Laparoscopic nephrectomy for ex-vivo correction of renal artery aneurism and auto transplant

INTRODUCTION AND OBJECTIVES: Renal artery aneurism are a rare condition, with a prevalence of 0.09% of the population. The outcomes and clinical management of this patients depend on the presence of symptoms and subsequent risk of rupture. Most patients are managed by endovascular techniques, but difficult cases may present a challenge to urologists. METHODS: We present a case of a 35 year old female, history of high blood pressure with the diagnosis of a left renal artery aneurism with a diameter of 27 mm. The patient was evaluated by vascular surgery, was unsuitable for endovascular treatment and was submitted to a laparoscopic left nephrectomy with correction of the aneurism ex-vivo and the kidney was transplanted to the left iliac region. RESULTS: Operative time was 150 minutes and the warm ischemia time was 160 seconds. Blood loss was estimated in 80 mL with a hematocrit drop of 2% post operative. Drainage and vesical catheter were removed at day 2 and 6 post-operative, respectively. Post operative creatinine clearance was comparable to the pre operative (Post - 95 vs. Pre - 98 mL/min/1.73m2) The follow up is 15 months and the patients has a functioning kidney and had a normalization of the blood pressure. CONCLUSIONS: In experienced centers, laparoscopic nephrectomy with subsequent autotransplantion can be a safe and effective option in the management of specific conditions. This case presents a possible way to treat renal artery aneurisms that can’t be managed by endovascular procedures

Short report. The AIDIT and IMPACT conference 2006: Outcomes and future directions

IMPACT (Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted screening in BRCA1/2 mutation carriers and controls) is an international collaboration investigating the utility of targeted prostate-specific antigen (PSA) screening for men at increased risk of prostate cancer due to inherited predisposition. Although the majority of prostate cancer occurs sporadically, it is recognized that family history plays a role in a significant number of cases: a family history either of prostate cancer alone, or of other cancers including breast and ovarian cancer. Evidence of the link between single genes and prostate cancer risk is strongest for the BRCA1 and BRCA2 genes, with BRCA2 in particular thought to lead to a relative risk of 4.65 (95%CI 3.48-6.22). This relative risk may be as high as 7.33 in men under the age of 65 years

Does Imaging Modality Used for Percutaneous Renal Access Make a Difference? A Matched Case Analysis

Objective: To assess perioperative outcomes of percutaneous nephrolithotomy (PCNL) using ultrasound or fluoroscopic guidance for percutaneous access. Methods: A prospectively collected international Clinical Research Office of the Endourological Society (CROES) database containing 5806 patients treated with PCNL was used for the study. Patients were divided into two groups based on the methods of percutaneous access: ultrasound versus fluoroscopy. Patient characteristics, operative data, and postoperative outcomes were compared. Results: Percutaneous access was obtained using ultrasound guidance only in 453 patients (13.7%) and fluoroscopic guidance only in 2853 patients (86.3%). Comparisons were performed on a matched sample with 453 patients in each group. Frequency and pattern of Clavien complications did not differ between groups (p = 0.333). However, postoperative hemorrhage and transfusions were significantly higher in the fluoroscopy group: 6.0 v 13.1% (p = 0.001) and 3.8 v 11.1% (p = 0.001), respectively. The mean access sheath size was significantly greater in the fluoroscopy group (22.6 v 29.5F; p = 27F) and multiple punctures. Prospective randomized trials are needed to clarify this issue

Urinary tract infections and post-operative fever in percutaneous nephrolithotomy

To review the incidence of UTIs, post-operative fever, and risk factors for post-operative fever in PCNL patients. Between 2007 and 2009, consecutive PCNL patients were enrolled from 96 centers participating in the PCNL Global Study. Only data from patients with pre-operative urine samples and who received antibiotic prophylaxis were included. Pre-operative bladder urine culture and post-operative fever (>38.5°C) were assessed. Relationship between various patient and operative factors and occurrence of post-operative fever was assessed using logistic regression analyses. Eight hundred and sixty-five (16.2%) patients had a positive urine culture; Escherichia coli was the most common micro-organism found in urine of the 350 patients (6.5%). Of the patients with negative pre-operative urine cultures, 8.8% developed a fever post-PCNL, in contrast to 18.2% of patients with positive urine cultures. Fever developed more often among the patients whose urine cultures consisted of Gram-negative micro-organisms (19.4-23.8%) versus those with Gram-positive micro-organisms (9.7-14.5%). Multivariate analysis indicated that a positive urine culture (odds ratio [OR] = 2.12, CI [1.69-2.65]), staghorn calculus (OR = 1.59, CI [1.28-1.96]), pre-operative nephrostomy (OR = 1.61, CI [1.19-2.17]), lower patient age (OR for each year of 0.99, CI [0.99-1.00]), and diabetes (OR = 1.38, CI [1.05-1.81]) all increased the risk of post-operative fever. Limitations include the use of fever as a predictor of systemic infection. Approximately 10% of PCNL-treated patients developed fever in the post-operative period despite receiving antibiotic prophylaxis. Risk of post-operative fever increased in the presence of a positive urine bacterial culture, diabetes, staghorn calculi, and a pre-operative nephrostom