Eight hours of hypotensive versus normotensive resuscitation in a porcine model of controlled hemorrhagic shock.

Objectives: The aim of this study was to compare hypotensive and normotensive resuscitation in a porcine model of hemorrhagic shock.

Methods: This was a prospective, comparative, randomized survival study of controlled hemorrhagic shock using 28 male Yorkshire-Landrace pigs (15 to 25 kg). In 24 splenectomized pigs, the authors induced hemorrhagic shock to a systolic blood pressure (sBP) of 48 to 58 mm Hg (approximately 35% bleed).

Management of rectal injuries sustained during laparoscopic radical prostatectomy.

Objectives: To report on a treatment algorithm for the management of rectal injures. Rectal injuries during laparoscopic radical prostatectomy (LRP) are rare. In the first 200 cases of LRP performed at our institution, 2 (1%) rectal injuries occurred.

IL-6 does not predict current urolithiasis in stone formers.

Introduction: Interleukin-6 (IL-6), an inflammatory marker, has previously been found to be elevated in the urine of patients with urolithiasis. Oxalate and other stone precursors have been shown to increase IL-6 production in proximal tubular epithelial cells in vitro. We examined whether urinary IL-6 could be used as a screening test to determine current urolithiasis in individuals who are known to form urinary stones.

Usefulness of urinalysis in following patients with distal ureterolithiasis.

Purpose: The determine the usefulness of urinalysis in monitoring patients with distal ureterolithiasis.

Materials And Methods: Patients with microhematuria who were found to have a distal ureteral stone and who were candidates for conservative management were enrolled in the study. Patients were typically seen in clinic at 1 to 2 weeks after initial diagnosis and reassessed.

Tubeless percutaneous nephrolithotomy with antegrade stent tether: clinical experience.

Background And Purpose: A limitation of tubeless percutaneous nephrolithotomy (PCNL) is the need for post-operative office cystoscopy to remove the ureteral stent. We developed a novel technique of intraoperative stent placement that allows removal via the flank. Herein, we report on our initial clinical experience.

Need for ancillary procedures among patients undergoing tubeless percutaneous renal surgery for nephrolithiasis.

Purpose: We routinely perform percutaneous nephrolithotomy (PCNL) without the use of nephrostomy tubes. We examined the need for secondary surgery for the treatment of residual stones in patients who underwent both tubeless surgery and PCNL with tube placement.

Patients And Methods: We retrospectively reviewed the charts of 180 patients who underwent 186 percutaneous nephrolithotomies.

Randomized trial comparing modified tubeless percutaneous nephrolithotomy with tailed stent with percutaneous nephrostomy with small-bore tube.

Background And Purpose: Recent trials using smaller percutaneous catheters as well as "tubeless" percutaneous technique have attempted to reduce postoperative analgesia requirements and the morbidity of a traditional large-bore nephrostomy tube after percutaneous nephrolithotomy (PCNL). We performed a randomized trial comparing tubeless procedures and use of small catheters to elucidate any differences in perioperative parameters, postoperative discomfort, complications, convalescence, and CT scan findings.

Patients And Methods: Twenty-four consecutive patients underwent randomization into tubeless (using a tailed 6F double-J stent) and small tube (using an 8.

Modification of tubeless percutaneous nephrolithotomy: anterograde stent with flank tether.

A limitation of tubeless percutaneous nephrolithotomy is the need for postoperative office cystoscopy for removal of the ureteral stent. We have developed a novel technique of intraoperative ureteral stent placement that allows for outpatient removal of the stent through the flank using the stent tether.

Laparoscopic urethrovesical anastomosis: a model to assess surgical competency.

Purpose: To create a model for the evaluation of resident competency and performance of laparoscopic skills in compliance with Accreditation Council for Graduate Medical Education (ACGME) outcome assessment guidelines for urology residency programs.

Materials And Methods: A model of laparoscopic interrupted urethrovesical anastomosis was developed using chicken skin from a local supermarket. Eight residents at various training levels utilized a simulator with a camera-operating assistant to practice placing interrupted stitches.

One-step percutaneous nephrolithotomy sheath versus standard two-step technique.

Objectives: Advances in technique and equipment have allowed urologists to perform percutaneous stone removal with increasing efficacy and decreasing complications. The procedure of choice for large renal calculi is percutaneous nephrolithotomy. At our institution, percutaneous access is achieved by a two-step process using either Amplatz dilators or placement of a high-pressure balloon catheter for tract dilation, followed by advancement of a sheath over the balloon.

Tubeless percutaneous renal surgery in obese patients.

Objectives: To assess the outcome and safety of tubeless percutaneous renal surgery in overweight and obese patients.

Methods: A single urologist performed tubeless percutaneous renal surgery on a total of 138 renal units in 133 patients from March 1996 to January 2003. The tubeless procedures consisted of either nephrolithotripsy or endopyelotomy.

Modified "tubeless" percutaneous nephrolithotomy using a tail-stent.

Introduction: "Tubeless" percutaneous renal surgery has previously been described at our institution. Avoiding external nephrostomy tube drainage significantly decreases the pain and morbidity of percutaneous renal surgery. However, internal drainage with a double-J ureteral stent still results in bothersome bladder symptoms, especially in younger male patients.

Use of fibrin glue in percutaneous nephrolithotomy.

Objectives: To report our experience with the use of fibrin glue during tubeless percutaneous nephrolithotomy. We addressed the safety of this approach and evaluated its use for any clinical benefit with respect to length of hospital stay, bleeding, analgesic usage, and urinary extravasation.

Methods: This was a retrospective review of 43 patients who underwent tubeless percutaneous nephrolithotomy.

Radiation protection during percutaneous nephrolithotomy: a new urologic surgery radiation shield.

Background And Purpose: As endourology becomes an important part of the practice of urology, the use of fluoroscopic guidance has increased the exposure of urologists to the possibly deleterious effects of radiation. There is a need for a method of radiation protection for percutaneous nephrolithotomy (PCNL), as the exposure from radiation scatter may be significant, depending on the difficulty of establishing access.

Patients And Methods: We ascertained the effectiveness of a newly modified radiation shield during PCNL.

Laparoscopic linear cutting stapler failure.

Objectives: To characterize the frequency and nature of problems with linear cutting staplers to help prevent complications in the future. These devices are often used during laparoscopic urologic procedures.

Methods: We retrospectively reviewed the experience with laparoscopic linear cutting staplers at two institutions routinely performing urologic laparoscopy and analyzed the difficulties with any staplers.

Blind percutaneous renal access.

We describe a technique of blind percutaneous renal access when retrograde/intravenous imaging is not possible. We present the surgical technique, the patient population, and situations in which the technique is used. Following a review of 40 accesses, we concluded that this technique is safe, simple, and effective.

Laparoscopic evaluation of indeterminate renal cysts: long-term follow-up.

Purpose: We present our long-term follow-up of patients who have undergone laparoscopic evaluation for their indeterminate renal cysts, specifically reporting those patients who were found to have cystic renal-cell carcinoma (RCC) and assessing the safety and efficacy of the procedure.

Patients And Methods: Fifty-seven patients with indeterminate renal cysts (28 Bosniak category II and 29 Bosniak category III) underwent laparoscopic evaluation between July 1993 and July 2000. A transperitoneal laparoscopic localization and aspiration of the cyst, cytologic analysis, and biopsy of the cyst wall and base were performed.

Tubeless percutaneous renal surgery: review of first 112 patients.

Objectives: To assess the outcome and safety of the first 112 patients undergoing tubeless percutaneous renal surgery.

Methods: A total of 116 renal units in 112 patients underwent tubeless percutaneous renal surgery from December 1995 to November 2000 performed by a single urologist. The "tubeless" procedures consisted of nephrolithotripsy or endopyelotomy.

Prospective randomized study of various techniques of percutaneous nephrolithotomy.

Objectives: To compare the modifications of the technique of percutaneous nephrolithotomy (PCN), including "mini-PCN" and tubeless PCN, to establish which technique is associated with the least morbidity and complications.

Methods: We performed a prospective randomized trial to assess the efficacy and morbidity of each method of percutaneous renal access. Standard PCN involved tract dilation to 30F for passage of a 34F working sheath, and our "mini-PCN" involved tract dilation to 22F for passage of a 26F sheath.

Percutaneous management of stones in a patient with sacral agenesis.

We report a case of a patient with sacral agenesis and nephrolithiasis in whom percutaneous nephrostolithotomy was used to treat the stone disease. Sacral agenesis is an uncommon congenital anomaly involving the lower vertebral bodies and is associated with urinary tract dysfunction. Nephrolithiasis in a patient with sacral agenesis poses a problem in access for percutaneous nephrostolithotomy because of the associated presence of renal ectopia.

Management of ureteral obstruction secondary to pelvic malignancies.

Purpose: To assess the efficacy of urinary diversion (internal v external) in the management of ureteral obstruction secondary to pelvic malignancies and the patients' quality of life after diversion.

Patients And Methods: Thirty-seven patients presented with malignant ureteral obstruction secondary to primary neoplasms of the pelvis or metastatic disease of the pelvis and retroperitoneum and underwent urinary diversion. Patients were categorized into two groups according to the success (Group I) or failure (Group II) of internal stent drainage.

Ureteropelvic junction obstruction presenting as early satiety and weight loss.

We present a case of ureteropelvic junction (UPJ) obstruction which had the unusual presentation of early satiety and weight loss secondary to gastric compression by a distended renal pelvis. The patient was treated successfully with percutaneous antegrade endopyelotomy.

Assessment of relative tumor burden in patients with clinical T1c prostate cancer treated with either external beam or radical prostatectomy.

The choice between external beam radiation therapy (EBRT) or retropubic radical prostatectomy (RPX) as potentially curative treatment for localized carcinoma of the prostate gland (CaP) has not been delineated in randomized studies. Both treatments are more effective if tumor burden is low. We sought to compare these two treatments in patients who had clinical stage T1c (cT1c) lesions and who were thought to have limited tumor burdens pretreatment.