Wayne Kuang

Rhabdomyolysis after laparoscopic donor nephrectomy

Rhabdomyolysis is a postoperative complication that may result in acute renal failure owing to excessive myoglobinuria. After uncomplicated laparoscopic left transperitoneal donor nephrectomy, a 32-year-old man developed anuric acute renal failure secondary to postoperative rhabdomyolysis that required intermittent hemodialysis for 2 weeks. The presumed risk factors in this case were the patients high body mass index, intraoperative flank position with flexion, a solitary kidney, and the duration of surgery. Our current surgical technique has been modified to drop the kidney bridge early, immediately after visualization of the hilum.

LAPAROSCOPIC DISMEMBERED TUBULARIZED FLAP PYELOPLASTY: A NOVEL TECHNIQUE

PURPOSE Laparoscopic dismembered pyeloplasty is now an effective option for ureteropelvic junction obstruction. We describe a novel laparoscopic technique of dismembered tubularized flap pyeloplasty for a difficult recurrent long ureteropelvic junction stricture. MATERIALS AND METHODS A 73-year-old woman with ureteropelvic junction obstruction of a solitary left kidney had undergone failed multiple procedures, including open pyeloplasty, balloon incision endopyelotomy, retrograde balloon dilation and percutaneous endopyelotomy. Using a 4-port transperitoneal laparoscopic technique, the upper ureter was dissected, the scarred ureteropelvic junction stricture was excised and the dismembered ureteropelvic junction was closed with a stitch. A wide base renal pelvic flap was created and tubularized to bridge the 3 cm. upper ureteral defect. Laparoscopic intracorporeal freehand suturing was done to reconstruct the renal pelvis and upper ureter over a Double-J stent (Medical Engineering Corp., New York, New York). RESULTS Total operative time was 4.5 hours and hospital stay was 4 days. The stent was removed 3 weeks later. At the 2-month followup the patient was asymptomatic. Excretory urography and diuretic renal scan confirmed a widely patent upper ureter with unobstructed drainage. CONCLUSIONS Dismembered renal pelvis tubularized flap pyeloplasty can be successfully performed laparoscopically to bridge a long upper ureteral defect. This approach is feasible even in a ureteropelvic junction in which previous surgery has failed.

SARCOMATOID TRANSITIONAL CELL CARCINOMA OF BLADDER MANAGED WITH TRANSURETHRAL RESECTION ALONE

Sarcomatoid carcinoma of the bladder is a rare entity that usually presents at high stage. Most cases have a poor prognosis despite aggressive surgery and adjuvant radiotherapy. We report a case of early stage sarcomatoid transitional cell carcinoma managed with transurethral resection alone with no evidence of recurrence at 48 months. CASE REPORT