Ureteric and urethral stenosis: a complication of BK virus infection in a pediatric renal transplant patient.

Viral infections remain an Achilles heel in solid organ transplant. In recent years, incidence of BK virus infection in the kidney transplant population is on rise. BK virus is known to cause severe renal dysfunction, ureteric stenosis, and hemorrhagic cystitis in renal transplant patients.

Surgical management of bilateral ureteral endometriosis.

Ureteral endometriosis is a rare disease that typically is unilateral. Endometriosis involving both ureters and surgical management after hormone therapy failure has seldom been described. We describe a patient with bilateral ureteral endometriosis who underwent ureteroneocystostomy with psoas hitches of both ureters.

Short-term impact of a laparoscopic "mini-residency" experience on postgraduate urologists' practice patterns.

Background: To assist practicing urologists incorporate laparoscopic urology into their practice, a 5-day mini-residency (M-R) program with a mentor, preceptor, and proctor experience was established at the University of California, Irvine, and we report the initial results.

Study Design: Thirty-two urologists underwent laparoscopic ablative (n=17) or laparoscopic reconstructive (n=15) training, including inanimate model skills training, animal laboratory, and operating room observation. A questionnaire was mailed 1 to 15 months (mean, 8 months) after their M-R program, and responses were reviewed.

Robotic-assisted laparoscopic ureteroureterostomy in an adolescent with an obstructed upper pole system and crossed renal ectopia with fusion.

Ureteropelvic junction obstruction (UPJO) in crossed renal ectopia with fusion is a rare condition. Management of UPJO occurring in ectopic kidneys generally requires open surgical reconstruction. Experience with minimally invasive techniques is minimal for repair of UPJO in ectopic kidneys.

Case report: robot-assisted laparoscopic reconstruction of a ureteropelvic junction disruption.

Purpose: We present our experience with robot-assisted laparoscopic repair of a ureteropelvic junction (UPJ) disruption in a child.

Case Report: An 11-year-old boy was found to have a UPJ disruption after being struck by an automobile. After unsuccessful retrograde ureteral-stent placement, a percutaneous nephrostomy tube was placed for a planned delayed repair because of the patient's multiple injuries.

Initial comparison of robotic-assisted laparoscopic versus open pyeloplasty in children.

Objectives: To compare the initial results of robotic-assisted laparoscopic versus open pyeloplasty in children with ureteropelvic junction obstruction.

Methods: From June 2002 to July 2004, 8 pediatric patients underwent robotic-assisted laparoscopic pyeloplasty and were matched by age group with patients undergoing conventional open pyeloplasty. The mean age was 11.

Laparoscopic removal of extraosseous Ewing's sarcoma of the kidney in a pediatric patient.

In the pediatric population, to the best of our knowledge, only 2 cases of renal extraosseous Ewing's sarcoma/primitive neuroectodermal tumor (EES/PNET) have been published. We report the initial case of renal EES/PNET occurring in a 10-year-old girl treated by a laparoscopic radical nephrectomy. The regimen used is the first documented use of neoadjuvant chemotherapy prior to laparoscopic radical nephrectomy for PNET.

Initial impact of a dedicated postgraduate laparoscopic mini-residency on clinical practice patterns.

Background And Purpose: Laparoscopic surgical techniques are difficult to master, especially for surgeons who did not receive this type of training during their residencies. We have established a 5-day mentor-preceptor- proctor-guided postgraduate "mini-residency" (M-R) experience in minimally invasive surgery. The initial results from the first 16 participants in the laparoscopic M-R modules are presented.

Laparoscopic vesicovaginal fistula repair with robotic reconstruction.

Introduction: To describe, to our knowledge, the first case report of robotic-assisted laparoscopic repair of a vesicovaginal fistula. A 44-year-old woman presented with a vesicovaginal fistula after vaginal hysterectomy. She had been noted to have a bladder injury that was repaired at that time.

Laparoscopic assisted radical cystectomy with ileal neobladder: a comparison with the open approach.

Purpose: To date, there have been only a few reports regarding the feasibility of the laparoscopic approach to radical cystectomy. In none of these cases has the laparoscopic approach been contrasted with a contemporary cohort of open cystectomy and diversion. Recently, we initiated laparoscopic assisted radical cystoprostatectomy and ileal neobladder (LACINB) wherein the cystoprostatectomy and pelvic lymph node dissections are performed laparoscopically and the reconstructive portion is performed via a 15 cm Pfannenstiel incision.

One-knot pyeloplasty.

Laparoscopic pyeloplasty represents one of the more advanced reconstructive procedures for the urologist. While early reports were replete with long operative times, there have been several changes that have added to the efficiency of the procedure. In our practice, we have found three changes to be of greatest value: (1) an upper-midline port placement; (2) use of a continuous suture for the anastomosis with a double-armed, knotted suture; and (3) antegrade stent placement.

Adenocarcinoma and dysplasia in an ileal neobladder after ileocystoplasty for interstitial cystitis.

We report a 54-year-old woman with an adenocarcinoma of an ileal neobladder arising upon a background of ileal mucosal dysplasia. We believe that no case study or report has previously documented neobladder ileal mucosal dysplasia adjacent to an ileal neobladder adenocarcinoma. This observation supports the current hypothesis that ileal neobladders are dynamic environments for potential malignancy, and moreover, suggests a sequence of morphologic and molecular derangements similar to that seen in colorectal carcinoma.

Long-term results of treatment for prostate carcinoma by staging pelvic lymph node dissection and definitive irradiation using low-dose rate temporary iridium-192 interstitial implant and external beam radiotherapy.

Background: The objective of this study was to evaluate long-term treatment outcome of definitive irradiation by using temporary interstitial implant and limited dose of external beam radiotherapy in treatment of localized prostate carcinoma.

Methods: In total, 536 patients with biopsy-proven adenocarcinoma of the prostate, classification T1-T3, underwent staging pelvic lymph node dissection and brachytherapy delivering an average tumor dose of 30 grays (Gy), supplemented by external beam radiation therapy for an additional dose of 36 Gy delivered over 4 weeks. One hundred of 536 (18%) patients had pathologic D1 disease.

Re-operative hypospadias repair using the Snodgrass incised plate urethroplasty.

Objective: To retrospectively assess the results of tubularized incised plate (Snodgrass) urethroplasty in a series of re-operative hypospadias repairs in children.

Patients And Methods: The study comprised a follow-up (from 1996 until 2000) of 13 patients (mean age 7.5 years, range 13 months to 27 years) who had at least one previous hypospadias repair and who then underwent a reconstruction using the Snodgrass repair.

Laparoscopic retroperitoneal renal and adrenal surgery in children.

Objective: To retrospectively assess the use of a retroperitoneal laparoscopic approach for simple nephrectomy and adrenalectomy in children.

Patients And Methods: All retroperitoneal laparoscopic renal and adrenal procedures carried out in children and completed between 1993 and March 2000 were reviewed retrospectively. Analgesic requirements, hospital stay, complications and blood loss were reviewed.

Medically resistant neonatal hypertension: revisiting the surgical causes.

Objective: To present the importance of searching for the surgical causes of pharmacologically resistant hypertension in the neonatal population.

Study Design: A case report and discussion are provided.

Results: Severe hypertension in the neonatal period is uncommon and almost always has a secondary cause.

Applications of the KTP laser in the treatment of posterior urethral valves, ureteroceles, and urethral strictures in the pediatric patient.

Purpose: We describes our experience using the potassium titanyl phosphate (KTP)-532 laser in treating posterior urethral valves, ureteroceles, and urethral strictures in the pediatric patient.

Methods: A retrospective chart review was performed from 1987 to 1997 on a total of 33 pediatric patients who underwent retrograde endoscopic treatment for posterior urethral valves (PUV), ureteroceles (UC), and urethral strictures using a KTP-532 laser.

Results: Overall, our success rate was excellent in the treatment of valves and ureteroceles.

Retroperitoneal laparoscopic nephrectomy in children.

Purpose: We report our experience with retroperitoneal laparoscopic nephrectomy and nephroureterectomy in children, and describe our surgical technique.

Materials And Methods: Five and 15 children 9 months to 17 years old underwent nephrectomy with cystoscopy plus intravesical ureteral stump fulguration for ureteral ablation and nephrectomy only, respectively. Surgical indications were unilateral multicystic dysplastic kidney in 8 cases (parental preference for surgery), a refluxing, chronic pyelonephritic kidney in 5, renal vascular hypertension in 2, and hydronephrosis and chronic pyelonephritis in 5, including 3 in whom a nephrostomy tube was placed percutaneously before laparoscopic nephrectomy.

Laser treatment of large cavernous hemangiomas of the penis.

Purpose: Cavernous hemangiomas of the penis are rare benign tumors commonly excised for cosmesis and bleeding. Reports of laser treatment of these lesions with the patient under local anesthesia indicate good functional and cosmetic results. We report our experience with 4 cavernous hemangiomas treated with the neodymium:YAG laser.