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Background: Laparoscopic donor nephrectomy (LDN) has become the gold standard approach for kidney donation. The procedure has evolved with time and technological advancements. Contemporary LDN unde...

Purpose To prospectively present the technique, functional and oncological outcome of internal genitalia sparing cystectomy for bladder cancer in 15 selected women. Patients and methods Between January 1995 and December 2010, 305 women underwent orthotopic neobladder after radical cystectomy. Of these, 15 cases with a mean age of 42 years underwent genitalia sparing. Inclusion criteria included stage (T2b N0 Mo or less, as assessed preoperatively, unifocal tumors away from the trigone, sexually active young women and internal genitalia free of tumor. Cystectomy with preservation of the uterus, vagina and ovaries and Hautmann neobladder were performed. Oncological, functional, urodynamic and sexual outcome using Female Sexual Function Index (FSFI) were evaluated. Results Definitive histopathology showed advanced stage not recognized preoperatively in 2 patients, who developed local recurrence and bony metastasis after 3–4 months. A third patient developed bony metastasis after 15 months. No recurrence developed in the retained genital organs. The remaining 12 patients remained free of disease with a mean follow-up of 70 months. Among women eligible for functional evaluation, daytime and nighttime continence were achieved in 13/13 (100%) and 12/13 (92)%, respectively. Chronic urinary retention was not noted. The urodynamic parameters were comparable to those in other patients without genital preservation. Sexual function (FSFI) was better in these patients than in others without genital preservation. Conclusions Genital sparing cystectomy for bladder cancer is feasible in selected women. It provides a good functional outcome, better sexual function and the potential for fertility preservation. So far, the oncological outcome is favorable.

Objective To assess the clinical relevance of small, asymptomatic, noninfection residual stone fragments (≤5 mm) after percutaneous nephrolithotomy (PNL), evaluated using spiral noncontrast-enhanced computed tomography (NCCT). Materials and Methods The present retrospective study included 75 patients who underwent PNL and were proved to have a single residual caliceal stone ≤5 mm as evaluated postoperatively by NCCT. All patients were free of urinary tract infections. The outcome of these residual fragments (RFs) were reassessed ≥12 months later using NCCT. Results The mean follow-up period was 36.2 ± 20.1 months (range 12-96). Of the 75 evaluated patients, 25 (33.3%) passed the stones spontaneously during the follow-up period, 22 (29.35%) had stable asymptomatic RFs, 25 (33.3%) showed regrowth of the RFs, and 3 patients (4%) presented with slippage of the stones into the ureter. Asymptomatic patients with stable RFs elected to continue follow-up. For the remaining patients, 14 (18.7%) and 9 (12%) were referred to shock wave lithotripsy and PNL, respectively. The 3 patients with ureteral stones were treated with ureteroscopy. Only the RF size (>3 mm) correlated significantly with RF growth or ureteral obstruction (odds ratio 1.882, 95% confidence interval 0.919-3.854; P = .05). Conclusion Small RFs (≤5 mm) after PNL, as assessed by NCCT, should be expected to require active intervention in one third of the patients at intermediate follow-up. A small, single, RF (≤3 mm), as assessed by NCCT, can be considered clinically insignificant.

Objective To compare recovery outcomes between laparoscopic donor nephrectomy (LDN) and open donor nephrectomy within a specified enhanced recovery program (ERP) for left kidney donations. Patients and Methods A phase III randomized trial was conducted between January 2013 and June 2015; eligible left-side donors were randomized to laparoscopic or open donor nephrectomy in a 1:1 ratio with recovery optimized within a standardized ERP. The primary outcome was patient-reported measure of physical fatigue, as measured by the physical fatigue domain of the translated Multidimensional Fatigue Inventory 20. Secondary outcomes included other donor recovery outcomes, postoperative pain scores, hospital stay, perioperative complications, and graft outcomes. Results A total of 224 donors (laparoscopy, n = 113; open surgery, n = 111) were randomly allocated. Six weeks postoperatively, physical fatigue domain scores in Multidimensional Fatigue Inventory 20 were significantly lower in the LDN group (mean: laparoscopy, 8.2 ± 3.2 vs open surgery, 13.05 ± 2.9) (P = .007). Median total hospital stay was also significantly shorter in the LDN group (median: laparoscopy, 2; interquartile range, 1-5 vs open surgery, 4; interquartile range, 2-9 days) (P = .002). LDN was associated with less pain scores and less non-opioid analgesic requirements. Warm ischemia times were not significantly different in both groups (mean: laparoscopy, 2.5 ± 0.8 vs open surgery, 2.2 ± 0.6) (P = .431). Conclusion Even when optimized within an ERP, LDN was associated with less general and physical fatigue and better physical function at 6 weeks postoperatively when compared with open surgery for left kidney donations.

To present the results of percutaneous nephrolithotomy (PCNL) for treating staghorn stones.A database was compiled from the computerised files of patients who underwent PCNL for staghorn stones between 1999 and 2009. The study included 238 patients (128 males and 110 females) with a mean (SD) age of 48.9 (14) years, who underwent 242 PCNLs, and included staghorn stones that were present in the renal pelvis and branched into two or more major calyces. PCNL was performed or supervised by an experienced endourologist. All perioperative complications were recorded. The stone-free status was evaluated after PCNL and again after 3 months.Multiple tracts were needed in 35.5% of the procedures, and several sessions of PCNL were needed in 30% of patients. There were perioperative complications in 54 procedures (22%); blood transfusion was needed in 34 patients (14%). The stone-free rate for PCNL monotherapy was 56.6% (137 patients). Secondary procedures were required for 51 patients (21%), and included shock-wave lithotripsy for 49 and ureteroscopy for two. The 3-month stone-free rate was 72.7% (176 patients). Multiple tracts resulted in an insignificantly higher overall complication rate than with a single tract (P = 0.219), but the reduction in the haemoglobin level was statistically significant with multiple tracts (P = 0.001).PCNL for staghorn stones must be done by an experienced endourologist in a specialised centre with all the facilities for stone management and treatment of possible complications. The patients must be informed about the range of stone-free and complication rates, and the possibility of multiple sessions or secondary procedures.

What's known on the subject? and What does the study add? Extracorporeal shockwave lithotripsy is effective for the treatment of paediatric renal stones with favourable short-term safety. Extracorporeal shockwave lithotripsy for treatment of paediatric renal stones is also safe for the kidney and the child on long-term follow-up. Objective To evaluate the long-term effects of extracoporeal shockwave lithotripsy (SWL) for treatment of renal stones in paediatric patients. Patients and Methods A database of paediatric patients who underwent SWL monotherapy for treatment of renal stones from September 1990 through to January 2009 was compiled. This study included only patients with follow-up for more than 2 years. The long-term effects of SWL were evaluated at the last follow-up with measurement of patients' arterial blood pressure, estimation of random blood sugar and urine analysis. The results of diastolic blood pressure were plotted against a standardized age reference curve. The treated kidney was examined by ultrasonography for measurement of renal length and detection of stones. The measured renal lengths were plotted against age-calculated normal renal lengths in healthy individuals. Results The study included 70 patients (44 boys (63%) and 26 girls) with mean age at the time of SWL 6.5 ± 3.6 years (range 1–14). The mean follow-up period was 5.2 ± 3.6 years (range 2.1–17.5). The mean age at last follow-up was 11.7 ± 5.3 years (range 4.4–27.5). No patients developed hypertension or diabetes. Only one treated kidney was smaller than one standard deviation of the calculated length. The cause of this was obstruction by a stone in the pelvic ureter 3 years after SWL. Conclusion The long-term follow-up after SWL for treatment of renal stones in paediatric patients showed no effect on renal growth and no development of hypertension or diabetes.

Objective To determine factors affecting the stone-free rate and complications of percutaneous nephrolithotomy (PNL) for treatment of staghorn stones. Methods The computerized database of patients who underwent PNL for treatment of staghorn stones between January 2003 and January 2011 was reviewed. All perioperative complications were recorded and classified according to modified Clavien classification system. The stone-free rate was evaluated with low-dose noncontrast computed tomography (CT). Univariate and multivariate statistical analyses were performed to determine factors affecting stone-free and complication rates. Results The study included 241 patients (125 male and 116 female) with a mean age of 48.7 ±14.3 years. All patients underwent 251 PNL (10 patients had bilateral stones). The stone-free rate of PNL monotherapy was 56% (142 procedures). At 3 months, the stone-free rate increased to 73% (183 kidneys) after shock wave lithotripsy. Independent risk factors for residual stones were complete staghorn stone and presence of secondary calyceal stones (relative risks were 2.2 and 3.1, respectively). The complication rate was 27% (68 PNL). Independent risk factors for development of complications were performance of the procedure by urologists other than experienced endourologist and positive preoperative urine culture (relative risks were 2.2 and 2.1, respectively). Conclusion Factors affecting the incidence of residual stones after PNL are complete staghorn stones and the presence of secondary calyceal stones. Complications are significantly high if PNL is not performed by an experienced endourologist or if preoperative urine culture is positive.

Objective To present the results of percutaneous nephrolithotomy (PCNL) for treating staghorn stones. Patients and methods A database was compiled from the computerised files of patients who underwent PCNL for staghorn stones between 1999 and 2009. The study included 238 patients (128 males and 110 females) with a mean (SD) age of 48.9 (14) years, who underwent 242 PCNLs, and included staghorn stones that were present in the renal pelvis and branched into two or more major calyces. PCNL was performed or supervised by an experienced endourologist. All perioperative complications were recorded. The stone-free status was evaluated after PCNL and again after 3 months. Results Multiple tracts were needed in 35.5% of the procedures, and several sessions of PCNL were needed in 30% of patients. There were perioperative complications in 54 procedures (22%); blood transfusion was needed in 34 patients (14%). The stone-free rate for PCNL monotherapy was 56.6% (137 patients). Secondary procedures were required for 51 patients (21%), and included shock-wave lithotripsy for 49 and ureteroscopy for two. The 3-month stone-free rate was 72.7% (176 patients). Multiple tracts resulted in an insignificantly higher overall complication rate than with a single tract ( P = 0.219), but the reduction in the haemoglobin level was statistically significant with multiple tracts ( P = 0.001). Conclusions PCNL for staghorn stones must be done by an experienced endourologist in a specialised centre with all the facilities for stone management and treatment of possible complications. The patients must be informed about the range of stone-free and complication rates, and the possibility of multiple sessions or secondary procedures.

Objective: To assess the incidence, imaging, surgical approach and prognosis of adrenal tumors associated with venous thrombosis. Material and Methods: Charts of 206 patients who underwent adrenal surgery were reviewed. Data of patients with pathologically confirmed venous thrombosis, utilized diagnostic modalities, operative treatment and prognosis were reviewed and analyzed. Results: Venous thrombosis was confirmed pathologically in 6 patients (2.9%). All were of male gender with age ranging between 2 and 54 years. The mean size of the masses was 11.5 ± 5.2 cm. Venous thrombosis was diagnosed preoperatively in 2 patients, adrenal vein thrombosis in 1 patient, and renal vein thrombosis in the others. Masses were successfully excised via an open approach in association with nephrectomy in 3 cases. There was no operative mortality or gross morbidity. Pathologically, thrombosis was limited to the adrenal vein in 4 patients and extended to the renal vein in 2. Pathology of the masses revealed neuroblastoma in 2, pheochromocytoma in 2, adrenocortical carcinoma in 1, and pleomorphic sarcoma in 1 case. Metastasis developed within 6 months in 3 of these patients. Conclusion: Venous thrombosis with adrenal tumors is a rare pathological condition in which open surgery is the standard of care. Primary malignant adrenal masses with venous thrombosis have a poor prognostic outcome.

To determine factors affecting the success of bilateral same-session ureteroscopy (BSU) in the treatment of ureteral calculi.From January 2003 to December 2008, BSU was carried out in 89 patients (178 renal units). A successful outcome was considered when both ureters were free of stones without intraoperative complications. Stone-free rate was evaluated with a kidney-ureter-bladder plain X-ray or non-contrast computed tomography. Factors interfering with successful completion of BSU were tested using univariate (chi-squared test and t test) and multivariate (logistic regression) analyses. Data on unilateral ureteroscopy for the treatment of multiple ureteral calculi carried out in 105 patients during the same period were compared with BSU.Intraoperative complications were recorded in 11 procedures (6.2%) in the form of ureteral perforation in three and mucosal injury in eight. After BSU, 153 renal units were stone free (86%) as 17 had residual fragments, stones migrated to the kidney in six and failure was encountered in two. A successful outcome was observed in 62 patients (70%). Stone impaction, stones located in the proximal ureter and stone surface area were the significant risk factors for unsuccessful BSU (relative risks 3.6, 3.3 and 1.47, respectively). Compared with unilateral ureteroscopy, no difference were found with regard to complication rate (6.7%, p = 0.5) or stone-free rate (80%, p = 0.2).Bilateral same-session ureteroscopy is a safe and effective procedure in the management of bilateral ureteral stones. Proximal ureteral calculi, large and impacted stones carry the highest risk of unsuccessful results.

Purpose: To critically analyze the role, accuracy and safety of percutaneous adrenal biopsy for indeterminate adrenal lesions. Materials and Methods: Adrenal biopsies were performed in 15 among 214 patients (7%) diagnosed with adrenal masses being indeterminate on preoperative imaging. Definitive histopathology was obtained in all and overall sensitivity and negative predictive value were calculated. Safety of the procedure was reported. Results: The study included 8 male and 7 female patients with a mean age of 33.3 ± 20.3 years (range 7–65). Biopsy was carried out under computed tomography and ultrasound guidance in 12 and 3 patients, respectively. There were 2 nonrepresentative biopsies that were proved to be adrenocortical carcinoma and myelolipoma after adrenalectomy. Results of biopsy in the remaining 13 patients provided accurate diagnosis as proved by definitive histopathology in all but 2 in whom the final diagnosis was established as adrenocortical carcinoma while biopsy was paraganglioma in one and cortical adenoma in the other. Overall sensitivity and negative predictive value of adrenal biopsy was 73.3 and 60%, respectively. Apart from two mild hypertensive episodes following silent pheochromocytoma biopsy, no complications were reported. Conclusions: Percutaneous biopsy is a safe procedure for the diagnosis of pathologic conditions of the adrenal gland with a reasonable diagnostic aid.

We determined the factors predicting unfavorable results of semirigid ureteroscopy for ureteral calculi.We reviewed the computerized files of 841 patients who underwent a total of 908 ureteroscopic procedures for ureteral stones from January 2003 through December 2006. A semirigid 6/7.5Fr ureteroscope was used in pediatric patients and an 8/10Fr or 8.5/11.5Fr ureteroscope was used in adults. Patients with favorable results were those who became stone-free after a single ureteroscopic procedure without any complications. They were compared with patients who had unfavorable results using univariate (chi-square and t tests) and multivariate (logistic regression) statistical tests to identify risk factors for unfavorable results.The study included 567 males and 274 females with a mean age of 48.5 years (range 2 to 81). The complication rate was 6.7% (61 procedures). The stone-free rate after a single ureteroscopic intervention was 87% (791 procedures). Favorable results were documented in 751 procedures (82.7%). Significant factors for unfavorable results were proximal ureteral stones, ureteroscopy done by surgeons other than experienced endourologists, stone impaction and stone width (relative risk 4, 2.5, 1.8 and 1.2, respectively).Semirigid ureteroscopy is a safe and highly effective treatment modality for ureteral stones.

Objective: It was the aim of this study to review and analyze clinical data on the diagnosis and management of patients with adrenal masses. Patients and Methods: Between 1976 and 2005, 238 patients admitted to our institute with adrenal masses were reviewed. Incidence, clinical features, imaging technique findings, surgical approaches, morbidity and mortality, as well as pathological diagnoses were reported. Results: The series comprised 134 males and 104 females (mean age 33.3 ± 20.3 years). Right-sided masses were more common (63.4%), with a mean size of 7.7 ± 4 cm. Pain was the most frequent presenting symptom (53.4%), while 62 (26%) had a functional tumor. Incidentaloma was diagnosed in 49 patients (20.6%). Both computed tomography and magnetic resonance imaging showed a high diagnostic yield (sensitivities of 98.9 and 100%, respectively). Open adrenalectomy was performed in 153 patients (64.3%), while a laparoscopic approach was employed in 53 patients (22.3%). The intraoperative complication rate was 14.7%, the postoperative complication rate 6.1% and perioperative mortality 1.7%. Most of the excised masses were pheochromocytomas (26.4%). Conclusions: Computed tomography is recommended as the first diagnostic modality to define and characterize adrenal masses. Laparoscopic adrenalectomy is currently replacing open surgery as the standard surgical management of adrenal masses.

This study was conducted to evaluate the safety and efficacy of the supracostal approach for percutaneous nephrolithotomy in pediatric patients.We retrospectively reviewed 60 percutaneous nephrolithotomy procedures done in 50 children (32 boys and 18 girls) between 2000 and 2007. Mean patient age was 7 +/- 4 years (range 9 months to 14 years). Noncontrast computerized tomography was the primary radiological investigation for most of the cases. The subcostal approach was used in 40 procedures, and the supracostal approach (above the 12th rib) was required in 20. We compared both approaches regarding preoperative characteristics, stone-free and complication rates, and the need for auxiliary procedures.The preoperative characteristics of the patients, urinary tracts and stones were comparable for both treatment groups. There were no major complications. Significant bleeding requiring blood transfusion was observed in 3 patients (5%), transient fever in 3 (5%) and urinary leakage through the nephrostomy site in 3 (5%). The distribution of complications among subcostal and supracostal approaches was comparable. Of the 60 renal units 46 (77%) were stone-free after percutaneous nephrolithotomy at discharge from the hospital. Of the remaining 14 units 9 (15%) were stone-free after shock wave lithotripsy and 5 (8%) had insignificant residual stones. Therefore, the overall stone-free rate at 3 months was 92.5%. Comparing the subcostal and supracostal approaches, there were no significant differences between hospital stays, complication rates, unplanned auxiliary procedures, and stone-free rates at discharge home and at 3-month followup.Percutaneous nephrolithotomy for treating renal stones in children provides a high degree of safety and efficacy whether a supracostal or subcostal approach is used.

Purpose: To present the combination of laparoscopy and nephroscopy for the treatment of stones in pelvic ectopic kidneys. Patients and Methods: The series included seven male and four female patients (mean age 43 ± 9 years). Laparoscopy-assisted percutaneous nephrolithotomy (PCNL) was performed for caliceal stones in five patients after failure of shockwave lithotripsy, while laparoscopic pyelolithotomy was performed for large or branched renal pelvic stones in six patients. Results: The mean operative time was 164 ± 30 minutes. There were neither complications nor conversions to open surgery. The stone-free rate was 91% (10 patients). One patient had a residual caliceal fragment that was treated with shockwave lithotripsy. The mean hospital stay was 3.5 ± 0.7 days. Conclusion: The combination of laparoscopy and nephroscopy is feasible, safe, and effective for the treatment of stones in pelvic kidneys.

Despite evidence that urologists can safely acquire percutaneous renal access for percutaneous nephrolithotomy, many centers still rely on interventional radiologists to obtain renal access. In this study we evaluated percutaneous access for percutaneous nephrolithotomy obtained by interventional radiologists or urologists, and compared access outcomes and complications.The surgical records of 1,121 patients with 1,155 stone bearing kidneys treated with percutaneous nephrolithotomy between 1999 and 2003 were reviewed. Patients were stratified according to percutaneous renal access into 509 patients with 661 access procedures performed by urologists and 612 patients with 612 access procedures performed by interventional radiologists.Both groups were comparable except there was a higher incidence of multiple stones in the urologist access group. Urologists had a significantly greater rate of using multiple and supracostal tracts compared to radiologists. The stone-free rates were 83.4% and 86.1% for urologist and radiologist access groups, respectively (p = 0.1). Major complications were seen in 74 patients (6.6%). Both groups had similar complication rates except for significant bleeding in the urology group (4.3%) compared with 2.1% in the radiology cohort (p = 0.02). Further multivariate analysis showed that bleeding was not related to the type of access whether performed by urologist or radiologist.The urologist is able to safely and effectively obtain percutaneous renal access for percutaneous nephrolithotomy as a single stage procedure. Despite more complex stones and higher access difficulty in the urology access group, access related complications and stone-free rates were comparable. We recommend percutaneous access training in urology training programs.

We identified risk factors predicting severe bleeding due to percutaneous nephrolithotomy.Computerized data on 2,909 patients who underwent a total of 3,878 percutaneous nephrolithotomy procedures between January 1995 and December 2005 were retrospectively reviewed. Data on patients who experienced severe bleeding requiring angiographic renal embolization were compared with those on other patients using univariate and multivariate analyses. We tested the characteristics of patients, kidneys and stones together with details of the operative procedure and surgeon experience.Severe bleeding complicated a total of 39 procedures (1%) in 25 males and 14 females with a mean age of 50.7 +/- 12.6 years. Associated morbidity included shock in 6 patients and perirenal hematoma in 4. Renal angiography revealed pseudoaneurysm in 20 patients, arteriovenous fistula in 9, the 2 lesions in 8 and arterial laceration in 2. Bleeding could be controlled with superselective embolization in 36 patients (92.3%). Followup was available on 33 patients (mean 21 +/- 15 months). Renal function was stable in all patients except 3 who had a post-embolization increase in serum creatinine, of whom all had a solitary kidney and none required renal replacement therapy. Significant risk factors for severe bleeding were upper caliceal puncture, solitary kidney, staghorn stone, multiple punctures and inexperienced surgeon.Percutaneous nephrolithotomy should be performed by an experienced endourologist in patients at risk for severe bleeding, such as those with a solitary kidney or staghorn stones.

Objectives To identify the risk factors implicated in colonic perforation during percutaneous nephrolithotomy. Methods From 1985 to 2004, 5039 percutaneous nephrolithotomy procedures were performed in our center. Colonic perforation complicated 15 procedures (0.3%). The patient files were retrospectively reviewed for detection of preoperative risk factors as shown by multivariate statistical analysis. The operative details and postoperative course were also studied to determine the time and mode of diagnosis of colonic injury and treatment strategies and outcome. Results All injuries were retroperitoneal. The mean patient age was 57 ± 8.4 years. Of the 15 patients, 11 were men and 4 were women. The left side was affected in 10 patients (66.6%). The right side was injured only in those with horseshoe kidneys or with recurrent disease. Colonic perforation complicated lower caliceal puncture in 12 procedures (80%) and complicated upper caliceal punctures in those with horseshoe kidneys or chronic colonic distension. Significant independent risk factors were advanced patient age and the presence of a horseshoe kidney. The diagnosis was established intraoperatively in 5 patients and postoperatively in 10, 5 of whom presented with colocutaneous fistula. The diagnosis was confirmed with abdominal computed tomography or opacification of the colon during antegrade or retrograde pyelography. Conservative treatment was successful in all but 2 patients who required colostomy. Conclusions Significant independent risk factors for colonic perforation during percutaneous nephrolithotomy were advanced patient age and the presence of a horseshoe kidney. Early diagnosis and proper treatment represent the key to minimizing patient morbidity and avoiding serious complications.

To present our experience with ureteroscopy for the treatment of pediatric ureteral calculi.The records of 32 children with an average age of 8.7 years (range 2-15 years) treated with rigid ureteroscopy between June 1994 and July 2003 were reviewed. In 33 ureteral units, 8F rigid ureteroscopy was carried out 35 times to treat stone disease. Stones were located in the upper ureter in 2 cases, the middle ureter in 2 cases, and the lower ureter in 29 cases. Stone size ranged from 4 to 15 mm (mean 7 mm). Dilatation of the ureteral orifice was necessary in 10 procedures.The management of stone in 29 children (90.7%) was straightforward, and a single procedure was sufficient to clear the ureters. In 2 children (6.2%), repeat ureteroscopy was undertaken to render the ureters stone free, and in 1 child (3.1%), it was not possible to remove the stone. Stones were fragmented with pneumatic lithotripsy in 2 cases and with the holmium laser in 9; in the remaining 22 cases, the stones were removed without fragmentation. Intraoperative complications occurred in 3 children (9.3%) and consisted of extravasation (1 patient) and stone migration (2 patients). The early postoperative complications were hematuria in one patient and renal colic in another. Of the patients, 28 were followed 3 to 48 months. No stricture was detected at the site of stone impaction in any patient.In the hands of an experienced surgeon, ureteroscopy can be a safe and efficient treatment for ureteral stones in children.

To determine prognostic variables which influence late recurrence after initially successful percutaneous endopyelotomy for secondary ureteropelvic junction obstruction (UPJO).Between July 1987 and March 2002, 67 patients with secondary UPJO were treated with percutaneous endopyelotomy at our center. Long-term follow-up data were available for 50 patients with initially successful results (42 after a single treatment and eight after repeated endopyelotomy). Follow-up excretory urography and diuretic renal scans were performed for objective evaluation. Late recurrence was diagnosed if obstruction developed after1 year of follow-up. Univariate (Kaplan-Meier method) and multivariate (Cox regression model) analyses of pre-, peri- and postoperative factors were carried out for detection of significant variables affecting the late recurrence rate.The follow-up period ranged from 1.27 to 13.85 years (mean 6 +/- 4.3 years). Late recurrence of UPJO was observed in seven cases (14%): 4/42 initially successful cases (9.5%) and 3/8 cases of repeated endopyelotomy (37.5%). In univariate analysis, the significant factors were severity of stenosis at the UPJ (p = 0.04), preoperative serum creatinine (p = 0.04), repetition of endopyelotomy (p = 0.03) and development of postoperative complications (p = 0.02). In multivariate analysis, all of the above factors, with the exception of severity of stenosis at the UPJ, were independent significant factors affecting late recurrence.As late recurrence was observed in 14% of cases after percutaneous endopyelotomy, long-term follow-up is needed, especially in patients with elevated preoperative serum creatinine, those in whom postoperative complications developed and those in whom a first attempt at endopyelotomy failed.

To determine factors affecting patients' discomfort during the period self-retaining ureteral stents are in place.Between April 2001 and May 2003, 58 male and 42 female patients underwent temporary double-pigtail stenting. The indications were endopyelotomy in 39 patients, ureteroscopy in 32, laparoscopic pyeloplasty in 18, and endoureterotomy in 11. The stents were silicone in 56 patients and Percuflex in 44. The median stenting period was 8 weeks (range 4-16 weeks). Patient discomfort was evaluated by a questionnaire conducted by the physician before stent removal. Tested variables were patients' sex, side of the stent, urine culture, stent material, stent length and diameter, and stenting duration. The site of the upper coil (renal pelvis or calix), the site of the lower coil (in the same side or crossing the midline), and the shape of the lower coil (complete circle or not) were also tested. Univariate and multivariate analysis were carried out to determine significant independent variables, with P0.05 being significant.Of the total, 59 patients experienced discomfort consisting of dysuria, urgency, urge incontinence, loin pain, suprapubic pain, frequency, nocturia, or gross hematuria or some combination. Significant factors associated with discomfort were a positive urine culture, crossing of the lower end of the stent to the opposite side, caliceal position of the upper coil, and longer stenting duration.Proper positioning of the coils of the stent, eradication of infection, and shorter stenting duration are advised to decrease patient discomfort during the period of ureteral stenting.

Objectives To present our experience with extracorporeal shock wave lithotripsy (ESWL) in the management of upper urinary tract calculi in patients with urinary diversion. Methods Between March 1989 and June 2004, 27 patients with radical cystectomy and urinary diversion were treated using ESWL for upper urinary tract calculi using the Dornier MFL 5000 lithotripter. The mean length of the stones was 11 ± 3.1 mm and the mean width was 8.8 ± 3.5 mm. The follow-up protocol included plain abdominal x-ray and renal ultrasonography every 2 weeks until complete stone clearance. All follow-up data were collected and analyzed after 3 months. Success was defined as the absence of residual stones or the presence of insignificant gravel less than 4 mm. Results Retreatment was required in 12 patients (44.4%). Failure to disintegrate the stones was recorded in 2 cases (7.4%) and significant residual stones were recorded in 1 (3.7%). Post-ESWL renal obstruction was observed in 2 cases (7.4%). Secondary procedures were needed in 5 cases (18.5%). Two percutaneous nephrolithotomy and one antegrade ureteroscopy were performed for treatment of ESWL failure. One open ureterolithotomy and one antegrade ureteroscopy were performed for treatment of post-ESWL renal obstruction. Thus, the overall success rate of ESWL monotherapy in the treatment of upper urinary tract stones was 81.5% (22 of 27). Conclusions ESWL monotherapy proved to be a valuable option in the treatment of upper tract lithiasis in patients with urinary diversion. However, it may cause renal obstruction, and antegrade endoscopic maneuvers should be available.

We studied the role of open surgery versus percutaneous nephrolithotomy (PCNL) in the treatment of complete staghorn stones in a prospective randomized manner.A total of 79 patients with 88 complete staghorn stones, defined as filling the entire collecting system or at least 80% of it, were prospectively randomized for PCNL (43) or open surgery (45). Intraoperative and postoperative morbidity, operative time, hospital stay, and stone clearance at discharge home and followup were compared for both methods. Patients with significant residuals in both groups were subjected to extracorporeal shock wave lithotripsy (Dornier Medical Systems, Inc., Marietta, Georgia) on an outpatient basis. Followup was completed for all cases with a mean duration +/- SD of 4.9 +/- 2.5 months (range 3 to 14). Renal function was evaluated by Tc-mercaptoacetyltriglycine renogram before and after treatment in both groups.Intraoperative complications in terms of bleeding requiring blood transfusion, and pleural, vascular or ureteral injuries were recorded in 7 patients (16.3%) in the PCNL and 17 (37.8%) in the open surgery groups, a difference of significant value (p0.05). Major postoperative complications including massive hematuria requiring blood transfusion, septicemia, urinary leakage and wound infection were observed in 8 patients (18.6%) in the PCNL group and in 14 (31.1%) in the open surgery group, a difference of no significant value. PCNL was associated with shorter operative time (127 +/- 30 vs 204 +/- 31 minutes, p0.001), shorter hospital stay (6.4 +/- 4.2 vs 10 +/- 4.2 days, p0.001) and earlier return to work (2.5 +/- 0.8 vs 4.1 +/- 1 weeks, p0.001). On the other hand both treatment groups were comparable in regard to stone-free rates at discharge home (49% vs 66%) and at followup (74% vs 82%). At followup renal function improved or remained stable in 91% and 86.7% in the PCNL and open surgery groups, respectively.PCNL is a valuable treatment option for complete staghorn stones with a stone-free rate approaching that of open surgery. Moreover, it has the advantages of lower morbidity, shorter operative time, shorter hospital stay and earlier return to work.

Purpose: We report our experience with percutaneous nephrolithotomy (PCNL) in children, and evaluate its early and late anatomical and functional results. Materials and Methods: A total of 65 children with renal calculi were treated with PCNL. Patient age at operation ranged from 9 months to 16 years (mean ± SD of 5.9 ± 0.9 years), and 27 (41.5%) were younger than 5 years. Seven patients had bilateral renal stones and, therefore, the number of kidneys treated by PCNL was 72. The patients were followed regularly every 3 months during year 1 and every 6 months thereafter. Renal scans using 99m technetium dimercapto-succinic acid for detection of renal scarring and 99m technetium diethylenetetramine-pentaacetic acid for determination of selective glomerular filtration rate (GFR) were performed in all patients at least once during followup, which ranged from 6 to 72 months (mean ± SD 40 ± 10). Results: Early complications included significant intraoperative bleeding in 1 case, renal pelvis perforation in 1 and transient fever in 2. Mean hospital stay ± SD was 3 ± 1.2 days (range 2 to 21). Of the renal units 62 (86%) were stone-free after a single PCNL, and the remaining 10 with residual stones were treated with a second look PCNL (4) and shock wave lithotripsy (6). Stone-free rates at hospital discharge and at 3 months were 93% and 100%, respectively. During followup 6 patients (9%) had recurrence of small renal stones and were successfully treated with shock wave lithotripsy. None of the kidneys had scarring on dimercapto-succinic acid renal scan. All of the kidneys except 1 showed improvement or stabilization of the corresponding GFR determined by diethylenetetraminepentaacetic acid renal scan. Comparison of the mean preoperative GFR of the corresponding kidney (28.8 ± 11.2 ml per minute) with mean value at followup (36.1 ± 9.9) showed an increase of statistical significance (p Conclusions: PCNL is a safe and effective procedure for the treatment of children with renal calculi. At long-term followup the procedure improves renal function without renal scarring.

OBJECTIVE To evaluate the role of multiphasic helical computed tomography (CT) in planning surgical treatment for pelvi-ureteric junction obstruction (PUJO). PATIENTS AND METHODS Multiphasic helical CT was used in 60 consecutive patients (mean age 32 years, sd 13.72) with primary PUJO. The different images were interpreted before surgery by a urologist and radiologist. The number, type and relation of the crossing vessels to the PUJ were detected. Pyeloplasty (open or laparoscopic) was used in patients where there was a significant crossing vessel (i.e. > 2 mm in diameter and passing at the PUJ) or with ballooning of the renal pelvis. Endopyelotomy (antegrade or retrograde) was used in the other patients. Subjective and objective success rates were determined 3–6 months after treatment and then every 6 months. RESULTS Hyperdense renal stones were detected in precontrast images in 15 patients, significant crossing vessels in 33 (55%), and anterior malrotation of the renal pelvis in 23 (38%; 19 associated with significant crossing vessels, i.e. ureterovascular hydronephrosis). A large para-pelvic cyst compressing the PUJ and upper ureter was detected in one patient. Pyeloplasty was used in 45 patients, among whom the sensitivity of multiphasic helical CT in detecting crossing vessels was 97%, the specificity 92% and accuracy 96%. Uncomplicated endopyelotomy was used in 14 patients and percutaneous aspiration of the para-pelvic cyst in one. CONCLUSION Multiphasic helical CT can accurately delineate the spatial anatomy of the renal and peri-renal area; it may be important in planning surgical treatment for PUJO, especially when endopyelotomy is considered.

Objectives To evaluate the outcome and morbidity of laparoscopic nephrectomy in patients with end-stage renal disease. Methods Between August 1991 and September 2001, 64 laparoscopic nephrectomies were carried out for the native kidneys of 62 patients with end-stage renal failure. The procedures were performed in preparation for renal transplantation. The indications were vesicoureteral reflux with persistent or recurrent urinary tract infection in 26 renal units, uncontrolled hypertension in 15, chronic pyelonephritis or hydronephrosis with urinary tract infection in 8, renal calculi in 13, heavy proteinuria in 1, and small renal tumor in 1. The left side was removed in 52 procedures and the right side was removed in 12. Forty-eight and 16 renal units were removed through the retroperitoneal and transperitoneal approach, respectively. Results Sixty procedures were successfully performed (94%). Four patients required open exploration (6%). Four major complications were recorded: pneumothorax in 1, large hematoma in 1, colonic injury in 1, and bleeding in 1. No mortality related to the procedures or their complications occurred. The patients received allograft transplantation shortly after the procedure, with a mean of 26 days. Both transperitoneal and retroperitoneal approaches were effectively used with satisfactory outcome. Conclusions Laparoscopy should be considered as the procedure of choice for pretransplant nephrectomy. The high success rate, low morbidity, early recovery, and short duration between nephrectomy and transplantation all are considered as real advantages for this patient population.

The data on laparoscopic nephrectomy in Mansoura UrologyNephrology Center were reviewed to identify the preoperative findings that may predict the need for conversion to open surgery.One hundred sixty-three patients were subjected to transperitoneal laparoscopic nephrectomy, while 82 underwent retroperitoneal laparoscopic nephrectomy for benign renal diseases. The preoperative demographic data and laboratory and radiologic findings of these patients were correlated with failure rate of the laparoscopic procedure.The overall failure rate was 10.4% and 11% for the transperitoneal and retroperitoneal approach, respectively. Positive urine culture, renographic clearance of the removed kidney (10 ml/min), and learning curve were independently associated with a greater risk of failure in patients undergoing transperitoneal nephrectomy. For the retroperitoneal approach, a positive urine culture, renographic clearance (or =10 ml/min), and large kidney showed statistical significance.Preoperative data could be used as a predictor of laparoscopic nephrectomy outcome in patients with benign renal diseases. A more experienced surgeon should be selected for risky cases, bearing in mind the greater potential for early conversion to open surgery.

Objective: To establish a polymerase chain reaction (PCR) assay for the rapid detection and identification of mycobacteria in urine, and to assess the value of such assay in routine laboratory diagnosis of genitourinary tuberculosis .Materials and Methods: Urine specimens from 1000 patients with clinical suspicion of urinary tuberculosis were examined. Two assays for the detection and identification of Mycobacterium tuberculosis (M. tuberculosis) complex and mycobacteria other than tuberculosis (MOTT) by non-radioactive DNA hybridization of PCR-product were applied. The first assay used PCR primers and probe derived from M. tuberculosis species-specific DNA insertion sequence, IS6110. The second utilized mycobacterium genus-specific sequence encoding ribosomal ribonucleic acid (16S rRNA). The results obtained by PCR were compared with those obtained by standard microbiological methods, acid-fast bacilli (AFB) stain and culture.Results: Compared with cultures, the sensitivity of AFB staining was 52.07% and...

To evaluate the long-term functional outcome of percutaneous nephrolithotomy (PNL) for calculi in solitary kidneys and to determine factors leading to renal function deterioration.The computerized files of patients with solitary kidneys who underwent PNL between January 2002 and December 2009 were retrospectively reviewed. Patients with follow-up2 years were excluded. Complications, secondary procedures, and stone-free rates were recorded. Changes in the renal function were judged by comparing preoperative and postoperative estimated glomerular filtration rates. Preoperative, intraoperative, and postoperative factors that may affect renal function were tested using univariate and multivariate analyses to define risk factors for deterioration of renal function on long-term follow-up.The study included 200 patients (133 men [66.5%] and 67 women [33.5%] with mean age 52.3 ± 11.7 years). Complications were reported in 34 patients (17%). Severe bleeding was noticed in 10 patients (5%). The overall stone-free rate was 89.5%. After a mean follow-up of 3 ± 1.4 years (range, 2-8), there was significant improvement of the estimated glomerular filtration rate from 57 to 64 mL/min (P.001). Thirty-one patients (15.5%) showed deterioration of the renal function. Multiple punctures and postoperative bleeding were independent risk factors for renal function deterioration (odds ratio was 3.7 and 4.5, respectively).PNL for calculi in solitary kidneys provided significant improvement in renal function at long-term follow-up. Multiple punctures and severe bleeding are independent risk factors for deterioration of the kidney function.

Objective To describe the technique and report our experience of laparoscopic nephrectomy. Patients and methods Between August 1992 and December 1993, 106 patients underwent laparoscopic nephrectomy at the Mansoura Urology and Nephrology Center. Results Of the 106 patients, laparoscopic nephrectomy was performed successfully in 97 cases. Conversion to an open procedure was necessary in the remainingnine patients. Conclusion For a selected group of patients, laparoscopicnephrectomy is a feasible and safe technique. The length of hospital stay and convalescence is short and return to work is rapid.

Between August 1992 and April 1993, 60 patients underwent laparoscopic nephrectomy in our institution for benign disease (35 hydronephrosis, 20 chronic pyelonephritis, 4 end-stage kidney, 1 renal hypoplasia). Conversion to open surgery was needed in six cases to overcome intraoperative bleeding or perirenal adhesions. The mean operative time was 3.5 +/- 1.3 hours, and the mean hospital stay was 3.2 +/- 2.1 days. No deaths occurred, but significant complications were encountered in four cases in the form of pulmonary embolism, a large hematoma, postoperative bleeding, and colonic perforation. Laparoscopic nephrectomy is a safe and effective alternative to open nephrectomy for benign renal conditions.

INTRODUCTION AND OBJECTIVES: To compare the results of percutaneous nephrolithotomy (PNL) and open surgery for treatment of staghorn stones in children. METHODS: The electronic records of children who underwent treatment of renal stones between September 2000 and 2009 were retrospectively reviewed. Exact matching criteria were used to compare PNL and open surgery in treatment of staghorn stones. The patients were matched for sex, stone burden (partial or complete staghorn) and laterality (unilateral or bilateral). Success, retreatment rates, need for auxiliary procedures, and complications were compared for both groups. RESULTS: We identified 13 matched pairs of renal units in 11 patients as 2 patients in each group had bilateral staghorn stones. Each group comprised 9 males and 2 females. All PNL procedures were completed successfully without intraoperative complication. Postoperative complications included hematuria in 2 patients and urinary leakage in one. Secondary procedures were needed after 7 PNL (53.8%). They included second look PNL in 3 units, SWL in 3 units and ureteroscopy for retrieval of a ureteral stone causing urinary leakage in one unit. Stone-free rate at three months was 77% as 10 renal units were free of stones and 3 had insignificant residual fragments 4mm. For open surgery, complications included; pleural injury, renal bleeding and postoperative fever in one patient for each complication. Secondary procedures were needed in 4 cases (30.8%) in the form of SWL for residual stones. Stone-free rate at 3 months was 84.6% because 11 renal units were free of stones and 2 had insignificant residuals. Table 1 summarizes the comparison between both treatment groups. The only significant difference was shorter hospital stay after PNL (P 0.008). CONCLUSIONS: For treatment of staghorn stones in children, percutaneous nephrolithotomy was comparable to open surgery with regard to complication and stone-free rates. However, PNL posed the advantage of shorter hospital stay and the disadvantage of more secondary procedures. Source of Funding: None

• To study long-term results of percutaneous nephrolithotomy (PNL) for treatment of staghorn stones.• The records of patients who underwent PNL for staghorn stones between January 1998 and January 2008 were retrospectively reviewed. • Patients who completed follow-up for one year or more were included. Follow-up with KUB and renal ultrasonography were performed every 3-6 months. • Renal radioisotopic scan was performed for patients who had already undergone this study before doing PNL.• The study included 122 patients (69 male and 53 female) with mean age 47.6 ± 14.5 years (5-74). They underwent 126 PNL. • Perioperative complications were encountered in 28 procedures (22%). The mean period of follow-up was 3.5 ± 2.3 years (1-11.3). Among 71 stone-free kidneys, 18 (25%) developed stone recurrence. Of 55 kidneys with residuals at the start of follow-up, 36 (65%) showed growth of these residuals. • Preoperative and postoperative renograms were performed for 71 patients. • At the last follow-up, differential GFR was stable in 53 (74.5%), improved in 12 (17%) and deteriorated in 6 (8.5%). Among patients with deteriorated renal function, 3 had undergone embolization to control severe bleeding, one developed secondary UPJO, and one had recurrent stone obstructing the kidney.• Long-term functional results of PNL for staghorn stones are satisfactory as 91.5% of kidneys showed stable or improved GFR. Long-term follow-up is mandatory especially for patients with residual stones.

OBJECTIVES To use a matched-pair analysis design to compare the safety and efficacy of shock wave lithotripsy (SWL) and ureteroscopy (URS). Controversy still exists regarding whether SWL or URS is the best management of upper ureteral calculi. METHODS We reviewed the records of patients with a single radiopaque upper ureteral stone treated by URS or SWL from January 2003 to December 2005. SWL was performed as an outpatient procedure using the electromagnetic lithotripter (Dornier Lithotripter S). URS was performed using an 8F or 8.5F semirigid ureteroscope. Intracorporeal lithotripsy with pneumatic or holmium laser energy was used when needed. A matched-pair analysis was performed using 3 parameters (sex, stone size, and degree of hydronephrosis). The success rates, retreatment rates, auxiliary procedures, and complications were compared in each group. RESULTS A total of 427 patients were treated for upper ureteral stones. Forty-three matched pairs were identified and compared. The success rate was 83.7% for SWL vs 88.4% for URS (P = .8). The retreatment rate was significantly greater in the SWL group than in the URS group (65% vs 2.3%, respectively; P < .001). The need for auxiliary procedures was equal in both groups (16.3%). The complication rate was 14% in the URS group and 4.7% in the SWL group (P = .1). CONCLUSIONS SWL and semirigid URS are highly effective in the treatment of proximal ureteral stones

OBJECTIVES To evaluate the role of percutaneous nephrolithotomy in management of the patients with autosomal dominant polycystic kidney disease and associated nephrolithiasis. METHODS A total of 19 patients with autosomal dominant polycystic kidney disease and upper urinary tract stones were included in the study. One patient had bilateral renal stones. Most of the stones were located in the renal pelvis and/or calices with a stone size >2 cm in the largest diameter. All patients were treated by percutaneous nephrolithotomy at 2 centers. Therefore, 20 percutaneous nephrolithotomy procedures were performed. Most of the procedures were performed in 1 stage by the urology team under fluoroscopic guidance; 6 cases were done in 2 stages. The success rate and morbidity and mortality of the technique and hospital stay were recorded. RESULTS The pelvicaliceal system was successfully approached in all cases but 1. The overall stone-free rate was 89.4%. Renal function improved in the patients who presented with azotemia and was stable in the others. No patient died. Complications occurred in 3 procedures and consisted of mild postoperative hematuria in 1, bleeding through the nephrostomy tube in 1, and low-grade fever in 1. The mean hospital stay was 3 days. CONCLUSIONS Percutaneous nephrolithotomy is a safe and effective method for the treatment of patients with autosomal dominant polycystic kidney disease and associated upper urinary tract stones.

We addressed the impact of stone density and size on the role of computerized tomography for diagnosing residual stones after percutaneous nephrolithotomy.We prospectively evaluated 100 renal units that underwent percutaneous nephrolithotomy. The study included 55 opaque and 45 lucent or faint stones. Patients were examined after the procedure by plain x-ray of the kidneys, ureters and bladder, linear tomography, ultrasound and spiral computerized tomography. Minute residual stones were defined as 1 or 2 caliceal stones less than 5 mm, as measured by computerized tomography.Stone-free status was achieved in 38 renal units. Minute and significant residual stones were detected in 26 and 36 renal units, respectively. For faint and lucent stones sensitivity for overall stone detection was 100% for computerized tomography, 11.1% for plain x-ray, 22.2% for linear tomography and 22.2% for ultrasound (p0.05). Sensitivity for detecting significant residual stones was 100% for computerized tomography, 20% for plain x-ray, 33.3% for linear tomography and 20% for ultrasound (p0.05). For opaque stones sensitivity for overall stone detection was 100% for computerized tomography, 62.9% for plain x-ray, 74.3% linear tomography and 48.6% for ultrasound (p0.05). Sensitivity for detecting significant residual stones was 100% for computerized tomography, 85.7% for plain x-ray (p not significant), 95.2% for linear tomography (p not significant) and 57.1% for ultrasound (p0.05).Computerized tomography provides the most sensitive tool for detecting residual stones after percutaneous nephrolithotomy. Nevertheless, it should not be routinely performed in patients with opaque stones because it yields no statistically valuable increase in the diagnosis of significant residual stones compared with that of plain x-ray and linear tomography.

Objective The surgical management of renal and upper ureteral calculi presents unique challenges in obese patients. We reviewed our recent experience with percutaneous nephrolithotomy (PNL) in obese patients to determine the safety and outcome of this procedure in such group of patients. Patients and methods The surgical records of 1121 patients treated with PNL between 2000 and 2004 were reviewed. Patients were stratified into four groups according to the World Health Organization classification of body mass index (BMI): 40kg/m 2 (morbidly obese). The outcomes of PNL in these four groups were compared. Results A total of 1287 procedures were performed on 1155 renal units (1.1 procedures per renal unit). The overall stone-free rate was 85.1% and the mean hospital stay was 3.3±2.6 d. Major complications were seen in 72 patients (6.4%). No statistically significant differences were found in decrease in haemoglobin concentration, hospital stay, and complication rate among the four study groups. The need for auxiliary procedures and stone-free rates were comparable. Conclusions PNL in obese and morbidly obese patients yields a stone-free rate that is comparable to that achieved in nonobese patients. The complication rate and length of hospital stay are also similar.

Authors from Egypt conducted a randomized prospective study into the benefit of an anti-reflux system in patients with orthotopic ileal neobladders. They found that anti-reflux procedures were associated with a higher incidence of anastomotic structures. An editorial comment accompanies this paper, and together the two manuscripts make for interesting reading. OBJECTIVE To assess the benefit of an antireflux system in patients with orthotopic ileal neobladders, as there is controversy about whether reflux prevention offers any advantages. PATIENTS AND METHODS We conducted a randomized prospective study between January 2002 and March 2004, on 60 patients (53 men and seven women) with a mean (sd) age of 52.7 (7.3) years, who were candidates for orthotopic neobladders. Patients with comorbidities were excluded. Preoperative evaluation included intravenous urography (IVU), cystoscopic biopsy and radioisotope renography to evaluate the differential glomerular filtration rates (GFRs). Cases with normal kidneys and ureters, and with similar GFRs, were enrolled. Surgery comprised a standard radical cystectomy with pelvic lymphadenectomy. The ureters were randomized to either a direct anastomosis into a 5-cm ileal chimney on one side, or to be implanted using the antireflux serous-lined extramural tunnel on the contralateral side in the same patient. Regular follow-up included IVU and renography every 6 months in cancer-free patients. RESULTS The mean (sd) follow-up was 23 (9.6) months. There was prolonged urinary leak from a refluxing ureter in one patient that was treated with a temporary percutaneous nephrostomy. Symptomatic pelvic collections required tube drainage in six cases. Six ureters developed early anastomotic strictures (one direct and five antirefluxing), and were treated with endoscopic ureterotomy in three and open revision in three. Serum creatinine levels were normal in all patients throughout the observation period. GFRs were similar in the two groups. The mean GFRs before surgery and at 6, 12, 18, and 24 months after cystectomy were: 55.1, 50.7, 49.4, 52.2 and 53.9 mL/min for the direct side; and 56.1, 53, 52.4, 53.2 and 50.4 mL/min for renal units with antirefluxing implantation. There was a significant deterioration of the GFRs due to anastomotic strictures, from 48.6 (6.7) mL/min before surgery to 31.8 (15.9) mL/min after the revision (P = 0.01). CONCLUSIONS The antireflux procedures were associated with a higher incidence of anastomotic strictures than the direct methods and there was a significant deterioration of renal function after obstruction. The long-term follow-up data are awaited.

To evaluate the surgical feasibility of laparoscopic adrenalectomy and what laparoscopy offers for the surgeon and the patient.From March 1996 to June 2004, 43 transperitoneal laparoscopic adrenalectomies were performed for various pathological states. Functioning adrenal masses and solid masses5 cm were the most common indications. The mean size of the masses on abdominal CT was 6.8 cm in the largest diameter. All patients were assessed regarding the operative time, blood loss, complications, and conversion to open surgery. The postoperative course was reported with special attention to the complications and hospital stay.The mean operative time was 125 minutes with a mean blood loss of 60 mL. Intraoperative complications occurred in 3 cases (6.9%), necessitating conversion to open surgery in 2 to control bleeding from the avulsed right adrenal vein. A third case of conversion was elective because of difficult dissection of a large left pheochromocytoma from the renal hilum, so there was a 6.9% rate of conversion to open surgery. All patients showed early ambulation, early start of eating, and a short hospital stay (mean 2.6 days).Laparoscopic adrenalectomy is surgically feasible and can be applied for different adrenal pathologies. The procedure can be performed with a reasonable operative time, minimal blood loss, and an acceptable rate of complications. Laparoscopic adrenalectomy provides excellent postoperative recovery and convalescence with a short hospital stay.

Objectives To present our experience in percutaneous management of large upper tract stones after urinary diversion. Methods From October 1984 to March 2005, 20 percutaneous nephrolithotomy and 4 antegrade ureteroscopy procedures were performed in 17 men and 7 women, with a mean age of 53.5 years. The urinary diversions were an ileal W neobladder, hemi-Kock pouch, ileal conduit, and rectal bladder in 10, 7, 4, and 3 patients, respectively. The median interval between diversion and stone management was 1.5 years. Success was defined as a stone-free, nonobstructed renal unit at 3 months after the intervention. Follow-up was performed every 6 months with intravenous urography or noncontrast computed tomography for diagnosis of stone recurrence and evaluation of renal morphology. Results Renal punctures were guided with ultrasonography in 18 patients (75%) and fluoroscopy in 6 patients. One intraoperative complication (4.16%) and two postoperative complications (8.3%) occurred. All patients with ureteral stones became stone free after one procedure. Auxiliary procedures were needed in 5 patients after percutaneous nephrolithotomy; 2 patients required a second session and 3 needed extracorporeal shock wave lithotripsy. The overall success rate was 87.5% (21 patients). One patient with treatment failure underwent open surgery, and two with small residual fragments were followed up. Long-term follow-up data were available for 15 patients. The stone recurrence rate was 33.3% (5 patients) after a median follow-up of 40 months (range 14 to 132). Recurrent stones were treated with extracorporeal shock wave lithotripsy. Conclusions The results of our study have demonstrated that percutaneous treatment of large upper tract stones after urinary diversion offers a high success rate with minimal morbidity. However, regular follow-up after treatment is recommended.

We compared the safety and efficacy of the 2 retrograde endopyelotomy techniques.A prospective study was done from January 2001 to October 2003. Preoperative radiological evaluation included excretory urography, multiphasic helical computerized tomography and diuretic renography. Exclusion criteria were marked hydronephrosis, ipsilateral renal function less than 25% and renal stones or a significant crossing vessel at the ureteropelvic junction. Eligible patients were randomized to ureteroscopic laser endopyelotomy and retrograde Acucise endopyelotomy (20 per group). UPJ obstruction was primary in 14 patients and secondary in 26. The ureteropelvic junction was incised in the lateral direction and an endopyelotomy Double-J stent (Medical Engineering Corp., New York, New York) was left for 6 weeks. Subjective and objective outcomes were evaluated 3 and 6 months after stent removal, and every 6 months thereafter.Mean operative time +/- SD was comparable in the laser and Acucise groups (64.7 +/- 22.4 and 58.7 +/- 20.2, respectively). The overall complication rate in the Acucise group was more than in the laser group (25% vs 10%). At a mean followup of 29.9 +/- 10.8 months (range 6 to 48) the laser group showed a higher success rate than the Acucise group (85% vs 65%) but the difference in the complication and success rates was not statistically significant.Despite the advanced endourological skills required for ureteroscopic laser endopyelotomy its safety and efficacy seem to be better than those of Acucise endopyelotomy. However, a larger number of patients is needed to confirm these findings.