Kidney transplant anastomosis: internal or external iliac artery?

Introduction: We compared the best technique for arterial anastomosis in kidney transplantation, end-to-side anastomosis to the external iliac artery or end-to-end anastomosis to the internal iliac artery.

Materials And Methods: A total of 38 patients with end-stage renal disease who received a kidney transplant from a deceased donor were randomized into two groups in order to undergo either end-to-end anastomosis to the internal iliac artery or end-to-side anastomosis to the external iliac artery. Length of arterial anastomosis, cold ischemia time, hospital stay, serum creatinine level, recovery of urinary output, and surgical and clinical complications during hospitalization were evaluated.

Upper-pole access for percutaneous nephrolithotomy.

Although the supracostal approach is thought to increase the difficulties and patient morbidity of PCNL, it facilitates the management of certain urinary infirmities, such as UPJ obstruction, staghorn stone, upper pole stone, proximal ureteral abnormalities, impacted UPJ stone and upper calix diverticulum. Hereby the authors briefly comment on the technical aspects of the supracostal approach, and also discuss the possible complications of this technique and how to avoid them.

Proximal ureteral calculi: shock wave or ureterolithotripsy?

Objective: To compare the success rates and efficiency of ureterolithotripsy (URL) and extracorporeal shock wave lithotripsy (SWL) for proximal ureteric stones. CASUISTRY AND METHODS: A prospective non-randomized study was performed between 1999 and 2004. Of a total of 235 patients, 121 underwent SWL and 114 had ureteroscopy with ultrasonic lithotripsy.

Transverse colon for continent urinary diversion: experimental study comparing two techniques.

Objectives: Patients who have undergone pelvic radiotherapy can develop urinary complications such as actinic cystitis or fistulas and ultimately need urinary diversion, for which several techniques have been described. The purpose of this experimental study was to compare 2 different types of continent urinary diversion with the colonic pouch.

Methods: Sixteen dogs of both sexes, weighing 20-25 kg were divided into 3 groups: the pilot group consisted of 6 dogs used to standardize the technique.

Primary leiomyosarcoma of the inferior vena cava: How should it be treated and the vein anatomy re-established?

Retroperitoneal sarcomas are responsible for 10-15% of all sarcomas in soft tissue. Leiomyosarcoma of the inferior vena cava has a slow growth rate, and the initial symptoms are related to the affected segment of the vein. A 56-year-old woman with leiomyosarcoma of the middle segment of the inferior vena cava underwent en-block resection of the affected segment of the vena cava and the right kidney.

New method for minimally invasive urodynamic assessment in men with lower urinary tract symptoms.

Objectives: Urodynamic studies are considered the reference standard to diagnose bladder outlet obstruction. However, the procedure is invasive, expensive, and time-consuming. The purpose of this study was to evaluate a new minimally invasive urodynamic assessment model and compare the results with those of conventional urodynamic evaluation.

Arteriovesical fistula as a complication of a gunshot wound to the pelvis: treatment dilemma.

The case is reported of an arteriovesical fistula after a gunshot wound to the pelvis in a 29-year-old man. It developed 20 days after an exploratory laparotomy with primary suture of the bladder. The patient presented with intermittent gross hematuria and diagnosis was made through cystoscopy and arteriogram.

Penetrating ureteral trauma.

Objective: The purpose of this series is to report our experience in managing ureteral trauma, focusing on the importance of early diagnosis, correct treatment, and the impact of associated injuries on the management and morbid-mortality.

Materials And Methods: From January 1994 to December 2002, 1487 laparotomies for abdominal trauma were performed and 20 patients with ureteral lesions were identified, all of them secondary to penetrating injury. Medical charts were analyzed as well as information about trauma mechanisms, diagnostic routine, treatment and outcome.

Surgical margins in radical prostatectomy: a comparison between retropubic and laparoscopic surgery.

Objectives: To compare positive surgical margins in both radical retropubic prostatectomies and laparoscopic surgery in two reference centres in Brazil.

Materials And Methods: One hundred and seventy nine pathological studies from patients, who underwent radical prostatectomy due to prostate adenocarcinoma, 89 submitted to retropubic surgery and 90 to laparoscopic surgery, were analyzed. Inclusion criteria Patients with PSA View Article and Find Full Text PDF

Adjustable continence therapy for the treatment of urinary incontinence after radical cystectomy and orthotopic neobladder in women.

The management of urinary incontinence after radical cystectomy and orthotopic neobladder reconstruction is a very challenging situation. We report on a patient that developed a neobladder-urethro-vaginal fistula successfully treated but resulting in severe urinary incontinence that was cured after the periurethral insertion of adjustable silicone balloons.

Histopathological alterations of the vas deferens in rats exposed to polypropylene mesh.

Objective: To assess the histological and physiological effects of polypropylene mesh for inguinal herniorraphy, as it can cause lesions in the vas deferens in 0.3-2.0%, leading to infertility, and induces an inflammatory process and adjacent fibrosis, strengthening the posterior inguinal wall.

Laparoscopic ileocystoplasty: an experimental study in pigs.

Background And Purpose: Bladder dysfunction may lead to urinary incontinence and progressive kidney deterioration. When clinical treatment fails, bladder augmentation is the operation of choice in most cases. The purpose of this study was the standardization of the technique of videolaparoscopic ileocystoplasty in a porcine model and demonstration of a tutor-supervised learning curve.

Is the minimally invasive treatment as good as transurethral resection for benign prostatic hyperplasia?

Despite the development of new technologies, transurethral resection of the prostate (TURP) is still considered the gold standard for surgical treatment of the benign prostate hyperplasia (BPH). In general, new minimally invasive treatments have not demonstrated better outcomes than TURP in evidence based medicine trials published to date, and should be reserved for patients who prefer to avoid surgery, who are unsuitable candidates for surgery or who no longer respond favorably to medication. TUMT and TUNA appears to be more effective than medical therapy but less effective than TURP.

Experimental animal model for training transobturator and retropubic sling techniques.

Introduction: Suburethral slings have become the treatment of choice for stress urinary incontinence. However, the lack of experimental models for surgical training is a problem for beginners. We present a model for sling training and evaluate its acceptance by surgeons who have had prior experience.

Macroplastique implantation system for female stress urinary incontinence: long-term follow-up.

Purpose: To evaluate the 60-month outcome of the Macroplastique Implantation System (MIS) for the treatment of female stress urinary incontinence (SUI) caused by intrinsic sphincter deficiency evaluated by objective and subjective measures, including Quality of Life (QoL) impact.

Patients And Methods: Twenty-one women, mean age 47.4 years, with urodynamically diagnosed intrinsic sphincter deficiency were enrolled.

Split technique in horseshoe kidney transplantation.

Background/aims: Nowadays, owing to a greater number of patients waiting for a kidney donation and to a shortage of organs donated, more suitable organ acceptance criteria have been formulated. Horseshoe kidney transplantations have become feasible giving good allograft outcomes. The aim of this paper is to illustrate the split technique in horseshoe kidney transplantation and to report long-term results.

Videolaparoscopic orchiectomy and nephrectomy: training model in rats.

Objective: Videolaparoscopic surgery conducted on small animals has proved to be of great importance for the improvement of surgical skills. This is a report utilizing an experimental model for laparoscopic orchiectomy and nephrectomy in training courses for urologists.

Material And Methods: Of 350 American Wistar rats enrolled, 319 animals underwent laparoscopic orchiectomy and nephrectomy under intraperitoneal general anesthesia.

External validation of outcome prediction model for ureteral/renal calculi.

Purpose: We externally validated a previously designed neural network model to predict outcome and duration of passage for ureteral/renal calculi. The model was also evaluated using a 6 mm largest stone dimension cutoff in predicting stone outcome.

Materials And Methods: The model was previously designed on 301 patients at Albany Medical Center (free shareware from www.

Massive prolapse of the urethral mucosa following periurethral injection of calcium hydroxylapatite for stress urinary incontinence.

The injection of bulking agents into the urethral submucosa is designed to create artificial urethral cushions that can improve urethral coaptation and hence restore continence. Ideally, a urethral bulking agent should be non-immunogenic and biocompatible, leading to minimal inflammatory and fibrotic response. The authors present a case report of a granulomatous reaction leading to urethral prolapse, 3 months after the transurethral injection of calcium hydroxylapatite.

Continent urinary diversion in patients with pelvic irradiation: an alternative utilizing transverse colon reservoir.

The use of radiation therapy in pelvic malignancies increases the risk of urinary complications, sometimes being necessary urinary diversion. The risk of utilizing previously irradiated bowel should be avoided. The use of transverse colon is a safe and effective alternative.

Nephron-sparing surgery for renal tumours using selective renal parenchymal clamping.

Objective: To describe a technical modification that facilitates nephron-sparing surgery (NSS) for renal tumours, without clamping the renal pedicle or promoting renal surface hypothermia.

Patients And Methods: Seventeen patients with renal tumours had NSS using the selective renal-parenchymal clamping technique. In 11 patients the tumour was polar and in six it was central.

Transobturator SAFYRE sling is as effective as the transvaginal procedure.

Introduction: SAFYRE is a monofilament polypropylene mesh held between two self-anchoring silicone columns that associates universal approach with readjustability. This unique feature allows for comparing two different approaches, i.e.

Comparative study of percutaneous access for staghorn calculi.

Objectives: To compare the success and complication rates of staghorn calculi treated through the upper pole calix, lower/middle calices, and multiple access.

Methods: Between January 1995 and December 2000, the records of 119 patients with staghorn calculi who underwent percutaneous nephrolithotomy were retrospectively reviewed. The mean stone burden was 6.

A stereological analysis of fibrosis and inflammatory reaction induced by four different synthetic slings.

Objectives: To analyse quantitatively, using stereological methods, the density of the collagen fibres induced by four types of sling materials, and verify by a histopathological analysis the corresponding inflammatory reaction, as fibrosis secondary to sling implantation is considered responsible for restoring urethral support and re-establishing continence in women with stress urinary incontinence, and new synthetic materials that promote adequate fibrosis with the least intensity and duration have been proposed to substitute the aponeurotic sling.

Materials And Methods: The study comprised 70 isogenic white Wistar rats divided into three groups: group A (30 rats) had 8 x 4 mm strips of silicone and porcine small intestine submucosa (SIS) implanted in the abdominal subcutaneous tissues; group B (30 rats) had 8 x 4 mm strips of polycaprolactone and polylactic acid copolymers and monofilament polypropylene (PLP) implanted the abdominal subcutaneous layer; while a control group of 10 rats had dissection and suturing with 5/0 Nylon in the abdominal subcutaneous layer, as used to fix the strips in the other rats. Picro-Sirius staining was used to assess collagen fibres, and haematoxylin-eosin for the histopathological study.