Comparative study of morbidity and mortality pre- and postoperative of laparoscopic nephrectomy for inflammatory versus tumoral cause according to the Clavien–Dindo classification: prospective study over 2 years

Background

For 29 years, Laparoscopic Nephrectomy has steadily established itself as a technique for kidney excision. Patients as well as surgeons appreciate the benefits of this less invasive technique. Although the morbidity and mortality of this minimally invasive technique are relatively low, the risks it entails must be taken into account seriously. The purpose of this study is to evaluate and compare the intra- and postoperative morbidity and mortality factors connected to Laparoscopic Transperitoneal Nephrectomy for inflammatory kidney versus tumoral kidney according to the Clavien–Dindo classification.

Methods

A prospective comparative mono-centric study was carried out over a period of 24 months (January 2018–January 2020) on patients having benefited from a Laparoscopic Transperitoneal Nephrectomy for Inflammatory (Group 1) or Tumoral (Group 2) causes. Postoperative morbidity and mortality were assessed according to the Dindo–Clavien classification.

Results

This study included 60 patients. Group 1 consisted of 32 patients (median age: 50.4 years) and Group 2 of 28 patients (median age: 61 years). Drainage of inflammatory kidneys was done preoperatively by nephrostomy drain (11 cases) and double J probe (3 cases). The mean operating time was longer in Group 1 (234 vs 186.8 min, p = 0.1). The conversion rate was statistically significant in Group 1 (6 vs 1, p < 0.05). The rate of Grade 1 complications is very significant in Group 1: ileus (6 vs 2, p = 0.02), postoperative antibiotic therapy (26 vs 3, p = 0.001) and infection of the wall (4 vs 0, p < 0.001). The rate of severe complications (Clavien ≥ 3) was the same in the two groups. The average length of hospital stay was higher in Group1.

Conclusion

Our work (study) showed a higher rate of severe complications in Laparoscopic nephrectomies for inflammatory causes.

Giant abdomino scrotal hydrocele: a case report with literature review

Abdomino scrotal hydrocele (ASH) is a condition in which the hydrocele sac is extended beyond the scrotum to the abdomen via the inguinal canal. The treatment is ordinarily surgical. Different approaches have been described like paramedian laparotomy, an inguinal or inguino scrotal approach. We report a case of giant unilateral hydrocele in an 18 year old male, occupying a large part of the abdomen with urinary symptoms. Ultrasonography and CT showed typical cystic mass in hourglass shape that we have approached surgically by scrotal incision and we removed all the cyst. Pathological examination found a hydrocele with no signs of malignancy. Urinary symptoms disappeared postoperatively. This is a rare entity that evolves often painless and little reported in the literature. The etiology and pathogenesis of this disease is discussed.

[Factors predicting of failure after conservative treatment in III-V grade renal trauma]

INTRODUCTION AND OBJECTIVES

Surgical exploration of renal injury secondary to major trauma often leads to nephrectomy. The aim of this work was to identify the factors associated with the need for surgery in patients with III-V grade renal trauma who were initially managed conservatively.

MATERIALS AND METHODS

We retrospectively reviewed data from patients with Grade III-V kidney injury between June 2005 and June 2015. Demographic, clinical and bio-radiological characteristics at admission and follow-up, as well as management and complications, were recorded. Patient data, including conservative treatment, was a success without recourse to nephrectomy, and those patients who needed surgery were analyzed.

RESULTS

Seventy three patients were included in this study. Grade III accounted for 45%, Grade IV: 49% and Grade V: 5%. The success rate for conservative treatment was 79%: 31 patients grade III (94%), 26 grade IV (72%) and no grade V patients. hypotension at admission (P=0.04), hematoma size greater than 3.5 centimeters (P=0.002), grade V (P=0.003), anemia (P=0.04), blood transfusion (P=0.01) and worsening of lesions of the control CT lesions (P=0.001), are the factors considered as predictive of failure of conservative treatment.

CONCLUSION

Conservative management is the treatment of choice in III-V grade renal trauma, and the prognostic factors found in this study make it possible to better select patients.

LEVEL OF EVIDENCE

4.

[Oncological results of a series of 93 laparoscopic radical cystectomies: 5 years of follow-up]

OBJECTIVE

To report oncological results at 5 years after laparoscopic radical cystectomy (LRC) with lymph node dissection for bladder cancer (BC).

PATIENTS AND METHODS

This is a retrospective single-center study of all patients who underwent LRC for BC by the same surgeon from February 2007 to March 2016. Demographic, perioperative and oncologic data were collected. We reported overall survival rate (OS), cancer specific (CSS) and recurrence-free survival (SSR), as primary indicators of oncologycal outcomes. These survival rates were estimated according to the Kaplan-Meier method. Log-rank tests were used to explore overall survival according tumor stage, lymph node involvement and surgical margins status.

RESULTS

In all, 93 patients (82 men and 11 women) underwent LRC. Mean age was 59 years. Minor complications (Clavien I-II) occurred in 24.7%. Major complications (Clavien IIIa-V) were observed in 8.6%. No patients received neoadjuvant chemotherapy. Median lymph node (LN) yield was 15 and 26.5% patients had positive LN. The positive surgical margins (SMs) rate was 5.3%. Median follow-up for the entire patients was 50 months (19-84 months). Forty-three patients (46.2%) were followed for at least 71 months. Five year RFS, CSS and OS were 67%, 85% and 79%, respectively. Non organ confined desease, positive LN and positive SMs were associated with poorer OS (P<0.039, P<0.016 and P<0.001).

CONCLUSION

LRC was associated with acceptable long-term oncologic outcomes, similar to those currently reported after open cystectomy for BC.

LEVEL OF EVIDENCE

3.

[Evaluation of the learning curve of laparoscopic radical cystectomy for cancer: Morbidity and oncological results]

INTRODUCTION

The objective of this work was to evaluate the impact of the laparoscopic radical cystectomy learning curve on perioperative and oncological outcomes.

PATIENT AND METHODS

This is a retrospective and single-center study of all patients who underwent laparoscopic radical cystectomy for bladder cancer from February 2007 to March 2016, (93 patients) Perioperative and oncological data were collected. We used mixed statistical models to predict the number of patients needed in the learning phase. We compared the perioperative parameters of the patients in the learning phase with those of the rest of the patients. Overall survival was estimated using the Kaplan-Meier method.

RESULTS

Thirty-six patients are required for the learning phase (P1). The expertise phase begins after the 36th LRC (P2). In both phases, there was no significant difference in age, ASA score, and tumor stage (P=0.237, P=0.577, P=0.998). Mean operative time was 328.3min and 262.4min in P1 and P2 (P=0.0001), mean blood loss was 333.7mL and 194.3mL in P1 and P2 respectively (P=0.0003). The rate of major complications was high in the learning phase (P=0.042). There was no significant difference in lymph node yield, positive surgical margins and overall survival (P=0.068, P=0.194, P=0.703).

CONCLUSION

This learning experience was evaluated without compromising oncological results, but with a significantly higher rate of major complications.

LEVEL OF EVIDENCE

3.

[The local anesthesia for the prostatic biopsies echo-guided: forward-looking randomized study comparing two methods]

INTRODUCTION

The realization of the prostatic biopsies is a painful act. The objective of our work was to compare the analgesic efficiency of the injection of the lidocaine at the level of periprostatics laterals and apical areas compared with the use of gel of lidocaine intrarectal associated with the taking of oral tramadol.

PATIENTS AND METHODS

Between November 2007 and December 2009, 60 patients admitted in the service of urology of the university hospital Mohammed VI of Marrakesh for prostatic biopsies were randomized in two groups. The group 1 (30 patients) received two tablets from tramadol 50mg with 10 mL of gel of lidocaine 2% intrarectal while 30 patients of the group 2 received 10 mL from lidocaine 2% injected at the level of periprostatics laterals and apicales. The pain was estimated by a visual analog scale (AVS) at the introduction of the probe of echography (AVS 1), at the time of the biopsy (AVS 2) and 20 minutes later (AVS 3).

RESULTS

There was no significant difference between both groups concerning AVS 1 means. The average score of the pain was significantly lower in the group 2 for the AVS 2 and AVS 3.

CONCLUSION

The periprostatics anesthesia assured a better control of the pain at the time of the prostatic biopsy and 20 minutes later, without increase of the complications. We recommend it to decrease the pain and the discomfort related to this technique.

[Renal hydatid cyst: radiologic features and therapy]

Hydatid disease is endemic in some Mediterranean countries. Kidney is a relatively rare site, representing 2 to 3 % of all visceral sites. The diagnosis of hydatid cyst of the kidney is suspected in epidemiological, clinical, radiological and biological arguments. It remains clinically silent for a long time and only presents at the stage of complications. Ultrasound can suspect the hydatid nature of the lesion in 50 % of cases. Computed tomography and magnetic resonance imaging are helpful in the event of problem of differential diagnosis. The standard treatment for renal hydatid cyst is resection of the prominent dome and nephrectomy is indicated in cases of destroyed kidney.

Bladder cancer in the second trimester of pregnancy: tough decisions. A case report with review of the literature

We report a rare case of a patient presenting with a nonmuscle invasive papillomatosis transitional cell carcinoma of the bladder in the second trimester of pregnancy. We describe the management dilemmas encountered and the challenging treatment option selected to optimize outcome for the patient and infant. Close collaboration between urologists, obstetricians and medical colleagues is needed for optimal, safe and effective management of bladder tumours during pregnancy.

Sciatica leading to the discovery of a renal cell carcinoma

Metastatic renal cell cancer is not exceptional in kidney cancer (30% of patients with kidneyl cancer). Its prognosis is particularly severe. However, sciatic neuralgia (sciatica) remains an exceptional revealing clinical sign of this disease. The authors report the case of a patient admitted with right sciatica as chief complain, leading to the discovery of a renal cell carcinoma. Although uncommon, renal cell carcinoma spine metastasis should be included in the differential diagnosis of back pain and sciatica.

Mule Bite to the Male Genitalia with Complete Penile and Anterior Urethra Amputation: Unusual Case and Review of the Literature

Animal bite is rare with few cases reported in the literature. The morbidity of animal bites is directly related to the severity of the initial wound. Most victims are boys, and dog bites are the most common injury. Infectious complications are unusual, since treatment is sought early (Wein 2007). Thus, urologists are not usually familiar with management and principles for treating this condition. The authors report the case of a 38-year-old male with a severe mule bite injury to the genitalia causing complete penile and anterior urethra amputation and scrotal wound with no involvement of its contents. To our knowledge, no such case had ever been reported in the medical literature. This kind of emergencies is challenging for urologists.

[Perineal-scrotal gangrene: epidemiological and therapeutic aspects. About 45 cases]

Perineoscrotal gangrene is an acute disease, a rare and severe affection of the perineum, whose evolution is unpredictable and rapidly extensive. The diagnosis is clinical. The paraclinical examinations allow early diagnosis and assessment of anatomical and biological repercussions. We conducted a retrospective study of 45 patients spread over six years, involving a multidisciplinary team consisting of three specialists (urologists, visceral, plastic surgeons). The average age was 52 years. The largely male dominated our series. Fournier gangrene was the most common etiology. We noted five cases of death (11%) in the acute phase, secondary to septic shock (four patients) or multiple organ failure (one patient). The evolution was favorable in 40 other patients in the series, requiring an initial management in intensive care unit, and surgical treatment. The average hospital stay was 17 days. After the acute phase, all patients underwent a surgery for skin coverage, ranging from guided healing (two patients) to musculocutaneous flap of the gracilis (six patients) via the secondary suture (four patients), the burying the testes (18 patients) and half thick skin graft, with a functional and aesthetic result was acceptable, and minimal sequelae. In our series, the most predictive prognostic factors would be the delay of care, sepsis on admission and associated diseases.

An unusual presentation of primary male genital tuberculosis

Urogenital tuberculosis is a rare disease; however, it is the second most common location for tuberculosis after the lung. Currently, incidence of urogenital tuberculosis is increasing due to factors such as a higher prevalence of immunosuppression (especially that caused by human immunodeficiency virus infection) and drug abuse. Herein a new case of male genital primary tuberculosis is reported presenting as a scrotal tumor; the originality of this observation lies in its unusual pseudotumor form.

[Paratesticular desmoplastic small round cell tumour: case report with literature review]

Desmoplastic small round cell tumors are rare aggressive cancers of adolescence and early adulthood. It has recently been separated from other small round cell tumors because of its pathological characteristics and clinical features. They are usually intra-abdominal tumors affecting young people and have classically been associated with a bad prognosis. However, in recent years there have been reports on desmoplastic small round cell tumors affecting other body regions, including the paratesticular area. We report the case of a 27-year-old male who consulted on a progressive enlargement of the right hemiscrotum. He referred no previous urological symptoms and had no systemic symptomatology. Physical examination revealed a round elastic firm 1-cm mass of the epididymis, which was excised. A computed tomography scan showed a para-aortic mass of 1cm. Histological and immunohistochemical diagnosis confirmed a desmoplastic small round cell tumor. The patient received chemotherapy. Today, 6 months after diagnosis the patient remains well and free of disease. Recent reviews on desmoplastic small round cell tumors affecting the paratesticular area have shown a better prognosis for tumors of this origin compared to abdominal ones. We should include this lesion among the differential diagnosis of paratesticular tumors, mainly in children and adolescents.

[Combined inguinal hernia repair and transurethral resection of the prostate (TURP) for benign prostatic hypertrophy]

OBJECTIVE

Our aim was to evaluate the outcome of transurethral resection of prostate (TURP) and inguinal hernia repair performed in a single session.

METHODS

Data was obtained retrospectively for 31 patients (mean age 65 years) who underwent simultaneous TURP and inguinal hernia repair. Most patients had lower urinary tract symptoms related to BPH such as acute urinary retention, recurrent bladder retention, or severe dysuria. Twenty-one patients had simple inguinal hernia and ten had large inguinoscrotal hernia. Operations were performed in 23 patients under spinal anesthesia. Bassini's operation was the most common herniorrhaphy technique (23 patients).

RESULTS

We observed good outcomes in 86% of the patients. The morbidity rate was 10.7%, the mean postoperative stay was 3.6 days (2-6 days). There was no recurrence of inguinal hernia.

CONCLUSION

Combining TURP and inguinal hernia repair in one session decreases the number of procedures and anesthesias, hospital stay, and thus direct health costs and does not result in an increase in operative or postoperative morbidity.

[Inflammatory myofibroblastic tumours of the bladder]

The inflammatory myofibroblastic tumour of the bladder is a rare benign affection that interests mainly young adults. Its etiopathogeny remains unknown, but its tumoral origin was evocated recently by Griffin (1999), incriminating a chromosomic abnormality involving the ALK gene. We will discuss the etiopathogenic, anatopathological and therapeutical aspects of this lesion for which the diagnosis is histological and the treatment remains conservative with a good prognosis.