Prospective evaluation of complications in laparoscopic urology at a mid-volume institution using standardized criteria: Experience of 1023 cases including learning curve in 9 years.

AIM: To evaluate the laparoscopic operations performed in our department according to the modified Clavien classification system of complications. MATERIALS AND METHODS: Between September, 2005 and February, 2014, a total of 1023 laparoscopic cases were performed. This period was divided into three terms (Terms 1, 2 and 3 consisting of 38, 32 and 32 months, respectively). According to the European Scoring System (ESS), easy (E), slightly difficult (SD), fairly difficult (FD), difficult (D), very difficult (VD) and extremely difficult (ED) cases were 35, 88, 170, 390, 203 and 137, respectively. The perioperative complications were evaluated based on the 3 time periods, with a specific emphasis on determining the learning curve according to the modified Clavien classification system of complications. RESULTS: A total of 236 (23.1%) complications were observed according to the modified Clavien classification. The minor (Clavien I-II) and major (Clavien III, IV and V) complication rates were 20.5% (n = 210) and 2.4% (n = 26), respectively. Clavien I was the most frequently encountered type of complication (n = 120, %11.7). No significant difference was observed among all 3 time periods regarding total complication rates. The D cases had the highest complication rate compared to E, SD, FD, VD and ED cases among all three terms. The total number of complications increased significantly with increasing grade of technical difficulty according to the ESS. CONCLUSION: Complications encountered in our laparoscopic surgery experience were predominantly minor, and the rate of complications was not significantly increased during the learning curve. The present data can provide guidance and manage expectations for surgeons introducing laparoscopy into their practice.

22-year survival following radical nephrectomy and several metastasectomies in a case of renal cell carcinoma.

Renal cell carcinoma (RCC) is a common malignancy. Metastases can be seen both synchronously, at the time of diagnosis, and metachronously during follow-up. At the time of diagnosis, 23% of the patients have metastatic disease. and 25% of patients will develop metastasis during follow-up period after nephrectomy. Nearly 80% of them develop within the first 5 years. However late metastasis of RCC have been also reported within the postoperative 10 years in the literature. For metastatic lesions, if surgically feasible, metastasectomy, and targeted pharmaceutical agents have been recommended. However any randomized controlled study which aimed to determine treatment protocol in patients who develop multiple metastases has not been cited in the literature. Herein, we are presenting a case with renal cell carcinoma in whom within 22 years of follow-up after 10 years of survival multiple metastases in different organs were detected which were managed with surgical, and medical treatments. As far as we know, this case is the first patient with the longest survival whose non-pulmonary metastases had been treated with more than one surgical interventions.

Thyroid metastasis from renal cell carcinoma eight years after radical nephrectomy: a case report.

A forty-five-year-old female patient presented with thyroid nodules eight years after radical nephrectomy for renal cell carcinoma (T2N0M0, grade 2, clear cell subtype) in the right kidney. Ultrasonography of the neck showed multiple hypoechoic macronodules. There was no lymphadenomegaly. During total thyroidectomy following an initial diagnosis of multinodular goiter, frozen section analysis was made, which showed metastasis from renal cell carcinoma. Immunohistochemical studies demonstrated that the tumor cells were negative for thyroglobulin staining. No recurrences or other metastatic disease were seen during a follow-up period of 12 months. Although clinically the thyroid gland is a rare site for tumor metastasis, this possibility should be kept in mind in patients with a previous history of renal cell carcinoma.

A prospective, randomized protocol to examine the efficacy of postinternal urethrotomy dilations for recurrent bulbomembranous urethral strictures.

OBJECTIVES: The high recurrence rate is still the major complication of endoscopic treatment of urethral stricture disease. To compare the outcome of patients who underwent direct vision internal urethrotomy (DVIU) and then followed a protocol that randomized them to either our urethral dilation protocol or consecutive DVIUs for the treatment of their urethral stricture. METHODS: A total of 37 patients, who had undergone at least two DVIUs to treat their recurrent urethral strictures, were enrolled in this study. They were randomized into two groups. The etiology and location of the strictures were similar, and their length ranged from 0.5 to 2 cm in each group. In group 1 (n = 18), the patients were observed by regular visits and uroflowmetry profiles after the initial DVIU and consecutive DVIUs were considered when the stricture recurred. In group 2 (n = 19), patients received urethral dilations with Benique dilatators (maximal 21F) under intraurethral anesthesia, beginning 10 days after the initial internal urethrotomy, according to the following protocol: weekly for the first month, once after 3 and after 6 months, and then once each year. RESULTS: After a median follow-up of 30 months, the urethral stricture recurred within 12 months in 55.6% (n = 10) of group 1, and consecutive DVIUs were indicated. During the same follow-up period, recurrence was observed in 2 patients (10.5%), 9 months and 2 years after randomization, in group 2 (P <0.05). The mean maximal urinary flow rate in groups 1 and 2 at last follow-up was 7.8 +/- 3.7 and 21.0 +/- 8.7 mL/s, respectively (P <0.01). CONCLUSIONS: We suggest a regular, simple urethral dilation protocol for patients with recurrent bulbomembranous urethral stricture shorter than 2 cm, because this significantly allays the stricture recurrence rate, possibly eliminates the need for consecutive DVIU, and reduces morbidity.