Reno-appendiceal fistula in autosomal dominant polycystic kidney disease.

We present a very rare Case of a 53-year-old female with autosomal dominant polycystic kidney disease (ADPKD) who was incidentally found to have a reno-appendiceal fistula while undergoing open bilateral nephrectomy. The mid-portion of the appendix was fistulized to a cyst in the lower pole of the right kidney. The etiology was likely due to chronic inflammation.

Litigation Patterns in Oncologic Nephrectomies: A 30-Year Review.

The litigious environment encompassing the medical-legal domain is an increasing concern for surgical fields, with urology being no exception. The objective of our study was to systematically review, evaluate, and summarize the factors associated with oncologic nephrectomy litigation to determine possible factors contributing to verdicts or settlements. Publicly available verdict reports were retrieved using the Westlaw legal database (Reuters).

Robotic-assisted single-port donor nephrectomy using the da Vinci single-site platform.

Background: Although single-port donor nephrectomy offers improved cosmetic outcomes, technical challenges have limited its application to selected centers. Our center has performed over 400 single-port donor nephrectomies. The da Vinci single-site robotic platform was utilized in an effort to overcome the steric, visualization, ergonomic, and other technical limitations associated with the single-port approach.

Single-port donor nephrectomy provides improved patient satisfaction and equivalent outcomes.

Objective: Minimally invasive techniques have expanded the donor pool for living kidney donation. We changed our approach to single-port donor nephrectomy in 2009 and have compared outcomes with traditional multiple-port laparoscopic donor nephrectomy.

Background: The development of minimally invasive surgical techniques to procure kidneys from living donors has allowed expansion of living donor renal transplantation to account for one third of all renal transplants.

Native nephrectomy for renal cell carcinoma in transplant recipients.

Background: Dialysis patients and transplant recipients, especially those with acquired cystic kidney disease, are at increased risk for renal cell carcinoma (RCC). We report our experience in 15 posttransplant patients who underwent nephrectomy for renal masses.

Methods: Institutional review board-exempt retrospective chart review was performed on 15 transplant recipients who subsequently underwent native nephrectomy for masses.

Adenomatoid tumor of the testis with intratesticular growth: a case report and review of the literature.

Adenomatoid tumor of the male genitourinary tract is a rare benign neoplasm thought to be of mesothelial origin. In exceptional cases, these lesions may involve the testicular parenchyma, of which there are only 9 published cases in the literature. The authors describe a rare case of a testicular tumor in a 41-year-old male with normal tumor markers.

Cryoablation of renal fossa recurrence after radical nephrectomy.

Background And Purpose: Renal fossa recurrence of renal-cell carcinoma (RCC) after radical nephrectomy historically necessitates open surgical resection. Cryoablation provides a minimally invasive alternative to open resection for local recurrence. We describe our experience with percutaneous cryoablation in three patients who were experiencing fossa recurrence.

Living-donor renal transplantation of grafts with incidental renal masses after ex-vivo partial nephrectomy.

Objectives: To assess transplantation of high-risk kidneys with incidental renal masses (found occasionally during the routine evaluation of a living kidney donor) into recipients with limited life-expectancy on haemodialysis, as this offers a potential solution to the current organ deficit.

Patients And Methods: We detected five small (<2.3 cm), incidental, enhancing renal masses during donor evaluation.

Repair of complex renal artery aneurysms by laparoscopic nephrectomy with ex vivo repair and autotransplantation.

Objective: Renal artery aneurysms are being discovered more frequently due to increased use of non-invasive imaging. Complex renal artery aneurysms involving multiple secondary or tertiary branches are not amenable to in vivo or endovascular treatment and often require ex vivo repair with autotransplantation. In order to minimize incisional morbidity and hasten recovery, we developed a technique of laparoscopic nephrectomy combined with backbench ex vivo repair, followed by autotransplantation through a small laparoscopic extraction incision.

Clinical images. Massive Meckel's enterolith mimicking urachal carcinoma.

Meckel's enterolith is a rare clinical entity that may be found on imaging and at surgery, as seen in this case of a 68-year-old man presenting for esophagogastrectomy. Images are presented with differential diagnosis and treatment choices.

A single center comparison of long-term outcomes of renal allografts procured laparoscopically versus historic controls procured by the open approach.

We have previously reported that renal allografts procured by the laparoscopic live donor nephrectomy (lapNx) demonstrate worse early renal outcomes but noninferior 1-year renal function as compared to those procured by the standard open nephrectomy (openNx). We undertook this study to examine whether the apparent early dysfunction will impair long-term renal allograft survival. We retrospectively updated the status of the first 132 consecutive adult left lapNx recipients at our center and the preceding 99 adult openNx recipients.

Endophytic lesions: a predictor of failure in laparoscopic renal cryoablation.

Background And Purpose: Laparoscopic renal cryoablation is an emerging minimally invasive management option for T(1) renal lesions. In an analysis of patients treated with laparoscopic cryoablation for renal lesions, our objective was to compare the treatment outcomes in patients with exophytic/partially exophytic and endophytic (peripheral but completely intrarenal) lesions.

Patients And Methods: We retrospectively reviewed medical records of 32 consecutive patients with anterior renal lesions who were treated with laparoscopic renal cryoablation between 2003 and 2005.

Transplant recipient renal function is donor renal mass- and recipient gender-dependent.

The effect of both donor renal mass and gender on renal function, in both gender recipients, was examined. Qualifying consecutive living-donor renal transplants (n = 730) were stratified into 4 donor-recipient groups: female-female (n = 177), male-female (n = 151), female-male (n = 240), male-male (n = 162). Groups were equivalent in age, race, body mass index (BMI), match, ischemia time, operative time, and estimated glomerular filtration rate (eGFR).

Renal metastasis of malignant melanoma with unknown primary.

The kidney is a common location for micrometastases in patients with malignant melanomas. These lesions are usually small, multiple, asymptomatic, and bilateral, and associated with a known primary lesion. This is an unusual case of a 38-year-old woman, with no history of melanoma, presenting with an asymptomatic solitary renal mass and two lung masses.

Venacavoscopy during nephrectomy for renal cell carcinoma with inferior vena caval thrombus.

Purpose: Renal cell carcinoma with inferior vena caval thrombus remains a complex challenge for the urologist. Aggressive surgery to remove all tumor can result in long-term survival. Liver transplant techniques, assistance from cardiac surgeons and bypass techniques can yield optimal vascular control but there is still a blind element inside the inferior vena cava when the thrombus is evacuated.

Gene therapy using replication-defective herpes simplex virus vectors expressing nerve growth factor in a rat model of diabetic cystopathy.

Diabetic cystopathy is one of the common complications of diabetes and current therapy is limited. In the present study, the effects of gene therapy, using replication-defective herpes simplex virus type 1 (HSV-1) vectors to deliver and express the nerve growth factor (NGF) gene (HSV-NGF) on tissue NGF levels and bladder function, were evaluated in streptozotocin (STZ)-induced diabetic rats. Diabetic rats exhibited a significant decrease in NGF levels in the bladder and lumbosacral dorsal root ganglia (DRG) detected by enzyme-linked immunosorbent assay and displayed marked bladder dysfunction 12 weeks after STZ injection.

Treatment of renal transplant ureterovesical anastomotic strictures using antegrade balloon dilation with or without holmium:YAG laser endoureterotomy.

Objectives: To report our results after antegrade endoscopic treatment of ureteral stenosis with balloon dilation with or without holmium laser endoureterotomy. Ureteral stenosis is the most common long-term urologic complication of renal transplantation.

Methods: From July 2000 to October 2002, 9 renal transplant patients with ureteral obstruction diagnosed by an increase in serum creatinine and radiologic evidence presented for endoscopic treatment.

Quality of life, pain and return to normal activities following laparoscopic donor nephrectomy versus open mini-incision donor nephrectomy.

Purpose: We evaluated pain, convalescence and health related quality of life in patients undergoing laparoscopic and open mini-incision donor nephrectomy.

Materials And Methods: We compared the records of consecutive patients who underwent laparoscopic and mini-incision open donor nephrectomy from our donor nephrectomy data base in retrospective fashion using 2 questionnaires. The first questionnaire evaluated postoperative pain, return to functioning time and satisfaction.

Laparoscopic partial nephrectomy and minimally invasive nephron-sparing surgery.

Surgical extirpation remains the most effective therapy for renal cell carcinoma. The surgical management of renal masses has evolved away from radical nephrectomy and now includes nephron-sparing surgery for small tumors. Nephron-sparing surgery has similar cure rates and does not appear to compromise cancer control.

Diabetic cystopathy correlates with a long-term decrease in nerve growth factor levels in the bladder and lumbosacral dorsal root Ganglia.

PURPOSE It has been proposed that a deficiency in the axonal transport of nerve growth factor (NGF) may have an important role in inducing diabetic neuropathy, which contributes to diabetic cystopathy. Therefore, in streptozotocin (Sigma Chemical Co., St.