Claus Dahl

Hand-assisted partial nephrectomy with early arterial clamp removal: Impact of the learning curve.

Abstract Objective. The aims of this study were to present the results of hand-assisted laparoscopic partial nephrectomy according to the margin, ischaemia and complications system; to assess the role of the learning curve; and to compare this approach with other approaches. Material and methods. Data from 60 consecutive patients were obtained from a prospectively maintained database. The patients were divided into three cohorts (1, 2 and 3), with 20 patients each, according to their surgery dates. Results. The overall margin, ischaemia and complications rate was 90%. The warm ischaemia time was 9.5 min in cohort 1, decreasing to 5 min in cohort 3 (p < 0.0001). The Padua score (p = 0.0287) and tumour size (p = 0.0003) were significantly increased in cohort 3, but loss of kidney function decreased significantly to 3.5% in this cohort. Loss of kidney function of less than 5% was reported for eight (40%), nine (45%) and 14 (70%) patients in cohorts 1, 2 and 3, respectively (p = 0.0185). Conclusions. Hand-assisted laparoscopic partial nephrectomy with early removal of arterial clamps is safe and easy to learn. An expert laparoscopic surgeon can perform hand-assisted laparoscopic partial nephrectomy for complex tumours with a relatively high success rate according to the margin, ischaemia and complications system. Warm ischaemia time could be obtained within 5 min after 40 procedures.

Hand-assisted laparoscopic versus laparoscopic nephrectomy as outpatient procedures: a prospective randomized study

Abstract Objectives: The aims of this study were to discuss the hand-assisted laparoscopic nephrectomy (HALNo) outpatient procedure and compare it to the transperitoneal laparoscopic nephrectomy (LNo) outpatient procedure. Materials and methods: A prospective, randomized study of 30 patients with renal tumor who were recruited between November 2014 and February 2016 was performed. The primary endpoint of the study was length of hospital stay (LOS). Results: Fifteen patients received HALNo and 15 received LNo, with a male to female ratio of 2:1. The mean age was 60 years for HALNo and 64 years for LNo (p = 0.62). All patients were discharged within 6 h after the operation. The mean ± SD operation time was 65 ± 24 min [95% confidence limits (CL) 51–79] and 69 ± 24 min (95% CL 56–83) for HALNo and LNo, respectively (p = 0.95). The mean time for which patients stayed at the postoperative care unit was 85 ± 53 min (95% CL 44–126) and 91 ± 66 min (95% CL 54–127) for HALNo and LNo, respectively (p = 0.14). The mean LOS was 220 ± 96 min (95% CL 155–284) and 272 ± 80 min (95% CL 224–320) for HALNo and LNo, respectively (p = 0.53). Conclusion: HALNo, when performed as an outpatient procedure, is safe and feasible for a well-informed, well-educated and well-selected patient group, and is comparable to LNo regarding postoperative LOS.

Eosinophilic cystitis: three cases, and a review over 10 years.

Eosinophilic cystitis (EC) is a rare disease. We describe three cases, where presentations of the disease are similar. To highlight probable causes of the disease, symptoms, clinical findings and treatment modalities, we reviewed 56 cases over a 10-year period. The most common symptoms were frequency, dysuria, urgency, pain and haematuria. Common clinical findings were presence of bladder mass, peripheral eosinophilia and thickened bladder wall. A variety of medical treatments were used, most frequently steroids, antibiotics and antihistamines. Recurrence occurred in patients on tapering or discontinuing prednisone, among other reasons. There is no consensus about the treatment of EC, but In light of our findings in this review, the treatment of choice in our department will be tapered prednisone over 6–8 weeks in combination with antihistamine.

Non-invasive, low-grade papillary urothelial carcinoma in the urachus

The urachus is a duct connecting the allantois with the fetal bladder, forming the median umbilical ligament; it usually obliterates during fetal life. Carcinomas arising from urachal remnants are rare but associated with a poor prognosis. We present one case of non-invasive urachal papillary urothelial carcinoma, and through a systematic literature search, we identified 12 additional cases of urachal urothelial carcinoma reported in English literature in the past 20 years. The cases were compared according to the Sheldon Staging System and the Mayo Staging System presented by Ashley et al in 2006, and both Staging Systems tend to predict clinical outcome. The urachal carcinoma is an important differential diagnosis in patients presenting with haematuria or an infraumbilical mass, because the symptoms may be sparse and diagnosis at an early stage is essential for successful treatment.

Amyloidosis in the bladder: Three cases with different appearance

Abstract Amyloidosis refers to a number of diseases characterized by extracellular deposition of misfolded proteins, called amyloid fibrils, in the tissues and organs of the body. Amyloidosis in the bladder is a generally localized, rare condition, with approximately 200 cases reported in the literature. This report presents three cases of amyloidosis in the bladder, two of which had coexisting transitional cell carcinoma. Evaluation for systemic disease is recommended in patients with newly discovered amyloidosis, even if first recognized in an area with the localized form, as in the bladder.

Active surveillance for localized prostate cancer. Nationwide, observational study

Purpose: The objective of this study was to investigate nationwide survival outcomes in men with localized prostate cancer managed on active surveillance. Materials and Methods: A total of 936 men with localized prostate cancer were initiated on active surveillance in Denmark in 2002 to 2012. Kaplan-Meier estimated curative treatment-free, hormonal therapy-free, castration resistant prostate cancer-free and cause specific survival was calculated. Results: Prostate cancer was classified as very low risk in 223 men, low risk in 436, intermediate risk in 259 (87% were at favorable intermediate risk) and high risk in 18. Median followup was 7.5 years (IQR 6.1–9.1). Kaplan-Meier estimated 10-year curative treatment-free survival was 62.8% (95% CI 59.1–66.3), 10-year hormonal therapy-free survival was 92.2% (95% CI 89.2–94.4), 10-year castration resistant prostate cancer-free survival was 97.2% (95% CI 95.3–98.4) and 10-year cause specific survival was 99.6% (95% CI 98.6–99.9). Compared to men with low risk prostate cancer, those with intermediate risk prostate cancer had higher curative treatment-free survival (69% vs 56%, p = 0.008), lower hormonal therapy-free survival (88% vs 95%, p = 0.005) and similar castration resistant prostate cancer-free survival (95% vs 99%, p = 0.17). Conclusions: In this nationwide cohort 10-year cause specific survival was similar to that in prospective active surveillance cohorts. Our study supports the use of active surveillance in men with localized prostate cancer, including men with favorable intermediate risk characteristics.

Pushing the Envelope: Laparoscopic Nephrectomy as Outpatient Surgery

Purpose of ReviewThe purposes of this review were to identify the possible limiting factors prohibiting laparoscopic nephrectomy being performed as an outpatient surgery and optimize these limiting factors.Recent FindingsLaparoscopic nephrectomy for patients who have kidney cancer can be performed as an outpatient surgery in well-selected, well-educated, and well-informed patients in a well-prepared hospital culture.SummaryPatient confidence, pain, and hospital culture are the most important limiting factors to the performance of laparoscopic nephrectomy as an outpatient procedure. Controlling these factors leads to a high success rate for the outpatient procedure.