The effect of CO2 pneumovesicum on upper urinary tract

The Feasibility, Technique, and Medium-Term Follow-Up of Laparoscopic Transvesical Diverticulectomy

BACKGROUND

To present our experience and results with the transvesical laparoscopic diverticulectomy, developed by Pansadoro et al. [BJU Int. 2009;103(3):412-24], as treatment of symptomatic bladder diverticula, with a medium-term follow-up.

METHODS

Between June 2010 and July 2018, we successfully operated 15 patients (13 male/2 female), aged 32-85 years (mean age 61 years) in 2 centers in Austria, using the aforementioned technique.

RESULTS

The median operative time was 297 min (range 83-488 min), and the blood loss was minimal. The median diameter of the diverticula was 94 mm (range 40-110 mm). The transurethral catheter was removed in most patients on day 7 (range 1-26 days), and cystography was performed before catheter removal. Patients were discharged on the ninth postoperative day (range 4-18 days). One case had a Clavien-Dindo grade IIIb complication (ureter injury), and 2 cases had a grade IIIa complication (nephrostomy drainage). After a median follow-up of 19 months, no recurrences were observed.

CONCLUSION

The laparoscopic, transvesical diverticulectomy is a feasible and valuable procedure with good outcomes. To avoid complications, the ureter needs to be spared meticulously.

CO2 Cystoscopy for Evaluation of Ureteral Patency

Gynecologic surgery is associated with various perioperative complications, especially urinary tract injuries. Intraoperative cystoscopy plays an important role in allowing assessment of the bladder to ensure the absence of injuries. Verification of the urinary jets from the ureters is a fundamental step that is not always easy to accomplish. Dyes are frequently used, but these are not always available and are associated with adverse effects. The present study aimed to demonstrate the use of CO₂ as a medium for distension during cystoscopy. A total of 47 patients underwent CO₂ cystoscopy after laparoscopic hysterectomy (n = 26) or bladder endometriosis nodule resection (n = 21). In all patients, the ureteral jets were readily identified, leaving no doubt as to their patency. The median interval between the onset of cystoscopy and the view of jetting from both ureteral ostia was 145 seconds (range, 80-300 seconds). All cystoscopies were normal, and no patient had any signs of accidental urinary tract injury in the follow-up period. Two patients experienced mild urinary tract infection. This cystoscopy technique using CO₂ is fast, easy, safe, and efficient. We recommend bladder distension with CO₂ as a reasonable alternative technique when cystoscopy is required during gynecologic procedures.

Laparoscopic Approach for Intravesical Surgery Using Pneumovesicum in Urology: Literature Review

Minimally invasive laparoscopic surgical procedures are increasingly being used in the management of various urological diseases. In particular, the laparoscopic approach for intravesical surgery using pneumovesicum (LPV) is a minimally invasive alternative with potential advantages including decreased morbidity, shorter hospital stays, and improved cosmesis. We review the applications of LPV in urology, summarize data for different surgical approaches, and provide an overview of patient management, as well as other considerations. This narrative review focused primarily on articles indexed in PubMed, Google Scholar, Scopus, and Embase databases. No formal search strategy was used, and no meta-analysis of data was performed.

Carbon dioxide insufflation causes upper urinary tract injury in the early period of an experimental vesicoureteral reflux model

PURPOSE

Ureteral reimplantation via pneumovesicum is a new aspect of vesicoureteral reflux management. We aimed to determine the effects of carbon dioxide (CO2) insufflation on the upper urinary tract in an experimental model.

MATERIALS AND METHODS

Thirty New Zealand rabbits were allocated into five groups of six rabbits each. Right ureters were cannulated for CO2 insufflation in four groups. The pressures and durations of CO2 insufflation in the respective groups were as follows: Group A (10 mm Hg, 2 h); B (12 mm Hg, 2 h); C (10 mm Hg, 4 h); and D (12 mm Hg, 4 h) and control (E). Blood gas analysis, urea and creatinine levels were measured from renal veins and aorta. Histopathological evaluation of the renal parenchyma and ureters was scored.

RESULTS

Significant histopathological changes were detected in the ipsilateral ureter and renal parenchyma exposed to CO2 insufflation, predominantly observed in groups insufflated for longer durations, p < 0.05. Blood gases drawn separately from renal veins were significantly more acidotic, and serum urea and creatinine levels were increased in all the groups, p < 0.05.

CONCLUSIONS

CO2 causes significant histopathological and biochemical changes in the early period. Long-term results are required to determine whether permanent renal injury occurs.