Anastomotic leak in colorectal surgery: are 75 % preventable?

Introduction: Anastomotic leak (AL) is a significant cause of morbidity and mortality associated with complications of colorectal surgery. Furthermore, AL results in prolonged hospital stays and significant increase in costs of medical resources.

Materials And Methods: In this study, we investigated the impact of anastomosis technique on the rate of anastomotic leak.

High pressure vaginography to diagnose vaginal ureteral ectopia in patients with continuous urinary incontinence.

Introduction: Continuous urinary incontinence in female patients can be a diagnostic dilemma if traditional imaging fails to identify a source. Vaginography has been used to diagnose vaginal ectopic ureters in the past with mixed results.

Materials And Methods: Institutional review board approval was obtained for a retrospective review.

Minimally invasive surgical approach to excision of symptomatic ectopic inverted-Y ureteral duplications.

Inverted-Y ureteral duplications are a rare duplication anomaly with few cases reported in the literature. We report a novel minimally invasive approach to managing inverted-Y duplications in two females who presented with continuous urinary incontinence and were found to have an ectopic insertion of the duplicated ureter. The ectopic segment was excised laparoscopically without complication in the outpatient setting with resultant cure of the continuous incontinence.

Hydro-Jet technology in urologic surgery.

Hydro-Jet technology utilizes an extremely thin, high-pressure stream of water. This technology has been routinely used in industry as a cutting tool for different materials such as metal, ceramic, wood and glass. Recently, Hydro-Jet technology has been used for dissection and resection during open and laparoscopic surgical procedures.

Voiding and sexual dysfunction after deep rectal resection and total mesorectal excision: prospective study on 52 patients.

Objective: Voiding and sexual dysfunction after deep rectal resection have been described with various frequencies in the literature. In this study, we prospectively evaluated the baseline preoperative voiding and sexual function in a cohort of patients undergoing deep rectal resection with mesorectal excision to determine any pre-existing abnormalities. Postoperatively, we sought first to determine the frequency of a urinary or sexual dysfunction, secondly whether there is a time-dependent change of a dysfunction and thirdly whether there is a relationship between postoperative urological dysfunction and the patient's age.

Impact of prostate size and body mass index on perioperative morbidity after laparoscopic radical prostatectomy.

Purpose: We prospectively evaluated the impact of body mass index (BMI) and prostate gland size on operative time, estimated blood loss (EBL) and hospital stay (LOS) in patients undergoing laparoscopic radical prostatectomy at our institution.

Materials And Methods: A total of 70 consecutive laparoscopic radical prostatectomies were performed at our institution from May 2002 to April 2003. Patients who had pelvic lymphadenectomy were excluded.

Nerve-sparing retroperitoneal lymphadenectomy using hydro-jet dissection: initial experience.

Background And Purpose: Nerve-sparing retroperitoneal lymphadenectomy (RPL) is performed in a significant number of patients to preserve ejaculation after treatment for testicular cancer. Identification and preservation of the sympathetic nerves may be challenging. Hydro-Jet technology has been utilized for various surgical applications.

Impact of temporary hilar clamping during laparoscopic partial nephrectomy on postoperative renal function: a prospective study.

Purpose: Laparoscopic partial nephrectomy for small renal tumors has been increasingly performed in the last few years. We prospectively evaluated preoperative and postoperative differential renal function by renal scan in patients with contralaterally functioning kidneys who underwent laparoscopic partial nephrectomy with hilar clamping.

Materials And Methods: From July 2002 to June 2003, 17 consecutive patients were included in this prospective protocol and underwent laparoscopic partial nephrectomy for exophytic tumors using en bloc hilar clamping.

Use of gelatin matrix thrombin tissue sealant as an effective hemostatic agent during laparoscopic partial nephrectomy.

Purpose: We describe a technique for achieving effective hemostasis during laparoscopic partial nephrectomy using gelatin matrix thrombin tissue sealant.

Materials And Methods: Between June 2002 and April 2003, 6 patients underwent laparoscopic partial nephrectomy using the 2-component tissue sealant. Median patient age was 59 years (range 28 to 71) and followup time ranged from 1 to 10 months (median 4.

Hydro-Jet-assisted laparoscopic cholecystectomy: a prospective randomized clinical study.

Background: A new dissection technique with high-pressure water stream (Hydro-Jet) has recently been applied for selective dissection during various surgical procedures. The aim of this study was to compare Hydro-Jet with the conventional technique for laparoscopic cholecystectomy.

Methods: Eighty patients were randomized to undergo laparoscopic cholecystectomy with standard (n = 40) or Hydro-Jet-assisted (n = 40) dissection techniques.

Radical prostatectomy with bladder neck preservation: impact of a positive margin.

Purpose: Bladder neck preservation during radical prostatectomy has been correlated with improved continence. However, the hazard of a positive margin at this specific site has discouraged many urologists. We evaluated if preservation of the bladder neck at the time of radical prostatectomy jeopardizes surgical cancer control with consequent deleterious outcomes.

Cystinuria and other noncalcareous calculi.

Urinary stone disease is the only clinical presentation in patients with cystinuria. Two genes have been associated with type I (SLC3A1) and non-type I (SLC7A9) cystinuria and multiple mutations of these genes have been identified. The type I form is completely recessive while the non-type I form is incompletely recessive.

Hydro-jet-assisted pneumonectomy: a new technique in a porcine model.

Background And Objectives: Hydro-jet technology has long been used to cut various materials, such as metal and wood, in the industrial field. In the medical field, this technology has been applied successfully in selective cutting of the parenchyma of the liver. However, to our knowledge, no data are available on the use of the hydro-jet technique for pneumonectomy.

Midshaft hypospadias.

The key to successful hypospadias surgery is minimal tissue handling, tension-free reconstruction, the use of well-vascularized tissue, and knowledge of which repairs are indicated. Preservation of the urethral plate along with an onlay graft has a low complication rate and should be attempted for midshaft hypospadias repair. Although tubularized pedicle flaps increase the risk of complications such as urethral strictures, urethral diverticula, and fistulas, they provide a good alternative in the presence of a poorly developed urethral plate.

Uric acid nephrolithiasis: current concepts and controversies.

Purpose: Uric acid calculi with or without a calcium component comprise a significant proportion of urinary stones. Knowledge of the pathophysiology of stone formation is important to direct medical treatment. The aim of this review is to provide an update on the epidemiology, pathophysiology and management of uric acid renal stones.

Hydro-Jet assisted laparroscopic cholecystectomy: initial experience in a porcine model.

Background And Objectives: Hydro-Jet technology has long been used for cutting various materials like metal and wood in the industrial field. In the medical field, this technology has been applied successfully for selective cutting of the parenchyma of the liver. However, to our knowledge, no data exist on the use of the Hydro-Jet technique for laparoscopic cholecystectomy.

Donor-gifted allograft urolithiasis: early percutaneous management.

Objectives: To describe our successful early management of donor-gifted nephrolithiasis by percutaneous nephrolithotomy. Donor-gifted nephrolithiasis is a rare and frustrating complication of renal transplantation. In the past, initial conservative management with relief of obstruction and shock wave lithotripsy has been recommended.

Comparison of costs and complications of radical and partial nephrectomy for treatment of localized renal cell carcinoma.

Objectives: To compare the complications and costs of radical and partial nephrectomy (PN) and to investigate the impact of increasing experience on costs and complications during a 7-year period. Nephron-sparing surgery has found increasing applications in the past decade. PN has achieved similar long-term results in localized renal cell carcinoma with respect to cancer control compared with radical nephrectomy (RN).

The use of fibrin sealant in urology.

Purpose: Fibrin sealant has been increasingly applied in various surgical fields, including urological surgery, in the last 2 decades. We determined the safety and efficacy of fibrin sealant in urological surgery and identified areas that need further clinical investigation.

Materials And Methods: A MEDLINE search of all available literature regarding the use of fibrin sealant was performed.

Matrix metalloproteinase activity, bone matrix turnover, and tumor cell proliferation in prostate cancer bone metastasis.

Background: The metastasis of prostate cancer to bone is associated with a substantial increase in bone matrix turnover. Matrix metalloproteinases (MMPs) play roles in both normal bone remodeling and invasion and metastasis of prostate cancer. This study was designed to determine the role of MMP activity in prostate cancer that has metastasized to bone.