Why is urological laparoscopy minimally invasive?

Objectives: Laparoscopic procedures have been developed and established with the view that a similar operative effect can be achieved with less traumatization, especially as far as systemic stress response is concerned. We report a prospective, controlled, nonrandomized animal and patient study to determine the systemic response to laparoscopic and open surgical procedures.

Methods: In the animal study, 26 female pigs underwent either a laparoscopic bilateral varix ligation followed by bilateral nephrectomy (group I), sole introduction of trocars (group II) or sole establishment of an open surgical approach (group III).

Shoulder arthroplasty. Indications, contraindications and complications.

Prosthetic substitution of the glenohumeral joint, begun at the end of the last century, has developed greatly in recent years. Today the most widely used shoulder prostheses are defined as "modular" because of their extensive adaptability. The capacity to adapt to anatomic variations must be incorporated within their structure, and normal articular biomechanics must be respected.

Use of frozen-thawed testicular sperm for intracytoplasmic sperm injection.

Objective: To determine the feasibility of using frozen-thawed testicular spermatozoa for intracytoplasmic sperm injection.

Design: Prospective clinical study.

Setting: A university hospital.

Intracytoplasmic injection of round and elongated spermatids from azoospermic patients: results and review.

Microinjection is established as the method of choice in the treatment of severe male factor infertility as well as in azoospermic patients. Recent studies have shown that fertilization and cleavage can be achieved by injection of ejaculated as well as testicular elongated spermatids into oocytes. Here we report on the two first pregnancies worldwide resulting from elongated spermatid injection from frozen-thawed testicular tissue.

Complications of laparoscopic procedures in urology: experience with 2,407 procedures at 4 German centers.

Purpose: The 4 most active centers of the laparoscopy working group of the German Urologic Association collected data about the complications associated with laparoscopic surgery in urology.

Materials And Methods: At 4 centers 2,407 laparoscopies or retroperitoneoscopies were performed as of May 1998, including 776 for varicocelectomy, 259 for cryptorchidism, 481 for pelvic lymph node dissection, 351 for nephrectomy/heminephrectomy renal pathology, 139 for renal cyst resection, 58 for ureteral procedures, 44 for adrenalectomy, 41 for nephropexy, 41 for lymphocele fenestration, 40 for retroperitoneal para-aortic lymphadenectomy and 187 for other operations. The complications were evaluated, listed according to the anatomical specificity and grouped with respect to the surgical step during laparoscopy.

[Early recognition of prostate carcinoma. Initial results of a prospective multicenter study in Germany. Project Group for Early Detection DGU-BDU Laboratory diagnosis Professional Circle].

To compare the efficacy of digital rectal examination (DRE) and serum prostate specific antigen (PSA) in early detection of prostate cancer, we initiated a prospective multicenter screening trial. In 12,542 men choosen at random with a mean age of 62 (+/- 7.5) a suspect DRE or a PSA level > 4.

Irrigation fluid absorption during transurethral resection of the prostate: spinal vs. general anaesthesia.

Background: The absorption of irrigation fluid during transurethral resection of the prostate (TURP) is determined primarily by hydrostatic pressure in the bladder and prostatic venous pressure. In comparison to spontaneously breathing patients, patients undergoing mechanical ventilation with positive pressure have a raised central venous pressure and a reduced venous return, both of which can influence intravascular absorption. The purpose of the prospective study was to compare the effects of general (GA) and spinal anaesthetic (SA) techniques on the perioperative absorption of irrigating fluid in patients undergoing TURP.

Irrigating fluid absorption during percutaneous nephrolithotripsy.

Background: The most common complication during percutaneous nephrolithotripsy (PNL) is the destruction of organ structures with extravasation of the irrigation fluid into the retroperitoneal space. Consequently, there is an increased risk of a urosepsis and a complicated therapeutic course. In this study we aimed to show that extravascular absorption could be differentiated from intravascular absorption due to their unique absorption characteristics, and that these characteristics enable a prediction of possible post-operative complications.

Laparoscopic nephrectomy: the experience of the laparoscopy working group of the German Urologic Association.

Purpose: The centers of the laparoscopy working group of the German Urologic Association collected data to prove the efficacy, safety and reproducibility of laparoscopic nephrectomy.

Materials And Methods: At 14 centers 482 laparoscopic nephrectomies have been performed until December 1996 via a transperitoneal approach in 344 (71%) and a retroperitoneal approach in 138 (29%). All 482 laparoscopic nephrectomies were performed by a total of 20 surgeons with an average of 24 procedures per surgeon (range 4 to 105).

Laparoscopic nephrectomy: comparison of dialysis and non-dialysis patients.

Background: Laparoscopy is believed to result in possible clinical benefits for the patient. We report our experience with renal laparoscopy in dialysis patients and compare the results with those from non-dialysis patients.

Methods: Between December 1994 and April 1997, 19 dialysis patients underwent laparoscopic nephrectomy or nephroureterectomy at our hospital.

Treatment of posttransplant hypertension by laparoscopic bilateral nephrectomy?

Background: Hypertension is an important risk factor for the development of chronic graft failure and decreased graft and patient survival after renal transplantation.

Methods: Between September 1994 and August 1996, 14 patients underwent laparoscopic bilateral nephrectomy for treatment of drug-resistant hypertension after successful renal transplantation. Common causes of hypertension were largely excluded before bilateral nephrectomy.

Comparison of laparoscopic and open nephroureterectomy for benign disease.

Purpose: We report our experience with laparoscopic nephroureterectomy for benign disease and compare the results to a contemporary group of patients undergoing open nephroureterectomy.

Materials And Methods: Between October 1994 and March 1997, 12 women and 4 men with a mean age of 50 years (range 22 to 70) underwent laparoscopic nephroureterectomy at our hospital. Indications for operation were nonfunctioning kidneys due to vesicoureteral reflux with recurrent episodes of pyelonephritis or analgesic nephropathy before a planned renal transplantation.

Laparoscopic nephropexy: 3-year experience.

Purpose: Operative treatment of nephroptosis is rarely performed and is indicated only in select patients. Postoperatively approach related symptoms and morbidity often limit therapeutic success. We evaluated the technique and outcome of laparoscopic nephropexy in patients with symptomatic nephroptosis.

Laparoscopy in renal transplant patients.

Objectives: To evaluate the use of laparoscopic techniques in patients with a renal transplant.

Methods: Since 1992, 358 patients have undergone urologic laparoscopy at our hospital. Among these, 37 procedures (10.

Laparoscopic bilateral nephrectomy: results in 11 renal transplant patients.

Purpose: We report our experience with bilateral laparoscopic nephrectomy after renal transplantation.

Materials And Methods: Between August 1994 and October 1995, 11 patients who had previously undergone renal transplantation underwent bilateral laparoscopic nephrectomy at our hospital due to poorly controlled hypertension. The records of 10 patients undergoing bilateral open nephrectomy were reviewed for comparison.

Quantitative scintigraphic evaluation of total knee arthroplasties: a feasibility study.

For the development and validation of a quantitative approach to the analysis of bone scans after total knee arthroplasty, 39 consecutive patients with 40 prostheses (6 males, 33 females; mean age, 70 years) were scheduled for clinical, radiographic, and scintigraphic examination ranging from 9 to 90 months after surgery. Twenty-seven total knee arthroplasties were considered to be asymptomatic and 13 symptomatic according to the clinical and radiographic findings. Significant differences were found for 99mTc-methylene diphosphonate uptake for femur and tibia and between symptomatic and asymptomatic patients.

MESA and TESE: experiences of the German section of urological microsurgery.

The introduction of microsurgical epididymal sperm aspiration (MESA) and testicular sperm extraction (TESE) followed by intracytoplasmic sperm injection (ICSI) has enlarged the therapeutic options for irreparable azoospermia. After standardization of the indications and surgical procedure, the German section for urological microsurgery combined the data of all groups performing assisted reproduction. The indication for MESA or TESE is given in cases of congenital aplasia of the vas deferens, irreparable obstruction of the reproductive tract, failure after refertilization, in combination with tubulovasostomy for subsequent cryopreservation and for conservatively untreatable ejaculatory disturbances.

Clinical study results of the new formulation leuprorelin acetate three-month depot for the treatment of advanced prostate carcinoma.

Androgen suppression, using gonadotrophin-releasing hormone analogues (leuprorelin), is being developed as an effective treatment of advanced prostate carcinoma. Treatment with leuprorelin acetate 1-month depot is already well established all over the world. In order to increase patients' acceptability of this treatment, by reducing frequency of administration, a 3-month depot formulation has been developed in Takeda's research laboratories.

Clinical evidence of systemic persistence of bacillus Calmette-Guerin: long-term pulmonary bacillus Calmette-Guerin infection after intravesical therapy for bladder cancer and subsequent cystectomy.

A patient with urothelial bladder carcinoma is reported who suffered from culture proved pulmonary bacillus Calmette-Guerin (BCG) infection 14 months after a single course of intravesical BCG and 11 months after subsequent radical cystectomy for progressive cancer. This unusual case raises the question of the ultimate fate of intravesically instilled BCG and the possible persistence of these mycobacteria in remote organs. Systemic spread and dormant survival at least in some cases are suggested, and therapeutic and diagnostic consequences are discussed.