Massive hemorrhage after percutaneous nephrolithotomy: Saving the kidney when angioembolization has failed or is unavailable

AbstractObjectivesTo describe the management protocol in cases with massive hemorrhage after percutaneous nephrolithotomy (PCNL) with a failed angioembolization or when angioembolization is not available.Patients and methodsBetween October 2006 and December 2012, the charts of patients who had undergone PCNL and were complicated with massive post procedural bleeding unresponsive to conservative management were reviewed. Those cases in whom angioembolization had failed, or was unavailable, or could not be afforded by the patient were selected and studied. These patients underwent open surgical exploration through a midline transperitoneal or a flank retroperitoneal approach. In both approaches, kidney mobilization outside the Gerota's fascia, temporal renal pedicle clamping and partial nephrectomy or renorrhaphy were done in a stepwise manner.ResultsDuring the study period, we had 8 patients for whom angioembolization had failed (n = 4), was not available (n = 2) or the patient could not afford it (n = 2). Median patients' age was 31 years (range 16–59 years). We did a partial nephrectomy in 2 and renorrhaphy in 6 of patients with a successful outcome. Median operative time was 2.25 h and median warm ischemia time was 26 min (range 24–42 min). After a median follow up period of 21 months, the involved renal unit, in all cases, remained functional in the postoperative intravenous urography.ConclusionMassive hemorrhage after PCNL when angioembolization failed or was not feasible due to any reason could be controlled by partial nephrectomy or renorrhaphy with the same principles as that used for surgical exploration in patients with high grade renal trauma

Massive hemorrhage after percutaneous nephrolithotomy: Saving the kidney when angioembolization has failed or is unavailable

AbstractObjectivesTo describe the management protocol in cases with massive hemorrhage after percutaneous nephrolithotomy (PCNL) with a failed angioembolization or when angioembolization is not available.Patients and methodsBetween October 2006 and December 2012, the charts of patients who had undergone PCNL and were complicated with massive post procedural bleeding unresponsive to conservative management were reviewed. Those cases in whom angioembolization had failed, or was unavailable, or could not be afforded by the patient were selected and studied. These patients underwent open surgical exploration through a midline transperitoneal or a flank retroperitoneal approach. In both approaches, kidney mobilization outside the Gerota's fascia, temporal renal pedicle clamping and partial nephrectomy or renorrhaphy were done in a stepwise manner.ResultsDuring the study period, we had 8 patients for whom angioembolization had failed (n = 4), was not available (n = 2) or the patient could not afford it (n = 2). Median patients' age was 31 years (range 16–59 years). We did a partial nephrectomy in 2 and renorrhaphy in 6 of patients with a successful outcome. Median operative time was 2.25 h and median warm ischemia time was 26 min (range 24–42 min). After a median follow up period of 21 months, the involved renal unit, in all cases, remained functional in the postoperative intravenous urography.ConclusionMassive hemorrhage after PCNL when angioembolization failed or was not feasible due to any reason could be controlled by partial nephrectomy or renorrhaphy with the same principles as that used for surgical exploration in patients with high grade renal trauma

Laparoscopic adrenalectomy: 10-year experience, 67 procedures

Introduction: The purpose of this study was to evaluate the short-term and long-term results of laparoscopic adrenalectomies carried out in our center. Materials and Methods: A total of 67 laparoscopic adrenalectomies were performed during the 10 years between 1995 and 2005 at Shahid Labbafinejad Medical Center. A transperitoneal lateral approach was used in 65 (97.0%) of the patients, and retroperitoneal approach was used in 2 (3.0%). The clinical characteristics and the outcomes were reviewed in a retrospective study. Results: Indications for laparoscopic adrenalectomy in our patients were as follows: pheochromocytoma in 28 patients (41.8%), aldosteroneproducing adenoma in 15 (22.4%), pseudocyst in 6 (9.0%), Cushing syndrome (macronodular adrenocortical hyperplasia) in 5 (7.5%), nonfunctioning adenoma (incidentaloma) in 5 (7.5%), myelolipoma in 2 (3.0%), almost normal adrenal tissue in 2 (3.0%), adrenal cyst in 2 (3.0%), adenocarcinoma in 1 (1.4%), and schwannoma in 1 (1.4%). The mean operative time for unilateral cases was 149.0 ± 36.1 minutes. The mean intraoperative blood loss was 126 ± 36 mL. Conversion rate to open surgery was 7.5%. Reoperation due to hemorrhage was performed in 1 patient. Conclusion: Laparoscopic adrenalectomy is a safe procedure in some adrenal tumors and a reasonable option for selected large adrenal tumors when complete resection is technically feasible and there is no evidence of local invasion

A Novel Irrigation System in Percutaneous Renal Surgery

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Neurologic complications in percutaneous nephrolithotomy

Percutaneous nephrolithotomy (PCNL) has been the preferred procedure for the removal of large renal stones in Iran since 1990. Recently, we encountered a series of devastating neurologic complications during PCNL, including paraplegia and hemiplegia. There are several reports of neurologic complications following PCNL owing to paradoxical air emboli, but there are no reports of paraplegia following PCNL. Materials and Methods: We retrospectively reviewed the medical records of patients who had undergone PCNL in 13 different endourologic centers and retrieved data related to neurologic complications after PCNL, including coma, paraplegia, hemiplegia, and quadriplegia. Results: The total number of PCNL procedures in these 13 centers was 30,666. Among these procedures, 11 cases were complicated by neurologic events, and four of these cases experienced paraplegia. All events happened with the patient in the prone position with the use of general anesthesia and in the presence of air injection. There were no reports of neurologic complications in PCNL procedures performed with the patient under general anesthesia and in the prone position and with contrast injection. Conclusions: It can be assumed that using room air to opacify the collecting system played a major role in the occurrence of these complications. Likewise, the prone position and general anesthesia may predispose to these events in the presence of air injectio

Early Continence After Open and Laparoscopic Radical Prostatectomy With Sutureless Vesicourethral Alignment: an Alternative Technique, 8 Years' Experience

<p><strong>Introduction: </strong>We reviewed urinary outcomes after sutureless vesicourethral alignment in open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP).</p><p><strong>Materials and Methods:</strong> Charts of 324 patients who underwent sutureless ORP (n = 188) and LRP (n = 136) were reviewed. After prostatectomy, a 22- to 24-F silicon Foley catheter was passed into the bladder via the preserved bladder neck. The Foley balloon was filled, and mild traction was applied to appose the bladder neck to the urethral stump. The Foley catheter was fixed to the patient's leg. No cystostomy was placed.</p><p><strong>Results:</strong> The follow-up period ranged from 12 to 60 months. The mean operative time was 65 minutes in ORP and 260 minutes in LRP. Blood transfusion was significantly less frequent with LRP (9.6% versus 19.7%, P = .02). The mean postoperative catheterization durations were 12 days in ORP and 13 days in LRP. Complete continence was achieve in 293 patients (90.4%) after 3 months of follow-up (88.9% in LRP and 91.5% in ORP, P = .78). The continence rate improved to 96.3% in LRP and 95.2% in ORP at 1 year (P = .52). Bladder neck stricture rate was 13.6% (12.8% in ORP versus 14.7% in LRP, P = .87).</p><p><strong>Conclusion:</strong> Sutureless vesicourethral alignment during ORP and LRP is a promising approach with minimum urinary extravasation, a high rate of continence, and an acceptable rate of stricture. This technique could be considered as an alternative in anatomically demanding situations.</p&gt