostate size, with a mean prostate size of 86.5 +/- 65.4 g (range: 20-350 g). Follow-up was performed regularly at 1, 3, 6, and 12 months, assessing the Q(max), PVR, and International Prostate Symptom Score. RESULTS: Weight of prostate chips retrieved after morcellation was 78.6 +/- 61.3 g (range: 10-350), with enucleation time 102.2 +/- 55.4 minutes and morcellation time 19.3 +/- 10.1 minutes, leading an estimated efficiency rate of 0.64 g/min. The rate of decrease in prostate volume and prostate-specific antigen was 90.8% and 82.5%, respectively. At 1 month, mean Q(max) increased from 7.7 +/- 2.3 to 25.8 +/- 10.1 mL/s (P

Laparoscopic augmentation ileocystoplasty: results and outcome.

BACKGROUND: Routine use of laparoscopic augmentation ileocystoplasty has not yet been established. OBJECTIVES: To assess the outcome of laparoscopic augmentation ileocystoplasty. DESIGN, SETTING, AND PARTICIPANTS: Twenty-three patients underwent laparoscopic augmentation ileocystoplasty for hypocompliant bladder. INTERVENTION: Bladder dissection and reconstruction of the ileovesical anastomosis were performed laparoscopically, whereas the ileal pouch was prepared extracorporeally through a small 3- to 4-cm muscle-splitting incision. MEASUREMENTS: Patient data, operative details, and follow-up were recorded. Urodynamic evaluation was performed preoperatively and after 12 mo, taking the bladder capacity and the maximum detrusor pressure as a measure for the outcome of the procedure. RESULTS AND LIMITATIONS: All cases were completed laparoscopically, with a mean operative time 202 min; mean hospital stay 5 d, and mean urethral catheter duration 11 d. After 12 mo, the estimated bladder volume increased from a mean 111 ml to 788 ml (p<0.01), whereas the maximum detrusor pressure dropped from a mean 92 cm H(2)O to 15 cm H(2)O (p<0.01). During a mean follow-up of 39 mo, two long-term complications have been reported: bladder stone and spontaneous rupture of the augmented bladder due to neglected clean intermittent self-catheterization. CONCLUSIONS: Laparoscopic augmentation ileocystoplasty is a safe procedure, technically feasible and with favourable urodynamic outcome.

Laparoscopic transperitoneal ureterolithotomy.

PURPOSE: To present our experience with laparoscopic ureterolithotomy as a potential alternative to open ureterolithotomy. PATIENTS AND METHODS: Between October 2003 and October 2005, a total of 27 laparoscopic ureterolithotomies were performed in 25 patients. The mean age of the patients was 39.8 +/- 17.5 years, and the mean body mass index (BMI) was 28.7 +/- 3.9 kg/m2. The inclusion criteria were stone(s) in the middle or upper ureter not suitable for treatment with SWL or endoscopy. Bilateral stones, multiple stones at the same level, recurrent stones, or stones in duplex systems were not a contraindication. A transperitoneal approach was used. RESULTS: The mean operative time was 145 +/- 42 minutes. The mean blood loss was 62.5 +/- 23 mL with mean hemoglobin decline of 0.78 +/- 0.31 g/dL. Postoperative analgesia was a single dose of a non-steroidal anti-inflammatory drug on day 1. The mean postoperative hospital stay was 4.1 +/- 6.7 days. No evidence of backpressure changes or increase in the serum creatinine concentration was observed during the follow-up. Assessment of the BMI, level of the stone, and laterality showed no statistical impact on the mean operative time. CONCLUSIONS: Laparoscopic ureterolithotomy is technically feasible with the advantage of being minimally invasive and having lower postoperative morbidity.

Laparoscopic vesical diverticulectomy.

PURPOSE: We report our initial experience with 13 cases of laparoscopic vesical diverticulectomy done via an extravesical approach between November 2002 and October 2004. PATIENTS AND METHODS: All patients were male, with a mean age of 53 years and a mean body mass index of 26.2 kg/m2. A transperitoneal approach was preferred. The diverticulum was of the primary type in three patients and of the secondary type resulting from benign prostatic hyperplasia in seven patients and a longstanding urethral stricture in three patients. RESULTS: The mean operative time was 265 minutes with a mean blood loss of <100 mL and a mean postoperative hemoglobin decline of 1.1 g/dL. The urethral catheter was removed on day 7 postoperatively in the patients with a primary diverticulum, whereas it was left for 11 to 14 days in patients with secondary bladder diverticula. Postoperative complications occurred in only one patient with a primary diverticulum, taking the form of extravasation from the suture line in the control gravity-fill cystogram that was done routinely prior to urethral-catheter removal. Leakage resolved with urethral catheterization for 2 more weeks. The postoperative stay was 3 to 4 days. CONCLUSION: Laparoscopic diverticulectomy is technically feasible and safe and may represent an alternative to the standard open procedure.

Laparoscopic radical cystectomy with orthotopic neobladder.

PURPOSE: We report our technique of laparoscopic radical cystectomy in nine patients. Diversion was achieved by a modified Camey II orthotopic neobladder (the Y bladder) performed by a minilaparotomy in three cases and laparoscopically in the last six cases. PATIENTS AND METHODS: There were eight men with muscle-invasive transitional-cell carcinoma and one woman with verrucous squamous-cell carcinoma of the bladder. The age range was 41 to 65 years. The control of the posterior and lateral bladder pedicles was achieved by vascular Endo-GIA in the first three cases and by the 10-mm Harmonic Shears (Ultracision; Ethicon) in the last six cases. The operative specimen was extracted through a 3- to 5-cm muscle-splitting incision in the right iliac fossa. The detubularized pouch was prepared extracorporeally through the same incision. The urethral and ureteral anastomoses were performed using laparoscopic intracorporeal suturing in the last six cases. RESULTS: The operative time ranged from 6.5 to 12 hours (median 8.3 hours). The blood loss was 150 to 500 mL. Oral feeding was resumed on the 3rd postoperative day. The stents were usually removed on the 8th postoperative day. A pouchogram was obtained on the 10th postoperative day, and the urethral catheter was removed. The lymph nodes as well as the surgical margins were tumor free. CONCLUSION: Laparoscopic radical cystectomy and orthotopic neobladder creation is feasible, although difficult and technically demanding. The use of the Harmonic Shears in the cystectomy reduces the operative cost significantly. With growing experience, laparoscopic radical cystectomy and continent urinary diversion can be an alternative to the open technique.