Laparoscopic treatment of small-bowel obstruction following laparoscopic lymphadenectomy.

Laparoscopic pelvic lymph node dissection followed by radical perineal prostatectomy has become the treatment of choice for selected patients at our institution with clinically localized adenocarcinoma of the prostate. We describe 2 cases in which bowel obstruction caused by incarceration of a loop of small bowel into a trocar site was managed with laparoscopic techniques.

Technetium-99m antimony sulphide colloid lymphoscintigraphy of the prostate by direct transrectal injection.

Laterality of prostatic lymphatic drainage was successfully assessed in nine patients with prostatic carcinoma after direct unilateral transrectal injections of 99Tcm-antimony sulphide colloid by Franzen needle. Pelvic lymphatic drainage was equally divided between ipsilateral, contralateral and bilateral patterns. The frequent observation of radiocolloid migration to contralateral lymph node groups in patients with prostate carcinoma, including those with primary disease localized clinically to a single lobe of the prostate, indicates the potential for contralateral pelvic lymph node metastases in this population. This finding may be important in determining the appropriate surgical staging and treatment of patients with prostate carcinoma. The clinical applicability of lymphoscintigraphy in the evaluation of metastatic spread and in lymph node biopsy planning requires further study.

Etiologic diagnosis of renal calculus disease.

Renal calculus disease is a common cause of morbidity in industrialized societies, accounting for seven to 10 of every 1000 hospital admissions. Recent advances in surgical therapy have made operative therapy much less invasive while maintaining a high level of success. However, the need to reduce the incidence of this disease persists as more than one half of all stone formers will have recurrence. Although the etiology and therapy for several types of renal calculi are established, much remains unknown concerning the mechanisms of formation of the most prevalent form of renal calculi, calcium oxalate. This article reviews recent basic science and clinical research that attempts to identify the etiologies of renal calculus formation.

Penetrating ureteral trauma at an urban trauma center: 10-year experience.

OBJECTIVES: To review the evaluation and management of patients with penetrating ureteral injuries not associated with iatrogenic etiology. METHODS: A retrospective analysis of 20 patients with penetrating ureteral injuries during a 10-year period at a Level 1 trauma center was performed. Data were collected regarding the mechanism of injury, initial urinalysis and radiographic studies, operative procedure, associated injuries, postoperative complications, and outcome. RESULTS: In general, patients were young (mean age 27.8 years) men (95%). All injuries were unilateral (14 left and 6 right), were primarily caused by gunshot wounds (95%), and were associated with other injuries (100%). Three injuries were to the proximal ureter, 7 to the middle, and 10 to the distal ureter. Admission urinalysis failed to show gross or microscopic hematuria in 25% of cases. Preoperative intravenous urography (IVU) was diagnostic in 25% of cases. Fifteen injuries were diagnosed intraoperatively, including 2 with diagnostic IVU. Delayed diagnoses were made in 4 cases at 3 to 11 days; two by IVU postoperatively and the other two by computed tomography. All patients were treated surgically by ureteroneocystostomy, ureteroureterostomy, or pyeloplasty. Every repair was stented for a mean of 38 days (range 10 to 72). All three major complications (ureteral stricture, persistent urinary leak, and ureterocutaneous fistula) were managed successfully. Thirteen patients with long-term follow-up demonstrated no evidence of obstruction. CONCLUSIONS: Ureteral injuries must be considered early during the evaluation of penetrating abdominal injuries. The admission urinalysis may be falsely normal and initial IVU may be nondiagnostic. The diagnosis may be made intraoperatively or be delayed. The surgical repair should be stented, and long-term success can be anticipated.

The effects of intraurethral lidocaine anesthetic and patient anxiety on pain perception during cystoscopy.

Despite current practice there is no evidence to demonstrate the efficacy of intraurethral lidocaine gel as an anesthetic for rigid cystoscopy. To evaluate the usefulness of lidocaine in decreasing pain associated with cystoscopy, we performed a prospective, randomized, controlled, double-blind study comparing lidocaine gel with a water based lubricant. The effects of pre-procedure anxiety and prior experience with cystoscopy on pain perception were also evaluated. Physician perception of pain experienced by the patient was compared with the actual pain experienced. We found no decrease in pain perception in men or women following lidocaine gel instillation with a 5 or 10-minute dwell time compared to instillation of the plain lubricant. Increased preprocedure anxiety correlated with increased pain perception in women. Personal experience with prior cystoscopic procedures significantly decreased the current pain perception in men. Physicians underestimated the patient pain perception in all groups. Overall, we found the use of lidocaine gel to be of no benefit in routine rigid cystoscopy. Lowering pre-procedure anxiety may decrease the amount of pain perceived by women but not by men.