Mingshuai Wang

Retroperitoneal Laparoscopic Nephroureterectomy for Tuberculous Nonfunctioning Kidneys: a single-center experience

Purpose To present our surgical techniques and experiences of retroperitoneal laparoscopic nephroureterectomy for the treatment of tuberculous nonfunctioning kidneys. Materials and Methods From March 2005 to March 2013, a total of 51 patients with tuberculous nonfunctioning kidney underwent retroperitoneal laparoscopic nephroureterectomy at our medical center. The techniques included early control of renal vessels and dissection of the diseased kidney along the underlying layer outside the Gerato’s fascia. The distal ureter was dissected through a Gibson incision and the entire specimen was removed en bloc from the incision. Patient demographics, perioperative characteristics and laboratory parameters as well as postoperative outcome were retrospectively reviewed. Results Retroperitoneal laparoscopic nephroureterectomy was successfully performed in 50 patients, whereas one case required conversion to open surgery due to non-progression of dissection. The mean operating time was 123.0 minutes (107-160 minutes) and the mean estimated blood loss was 134 mL (80-650 mL).The mean postoperative hospital stay was 3.6 days (3-5days) and the mean return to normal activity was 11.6 days (10-14days). Most intra-operative and post-operative complications were minor complications and can be managed conservatively. After 68 months (12-96 months) follow-up, the outcome was satisfactory, and ureteral stump syndrome did not occur. Conclusions Retroperitoneal laparoscopic nephroureterectomy as a minimally invasive treatment option is feasible for treatment of tuberculous nonfunctioning kidneys.

Feasibility of Pure Conventional Retroperitoneal Laparoscopic Radical Nephrectomy With Level II Vena Caval Tumor Thrombectomy.

OBJECTIVE To report our surgical outcomes and experiences with pure conventional retroperitoneal laparoscopic nephrectomy and tumor thrombectomy for patients with right renal tumors and level II inferior vena caval tumor thrombus. MATERIALS AND METHODS From February 2012 to June 2014, five patients underwent pure conventional retroperitoneal laparoscopic nephrectomy and tumor thrombectomy. After the inferior vena cava was blocked using tourniquet loops above and below the thrombus with the contralateral renal vein being clamped, the inferior vena cava was opened, and the tumor thrombus was fully extracted. RESULTS The mean patient age was 57 years (43-71 years) and the mean body mass index was 22.44 kg/m(2) (20-25 kg/m(2)). The mean operative time was 241 minutes (180-300 minutes) and the mean estimated blood loss was 290 ml (50-1000 mL). The mean tumor size was 6.9 cm (3.5-9 cm) and the mean tumor thrombus length was 5.5 cm (4-10 cm). One patient needed an intraoperative transfusion, and the patient encountered bilateral lower limb deep vein thrombus. With a mean follow-up of 11.5 months (5-30 months), one patient was identified with lung metastasis 4 months postoperatively. CONCLUSION Although pure conventional laparoscopic nephrectomy and tumor thrombectomy for level II tumor thrombus are challenging, they are feasible in carefully selected patients. More studies are needed to confirm their superiority and oncologic outcomes.

Quercetin protects against chronic prostatitis in rat model through NF-κB and MAPK signaling pathways

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a common disease of urology, of which the pathogenesis and therapy remain to be further elucidated. Quercetin has been reported to improve the symptoms of CP/CPPS patients. We aimed to verify the therapeutic effect of quercetin on CP/CPPS and identify the mechanism responsible for it.

Endoscopic Combined Intrarenal Surgery for the Treatment of Postpercutaneous Nephrolithotomy Residual Stones

IntroductIon Endourological treatment modalities for kidney stones include extracorporeal shock wave lithotripsy (ESWL), f l e x i b l e u r e t e r o s c o p y ( f U R S ) , p e r c u t a n e o u s nephrolithotomy (PCNL), and laparoscopy.[1] PCNL is currently the recommended treatment for patients with complex renal stones. However, for complex renal stones, the residual stone after PCNL is very common, and the treatment is a sticky business. Complex stone situations, such as renal staghorn calculi, often necessitate several access points and multiple stage procedures. With the recent advances in endoscopic technology, fURS has become a more efficient and safer treatment of stones throughout all renal calyces compared with ESWL and PCNL. However, it is difficult to clear all the stones from each renal calyx using single technical equipment in some cases.[2] A potential technique, which called endoscopic combined intrarenal surgery (ECIRS), is a practical option for the treatment of complex renal calculi.[3] It simultaneously combines fURS and PCNL to explore renal cavities and aims at the one‐access resolution of urolithiasis along the whole urinary tract. The major advantage of using simultaneous antegrade‐retrograde therapy for complex renal calculi is the better stone‐free rates (SFRs).[4] ECIRS is especially convenient for the treatment of post‐PCNL residual stone fragment. We hereby present our experiences with the efficient surgery for patients and determine the efficacy and safety of this method to treat renal residual stones.

Self-retaining barbed suture reduces warm ischemia time during laparoscopic partial nephrectomy

Abstract Objective: To evaluate the efficacy and safety of self-retaining barbed suture in renorrhaphy during laparoscopic partial nephrectomy by comparing surgical outcomes in a prospective randomized manner. Material and methods: From July 2014 to July 2015, a total of 60 patients with T1 renal tumor were randomized into two equal groups: self-retaining barbed suture (SRBS) and conventional absorbable polyglactin suture (non-SRBS group). All patients were treated by retroperitoneal laparoscopic partial nephrectomy. One surgeon with high volume experience performed all procedures. The patient demographics and perioperative outcomes were compared. Results: The patient demographics and tumor characteristics were comparable. The mean tumor size and R.E.N.A.L. scores were comparable between the two groups. LPN was successfully accomplished in all patients without open conversion. The warm ischemia and renorrhaphy times were significantly shorter in the SRBS group (18.8 ± 8.2 vs. 22.9 ± 7.3 min, P = .04; 10.4 ± 3.7 vs. 13.8 ± 5.6 min, P = .01). The minor complication rate was 13.3% vs. 10.0%, which was comparable. No major complication occurred. Conclusions: The randomized controlled trial demonstrates that SRBS for renorrhaphy during retroperitoneal laparoscopic partial nephrectomy is safe and efficient. Application of barbed suture simplifies the parenchymal repair procedure and reduces warm ischemia time in comparison with conventional suture.

A Retrospective Study Comparing Surgical and Early Oncological Outcomes between Intracorporeal and Extracorporeal Ileal Conduit after Laparoscopic Radical Cystectomy from a Single Center

Background: Robot-assisted/laparoscopic intracorporeal ileal conduit (ICIC) has been reported in many experienced centers. Whether laparoscopic ICIC is superior to extracorporeal ileal conduit (ECIC) and whether laparoscopic ICIC should be promoted is still controversial. The aim of the study was to compare surgical and early oncological outcomes between patients undergoing laparoscopic radical cystectomy (LRC) with ICIC and ECIC. Methods: From January 2011 to June 2016, a total of 45 patients with bladder cancer underwent LRC with ileal conduit at our department, of whom 20 patients underwent LRC with ECIC and 25 patients underwent LRC with ICIC. Data of each patients characteristics, surgical outcomes, and short-term oncological outcomes were collected and analyzed. Results: LRC with ileal conduit was performed successfully on all 45 patients. There were no significant differences in patients’ characteristics, mean total operative time, and mean estimated blood loss between the ICIC and ECIC groups. Median time of flatus and oral intake was shorter in the ICIC group compared with the ECIC group (3 vs. 5 days, P = 0.035; 4 vs. 5 days, P = 0.002). The complications rates did not show significant difference between the two groups within the first 90 days postoperatively (P = 0.538). Cancer staging showed 45% of patients in the ECIC group and 36% in the ICIC group had a pathologic stage of T3 or T4, and 50% of patients in the ECIC group and 44% in the ICIC group had a pathologic stage of N1 or N1+. Kaplan–Meier analysis showed no significant difference in overall survival at 24 months (60% vs. 62%, P = 0.857) between the ECIC and ICIC groups. Conclusions: ICIC after LRC may be successful with the benefits of faster recovery time. No significant difference was found in complications and oncological outcomes between ICIC and ECIC. However, larger series with longer follow-up are needed to validate this procedure.

Rupture of ectopic renal arterial pseudoaneurysm after percutaneous nephrolithotomy

ABSTRACT A 35-year-old female patient presented with swelling pain at left waist for 1 month. Left renal pelvis stones were found and standard percutaneous nephrolithotomy was successfully performed. Two weeks later, the patient suddenly suffered massive bleeding presented with gross hematuria. Rupture of ectopic renal artery pseudoaneurysm was identified by computed tomography and angiography of the renal artery. Emergency selective angioembolization of one branch of the artery was performed. To our knowledge, this is the first report of ruptured ectopic renal arterial pseudoaneurysm.