Spontaneous nephroduodenal fistula in a 27-year-old woman.

Spontaneous nephroduodenal fistula formation is a rare occurrence. An otherwise healthy young patient presented with worsening chronic right flank pain and fevers. Retrograde pyelogram and computed tomography studies eventually led to a diagnosis and successful management of a right nephroduodenal fistula.

Simultaneous bilateral retrograde intrarenal surgery for stone disease in patients with significant comorbidities.

Background And Purpose: Advances in endoscopic equipment have allowed urologists to access stones in virtually any location in the upper tracts. Where clinically appropriate, this approach may represent the preferred treatment option, regardless of stone size. We report the first description of simultaneous bilateral retrograde intrarenal surgery (SB-RIRS) in patients with both significant upper-tract stone burdens and comorbidities such as morbid obesity or heart disease.

Bladder reconstitution with bone marrow derived stem cells seeded on small intestinal submucosa improves morphological and molecular composition.

Purpose: Tissue engineering has been used for bladder augmentations with small intestinal submucosa (SIS). Although favorable short-term outcomes have been reported, long-term followup has been poor. We investigate whether tissue engineering with stem cells improves the morphological and genetic composition.

Looped silk tie: surgical technique for management of the renal vein during laparoscopic live-donor nephrectomy.

Laparoscopic live-donor nephrectomy has revolutionized the field of kidney transplantation and has been adopted in many tertiary centers as the method of choice in procuring kidneys. While standard techniques for laparoscopic live-donor nephrectomy have been well described in the literature, there continues to be ample discussion about renal-vein ligation. Endo-GIA and other commonly used vascular stapling devices can be costly and prone to mechanical failures and may not be applicable in certain anatomic situations.

Simultaneous bilateral retrograde intrarenal surgery for bilateral complex upper tract stone disease.

Recent advances in retrograde endoscopy have greatly expanded the role of minimally invasive surgery in addressing upper tract stone disease. In an attempt to decrease patient morbidity further, we present our initial experience with simultaneous bilateral retrograde intrarenal surgery in a patient with complex bilateral upper tract stones.

Newly designed laparoscopic retractable dissector and suture passer.

We introduce a novel laparoscopic instrument that performs as a dissector and retractable suture passer in preparation for intracorporeal knot tying. The newly designed instrument was developed at our institution to duplicate techniques of vessel ligation in open surgery.

Cardiac murmur prompting diagnosis of metastatic nonseminomatous germ cell testicular neoplasia in an 18-year-old patient.

Most retroperitoneal tumors such as renal cell carcinoma have been associated with tumor thrombus extending into the renal vein, inferior vena cava (IVC), and heart. The retroperitoneal metastatic potential of testicular tumors is well known. We report here the first instance of a cardiac murmur prompting diagnosis of metastatic testicular neoplasia in an 18-year-old patient.

Spontaneous, unremitting gross hematuria occurring one week after laparoscopic donor nephrectomy.

Complications associated with the ureteral stump after nephrectomies rarely occur, especially after donor nephrectomies. The potential for the slippage of clips is a well-known event associated with vascular ligations. We report on the first case of clip slippage from the ureter and describe diagnosis and management of the most extreme of morbid presentations.

Laparoscopic skills training using a webcam trainer.

Purpose: Many sophisticated and expensive trainers have been developed to assist surgeons in learning basic laparoscopic skills. We developed an inexpensive trainer and evaluated its effectiveness.

Materials And Methods: The webcam laparoscopic training device is composed of a webcam, cardboard box, desk lamp and home computer.

Delayed intraoperative hydration limits blood loss during radical retropubic prostatectomy.

Objectives: To evaluate the effects of limiting hydration during prostate mobilization on intraoperative blood loss.

Methods: The patient records of 519 consecutive men undergoing radical retropubic prostatectomy by a single surgeon from January 2000 through April 2003 were reviewed. In the initial 328 cases, intravenous fluids were not limited throughout the case (constant hydration group).

Biaxial mechanical properties of muscle-derived cell seeded small intestinal submucosa for bladder wall reconstitution.

Bladder wall replacement remains a challenging problem for urological surgery due to leakage, infection, stone formation, and extensive time needed for tissue regeneration. To explore the feasibility of producing a more functional biomaterial for bladder reconstitution, we incorporated muscle-derived cells (MDC) into small intestinal submucosa (SIS) scaffolds. MDC were harvested from mice hindleg muscle, transfected with a plasmid encoding for beta-galactosidase, and placed into single-layer SIS cell culture inserts.

15-year experience with the management of extrinsic ureteral obstruction with indwelling ureteral stents.

Purpose: We assessed the success of retrograde placement of indwelling ureteral stents in the management of ureteral obstruction due to extrinsic compression.

Materials And Methods: Between July 1987 and December 2002 adequate followup was available for 101 patients who underwent primary retrograde ureteral stenting for extrinsic ureteral obstruction. Mean age at presentation was 61.

Laparoscopic assisted reconstructive surgery: a 7-year experience.

Purpose: Laparoscopic assisted surgery results in an improved cosmetic appearance by allowing complex reconstruction without a midline upper abdominal incision. We report technique and outcomes in patients undergoing laparoscopic assisted reconstruction during a 7-year period.

Materials And Methods: A total of 31 consecutive patients with a mean age of 14 years (range 1 to 36) underwent laparoscopic assisted reconstructive surgery through a lower midline or Pfannenstiel incision by a single surgeon (SGD) between June 1995 and July 2002.

Novel technique for diagnosis and management of Fraley's syndrome: helical CT with three-dimensional volume rendering.

We report on the diagnosis and minimally invasive management of Fraley's syndrome using helical CT with volume-rendering techniques in an 18-year-old patient. Three-dimensional images were generated rapidly and allowed safe planning and execution of a laser infundibulotomy of the upper-pole calix. After 24 months of follow-up, the patient remains pain free.

Large cerebellar lesion as original manifestation of transitional cell carcinoma of the bladder.

Patients with transitional cell carcinoma of the bladder classically present with irritative voiding symptoms or painless hematuria. Common sites of vascular metastases include the liver (38%), lung (36%), bone (27%), adrenal glands (21%), and intestine (13%). Vascular metastasis to the brain, without a prior history of chemotherapy, is extremely rare.

Mortality from grossly encrusted bilateral pyelitis, ureteritis, and cystitis by Corynebacterium group D2.

This is the first report of death due to gross encrustations of the entire upper urinary tract and bladder by Corynebacterium group D2 in a man with no history of renal transplantation or prolonged catheterizations. This case demonstrates that debilitated patients with a prior endoscopic procedure are at risk for this disease process. Prolonged treatment with appropriate antibiotics, acidification of the urine, and removal of crusts is essential for proper management.

Technique of combined pubovaginal sling and cystocele repair using a single piece of cadaveric dermal graft.

Objectives: To investigate the feasibility of using a single piece of cadaveric dermal allograft for the repair of stress urinary incontinence (SUI) with concurrent cystocele.

Methods: Nineteen patients with combined SUI and symptomatic grade III cystoceles were treated. Eleven of 19 patients had undergone prior repairs for SUI.