Endoscopic Management of Bladder Diverticula.

A 50-year-old man with benign prostatic hyperplasia and urinary retention had a very large diverticulum on the posterior wall of the bladder. The patient was managed with transurethral resection of the prostate and endoscopic fulguration of the bladder diverticulum mucosa using the Orandi technique. There was near-complete resolution of the bladder diverticulum following endoscopic management, obviating the need for bladder diverticulectomy.

Renal Autotransplantation: 27-Year Experience at 2 Institutions.

Purpose: Renal autotransplantation is an infrequently performed procedure. It has been used to manage complex ureteral disease, vascular anomalies and chronic kidney pain. We reviewed our 27-year experience with this procedure.

Reversal of diabetes in mice with a bioengineered islet implant incorporating a type I collagen hydrogel and sustained release of vascular endothelial growth factor.

We have developed a bioengineered implant (BI) to evaluate strategies to promote graft survival and function in models of islet transplantation in mice. The BI, sized for implantation within a fold of intestinal mesentery, consists of a disk-shaped, polyvinyl alcohol sponge infused with a type I collagen hydrogel that contains dispersed donor islets. To promote islet vascularization, the BI incorporates a spherical alginate hydrogel for sustained release of vascular endothelial growth factor (VEGF).

Omental roll-up: a technique for islet engraftment in a large animal model.

Background: Attrition of transplanted islets is significant after hepatic embolization. This study was designed to investigate a novel surgical technique for islet transplantation into the omentum. This site allows placement of the islets in a three-dimensional (3D) matrix, with growth factors, to temporarily culture the islets in vivo while revascularization progresses.

Aortic extension for en bloc transplantation of horseshoe kidneys.

Introduction: We report a technique for extending the distal aorta to facilitate the transplantation of en bloc horseshoe kidneys.

Technical Considerations: En bloc horseshoe kidneys can be transplanted by a technique that is analogous to the en bloc transplantation of small pediatric kidneys. However, the horseshoe kidney's isthmus prevents ascent of the kidney, and the fused lower poles stay below the level of the inferior mesenteric artery.

The kidney bridge procedure for bilateral ureteral loss.

Bilateral ureteral loss is an uncommon occurrence that challenges the usual reconstructive approaches. We developed a novel procedure, using autotransplantation of one kidney to bridge the ureteral deficit of the contralateral kidney. A 61-year-old woman developed long bilateral mid and distal ureteral strictures from idiopathic retroperitoneal fibrosis.

Learning laparoscopic donor nephrectomy safely: a report on 100 cases.

Hypothesis: There is concern that learning laparoscopic live donor nephrectomy (LLDN) is associated with increased morbidity. We propose that with a team approach LLDN can be learned safely, without increased donor morbidity or graft failure, even during the early portion of a learning curve.

Design: Case series with cohort comparison.

Laparoscopic live donor nephrectomy: a comparison with the conventional open approach.

Purpose: Laparoscopic live donor nephrectomy is an emerging technique that has not yet gained widespread acceptance in the transplant community due to perceived technical difficulties. However, the potential advantages of decreasing donor morbidity, decreasing hospital stay and improving convalescence while producing a functional kidney for the recipient may prove to enhance living related renal transplantation. We report our early experience with laparoscopic live donor nephrectomy.

Decreased use of post-renal transplant imaging.

Objectives: The current need to evaluate necessity and cost of diagnostic and therapeutic procedures extends to transplant services. We reviewed our experience over the past 3 years as we have moved away from routine post-transplant nuclear medicine scans, ultrasounds, and cystograms.

Methods: From January 1, 1992 to December 31, 1994, 252 kidney transplants were performed at Virginia Mason Medical Center.

Pubovaginal slings using fascia lata for the treatment of intrinsic sphincter deficiency.

Purpose: Various materials and techniques have been used to construct a pubovaginal sling. We believe that fascia lata has several advantages and report our experience.

Materials And Methods: A total of 32 female patients with urodynamically proved intrinsic sphincter deficiency underwent a pubovaginal sling procedure using fascia lata.

Timing of penile color flow duplex ultrasonography using a triple drug mixture.

Duplex ultrasonography is an accepted method to assess noninvasively arterial inflow to the penis. Optimal pharmacological agents as well as timing of the scan and stimulation during the scan continue to be debated. In an effort to achieve a more complete smooth muscle relaxation and capture what we perceived was a wide variation in interval to maximum arterial velocity, we revised our duplex protocol in January 1991.

Complications following unstented parallel incision extravesical ureteroneocystostomy in 1,000 kidney transplants.

Between May 10, 1982 and September 1, 1990, 1,000 kidney transplant recipients underwent parallel incision extravesical ureteroneocystostomy for urinary tract reconstruction. Complications attributed to this surgical technique that required reoperation occurred in 2.1% of the recipients.

Outcome of renal transplantation at Oregon Health Sciences University: 1982 to 1990.

1. Graft survival increased over the 4 periods between 1982 and 1990 (82-84, 85-86, 87-88, 89-90). The largest increase was in the 89-90 period.

Ten years of training community urologists and general surgeons to do cadaver kidney retrievals.

We trained 82 community hospital cadaver kidney retrieval teams during a 10-year period ending June 30, 1987. During the last 5 years of that period the concept of multiple organ retrieval was introduced into the training sessions and 429 cadaver kidney grafts were retrieved. Of those kidneys 292 were transplanted at our hospital, and the function of 220 cadaver kidney grafts retrieved by the community hospital teams was compared to that of 72 retrieved by the transplant center retrieval team.

The Goodwin sound: an aid in treating obliterated membranous urethral strictures endoscopically.

The treatment options for a man with obliteration of the membranous urethra are many today because of the great progress that has been made in the past 40 years. No one procedure is likely to be ideal for all situations. Pullthrough, two-stage scrotal inlay, and transpubic or perineal approaches can be applied with success.

Bilateral ureteral stricture from polyarteritis nodosa.

A case of bilateral, asynchronous ureteral stricture from polyarteritis nodosa is described. Two cases of unilateral ureteral stricture from polyarteritis nodosa have been reported previously. Ureteral obstruction not associated with retroperitoneal fibrosis is rare with polyarteritis nodosa.

Recovery of function in a solitary kidney after intra-arterial thrombolytic therapy.

Renal artery thromboembolism is a rare event that most often occurs in patients with cardiac dysrhythmias. Surgical thromboembolectomy is risky and medical therapy with intra-arterial thrombolytic agents has become increasingly popular. Although successful clot dissolution has been well documented, renal function often is not recovered.