Long-term follow-up of childhood duodenal ulcers

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Robot-assisted versus standard laparoscopic partial nephrectomy: comparison of perioperative outcomes from a single institution

OBJECTIVE: To evaluate the perioperative outcomes of robot-assisted laparoscopic partial nephrectomy and standard laparoscopic partial nephrectomy in a teaching hospital. DESIGN: Retrospective study. SETTING: Division of Urology, Department of Surgery, Queen Mary and Tung Wah hospitals, Hong Kong. PATIENTS: The first 10 consecutive patients who had robot-assisted laparoscopic partial nephrectomy for renal tumours between January 2008 and September 2009 with prospective data collection were evaluated. Their outcomes were compared with the last 10 consecutive patients in our database, who had standard laparoscopic partial nephrectomy between November 2004 and October 2007. MAIN OUTCOME MEASURES: Demographics, tumour characteristics, perioperative outcomes, renal function, and pathological outcomes. RESULTS: There were no differences between the groups with regard to age (63 vs 56 years; P=0.313) and tumour size (2.7 vs 2.8 cm; P=0.895). No significant difference was found between the two groups with respect to the operating room time (376 vs 361 min; P=0.722), estimated blood loss (329 vs 328 mL; P=0.994), and length of hospital stay (7 vs 14 days; P=0.213). A statistically significant shorter mean warm ischaemic time for the robot-assisted group was noted (31 vs 40 minutes; P=0.032). Respective renal functional outcomes as shown by the difference between day 0 and day 60 serum creatinine levels were comparable (+10 vs +7 mmol/L; P=0.605). In both groups, there were no intra-operative complications or instances of surgical margin tumour involvement. Three patients endured postoperative complications in the standard laparoscopic group (a perinephric haematoma, urine leakage, and lymph leakage) compared with one in the robot-assisted group (a perinephric haematoma). These complications all resolved with conservative treatment. CONCLUSIONS: Robot-assisted laparoscopic partial nephrectomy is a technically feasible alternative to standard laparoscopic partial nephrectomy, and provides comparable results. Robot-assisted laparoscopic partial nephrectomy appears to offer the advantage of decreased warm ischaemic time. Longer follow-up is required to assess renal function and oncological outcomes. Further experience and randomised trials are necessary to compare robot-assisted with standard laparoscopic partial nephrectomy.published_or_final_versio

Disease spectrum and treatment patterns in a local male infertility clinic

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Subinguinal microsurgical varicocelectomy for male factor subfertility: a ten-year experience

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Disease spectrum and treatment patterns in a local male infertility clinic

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Radical versus partial nephrectomy for T1 renal cancer: equivalent oncological outcome with better renal preservation

OBJECTIVE: To examine and compare the outcome of radical and partial nephrectomy for T1 renal cancer (≤7 cm) in our centre. PATIENTS AND METHOD: Between January 2005 and December 2010, 38 (44.2%) radical nephrectomies (RN) and 48 (55.8%) partial nephrectomies (PN) were performed for solitary, T1 renal cancer in patients with normal contralateral kidney. GFR was estimated with the Modification of Diet in Renal Disease (MDRD) formula. CKD was defined as GFR lower than 60 mL/min per 1.73 m2. Cox regression model was used to compare overall survival and new onset of CKD. RESULTS: At last follow-up 32 RN patients (84.2%) and 43 PN patients (89.6%) were alive. There was no significant difference in overall survival between RN and PN patients (hazard ratio, 0.673; 95% confidence interval [CI], 0.128–3.529; p = 0.64). 1 RN patient (2.6%) developed systemic metastasis. RN patients had significantly higher reduction rate in GFR (35.4% vs 12.6%, p = 0.000), and higher risk in developing CKD (hazard ratio, 6.308; 95% CI, 2.074–19.189, p = 0.001). CONCLUSION: Relative to RN in managing T1 renal cancer, PN has equivalent survival and oncological clearance, with superiority in renal preservation and lower incidence of new CKD onset. PN should be the treatment of choice for T1 renal cancer.postprin

以前瞻性雙盲隨機對照方式, 試驗香港華籍人士在進行經直腸超聲波導引的前列腺活組織切除術時, 使用含利多卡因的凝膠與純粹潤滑劑在止痛效用上的分別

OBJECTIVE. To compare the level of pain experienced by patients during transrectal ultrasound-guided prostatic biopsy using intrarectal 2% lidocaine gel versus plain lubricant gel. DESIGN. Prospective double-blind randomised controlled trial. SETTING. Regional hospital, Hong Kong. PATIENTS. From March 2002 to December 2003, patients who underwent ultrasound-guided prostate biopsy at a Geriatric Urology Centre. MAIN OUTCOME MEASURES. Pain and discomfort scores measured by horizontal visual analogue scales. RESULTS. A total of 338 consecutive patients were randomised to lidocaine gel or plain lubricant gel groups. The two groups were statistically similar in demographic and disease characteristics. There were no significant statistical differences in pain or discomfort score in the lidocaine gel and plain lubricant groups—pain score: 1.75 versus 1.79 (P=0.66) on day 0 and 0.21 versus 0.15 (P=0.97) on day 1; discomfort score: 0.79 versus 0.77 (P=0.86) on day 0 and 0.12 versus 0.12 (P=0.76) on day 1. No major complications were recorded in this cohort. CONCLUSIONS. Transrectal ultrasound-guided trucut biopsy of the prostate can be safely performed with no anaesthesia in Chinese patients. Pain and discomfort are minimal. It was found that 2% lidocaine gel has no statistical therapeutic or analgesic benefit over plain lubricant gel.published_or_final_versio