Contemporary experience with laparoscopic radical nephrectomy.

Introduction: We present our single-center contemporary experience with laparoscopic radical nephrectomy (LRN). LRN is an established minimally invasive approach comparable to open radical nephrectomy for the treatment of renal cortical neoplasms. Technical advancements and surgical experience with LRN mandate a re-evaluation of contemporary outcomes.

Prospective randomized single-blinded in vitro and ex vivo evaluation of new and reprocessed laparoscopic trocars.

Background: Reprocessing of single-use medical instruments has been proposed as a mechanism for managing the rising costs of health care. We compared the performance of new and reprocessed laparoscopic trocars.

Study Design: New and reprocessed laparoscopic trocars were evaluated.

Contemporary experience in the management of angiomyolipoma.

Purpose: We review our single center experience in the management of renal angiomyolipoma (AML) in patients who were treated with active surveillance (AS) or invasive treatment protocols.

Patients And Methods: A prospectively evaluated database was reviewed, and we identified 91 patients with the diagnosis of renal AML who presented between June 1985 and February 2009. Patient characteristics, clinical presentation, treatment modalities, and patient outcomes were evaluated.

Intraoperative evaluation of renal blood flow during laparoscopic partial nephrectomy with a novel Doppler system.

Introduction: Hemostasis remains a major challenge associated with laparoscopic renal surgery. We evaluated a cost-effective novel Doppler probe (DP) for assessment of vascular control during laparoscopic partial nephrectomy (LPN).

Methods: We prospectively collected data during LPN procedures.

Evaluation of optimal color for stent identification in a hemorrhagic environment.

Introduction: The endoscopic deployment and extraction of endoluminal stents, such as ureteral stents, is commonplace in contemporary medical management of many diseases. In a hemorrhagic environment, endoscopic identification of a stent can be challenging. To date, no study has evaluated the optimal color for endoscopic stent identification.

The effect of argon gas pressure on ice ball size and rate of formation.

Introduction: Contemporary cryoablation technology utilizes the Joule-Thomson effect, defined as a change in temperature that results from expansion of a nonideal gas through an orifice or other restriction. We evaluated the effect of initial gas tank pressures on freezing dynamics in a single-probe model and in a multiprobe model using contemporary cryoablation technology.

Materials And Methods: Cryoablation trials were performed in a standardized system of transparent gelatin molds at 25°C.

Active surveillance for larger (cT1bN0M0 and cT2N0M0) renal cortical neoplasms.

Objectives: To report our experience with patients undergoing active surveillance (AS) with Stage T1bN0M0 and T2N0M0 tumors. AS is a reasonable option for selected patients with renal cortical neoplasms (RCNs). Most patients undergoing AS are high-risk surgical candidates with Stage T1a lesions.

Endoscopic management of completely excluded calices: a single institution experience.

Background And Purpose: Excluded calices refer to a single calix or multiple calices that are completely isolated from the collecting system. The etiology is a result of infection, malignancy, or inflammation that is secondary to endoscopic renal surgery. We report our experience with the endoscopic management of excluded calices.

Use of a flexible carbon dioxide laser fiber for precise dissection of the neurovascular bundle during robot-assisted laparoscopic prostatectomy.

Introduction: Carbon dioxide (CO(2)) lasers deliver energy with minimal thermal spread to tissues during dissection. Excess thermal spread during dissection of the neurovascular bundle (NVB) can affect potency in men after robot-assisted radical prostatectomy (RARP). We report on a novel delivery mechanism for CO(2) laser energy through a flexible fiber to enhance accuracy of NVB dissection during RARP.

Multicenter experience with metallic ureteral stents for malignant and chronic benign ureteral obstruction.

Background And Purpose: A new coil-based metallic ureteral stent offers greater radial strength with longer indwelling time compared with plastic stents. This multicenter retrospective study reviews the clinical experience with this stent for malignant or benign chronic ureteral obstruction.

Patients And Methods: Patients had stent placement in a retrograde fashion.

Intrarenal pressures generated during deployment of various antiretropulsion devices in an ex vivo porcine model.

Introduction: Pressurized saline irrigation is commonly used during ureteroscopy, which can cause an increase in intrarenal pressure leading to postoperative pain, sepsis, and renal injury due to pyelovenous and pyelolymphatic backflow. To prevent retrograde stone migration during ureteroscopic lithotripsy, antiretropulsion devices can be deployed, which may or may not protect the kidney against high intrarenal pressures. This study compares the intrarenal pressures generated during the use of two antiretropulsion devices in an ex vivo porcine model.

Comparison of percutaneous and laparoscopic renal cryoablation for small (<3.0 cm) renal masses.

Purpose: We reviewed our experience with laparoscopic cryoablation (LCA) and percutaneous cryoablation (PCA) in the management of small renal tumors and compared clinical outcomes, short-term oncologic results, and patient complications.

Patients And Methods: A retrospective comparison of two prospectively collected oncologic databases was performed. Ninety patients underwent PCA for 99 lesions and 81 patients underwent an LCA for 97 lesions.

Image-guided percutaneous ablation of renal tumors: outcomes, technique, and application in urologic practice.

The recent increase in detection of small ( View Article and Find Full Text PDF

Results of kidney tumor cryoablation: renal function preservation and oncologic efficacy.

Introduction: Changes in the management of minimally invasive oncologic renal surgery have introduced ablative therapies as the most recent advancement in minimally invasive technology.

Methods: The current evidence-based medicine on the topic of laparoscopic (LCA) and percutaneous (PCA) renal cryoablation was gathered and outlined in this review. The mechanism and surgical approach to performing renal cryoablation as well a focus on the oncologic and renal functional outcomes after cryoablation will be discussed.

Prospective randomized evaluation of FOOT gel pads for operating room staff COMFORT during laparoscopic renal surgery.

Objectives: We evaluated the comfort level of our laparoscopy team during and after laparoscopic renal surgery, with or without the use of gel footpads.

Methods: Between September 2008 and April 2009 we prospectively randomized 100 consecutive laparoscopic renal procedures to examine whether the use of a foot gel pad altered the surgical team's comfort level. A questionnaire was used to measure the discomfort in 18 different subjects before and during surgery, and one day postoperatively.

Impact of ischemia on renal function after laparoscopic partial nephrectomy: a multicenter study.

Purpose: We assessed the influence of renal ischemia on long-term global renal function after laparoscopic partial nephrectomy in patients with 2 functioning kidneys in a large, multicenter cohort.

Materials And Methods: Collected data included demographic, clinical and surgical characteristics, tumor parameters and renal function outcomes at 4 institutions in a total of 401 patients with 2 functioning kidneys who underwent laparoscopic partial nephrectomy. Renal function was assessed in the immediate postoperative period (days 1 to 3) and at last followup (greater than 1 month) using the estimated glomerular filtration rate calculated by the 4-variable Modification of Diet in Renal Disease equation.

Active surveillance for renal cortical neoplasms.

Purpose: We retrospectively evaluated our single center experience with patients with renal cortical neoplasms who elected active surveillance.

Materials And Methods: We retrospectively evaluated our urological oncology database between January 1993 and January 2009, identifying a total of 223 renal cortical neoplasms in 212 patients that were initially managed by active surveillance. We described patient and tumor characteristics, and assessed the differences between patients who remained on AS and those who underwent delayed intervention or progressed with metastasis.

Complete ileal neobladder intracorporeal construction with standard sutured technique and novel technology.

Purpose: We compared the surgical efficacy and efficiency of a completely suture based procedure with a novel entero-urethral anastomosis device and an EndoGIA stapler to create an ileal neobladder.

Materials And Methods: Two groups of 7 pigs each were survived for 8 weeks. In group 1 the neobladder was constructed using a U-shaped segment of ileum sealed with the stapler.

Small renal masses: current concepts regarding the natural history and reflections on the American Urological Association guidelines.

Purpose Of Review: Although surgical resection is the current standard for treatment of small (<4 cm) renal cortical neoplasms, active surveillance remains an option in selected patients depending on tumor characteristics and surgical risk. We review the natural history of small renal masses according to the current literature, and highlight issues regarding the recent guidelines for the management of T1 renal masses put forth by the American Urological Association.

Recent Findings: The natural history of small renal masses is still largely unknown; however, initial size or volume of the mass seems to predict the risk of malignancy in retrospective studies.

Prospective randomized evaluation of periureteral botulinum toxin type A injection for ureteral stent pain reduction.

Purpose: The use of ureteral stents for ureteral obstruction and after ureteroscopy can result in substantial deterioration in patient quality of life due to pain, frequency and urgency. We postulated that many stent related symptoms may be related to detrusor muscle spasm in and around the intramural ureter, and evaluated the effect of botulinum toxin type A (Botox) in patients with indwelling stents after ureteroscopy.

Materials And Methods: A total of 51 patients between December 2007 and March 2009 were enrolled in an institutional review board approved, prospective, randomized, single-blind study comparing botulinum toxin type A injection at a concentration of 10 U/ml to 3 locations around the ureteral orifice (30) vs no injection after unilateral ureteral stent insertion (21).

Current status of ablative therapies for renal tumors.

The increase in detection of small ( View Article and Find Full Text PDF

Synchronous cryoablation of multiple renal lesions: short-term follow-up of patient outcomes.

Objectives: To report on various perioperative and short-term clinical outcomes of 7 patients who underwent cryoablation of multiple renal lesions during the same operative setting. Cryotherapy is the most well studied minimally invasive ablative technique for the treatment of renal tumors.

Methods: A retrospective analysis of our institutional renal cryotherapy database yielded a total of 7 patients who underwent synchronous cryoablation of > 1 renal lesion between August 2005 and May 2007.

Contemporary applications and limitations of magnetic resonance imaging contrast materials.

Purpose: Improvements in imaging technologies have dramatically increased the ability to accurately diagnose and treat many urological disease processes. As urological patients often have chronic kidney disease, the well characterized nephrotoxicity of contrast induced nephropathy when using iodine based contrast materials has long been a concern. With the development of gadolinium based contrast agents it seemed that the concern regarding nephrotoxicity had been resolved.

Where next for the endoscope?

The concept of examining the body's interior and its organs dates back to ancient times. The roots of modern endoscopy lie in early nineteenth century Europe, and the intervening centuries have seen a steady evolution of devices and techniques. Nowadays, a wide variety of urinary tract disorders are successfully managed in a minimally invasive manner thanks to the endoscope and related technologies.

Treatment outcomes after endopyelotomy performed with or without simultaneous nephrolithotomy: 10-year experience.

Introduction: The incidence of renal calculi associated with ureteropelvic junction obstruction (UPJO) has been reported to be as high as 20%. Although it has been suggested that simultaneous stone removal be performed with endopyelotomy (EP) for patients with UPJO, no crossing vessel, and renal calculi, there are no large series to date reporting in a rigorous fashion the success rate for resolution of the UPJO. This study intends to determine if stone extraction performed with EP increases failure rate.