Kittinut Kijvikai

Laparoscopic ureterolithotomy: Its role and some controversial technical considerations

Objective:  To define the role of laparoscopic ureterolithotomy in the management of urolithiasis and evaluate the controversial techniques of this operation.

Assessment of stone composition in the management of urinary stones

Several explanations have been suggested to account for the failure of extracorporeal shockwave lithotripsy (ESWL) treatment in patients with urinary stones, including large stone volume, unfavorable stone location or composition and the type of lithotriptor used. Unfavorable stone composition is considered a major cause of failure of ESWL treatment, and consequently knowledge of the stone composition before treatment is initiated is desirable. Plain abdominal radiographs cannot accurately determine either stone composition or fragility, and although the CT attenuation value in Hounsfield units (HU) (that is, normalized to the attenuation characteristics of water) is useful, this parameter has limited value as a predictor of stone composition or the response to ESWL treatment. By contrast, stone morphology as visualized by CT correlates well with both fragility and susceptibility to fragmentation by ESWL. For patients prone to recurrent calculi, analyses of stone composition are especially important, as they may reveal an underlying metabolic abnormality. The development of advanced imaging technologies that can predict stone fragility is essential, as they could provide extra information for physicians, enabling them to select the most appropriate treatment option for patients with urinary stones.

Primary Renal Inflammatory Myofibroblastic Tumor

A case of primary renal inflammatory myofibroblastic tumor of the left kidney in a 51-year-old man clinically presenting bleeding from the gums with thrombocytopenia and left flank mass is reported. Pathological examination of the left renal tumor characterizes macroscopically by a cortical mass and histologically by spindle cells admixed with variable amounts of extracellular collagen, lymphocytes and plasma cells. Immunohistological stainings are positive vimentin and focal positive smooth muscle actin. Clinical and pathological features with a brief review of the relevant literature are discussed. This is the first reported description in the literature of primary renal inflammatory myofibroblastic tumor associated with thrombocytopenia.

Lithotrites and postoperative fever: does lithotrite type matter? Results from the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study

Objective: To compare the risks of fever from different lithotrites after percutaneous nephrolithotomy (PNL). Materials and Methods: The Clinical Research Office of the Endourological Society (CROES) PNL database is a prospective, multi-institutional, international PNL registry. Of 5,803 total patients, 4,968 received preoperative antibiotics, were supplied with complete information and included in this analysis. The lithotrites assessed included no fragmentation, ultrasonic, laser, pneumatic and combination ultrasonic/pneumatic. Risk of fever was estimated using multivariate logistic regression with adjustment for diabetes, steroid use, a history of positive urine culture, the presence of staghorn calculi or preoperative nephrostomy, stone burden and lithotrite. Results: The overall fever rate was 10%. Pneumatic lithotrites were used in 43% of the cohort, followed by ultrasonic (24%), combination ultrasonic/pneumatic (17.3%), no fragmentation (8.4%) and laser (7.3%). Fever rates were no different between patients who underwent no or any fragmentation (p = 0.117), nor among patients when stratified by lithotrite (p = 0.429). On multivariate analysis, fragmentation was not significantly associated with fever [Odds Ratio (OR) 1.17, p = 0.413], while diabetes (OR 1.32, p = 0.048), positive urine culture (OR 2.08, p < 0.001), staghorn calculi (OR 1.80, p < 0.001) and nephrostomy (OR 1.65, p < 0.001) increased fever risk. Fever risk among lithotrites did not differ (p ≥ 0.128). Conclusions: Risk of post-PNL fever was not significantly different among the various lithotrites used in the CROES PNL study.

Hand-assisted laparoscopic nephrectomy for xanthogranulomatous pyelonephritis with nephrocutaneous fistula after failed flank exploration.

Xanthogranulomatous pyelonephritis presenting with nephrocutaneous fistula is a rare condition, and its treatment of choice is nephrectomy. Laparoscopic management has been proved to be challenging in these inflammatory renal conditions. However, there was no previous report in the literature regarding laparoscopic treatment of nephrocutaneous fistula especially after previous operation. In this communication, we report the first case of hand-assisted laparoscopic nephrectomy for xanthogranulomatous pyelonephritis with nephrocutaneous fistula after previous failed flank exploration.

Renal Leiomyoma: A Case Report and Review of the Literature

Leiomyoma is an uncommon tumor of the kidney. The authors report a rare case of renal leiomyoma in a 39-year-old male patient who presented with a right flank mass. Laparoscopic nephrectomy was performed. The histopathology and immunohistochemistry confirm the diagnosis of renal leiomyoma. The review of literature in the clinicoradiopathological correlation was illustrated.

Laparoscopic management of a single system ectopic ureterocele with transitional cell carcinoma in the distal ureter

Abstract  Single system ectopic ureterocele associated with transitional cell carcinoma in the ureter has not been described previously. Only two cases of transitional cell carcinoma in a single ectopic ureter have been reported in the published literature. With the development of minimally invasive surgery, we report the first case of single system ectopic ureterocele with transitional cell carcinoma in the distal ureter that was successfully managed by laparoscopic surgery.

Control of the large renal vein in limited dissected space during laparoscopic nephrectomy: a simple and reliable method

Abstract  We describe our technique for large renal vein control in the limited dissected space during laparoscopic nephrectomy. This technique is a simple, inexpensive and reliable method, especially for large and short renal vein ligation.