Ureteroscopic Lithotripsy in Reverse Trendelenburg Position and Intraoperative Furosemide.

PURPOSE: Upward stone migration is a significant problem during ureteroscopic lithotripsy (URSL) for upper ureteral stone, especially in absence of a ureteral occlusion device. In this study, we evaluated the novel strategy of reverse Trendelenburg position (RTP) and intraoperative diuresis for URSL without ureteral occlusion devices to avoid upward migration. MATERIALS AND METHODS: From March 2018 to May 2020, a total of 119 URSLs were performed for upper ureteral stone (6-15 mm) with 67 procedures in RTP and 52 procedures in conventional lithotomy position (CLP). 20 mg of intravenous furosemide was administered prior to stone fragmentation with holmium laser only in RTP group. Patient demographics, stone side, stone size and operative characteristics were recorded and compared between the two groups. RESULTS: Patient data, stone side and size were similar in the two groups. All procedures were complete without conversion to open surgery and major complications. There was no significant difference in the mean operative time (47.9 ± 7.7 min vs 45.3 ± 7.0 min, P = .062) and mean hospital stay (3.9 ± 0.9 d vs 4.0 ± 1.0 d, P = .336) between the RTP and CLP group. Stone upward migration was significantly less in RTP group (3.0%, 2/67) than in CLP group (19.2%, 10/52) (P = .005). Stone-free rate at one month after initial treatment was 92.5% in RTP group and 73.1% in CLP group (P = .004). CONCLUSION: The strategy of placing the patient in RTP and intraoperative administration of intravenous furosemide is simple, feasible and cost-effective in preventing stone upward migration during URSL with holmium laser in absence of a ureteral occlusion device for upper ureteral stone.

Comparison of clinicopathologic parameters and oncologic outcomes between type 1 and type 2 papillary renal cell carcinoma.

BACKGROUND: To compare the clinicopathologic parameters and oncologic outcomes between type 1 and type 2 papillary renal cell carcinoma (PRCC). METHODS: This study was approved by the review board (NO.XYFY2019-KL032-01). Between 2007 and 2018, 52 consecutive patients who underwent surgery at a single tertiary referral hospital were included. Clinicopathologic and survival data were collected and entered into a database. The Kaplan-Meier method, and univariate and multivariate Cox proportional hazard regression analyses were performed to estimate progression-free survival (PFS) and cancer-specific survival (CSS). RESULTS: Of the 52 patients, 24 (46.2%) were diagnosed with type 1 PRCC, and 28 (53.8%) had type 2 PRCC. The mean tumor size was 4.8 ± 2.5 cm. The two subtypes displayed different morphological features: foamy macrophages were more common in type 1 PRCC, while eosinophils and microvascular angiolymphatic invasion were more frequent in type 2 PRCC. Type 2 cases showed higher tumor stage and World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade than type 1 cases (T3-T4: 43% vs 17%, P = 0.041; G3-G4: 43% vs 8%, P = 0.005). In univariate analysis, type 2 PRCC had a lower probability for PFS and CSS than patients with type 1 PRCC (P = 0.016, P = 0.049, log-rank test, respectively). In multivariate analysis, only WHO/ISUP grade (HR 11.289, 95% CI 2.303-55.329, P = 0.003) and tumor size (HR 1.244, 95% CI 1.034-1.496, P = 0.021) were significantly associated with PFS. CONCLUSIONS: PRCC subtype displayed different morphological features: foamy macrophages, eosinophils and microvascular angiolymphatic invasion are pathologic features that may aid in the distinction of the two subtypes. Histologic subtype of PRCC is not an independent prognostic factor and only WHO/ISUP grade and tumor size were independent predictors for PFS.

Novel oncolytic adenovirus sensitizes renal cell carcinoma cells to radiotherapy via mitochondrial apoptotic cell death.

Renal cell carcinoma is the most frequent kidney malignancy and patients with metastatic disease have a poor prognosis. Suppressed apoptosis and marked invasiveness are distinctive features of renal cell carcinoma. In the present study, a dual­regulated oncolytic adenovirus expressing the interluekin (IL)­24 gene (Ki67­ZD55­IL­24) was constructed utilizing the Ki67 promoter to replace the native viral promoter of the E1A gene. Whether the combination of Ki67­ZD55­IL­24­mediated gene virotherapy and radiotherapy produced increased cytotoxicity in renal cell carcinoma cells via mitochondrial apoptotic cell death was investigated. The data indicated that this novel strategy has the potential to be further developed into an effective approach to treat renal cell carcinoma. The results showed that the combination of Ki67­ZD55­IL­24 and radiotherapy significantly enhanced anti­tumour activity via increasing the induction of apoptosis in melanoma cells compared with the other agents.

Closed technique for the creation of retroperitoneal working space for symptomatic renal cysts.

PURPOSE: To evaluate the feasibility and safety of the closed technique (CT) with Veress needle for the creation of retroperitoneal working space (RWS) for the retroperitoneoscopic ablation of symptomatic renal cysts by comparison with the open technique (OT). MATERIAL AND METHODS: In this series of 412 patients who underwent retroperitoneoscopic ablation of symptomatic renal cysts, RWS was created by OT in 231 patients and CT in 181 patients, respectively. The time to create RWS, operative time, and complications were analyzed. RESULTS: Creation of RWS and retroperitoneoscopic cyst ablation were completed successfully in all cases. The time to create RWS by CT was significantly shorter than that by OT (6.4 ± 1.2 vs 9.6 ± 1.2 min, P < 0.01). The operative time was shorter with CT than with OT (50.5 ± 6.5 vs 52.5 ± 6.7 min, P < 0.01). Subcutaneous emphysema developed in five (2.16%) of 231 patients undergoing OT and one (0.55%) of 181 patients undergoing CT. Port-site gas leakage was observed in six patients undergoing OT. CONCLUSIONS: Our study shows that CT with Veress needle for the creation of RWS for symptomatic renal cysts is feasible and safe in experienced hands, reducing troublesome port-site gas leakage and subcutaneous emphysema.

Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria in presence of complex renal vasculature.

OBJECTIVE: To evaluate retroperitoneoscopic renal pedicle lymphatic disconnection (RRPLD) for chyluria in the setting of complex renal vasculature and compare those outcomes with the RRPLD outcomes of patients with normal renal vasculature. MATERIALS AND METHODS: From December 2002 to December 2011, RRPLD was performed in 14 patients with complex renal vasculature and 64 patients with normal renal vasculature. Preoperative multislice spiral computed tomography angiography for renal vessels was done on 5 patients with complex vasculature. The demographic and perioperative data were collected to assess critical outcomes. RESULTS: The abnormal vasculature was identified using preoperative multislice spiral computed tomography angiography in 5 patients and surgical exploration in 9 patients. RRPLD was successfully completed in all patients without conversion to open surgery or vascular injury. The mean operative time was significantly longer in those with complex renal vasculature than those with normal renal vasculature (105.4 ± 18.7 vs 84.5 ± 15.6 minutes; P = .000). The outcomes were similar in the 2 groups in terms of intraoperative blood loss (P = .060), mean hospital stay (P = .478), and intraoperative complications (P = .660). The occurrence of postoperative gross hematuria was significantly greater in those with complex renal vasculature than in those with normal renal vasculature (4 of 14 vs 2 of 64; P = .008). The event was resolved uneventfully. CONCLUSION: Although it is technically challenging, RRPLD is feasible and safe for patients in the presence of complex renal vasculature. Preoperative evaluation of the renal vasculature with multislice spiral computed tomography angiography is beneficial for managing abnormal renal vessels.

Comparison of two approaches to retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria.

BACKGROUND AND PURPOSE: The retroperitoneoscopic renal pedicle lymphatic disconnection has been performed mainly via a renal adipose (RA) capsule approach. In this study, we reported a novel technique via extra-adipose (EA) capsule approach and compared the two approaches for intractable chyluria. PATIENTS AND METHODS: From December 2002 to March 2008, retroperitoneoscopic renal pedicle lymphatic disconnection was performed on 41 patients with 23 EA and 18 RA. The stripping of hilar vessels and ureterolympholysis were performed in both approaches, while the mobilization of the kidney was only performed in RA. Comparisons of the two approaches were conducted, including mean operative time, intraoperative blood loss, postoperative bed rest, and hospital stay, as well as operative outcome. RESULTS: Patients were treated successfully without major complications. EA showed the same advantages as RA in terms of intraoperative blood loss (54.9±19.3 mL vs 59.3±26.5 mL, P>0.05), postoperative hospital stay (6.6±1.0 d vs 7.2±0.9 d, P>0.05). Chyluria disappeared in all patients immediately after the operations. EA was significantly superior to RA in operative time (78.9±18.3 min vs 101.8±20.6 min, P<0.05) and the postoperative bed rest time (20.7±1.7 h vs 72.0±0.0 h, P<0.05). No recurrence or nephroptosis was diagnosed in any patient within the follow-up of 21 to 84 months. CONCLUSIONS: Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria is safe and efficacious. EA offers significantly shorter operative time and earlier return to postoperative ambulation.

[The value of pre-operative semen analysis as a restore index of fertilizing capacity after varicocelectomy].

OBJECTIVE: To discuss the value of pre-operative semen analysis of patients with varicocele as a predictive restore index of sperm motility and fertilizing capacity after varicocelectomy. METHODS: Semen analysis was carried out with computer-aided sperm analyzer in 107 patients with varicocele and all patients were referred to the clinic with diagnosis of male infertility. Stratification of patients as group A (n = 32), B ( n = 36) and C (n = 39) was based on pre-operative total motile sperm count (TMSC). Follow-up included semen analysis and pregnancy data after three months following left or bilateral varicocelectomy. RESULTS: The average post-operative TMSC increased significantly when compared with the pre-operative. However, a mean absolute increase in group A and B was better than that in group C (P < 0.05). Of the 68 patients in groups A and B based on pre-operative TMSC, 56 patients' TMSC (82.4%) was > or =20 x 10(6) after varicocelectomy, and that of only 8 (20.5%) patients in group C was > or =20 x 10(6) following varicocelectomy. Of the 98 patients wives, 36 had natural conception. Pregnancy rates in groups A and B were higher than that in group C (P < 0.05). CONCLUSION: Varicocelectomy may be the most effective method to patients with varicocele with pre-operative TMSC > or = 5 x 10(6), but it may be not the best method for patients with severe oligoasthenospermia (pre-operative TMSC < 5 x 10(6)).