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Wang X, Tang K, Chen Z, Liu H, Peng E, Xia D. Retroperitoneoscopic nephrectomy versus open surgery for non-tuberculous pyonephrotic nonfunctioning kidney: a single-center experience. Transl Androl Urol 2021; 10:1212-1221. [PMID: 33850756 PMCID: PMC8039631 DOI: 10.21037/tau-20-1449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Patients with obstructive pyonephrotic nonfunctioning kidney (OPNK) often require simple nephrectomy for long-term severe clinical symptoms. We aimed to analyze the outcomes of retroperitoneal laparoscopy versus open surgery for OPNK. Methods The study included clinical data of 69 patients with non-tuberculous OPNK from January 2015 to June 2019 in a single center. The patients were divided into laparoscopic group (LS, N=33) and open surgery group (OS, N=36). Those whose pathological findings were xanthogranulomatous inflammation or tuberculous granuloma were excluded. Statistical analysis compared the two groups in terms of basic demographic characteristics, preoperative laboratory examination results, and intraoperative and postoperative observation indicators. Results The results showed that non-tuberculous OPNK were more common in women (female/male =4:1). Compared with the LS group, patients in the OS group had higher white blood cells (WBC; P=0.010) and neutrophils (P=0.005) counts before surgery. The main clinical symptoms were low back pain, pyuria, and fever; among them, low back pain combined with pyuria was in the majority. More intraoperative hypotension events were observed in the OS group (P=0.007). Notably, subgroup analysis showed larger stone size happened in the OS group (OR 3.538, 95% CI, 1.337, 9.208). No statistical difference was found in the duration of surgery between the two groups while the length of postoperative hospitalization and retroperitoneal drainage, and postoperative blood transfusion rate increased significantly in the OS group. Postoperative use of non-steroidal anti-inflammatory drugs was more common in the LS group, while opioid analgesics were in the OS group (P=0.0006). There was no statistical difference in other complications. Conclusions In conclusion, considering the advantages of LS in terms of postoperative blood transfusion, surgical drainage and length of hospital stay, we recommend it for non-tubercular OPNK when the stone load of pyonephrosis side was less than 280 mm2 and the preoperative WBC and neutrophil count were within the normal range.
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Affiliation(s)
- Xinguang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Tang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hailang Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ejun Peng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ding Xia
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Urogenital tuberculosis - epidemiology, pathogenesis and clinical features. Nat Rev Urol 2019; 16:573-598. [PMID: 31548730 DOI: 10.1038/s41585-019-0228-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2019] [Indexed: 02/07/2023]
Abstract
Tuberculosis (TB) is the most common cause of death from infectious disease worldwide. A substantial proportion of patients presenting with extrapulmonary TB have urogenital TB (UG-TB), which can easily be overlooked owing to non-specific symptoms, chronic and cryptic protean clinical manifestations, and lack of clinician awareness of the possibility of TB. Delay in diagnosis results in disease progression, irreversible tissue and organ damage and chronic renal failure. UG-TB can manifest with acute or chronic inflammation of the urinary or genital tract, abdominal pain, abdominal mass, obstructive uropathy, infertility, menstrual irregularities and abnormal renal function tests. Advanced UG-TB can cause renal scarring, distortion of renal calyces and pelvic, ureteric strictures, stenosis, urinary outflow tract obstruction, hydroureter, hydronephrosis, renal failure and reduced bladder capacity. The specific diagnosis of UG-TB is achieved by culturing Mycobacterium tuberculosis from an appropriate clinical sample or by DNA identification. Imaging can aid in localizing site, extent and effect of the disease, obtaining tissue samples for diagnosis, planning medical or surgical management, and monitoring response to treatment. Drug-sensitive TB requires 6-9 months of WHO-recommended standard treatment regimens. Drug-resistant TB requires 12-24 months of therapy with toxic drugs with close monitoring. Surgical intervention as an adjunct to medical drug treatment is required in certain circumstances. Current challenges in UG-TB management include making an early diagnosis, raising clinical awareness, developing rapid and sensitive TB diagnostics tests, and improving treatment outcomes.
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Peña PA, Torres-Castellanos L, Patiño G, Prada S, Villarraga LG, Fernández N. Minimally invasive nephrectomy for inflammatory renal disease. Asian J Urol 2019; 7:345-350. [PMID: 32995279 PMCID: PMC7499324 DOI: 10.1016/j.ajur.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/02/2019] [Accepted: 04/23/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Once chronic inflammatory renal disease (IRD) develops, it creates a severe peri-fibrotic process, which makes it a relative contraindication for minimally invasive surgery (MIS). Our objective is to show that laparoscopic nephrectomy (LN) is a surgical option in IRD with fewer complications and better outcomes. Methods Retrospective review of patients who underwent a modified-surgical laparoscopic transperitoneal nephrectomy was performed. Data search included all operated patients between May 2013 and May 2018 that had a pathology result with any renal inflammatory condition (xanthogranulomatous pyelonephritis, chronic nephritis, and renal tuberculosis). We describe intra-operative variables such as operative time, blood loss, conversion rate, postoperative complications and length of hospital stay. Results There were 51 patients who underwent laparoscopic nephrectomy with a confirmatory pathology report for IRD. We identified four (8%) major complications; three of them required transfusion and one conversion to open surgery. The mean operative time was 233±108 min. Mean estimated blood loss was 206±242 mL excluding the conversion cases and 281±423 mL including them. The mean length of hospital stay was 3.0±2.0 days. Conclusion Laparoscopic nephrectomy for IRD can safely be done. It is a reproducible technique with low risks and complication rates. Our experience supports that releasing the kidney first and leaving the hilum for the end is a safe approach when vascular structures are embedded into a single block of inflammatory and scar tissue.
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Affiliation(s)
- Paula Andrea Peña
- Pontificia Universidad Javeriana, School of Medicine, Bogotá D.C., Colombia
| | - Lynda Torres-Castellanos
- Department of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, School of Medicine, Bogotá D.C., Colombia
| | - Germán Patiño
- Division of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
| | - Stefanía Prada
- Department of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, School of Medicine, Bogotá D.C., Colombia
| | - Luis Gabriel Villarraga
- Department of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, School of Medicine, Bogotá D.C., Colombia
| | - Nicolás Fernández
- Division of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, School of Medicine, Bogotá D.C., Colombia.,Department of Urology, Fundación Santa Fe de Bogotá, Colombia.,Division of Urology, Hospital for SickKids, University of Toronto, Toronto, Canada
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Li X, Liu ZJ, Liu JW, Cai M, Chen S, Yu T, Tang YZ, Liu YB, Wang Q. A Clinical Comparative Analysis of Retroperitoneal Laparoscopic Tuberculous Nephrectomy and Open Tuberculous Nephrectomy. J Laparoendosc Adv Surg Tech A 2019; 29:909-913. [PMID: 30932738 DOI: 10.1089/lap.2018.0808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Xiang Li
- Department of Urology, Organ Transplant Institute of 309th Hospital of PLA, Beijing, China
| | - Zhi-Jia Liu
- Department of Urology, Organ Transplant Institute of 309th Hospital of PLA, Beijing, China
| | - Jian-Wu Liu
- Department of Urology, ShanXiZhongLiu Hospital, Shanxi, China
| | - Ming Cai
- Department of Urology, Organ Transplant Institute of 309th Hospital of PLA, Beijing, China
| | - Song Chen
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Tao Yu
- Department of Urology, Organ Transplant Institute of 309th Hospital of PLA, Beijing, China
| | - Yu-Zhe Tang
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yu-Bao Liu
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Qiang Wang
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Jain S, Jain SK, Kaza RCM, Singh Y. This challenging procedure has successful outcomes: Laparoscopic nephrectomy in inflammatory renal diseases. Urol Ann 2018; 10:35-40. [PMID: 29416273 PMCID: PMC5791455 DOI: 10.4103/ua.ua_9_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In prospective study from November 2011- November 2013, we performed 44 laparoscopic nephrectomies for benign non-functioning kidney diseases. Twenty eight patients underwent laparoscopic transperitoneal nephrectomies (63.6%), ten were laparoscopic assisted (22.7%) and six (13.6%) were converted to open. Patient's age, gender, laterality and etiology of renal failure were noted. Outcomes were measured as operative time, intraoperative and post operative complications, blood loss, pain score and hospital stay. Patients were followed up at one, three and 12 weeks and 6 monthly thereafter. Of the 44, ten (22.7%) were 15-24 years old, 32 (72%) between 25-50 years and two were more than 50 years old. Females were 54.6%. 22 patients had either right or left nephrectomy. Pelviureteric-junction (PUJ) obstruction was the commonest cause, 26 cases (59.0%). Operative time: less than two hours in 30 (68.2%) patients, more than two hours in 14 cases. Blood loss: less than 100 ml in 12 (27.3%), 100-200 ml in 20 (45.4%) and more than 200 ml in 12 (27.3%) patients. All four major complications were converted to open, two had injury to mesocolic veins and two had vascular stapler malfunction. Post-operative complications: surgical site infection (SSI), paralytic ileus and mild grade fever in six cases each and non infected benign intra abdominal collection in two cases. Maximum pain score on POD-1: four in 20 cases (45.7%), two in 24 (54%). Two had pain score between 3-4 three weeks after surgery. Oral intake started by POD-2 in 30 (68.2%) and by POD-4 in 100% cases. 22 (50%) patients were ambulating by POD-2, 16 (36.7%) by POD-4. Our study and randomized and non-randomized published literature report acceptables complication and conversion rates. In conclusion, laparoscopic nephrectomy for benign non functional kidney is a better alternative to open nephrectomy.
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Affiliation(s)
- Siddharth Jain
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Sudhir K Jain
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Ram C M Kaza
- Department of Surgery, Dr. BR Ambedkar Hospital, New Delhi, India
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Chen Y, Zheng H, Liang G, Wang D, Qiu J, Fang Y. Comparison of Transperitoneal and Retroperitoneal Laparoscopic Nephrectomy for Nonfunctional Tuberculous Kidneys: A Single-Center Experience. J Laparoendosc Adv Surg Tech A 2017; 28:325-329. [PMID: 28657827 DOI: 10.1089/lap.2017.0270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To compare the effectiveness and safety between retroperitoneal laparoscopic nephrectomy (RLN) and transperitoneal laparoscopic nephrectomy (TLN) for nonfunctional tuberculous kidneys (NTK). METHODS From March 2013 to February 2016, 24 patients with NTK underwent laparoscopic nephrectomy in our department. Eleven patients underwent RLN, and 13 underwent TLN. The demographics and perioperative outcomes were compared retrospectively. RESULTS Characteristics, including gender, age, body mass index, and location, were similar in these two groups. All operations were successfully completed in the RLN group, while 1 case in the TLN group was converted to open surgery due to severe adhesions and excessive bleeding (1 of 13 patients). Time to oral intake after surgery in the TLN and RLN group was 43.85 ± 6.01 hours and 27.45 ± 6.83 hours (P < .05). No notable differences were found between two groups in terms of estimated blood loss, operative time, days of drain removal, and postoperative hospital stay. No local or disseminated recurrence was identified during the follow-up period. CONCLUSION Taking the same safety and effectiveness into consideration, TLN can be an alternative choice for experienced surgeons to deal with NTK. Also, further studies with a larger sample size should be performed to confirm this finding.
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Affiliation(s)
- Yanxiong Chen
- Department of Urology, the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou, Guangdong Province, China
| | - Haofeng Zheng
- Department of Urology, the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou, Guangdong Province, China
| | - Guancan Liang
- Department of Urology, the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou, Guangdong Province, China
| | - Dejuan Wang
- Department of Urology, the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou, Guangdong Province, China
| | - Jianguang Qiu
- Department of Urology, the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou, Guangdong Province, China
| | - Youqiang Fang
- Department of Urology, the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou, Guangdong Province, China
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Ghosh B, Sridhar K, Pal DK. Laparoscopic Reconstruction in Post-Tubercular Urinary Tract Strictures: Technical Challenges. J Laparoendosc Adv Surg Tech A 2017; 27:1121-1126. [PMID: 28488946 DOI: 10.1089/lap.2016.0609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Genitourinary tuberculosis still continues to plague developing countries and is a significant cause of morbidity as well as mortality in the developing world. At present, nearly 55% of the patients of genitourinary tuberculosis (GUTB) need surgical management. Owing to the presence of dense adhesions and loss of normal anatomical planes, GUTB was considered to be a contraindication to laparoscopic surgery. However, recent literature shows laparoscopy to be feasible in GUTB. Our study aimed at identifying the challenges in laparoscopic urinary tract reconstructive surgery in genitourinary tuberculosis-related urinary tract obstruction. MATERIALS AND METHODS The details of 6 patients who underwent different types of laparoscopic reconstructive surgery for genitourinary tuberculosis-related urinary tract obstruction from January 2014 to December 2015 were reviewed. Baseline characteristics, indications of surgery, type of surgery, operative duration, blood loss, and follow-up details were noted. All patients received antitubercular treatment before surgery as per the direct observed treatment short-course regimen followed in our country. RESULTS We performed one bilateral laparoscopic pyeloplasty, one unilateral laparoscopic pyeloplasty, two laparoscopic ureteroneocystostomies, and two ureteroureterostomies. Difficulty was encountered during dissection owing to the presence of adhesions, but conversion to open surgery was not done in five cases. Dense adhesions adjacent to the common iliac vessels necessitated conversion to open surgery in one of the ureteroureterostomies. Stenting was done in all the patients. All patients had uneventful postoperative recovery. Functional imaging following stent removal showed unobstructed tracer flow, showing successful operative outcome. CONCLUSIONS Our study showed that laparoscopic reconstructive surgery is feasible in genitourinary tuberculosis despite the presence of adhesions that may pose a challenge to dissection. This is in contrast to the previous studies which conclude that genitourinary tuberculosis is a relative contraindication to laparoscopic surgery.
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Affiliation(s)
- Bastab Ghosh
- Department of Urology, Institute of Post Graduate Medical Education and Research , Kolkata, India
| | - Kartik Sridhar
- Department of Urology, Institute of Post Graduate Medical Education and Research , Kolkata, India
| | - Dilip Kumar Pal
- Department of Urology, Institute of Post Graduate Medical Education and Research , Kolkata, India
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Zhang S, Luo Y, Wang C, Xiong H, Fu SJ, Yang L. Open surgery versus retroperitoneal laparoscopic nephrectomy for renal tuberculosis: a retrospective study of 120 patients. PeerJ 2016; 4:e2708. [PMID: 27917313 PMCID: PMC5131615 DOI: 10.7717/peerj.2708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/20/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Laparoscopic renal surgery has been widely used in the treatment of renal diseases. However, there is still little research about its application in addressing renal tuberculosis. The purpose of this study is to retrospectively investigate the surgical results of laparoscopic and open surgery for nonfunctional tuberculous kidneys. METHODS Between May 2011 and June 2016, 120 nephrectomies were performed in patients with a nonfunctional tuberculous kidney. Of these, 69 patients underwent retroperitoneal laparoscopic nephrectomy, and 51 patients underwent open nephrectomy. Data about the patients' characteristics and surgical outcomes were collected from their electronic medical records. Outcomes were compared between these two groups. RESULTS Our results showed that a number of renal tuberculosis patients presented no significant symptoms during their disease. Lower urinary tract symptoms (LUTS) were the most common at a rate of 73/120, followed by flank pain or accidently discovery (66/120), urine abnormality (30/120) and fever (27/120). Patients who underwent open surgery were similar to laparoscopic patients with regard to sex, BMI, location, previous tuberculous history, grade, anemia, adhesion, hypertension, diabetes and preoperative serum creatinine level, but were generally older than laparoscopic patients. There were no significant differences between open and laparoscopic surgery in estimated blood loss, transfusion, postoperative hospital days and perioperative complication rate. However, the median operation time of laparoscopic operation was much longer than open surgery (180 [150-225] vs 135 [120-165] minutes, P < 0.01). Seven of the 69 laparoscopic operations were converted to open surgery because of severe adhesions. CONCLUSION Laparoscopic nephrectomy is as an effective treatment as open surgery for a nonfunctional tuberculous kidney, although it requires more time during the surgical procedure. No significant differences in other surgical outcomes were observed.
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Affiliation(s)
- Su Zhang
- Department of Urology, Lanzhou University Second Hospital, Lan Zhou, China
| | - You Luo
- Department of Urology, Lanzhou University Second Hospital, Lan Zhou, China
| | - Cheng Wang
- Department of Urology, Lanzhou University Second Hospital, Lan Zhou, China
| | - Hu Xiong
- Department of Urology, Lanzhou University Second Hospital, Lan Zhou, China
| | - Sheng-Jun Fu
- Department of Urology, Lanzhou University Second Hospital, Lan Zhou, China
| | - Li Yang
- Department of Urology, Lanzhou University Second Hospital, Lan Zhou, China
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Gupta R, Dorairajan LN, Muruganandham K, Manikandan R, Kumar A, Kumar S. Laparoscopic ablative and reconstructive surgeries in genitourinary tuberculosis. JSLS 2016; 18:JSLS-D-13-00203. [PMID: 25392614 PMCID: PMC4154404 DOI: 10.4293/jsls.2014.00203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Laparoscopy is the present standard of care for urologic diseases. Laparoscopy in renal tuberculosis (genitourinary tuberculosis) is difficult because of inflammation and fibrosis associated with the disease. We present the outcome of our experience of laparoscopy in genitourinary tuberculosis, both ablative and reconstructive. METHODS The detailed data of patients with genitourinary tuberculosis who underwent laparoscopic surgeries between January 2011 and September 2012 were reviewed. Indications, type of surgery, duration, blood loss, intraoperative problems, postoperative outcomes, and follow-up details were noted. RESULTS Overall, 7 laparoscopic procedures were performed: 5 nephrectomies, 1 ureteric reimplantation with psoas hitch, and 1 combined nephrectomy and laparoscopy-assisted Mainz II pouch reconstruction. The mean operative time was 192 minutes for nephrectomy, 210 minutes for ureteric reimplantation, and 480 minutes for nephrectomy with Mainz II pouch reconstruction. There were no conversions to open surgery. The mean amount of blood loss was 70 mL for the nephrectomies, 100 mL for ureteric reimplantation, and 200 mL for nephrectomy with Mainz II pouch reconstruction. In 5 of 6 patients who underwent nephrectomy, there was severe perinephric and peripelvic fibrosis posing difficulty in dissection. However, the renal vessels could be controlled individually. The mean postoperative hospital stay was 3 days for the nephrectomies, 5 days for the ureteric reimplantation, and 10 days for the nephrectomy with Mainz II pouch reconstruction. In all cases the recovery was uneventful. CONCLUSIONS Laparoscopy, though technically more demanding, is a feasible and safe option for ablative and complex reconstructive procedures in genitourinary tuberculosis. It offers the benefits of minimally invasive surgery. The difficulty with this procedure is mostly because of peripelvic and perinephric fibrosis, whereas the lower ureter and bladder are relatively easier to dissect.
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Affiliation(s)
- Rahul Gupta
- Department of Urology, JIPMER (Jawaharlal Institute of Postgraduate Medical Education and Research), Pondicherry, India
| | - Lalgudi N Dorairajan
- Department of Urology, JIPMER (Jawaharlal Institute of Postgraduate Medical Education and Research), Pondicherry, India
| | - K Muruganandham
- Department of Urology, JIPMER (Jawaharlal Institute of Postgraduate Medical Education and Research), Pondicherry, India
| | - Ramanitharan Manikandan
- Department of Urology, JIPMER (Jawaharlal Institute of Postgraduate Medical Education and Research), Pondicherry, India
| | - Avijit Kumar
- Department of Urology, JIPMER (Jawaharlal Institute of Postgraduate Medical Education and Research), Pondicherry, India
| | - Santosh Kumar
- Department of Urology, JIPMER (Jawaharlal Institute of Postgraduate Medical Education and Research), Pondicherry, India
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Shah HN, Badlani GH. Genitourinary Tuberculosis; An Update. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0197-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wong N, Hoag NA, Jones EC, Rowley A, McLoughlin MG, Paterson RF. Genitourinary tuberculosis masquerading as a ureteral calculus. Can Urol Assoc J 2013; 7:E363-6. [PMID: 23766841 DOI: 10.5489/cuaj.1219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The genitourinary tract is a common extrapulmonary site of tuberculosis infection, yet remains a rare clinical entity in North America. We report the case of a 37-year-old man who presented for extracorporeal shock wave lithotripsy for a suspected ureteral stone on imaging. Further workup confirmed a diagnosis of genitourinary tuberculosis. Medical management was undertaken and, ultimately, nephrectomy performed. This case highlights the importance of maintaining a high index of clinical suspicion for genitourinary tuberculosis.
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Affiliation(s)
- Nathan Wong
- University of British Columbia, Department of Urologic Sciences, Gordon & Leslie Diamond Health Care Centre, Vancouver, BC
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Abstract
Genitourinary tuberculosis (GUTB) usually results from the reactivation of old, dormant tuberculous diseases by pathogens of the Mycobacterium tuberculosis complex. The diagnosis of tuberculosis of the urinary tract is based on the case history, the finding of pyuria in the absence of infection as judged by culture on routine media and by radiological imaging. A positive yellow egg culture and/or histological analysis of biopsy specimens possibly combined with the polymerase chain reaction (PCR) is still required in most patients to establish a definitive diagnosis of GUTB. Antituberculous drug treatment is based on an initial 2 month intensive phase with three or four drugs daily followed by a 4 month continuation phase with only two drugs. Surgery as a treatment option in GUTB might be indicated in complicated urinary tuberculosis. After antituberculous treatment of GUTB a follow-up surveillance over 5 years is recommended. Although the incidence of GUTB in Germany is relatively low, it is still necessary to impart and deepen scientific knowledge of the diagnosis and therapy of GUTB.
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Duarte RJ, Mitre AI, Chambô JL, Arap MA, Srougi M. Laparoscopic nephrectomy outside gerota fascia for management of inflammatory kidney. J Endourol 2008; 22:681-6. [PMID: 18324896 DOI: 10.1089/end.2007.0291] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE A nonfunctioning inflammatory kidney is a challenging surgical condition for urologists. Some investigators recommend open surgery because of the surgical difficulties caused by the inflammatory process, whereas others try to apply the advantages of a "simple" non-hand-assisted laparoscopic approach. We report our experience with simple laparoscopic nephrectomy for inflammatory kidney management. PATIENTS AND METHODS From July 2002 through December 2006, 50 pure laparoscopic nephrectomies were performed for inflammatory kidney (43 because of pyelonephritis, 5 for xanthogranulomatous pyelonephritis (XGP), and 2 for pyonephrosis). Histopathologic analysis was the criterion used for inflammatory kidney diagnosis. Pain or recurrent urinary tract infection associated with a nonfunctioning excluded kidney was the eligibility criterion for the procedure. Preoperatively, all patients underwent complete image and functional renal assessment. Morcellation was used to remove surgical specimens. Conversion index, surgical difficulties, operative time, and postoperative complications were evaluated. RESULTS Conversion was performed in 14 of 50 (28%) patients, including two with XGP and one with pyonephrosis. Adhesions, vascular (two inferior vena cava) lesions, and intestinal lesions (two colon) were the main causes of conversion. Acute pancreatitis developed in one patient, and one patient had a wound infection. Reoperations were unnecessary, and no deaths occurred. CONCLUSION Pure laparoscopic nephrectomy was successful in 72% of patients with inflammatory kidneys. The laparoscopic dissection was useful even in those cases converted to open surgery. This is a high-risk procedure, however, and both surgeon and patient must be aware of that before the decision is made for this approach.
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Affiliation(s)
- Ricardo J Duarte
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.
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Manohar T, Desai M, Desai M. Laparoscopic nephrectomy for benign and inflammatory conditions. J Endourol 2008; 21:1323-8. [PMID: 18042023 DOI: 10.1089/end.2007.9883] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate the outcomes of laparoscopic nephrectomy for benign renal conditions associated with dense perinephric inflammation, such as xanthogranulomatous pyelonephritis (XGPN), pyonephrosis, tuberculous pyelonephritis, and calculus pyelonephritis, and compare outcomes with a matched group of patients undergoing open nephrectomy for similar indications. An additional objective was to evaluate factors predictive of complications and open conversions. PATIENTS AND METHODS We retrospectively analyzed data from 84 patients with benign inflammatory diseases who underwent laparoscopic nephrectomy and compared the data with data from 94 matched patients undergoing open nephrectomy. Both groups were compared with regard to operative time, blood loss, intraoperative and postoperative complications, analgesia requirement, blood transfusion, and hospital stay. Univariate analysis assessed the predictive value of factors such as kidney size, presence of hilar lymphadenopathy, perinephric and perihilar adhesion, laterality and body mass index on complications and risk of open conversion. RESULTS Mean operative time was 170 +/- 59.8 and 148 +/- 42.5 minutes, blood loss was 156.2 +/- 6.8 and 154.6 +/- 68.8 mL, analgesia requirement was 165 +/- 71.2 and 284 +/- 81 g diclofenac sodium, and average hospital stay was 4.34 +/- 0.8 and 8.07 +/- 1.8 days in the laparoscopic and open groups, respectively. Abnormal renal hilum (71%) and perihilar adhesions (86%) were common findings in patients with XGPN, whereas abnormal hilum and hilar lymphadenopathy (55%) were commonly seen in those with tuberculosis. The renal hilum was relatively unaffected in patients with pyonephrosis and calculus pyelonephritis. Pleural entry was more common (P < 0.0001) in the open group, and visceral injury was more common in the laparoscopic group (P = 0.04). Blood transfusion was necessary in 7% and 11% of patients in the laparoscopic and open groups, respectively. Open conversion was required in 8 cases (autosomal dominant polycystic kidney disease-3, pyonephrosis, 2, XGPN and calculus pyelonephritis, 3). Intestinal obstruction that required laparotomy and adhesinolysis developed in one patient in the laparoscopic group. CONCLUSION Laparoscopic nephrectomy can be performed safely in most patients with benign inflammatory conditions that require surgical extirpation. Proper patient selection and technical modifications may help reduce morbidity. One should keep a low threshold for laparoscopic-assisted open conversion whenever necessary.
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Affiliation(s)
- T Manohar
- Department of Urology, Muljibhai Patel Urological Hospital, Gujarat, India
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Cho HK, Kim DS, Ryu DS, Oh TH, Jeon YS. Retroperitoneal Laparoscopic Nephrectomy for Inflammatory Renal Diseases. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.2.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hyun Kee Cho
- Department of Urology, College of Medicine, Soonchunhyang University, Cheonan, Korea
| | - Doo Sang Kim
- Department of Urology, College of Medicine, Soonchunhyang University, Cheonan, Korea
| | - Dong Soo Ryu
- Department of Urology, College of Medicine, Sungkyunkwan University College of Medicine, Masan, Korea
| | - Tae Hee Oh
- Department of Urology, College of Medicine, Sungkyunkwan University College of Medicine, Masan, Korea
| | - Youn Soo Jeon
- Department of Urology, College of Medicine, Soonchunhyang University, Cheonan, Korea
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Abstract
We evaluated the role of retroperitoneal laparoscopic ureterolithotomy (RPLU) for upper ureter stones. Between February 1998 and July 2004, 12 patients (10 men and 2 women) underwent RPLU for upper ureter stones (mean size 18.1 mm, range 10-25). RPLU was carried out in 5 patients as a salvage treatment after failed shock wave lithotripsy (SWL) (3) and both of failed SWL and ureteroscopy (URS) (2), and in 7 patients as primary treatment for large impacted stones. Total 6 of 12 cases were converted to open surgery. The reason of open conversion was failure of locating ureter due to severe adhesion in 5 cases and vascular injury in 1 case. In 6 successful cases, mean operation time, mean estimated blood loss, and mean postoperative hospital stay were respectively 109 min (90-120 min), 50 mL (10-100 mL), 4.6 days (2-7 days). There was no serious postoperative complication except for one patient who showed delayed urinary leakage but was cured with conservative management. Our experience suggested that RPLU was not easy to perform simply because it was indicated mainly in ureter stones with severe adhesion or after failed SWL and/or URS. Nevertheless, it can be considered as a primary procedure before open ureterolithotomy.
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Affiliation(s)
- Byong Chang Jeong
- Department of Urology, Seoul National University Boramae Hospital, Korea
| | - Hyeung Keun Park
- Department of Urology, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Seok Soo Byeon
- Department of Urology, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
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Ku JH, Byun SS, Choi H, Kim HH. Laparoscopic nephrectomy for congenital benign renal diseases in children: comparison with adults. Acta Paediatr 2005; 94:1752-5. [PMID: 16421035 DOI: 10.1111/j.1651-2227.2005.tb01849.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To compare the results of laparoscopic nephrectomy for congenital benign renal diseases in children and adults. METHODS From August 1996 to February 2003, laparoscopic nephrectomies were performed on 26 children and 60 adults. Of these patients, 33 patients (17 children, 16 adults) with comparable diseases were included in the analysis. RESULTS Disease was on the right side in 16 patients and on the left in 17. Operative and convalescence parameters, including operative time, blood loss, transfusion rate, conversion rate to open surgery, resumption of oral intake, hospital stay, and complication rate, were evaluated in both groups. Median operative time in the paediatric group was 140 min compared to 147.5 in adults (p=0.626). The estimated blood loss was significantly different (median 25 and 75 cm(3) in children and adults, respectively; p<0.001). Other operative and convalescence parameters were not statistically different. However, whereas no child required a blood transfusion, three adults (18.8%) did. No major perioperative complications occurred in the paediatric group, but open surgical exploration was needed due to retroperitoneal bleeding in a single adult. CONCLUSION Our findings indicate that laparoscopic nephrectomy for congenital benign disease in children is achieved safely and that the modality offers additional advantages in children as compared to adults.
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Affiliation(s)
- Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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18
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Abstract
BACKGROUND/PURPOSE We evaluated the impact of a surgeon's experience, divided our first 20 consecutive series that involved a single surgeon at the numerical midpoint of his experience, and compared outcomes regarding this midpoint. METHODS From August 1996 to August 2001, laparoscopic nephrectomy or nephroureterectomy was performed in 20 consecutive children, 12 girls and 8 boys aged between 1 and 15 years (median, 5.9 years). Disease was in the right side in 11 patients and in the left side in 9. The children were divided into 2 groups of 10. We retrospectively obtained data on all patients and compared pertinent perioperative information including operation time, blood loss, length of hospital stay, and postoperative complications. RESULTS The procedure was feasible in all cases and did not require conversion to open surgery or perioperative transfusion in any case. The operation time reduced from a median of 181 minutes over the first 10 patients to 125 minutes over the second 10, and this difference was significant (P = .02). Estimated blood loss and days to the first postoperative oral feeding for the second 10 patients were less than for those of the first 10 but there was no significant difference. The median hospital stay of the first 10 patients was 5.4 days (range, 2-10 days), significantly longer than the 2.5 days of the second 10 (range, 2-7 days) (P = .009). CONCLUSIONS Laparoscopic nephrectomy operation times in children reduced when the surgical experience level exceeded approximately 10 cases.
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Affiliation(s)
- Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul 110-744, Korea
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Chibber PJ, Shah HN, Jain P. Laparoscopic Nephroureterectomy for Tuberculous Nonfunctioning Kidneys Compared with Laparoscopic Nephroureterectomy for Other Diseases. J Laparoendosc Adv Surg Tech A 2005; 15:308-11. [PMID: 15954835 DOI: 10.1089/lap.2005.15.308] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To summarize the results of 8 consecutive laparoscopic nephroureterectomies (LNUs) for tuberculous nonfunctioning kidneys and compare them with 10 LNUs performed for other benign etiologies (control group). MATERIALS AND METHODS From November 1999 to February 2004, 8 patients underwent LNU for tuberculous ureteric stricture with a nonfunctioning kidney at our center. During the same time period, 10 LNUs were performed for other benign conditions. Hospital records were reviewed to obtain demographic data. In addition, operative time, intraoperative and postoperative complications, duration of postoperative ileus, and hospital stay was recorded. The outcomes of surgery for tuberculosis were compared with that for the control group. Patients were followed up for long-term complications of laparoscopic surgery. RESULTS The two groups had a comparable demographic data. Nephroureterectomy was successfully performed laparoscopically in all 8 patients with tuberculosis. One patient in the control group, with a large staghorn renal and ureteral calculus, required conversion to open surgery due to dense perinephric adhesions. The outcome of surgery for tuberculosis was compared with outcomes in the control group using SPSS software. The mean operative time, blood loss, analgesic requirement, duration of postoperative ileus, and hospital stay of both groups was comparable, and the differences between them were statistically insignificant. CONCLUSION The results of this study indicate that LNU for a tuberculous nonfunctioning kidney is a safe, effective, and less invasive treatment modality. Comparing our results with those of nephroureterectomy for other, benign diseases shows that the procedure has similar safety and efficacy even for tuberculous kidneys. Tuberculosis should not be considered a contraindication for a laparoscopic approach. Laparoscopic nephroureterectomy should be offered as the treatment modality of choice to all patients with tuberculous nonfunctioning kidney whose disease involves the kidney and ureters.
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Affiliation(s)
- Percy Jal Chibber
- Department of Urology, Sir J. J. Hospitals and Grant Medical College, Mumbai, India.
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Zhang X, Zheng T, Ma X, Li HZ, Li LC, Wang SG, Wu ZQ, Pan TJ, Ye ZQ. Comparison of retroperitoneoscopic nephrectomy versus open approaches to nonfunctioning tuberculous kidneys: a report of 44 cases. J Urol 2005; 173:1586-9. [PMID: 15821498 DOI: 10.1097/01.ju.0000154624.44403.b9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We retrospectively investigated the advantages of retroperitoneoscopic nephrectomy for nonfunctioning tuberculous kidneys by comparing its clinical results, operative methods and skills with those of open nephrectomy. MATERIALS AND METHODS Clinical data on 22 patients with nonfunctioning tuberculous kidneys who underwent retroperitoneoscopic nephrectomy, including simple and subcapsular nephrectomy, were compared with those on 22 who underwent open nephrectomy for a similar indication during the same period. Results in the 2 groups were analyzed. RESULTS There was no statistical difference between the retroperitoneoscopy and open surgery groups with regard to patient age, sex or mean operative time +/- SD (93.0 +/- 12.6 vs 92.6 +/- 35.5 minutes). Mean blood loss was significantly less in the retroperitoneoscopy group than in the open surgery group (78.3 +/- 60.6 vs 160 +/- 120.0 ml). Mean hospital stay after operation was notably shorter in the retroperitoneoscopy group compared with the open surgery group (3.3 +/- 0.9 vs 9.1 +/- 0.8 days). The mean analgesic requirement for opioids and diclofenac sodium was also lower in the retroperitoneoscopy group than in the open surgery group (0 vs 2.1 +/- 0.9 and 5.2 +/- 1.1 vs 5.8 +/- 1.3 doses, respectively). CONCLUSIONS Retroperitoneoscopic nephrectomy for renal tuberculosis has several advantages over open nephrectomy, namely a smaller wound, less blood loss and more rapid recovery. It may provide a safe and reliable method for treating refractory renal tuberculosis clinically.
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Affiliation(s)
- Xu Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
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Katz R, Pode D, Golijanin D, Gofrit ON, Shenfeld OZ, Shapiro A, Reissman P. Laparoscopic nephrectomy for infected, obstructed and non-functioning kidneys. Surg Laparosc Endosc Percutan Tech 2005; 14:340-3. [PMID: 15599298 DOI: 10.1097/01.sle.0000148466.25814.e1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since laparoscopic nephrectomy was introduced by Clayman et al, it has been doubted whether it should be employed in patients with extensive perirenal fibrosis. In this series, 20 consecutive patients underwent laparoscopic nephrectomy for obstructed, infected, non-functioning kidneys. Preoperative assessment included urine cultures, abdominal sonography, intravenous pyelography, computerized tomography and a renal scan. Laparoscopic nephrectomies were performed using either the transperitoneal or the retroperitoneal approach.Patients' mean age was 52 years (range 20-77, SD = 15.2). Three patients underwent previous open surgery on the same kidney and 15 had percutaneous nephrostomies. The etiology of obstruction was stone disease in 15 cases, uretero-pelvic junction obstruction (3), iatrogenic ureteral injury (1), and infected multicystic kidney (1). Mean operative time was 224 minutes (range 140-325, SD = 57). Conversion to open surgery was necessary in one patient due to splenic injury. Mean hospital stay was 3 days (range 2-6, SD = 1). Laparoscopic nephrectomy was feasible in cases of severe perirenal fibrosis, with an acceptable rate of complications, and may be considered in patients with obstructed, infected, and non-functioning kidneys.
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Affiliation(s)
- Ran Katz
- Departments of Urology and General Surgery, Hadassah and Hebrew University Medical Center, Jerusalem, Israel.
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Baek M, Chun H, Oh SJ, Kim HH. Open Conversion From Laparoscopic Nephrectomy:: Slippage of Surgical Clips Ligating the Renal Artery Affected by Atherosclerosis. J Urol 2004; 171:333-4. [PMID: 14665910 DOI: 10.1097/01.ju.0000102478.32057.13] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Minki Baek
- Department of Urology, Clinical Research Institute, Seoul University Hospital, Seoul National Univerity College of medicine, Korea
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23
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Casaccia M, Torelli P, Fontana I, Panaro F, Valente U. Laparoscopic bilateral hand-assisted nephrectomy: end-stage renal disease from tuberculosis, an unusual indication for nephrectomy before transplantation. Surg Laparosc Endosc Percutan Tech 2003; 13:59-62. [PMID: 12598763 DOI: 10.1097/00129689-200302000-00015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of the study was to sterilize renal tuberculous foci in a pretransplantation patient with a laparoscopic hand-assisted approach and to verify the feasibility of bilateral nephrectomy for this indication. This case report is the first description of hand-assisted laparoscopic bilateral nephrectomy for this pathologic condition. The 33-year-old patient had end-stage renal disease from renal tuberculosis. A commercially available hand-assistance device was used through a midline 8-cm supraumbilical incision and with four ports. The procedure was successfully completed. The total operative time was 3 hours and 40 minutes. Estimated blood loss was 250 mL. The postoperative course was uneventful, and clinical follow-up at 3 weeks revealed a successful outcome. Hand-assisted bilateral laparoscopic nephrectomy in patients with chronic renal failure from tuberculosis represents a viable option because it is feasible and effective. The hand-assisted approach increases the safety of the procedure while retaining all the advantages of minimally invasive surgery.
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Affiliation(s)
- Marco Casaccia
- Advanced Laparoscopic Unit, Department of General Surgery and Transplant, San Martino Hospital, University of Genoa, Monoblocco IVo piano, Largo Rosanna Benzi no 10, 16132 Genoa, Italy.
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Lee KS, Kim HH, Byun SS, Kwak C, Park K, Ahn H. Laparoscopic nephrectomy for tuberculous nonfunctioning kidney: comparison with laparoscopic simple nephrectomy for other diseases. Urology 2002; 60:411-4. [PMID: 12350474 DOI: 10.1016/s0090-4295(02)01759-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To summarize the results of our 31 consecutive laparoscopic nephrectomies for renal tuberculosis and compare them with 45 laparoscopic nephrectomies performed for other benign etiologies. We previously reported our initial successful experiences in expanding the role of laparoscopic surgery with the introduction of laparoscopic nephrectomy for renal tuberculosis. METHODS Thirty-one laparoscopic nephrectomies for renal tuberculosis were performed between June 1996 and December 2001. The patients consisted of 11 men and 20 women with a mean age of 44.2 years (range 29 to 64). The control group consisted of 17 men and 28 women with a mean age of 48.6 years (range 17 to 60). The two groups were comparable with regard to demographic data. Statistical analyses were used to compare the two groups in terms of various parameters, including surgical time, blood loss, analgesic requirements, resumption of oral intake, and hospital stay. RESULTS Laparoscopic nephrectomy was successful in 30 cases of the tuberculosis group and 44 cases of the control group. The two groups showed comparable perioperative and postoperative parameters, except for mean operative time, which, at 244 minutes for the tuberculosis group, was significantly greater than the 216 minutes for the control group (P <0.05). No significant intraoperative or postoperative complications were observed in either group. CONCLUSIONS The results of this study indicate that laparoscopic nephrectomy for renal tuberculosis is a safe, effective, and less invasive treatment modality. Therefore, we suggest that the renal tuberculous nonfunctioning kidney should be approached initially using the laparoscopic approach.
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Affiliation(s)
- Kyu-Seong Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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LAPAROSCOPIC NEPHRECTOMY FOR INFLAMMATORY RENAL CONDITIONS. J Urol 2001. [DOI: 10.1097/00005392-200112000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- P N Schlegel
- Department of Urology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, USA
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28
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Literature Watch. J Laparoendosc Adv Surg Tech A 2000. [DOI: 10.1089/lap.2000.10.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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