Tomasz Szydełko

Antegrade endopyelotomy versus laparoscopic pyeloplasty for primary ureteropelvic junction obstruction.

OBJECTIVES A retrospective study was performed to compare the results of laparoscopic pyeloplasty and antegrade endopyelotomy and complications observed after the two procedures. MATERIALS AND METHODS Seventy-five endopyelotomies and 90 laparoscopic pyeloplasties in patients with primary ureteropelvic junction obstruction (UPJO) were performed. The diagnosis of UPJO was based on a complete medical history, ultrasonography, urography (IVU), and/or diuretic renography. In 52 cases, a Whitaker test was performed before endopyelotomy. The mean follow-up was 31 months in the endopyelotomy group and 28.5 months in the laparoscopy group. Complete success was defined as absence of any clinical symptoms combined with significant reduction of hydronephrosis on diuretic IVU and ultrasonography, and no sign of obstruction on diuretic IVU, diuretic renography, or Whitaker test. RESULTS Complete success was observed in 55.4% of patients after endopyelotomy and in 95.3% of patients after laparoscopic pyeloplasty. In patients with primary UPJO, laparoscopic procedures yield better therapeutic results than endopyelotomy, irrespective of the degree of hydronephrosis. The number of complications after the two procedures was comparable with the exception of intraoperative bleeding, which was more frequent in the case of endopyelotomy. CONCLUSIONS Laparoscopic pyeloplasty should be the procedure of choice in the treatment of primary UPJO.

Bladder agenesis in a male neonate

Bladder agenesis, especially in male, is a rare congenital anomaly. This is a case report of a male patient with several congenital anomalies including penoscrotal transposition, severe kidneys dysplasia, and agenesis of the bladder. The patient lived for 4 months and died because of severe pneumonia.

Comparison of Dismembered and Nondismembered Y-V Laparoscopic Pyeloplasty in Patients with Primary Hydronephrosis

INTRODUCTION A retrospective study was performed to compare the results of dismembered and nondismembered Y-V laparoscopic pyeloplasties and the complications observed after the two types of surgery. MATERIALS AND METHODS Eighty-eight patients with ureteropelvic junction obstruction (UPJO) underwent a laparoscopic operation. In 2 cases, an open conversion was made. A laparoscopic Hynes-Anderson pyeloplasty (LH-AP) was performed on 50 patients, whereas a laparoscopic Y-V pyeloplasty (LY-VP) was performed in 36 cases. The diagnosis of UPJO was based on a complete medical history, ultrasonography, diuretic urography (IVU), and/or diuretic renography. The mean follow-up was 29 (range, 6-66) months. Complete success was defined as the absence of any clinical symptoms, combined with a significant reduction of hydronephrosis on IVU and ultrasonography, as well as no sign of obstruction on IVU and/or diuretic renography. RESULTS The mean operative time for LH-AP was 219 minutes and for LY-VP 185 minutes. The mean hospital stay after LH-AP was 5.9 days and after LY-VP 5.3 days. The overall success rate was 91.5% (91.8% for LH-AP patients and 91.2% for LY-VP patients). CONCLUSION LY-VP appears to be a safe, attractive alternative to LH-AP.

The clinical significance of lymphangiogenesis in renal cell carcinoma

Background The formation of lymphatic vessels (lymphangiogenesis) occurs in tumor tissues and is crucial for tumor development and progression in some cancers. Lymphangiogenesis and its clinical effect on renal cell carcinoma have been less thoroughly investigated in comparison with angiogenesis. The aim of this study was to evaluate the role of lymphangiogenesis as a prognostic factor in renal cell carcinoma (RCC). Material/Methods The expression of peritumoral/intratumoral lymphatics was studied by immunohistochemical methods in paraffin-embedded nephrectomy specimens from 133 patients with clear cell carcinoma. Patients were divided into 3 groups depending on postoperative follow-up: I) patients without metastases, II) patients with metastases during follow-up, and III) patients with metastases during the operation. Peritumoral lymphatics (PTL) and intratumoral lymphatics (ITL) were immunostained with a D2-40 antibody. Results The mean number of PTL present in each group was I=14.1, II=10.6, III=12.1. The mean number of ITL present in each group was I=0.7, II=2.3, III=2.3. The 3 groups showed statistically significant differences only in the case of ITL. A mean count of ITL ≥1 is significantly associated with an increased risk of regional lymph node involvement and distant metastasis. Patients with expression ITL >0.2 and PTL ≤15.2 had a significantly shorter cancer-specific survival. Conclusions The number of ITL showed an association with more aggressive cases of RCC and progression of disease. Therefore, the level of expression ITL, together with stage and histological grading, may provide valuable predictive information about the outcome of treatment.

Clavien Classification of Complications After 150 Laparoscopic Pyeloplasties

OBJECTIVES To compare the complications of laparoscopic pyeloplasty observed in 3 periods of our learning curve using the Clavien classification. METHODS We reviewed and retrospectively analyzed the records of 150 cases of laparoscopic pyeloplasty performed for primary ureteropelvic junction obstruction at our center. All patients were divided into 3 groups according to the order of the case number (1-50, 51-100, 101-150) to compare the intergroup differences in the preoperative data and perioperative parameters. The postoperative complications were subdivided according to the 5-grade Clavien classification of surgical complications. The groups of patients with and without complications were compared with respect to age, degree of hydronephrosis, positive urine culture before surgery, concomitant nephrolithiasis, crossing vessel, and the type of operation performed (dismembered vs nondismembered). RESULTS The success rate was 90.5%. The mean follow-up was 53.7 months (range 5-103). Intraoperative complications occurred in 9 (6%) of 150 patients and postoperative complications in 27 (18%) of 150 patients. No statistically significant differences were seen between the incidence of intra- and postoperative complications among the compared groups. The only statistically significant difference among the groups with and without complications was the presence of a positive urine culture (19% vs 6%, respectively). CONCLUSIONS The most common complications were connected with stent obstruction, and they did not seem dependent on surgeon experience. Patients with a preoperative positive urine culture might have a greater risk of postoperative complications.

Dismembered Laparoscopic Anderson-Hynes Pyeloplasty Versus Nondismembered Laparoscopic Y-V Pyeloplasty in the Treatment of Patients with Primary Ureteropelvic Junction Obstruction: A Prospective Study

PURPOSE An attempt has been made to prospectively compare the results of two laparoscopic pyeloplasties: Dismembered Anderson-Hynes (A-H) plasty and nondismembered Y-V plasty. Complications following the procedures have been studied as well. PATIENTS AND METHODS Fifty patients with primary ureteropelvic junction obstruction (UPJO) were prospectively selected at random to undergo dismembered A-H (25 patients-even numbers) and nondismembered Y-V (25 patients-odd numbers) laparoscopic pyeloplasty. UPJO was diagnosed on the basis of ultrasonography, excretory urography, and diuretic renography (DR). The intensity of pain was assessed according to a visual analog pain scale (VAS). Success was defined by three factors taken collectively: 80% or greater pain relief in comparison with the preoperative VAS score, no obstruction on DR (decreasing renographic excretion curve, T(1/2) <12 min), and improved or stable differential renal function. The mean follow-up was 26.2 months for the A-H group and 26.6 months for Y-V group (P=0.865). RESULTS Both groups were comparable in terms of preoperative data, except for the presence of the crossing vessel, which was more often observed in the Y-V group. No statistically significant differences between the studied groups were found in operative times, morbidity, and hospitalization length. The success rate in the A-H group was 95% and 86% in the Y-V group, the difference being not statistically significant. CONCLUSIONS Laparoscopic A-H pyeloplasty achieved a higher success rate then Y-V pyeloplasty; however, the difference was not statistically significant.

Endovascular exclusion of a large spontaneous aortocaval fistula in a patient with a ruptured aortic aneurysm

A primary aortocaval fistula (ACF) is present in less than 1% of all abdominal aortic aneurysms (AAA). The case of a 62-year-old patient with a ruptured AAA and ACF was reported. A stent-graft was implanted into the abdominal aorta. An inferior vena cava filter was inserted to prevent pulmonary embolism. The patient made a smooth recovery. The follow-up computed tomographic scan three months later did not reveal any evidence of endoleaks or that the fistula was still present. Hemodynamic changes with regard to transient acute liver impairment were discovered (renal and liver parameters were presented). Endovascular exclusion appears to be an effective option in the treatment of an aortocaval fistula in comparison to conventional open repair.

Laparoscopic Anderson-Hynes procedure as a treatment of ureteropelvic junction obstruction caused by fibroepithelial polyp

Fibroepithelial polyps (FEPs) are rare benign ureteral neoplasms of mesodermal origin. As an intrinsic cause of ureteropelvic junction obstruction (UPJO) they are very uncommon. Excretory urography and diuretic renography used by many urologists to diagnose a UPJO may not detect the ureteral polyp. We present a case of ureteropelvic junction obstruction caused by a fibroepithelial polyp, which was not diagnosed preoperatively. The patient underwent successful laparoscopic excision of the polyp with Anderson-Hynes pyeloplasty. We believe that laparoscopy is a useful, minimally invasive operative technique in the treatment of FEPs and may be considered a procedure of choice in large polyps, in which cases the endoscopic procedure is difficult or impossible to perform.

laparoscopic adrenalectomy - ten-year experience

Objectives The objective of the study is to summarize the authors’ 10-year experience with laparoscopic adrenalectomy and to analyze the intra- and postoperative complications of the procedure. Material and methods The records of 80 patients who had undergone laparoscopic adrenalectomy from January 2002 to January 2012 were reviewed retrospectively. There were 51 female and 29 male patients. The average age was 52. In 33 cases the right adrenal gland was affected, in 47 it was the left adrenal gland. Nineteen operations were performed with the retroperitoneal approach, in 61 a transperitoneal access was used. The average size of the tumor was 5 cm. The diagnosis was based on ultrasonography (USG) and computed tomography (CT). The biochemical tests were performed in all cases to assess hormonal activity of the tumor. Pheochromocytoma was diagnosed in 16 cases, Cushing syndrome in 3 cases, and Conn syndrome in 4 cases. All other tumors were hormonally inactive. Six patients were operated on because of adrenal metastases – from renal carcinoma in five cases and from lung carcinoma in one case. Results There were three open conversions. The mean operative time was 158 minutes. The mean hospital stay was 5.5 days Blood transfusion was necessary in three patients. Postoperative complications were observed in 11 patients (13.7%). Conclusions Laparoscopic adrenalectomy is a safe and effective procedure and should be considered the first – line treatment of benign adrenal masses. Our experience indicates that patients with adrenal metastases are suitable candidates for laparoscopic adrenalectomy, providing a skilled laparoscopic surgeon is involved in operation.

Modified laparoscopic Y-V pyeloplasty: experience of a single center.

The aim of this study was to compare the results of two procedures: laparoscopic Foley Y-V pyeloplasty and our modification of the technique. Sixteen operations performed were Foley Y-V plasties (LY-VP), and 23 were the modifications (LY-V1P). In the modified version, a V-shaped flap was created from the anterior wall of the renal pelvis. Ultrasonography, diuretic urography, and/or diuretic renography were used to diagnose ureteropelvic junction obstruction. The mean follow-up was 30 months. Complete success was defined as the absence of any clinical symptoms combined with a significant reduction of hydronephrosis on diuretic urography and ultrasonography as well as no sign of obstruction on diuretic urography, diuretic renography, and/or the Whitaker test. We did not observe any serious postoperative complications. The success rate was 93.3% for LY-VP patients and 95.4% for LY-V1P patients. The modified plasty group had easier intracorporeal laparoscopic suturing while maintaining similar postoperative outcomes.