Laparoscopic stentless pyeloplasty: An early experience

Introduction : Double J stent has been an important adjunct to laparoscopic pyeloplasty. It is also associated with symptoms and significant morbidity. This study analyses the outcome of transperitoneal laparoscopic pyeloplasty without a double J stent. Materials and Methods : Sixteen patients of ureteropelvic junction obstruction (age range: 1.5-50 yrs) were selected to undergo transperitoneal stentless laparoscopic pyeloplasty after obtaining the informed consent from August 2004 to December 2008. Ten patients were under the age of 14 years (pediatric age group). Some additional steps in the standard technique of laparoscopic pyeloplasty included anatomical spatulation of the ureter to avoid rotation, temporary splinting while suturing ureteropelvic junction and ensuring water tightness of suture line. Preoperative differential renal function, operative time, post operative complications (pain, drain output, fever), hospital stay and renal functional outcomes (Tc 99 DTPA) were recorded. Results : The median age of the pediatric age group was eight (1.5-14) years and adult group - 27 (20-50) years. Median operative time was 100 min (72-140) in pediatric and 110 min (90-138) in adult group. The preoperative ipsilateral differential renal function ranged from 16-45% and 16-50% in pediatric and adult groups respectively. Five of the 10 pediatric patients had persistent leak of urine for which stenting was done in four and ureteric re-implantation in one. Only one of the six adult patients (who had secondary UPJO following Endopyelotomy) needed postoperative stenting for persistent urinary leak. Conclusions : Though the need for postoperative stenting is high in smaller children, stentless laparoscopic pyeloplasty can be considered in adult patients with primary ureteropelvic junction obstruction

Examining HIV Stigma, Depression, Stress, and Recent Stimulant Use in a Sample of Sexual Minority Men Living with HIV: An Application of the Stigma and Substance Use Process Model

Sexual minority men (SMM) with HIV are disproportionately impacted by stigma and mental health disorders. Guided by the Stigma and Substance Use Process Model, we evaluated how HIV stigma impacts mental health outcomes among SMM with HIV. Data were drawn from Thrive With Me, an RCT of an mHealth intervention targeting ART adherence among SMM with HIV. Path analyses tested the relationships between HIV stigma, depression, stress, and recent stimulant use. Overall, 49.1% (194/401) had depression symptoms, 68.8% (276/401) had moderate-to-high stress, and 28.1% (111/401) had detectable stimulant use in urine samples at baseline. In path analyses, baseline internalized HIV stigma was associated with depression and stress 5-months post-baseline and enacted stigma was associated with recent stimulant use 11-months post-baseline. We identified internalized and enacted HIV stigma, but not anticipated stigma, as potentially important intervention targets for stimulant use, depression, and stress among SMM with HIV

Survey of neuromuscular injuries to the patient and surgeon during urologic laparoscopic surgery

Objectives. Laparoscopy may be complicated by neuromuscular injuries, both to the patient and to the surgeon. We used a survey to estimate the incidence of these injuries during urologic laparoscopic surgery, to assess risk factors for these injuries, and to determine preventive measures. Methods. A survey of neuromuscular injuries associated with laparoscopy submitted to 18 institutions in the United States was completed by 18 attending urologists from 15 institutions. Results. From among a total of 1651 procedures, there were 46 neuromuscular injuries in 45 patients (2.7%), including abdominal wall neuralgia (14), extremity sensory deficit (12), extremity motor deficit (8), clinical rhabdomyolysis (6), shoulder contusion (4), and back spasm (2). Neuromuscular injuries were twice as common with upper retroperitoneal as with pelvic laparoscopy (3.1% versus 1.5%). Among patients with neuromuscular injuries, those with rhabdomyolysis were heavier (means 91 versus 80 kg) and underwent longer procedures (means 379 versus 300 minutes), and those with motor deficits were older (means 51 versus 42 years of age). Of the surgeons, 28% and 17% reported frequent neck and shoulder pain, respectively. Conclusions. Although not common, neuromuscular injuries during laparoscopy do contribute to morbidity. Abdominal wall neuralgias, injuries to peripheral nerves, and joint or back injuries likely occur no more frequently than during open surgery, but risk of rhabdomyolysis may be increased. Positioning in a partial rather than full flank position may reduce the incidence of some injuries. Measures to reduce neuromuscular strain on the surgeon during laparoscopy should be considered