Spinal versus General Anaesthesia in Postoperative Pain Management during Transurethral Procedures

We compared the analgesic efficacy of spinal and general anaesthesia following transurethral procedures. 97 and 47 patients underwent transurethral bladder tumour resection (TUR-B) and transurethral prostatectomy (TUR-P), respectively. Postoperative pain was recorded using an 11-point visual analogue scale (VAS). VAS score was greatest at discharge from recovery room for general anaesthesia (P = 0.027). The pattern changed significantly at 8 h and 12 h for general anaesthesia's efficacy (P = 0.017 and P = 0.007, resp.). A higher VAS score was observed in pT2 patients. Patients with resected tumour volume >10 cm3 exhibited a VAS score >3 at 8 h and 24 h (P = 0.050, P = 0.036, resp.). Multifocality of bladder tumours induced more pain overall. It seems that spinal anaesthesia is more effective during the first 2 postoperative hours, while general prevails at later stages and at larger traumatic surfaces. Finally, we incidentally found that tumour stage plays a significant role in postoperative pain, a point that requires further verification

Laparoscopic pyeloplasty for ureteropelvic junction obstruction of the lower moiety in a completely duplicated collecting system: a case report

<p>Abstract</p> <p>Introduction</p> <p>There are only a few reports on laparoscopic pyeloplasty in kidney abnormalities and only one case for laparoscopic pyeloplasty in a duplicated system. Increasing experience in laparoscopic techniques allows proper treatment of such anomalies. However, its feasibility in difficult cases with altered kidney anatomy such as that of duplicated renal pelvis still needs to be addressed.</p> <p>Case presentation</p> <p>We present a case of a 22-year-old white Caucasian female patient with ureteropelvic junction obstruction of the lower ureter of a completely duplicated system that was managed with laparoscopic pyeloplasty. Crossing vessels were identified and transposed. The procedure was carried out successfully and the patient's symptoms subsided. Follow-up studies demonstrated complete resolution of the obstruction.</p> <p>Conclusion</p> <p>Since laparoscopic pyeloplasty is still an evolving procedure, its feasibility in complex cases of kidney anatomic abnormalities is herein further justified.</p

Hydronephrosis Promotes Expression of Hypoxia-Inducible Factor 1 alpha

Background: Obstructive uropathy is argued to involve an ischemia-type tissue injury. Further, hypoxia-inducible factor 1 alpha (HIF-1 alpha) constitutes a nuclear transcription factor normally upregulated under hypoxic conditions. We hypothesized that HIF-1 alpha is expressed in the hydronephrotic renal pelvis, as a result of tissue hypoxia. Patients and Methods: Renal pelvis tissue specimens were obtained from 2 patient groups. Group 1 (controls, n = 10) consisted of patients who underwent nephrectomy due to nonobstructive renal malignancy. Group 2 (n = 18) consisted of patients who underwent open procedures due to intractable hydronephrosis, not amenable to conservative measures. HIF-1 alpha detection was conducted via immunohistochemical techniques, while histological alterations in both groups were also recorded. Results: Smooth muscle hypertrophy and urothelial hyperplasia were major findings in group 2. HIF-1 alpha-positive cells (fibroblasts and occasionally macrophages), mainly localized in the stroma, were also found to a greater extent in group 2 (p = 0.0066). Conclusion: We conclude that HIF-1 alpha is mainly expressed in stroma fibroblasts of the hydronephrotic renal pelvis, implying the presence of significant tissue hypoxia at the dilated upper urinary tract. Copyright (C) 2009 S. Karger AG, Base

Renal Transplant Lithiasis: Analysis of Our Series and Review of the Literature

Background and Purpose: Renal transplant lithiasis represents a rather uncommon complication. Even rare, it can result in significant morbidity and a devastating loss of renal function if obstruction occurs. We present our experience with graft lithiasis in our series of renal transplantations and review the literature regarding the epidemiology, pathophysiology, and current therapeutic strategies in the management of renal transplant lithiasis. Patients and Methods: In a retrospective analysis of a consecutive series of 1525 renal transplantations that were performed between January 1983 and March 2007, 7 patients were found to have allograft lithiasis. In five cases, the calculi were localized in the renal unit, and in two cases, in the ureter. A review in the English language was also performed of the Medline and PubMed databases using the keywords renal transplant lithiasis, donor-gifted lithiasis, and urological complications after kidney transplantation. Several retrospective studies regarding the incidence, etiology, as well as predisposing factors for graft lithiasis were reviewed. Data regarding the current therapeutic strategies for graft lithiasis were also evaluated, and outcomes were compared with the results of our series. Results: Most studies report a renal transplant lithiasis incidence of 0.4% to 1%. In our series, incidence of graft lithiasis was 0.46% (n = 7). Of the seven patients, three were treated via percutaneous nephrolithotripsy (PCNL); in three patients, shockwave lithotripsy (SWL) was performed; and in a single case, spontaneous passage of a urinary calculus was observed. All patients are currently stone free but still remain under close urologic surveillance. Conclusion: Renal transplant lithiasis requires vigilance, a high index of suspicion, prompt recognition, and management. Treatment protocols should mimic those for solitary kidneys. Minimally invasive techniques are available to remove graft calculi. Long-term follow-up is essential to determine the outcome, as well as to prevent recurrence

Ureterointestinal strictures following Bricker ileal conduit: management via a percutaneous approach

Objective Urinary diversion after radical cystectomy is commonly performed via an ileal conduit using the Bricker method. However, 4-8% of these cases are complicated with stricture formation at the ureterointestinal junction. Thus, this could eventually lead to hydronephrosis and kidney loss in neglected patients. Few data exist concerning the outcomes of patients with ureterointestinal junction strictures managed via a percutaneous approach and balloon dilatation of the stricture. The potential of managing these strictures, using a stent replacement strategy, was evaluated. Patients and methods A total of 14 patients (10 male, 4 female; age range 24-72 years) were enrolled in the study. Mean follow-up time was 30.9 months. Invasive bladder cancer was diagnosed in 11, neurogenic bladder in 2 and shrunk bladder after external beam radiation for prostate cancer in 1 patient. They were all managed by radical cystectomy followed by Bricker ileal conduit. In 6 cases, ureterointestinal strictures bilaterally were discovered, whereas unilateral (left-sided) strictures were noted to the remaining 8 patients. All strictures were managed via a percutaneous approach and balloon dilatation. A double J stent was placed at the end of the procedure and was regularly replaced after an interval of 3-6 months. Results A percutaneous nephrostomy was successfully placed in all patients. Double J stent insertion was possible in 18 of a total of 20 (90%) obstructed ureters. No major complications were observed in any of the cases while adequate renal function was preserved in all patients. Quality of life is not reported to be significantly compromised in any patient. Double J ureteral stent replacement is performed every 3-6 months in a retrograde fashion. One patient died in the follow-up period due to disease progression. Conclusion Placement of a double J stent via a percutaneous approach seems to have offered a viable option in the management of ureterointestinal strictures in this patient population. In addition, periodical retrograde replacement of the stent probably does not constitute a factor compromising quality of life. However, further studies are required to justify these primary clinical data

tRNA-Derived Fragments (tRFs) in Bladder Cancer: Increased 5′-tRF-LysCTT Results in Disease Early Progression and Patients’ Poor Treatment Outcome

The heterogeneity of bladder cancer (BlCa) prognosis and treatment outcome requires the elucidation of tumors&rsquo; molecular background towards personalized patients&rsquo; management. tRNA-derived fragments (tRFs), although originally considered as degradation debris, represent a novel class of powerful regulatory non-coding RNAs. In silico analysis of the TCGA-BLCA project highlighted 5&prime;-tRF-LysCTT to be significantly deregulated in bladder tumors, and 5&prime;-tRF-LysCTT levels were further quantified in our screening cohort of 230 BlCa patients. Recurrence and progression for non-muscle invasive (NMIBC) patients, as well as progression and patient&rsquo;s death for muscle-invasive (MIBC) patients, were used as clinical endpoint events. TCGA-BLCA were used as validation cohort. Bootstrap analysis was performed for internal validation and the clinical net benefit of 5&prime;-tRF-LysCTT on disease prognosis was assessed by decision curve analysis. Elevated 5&prime;-tRF-LysCTT was associated with unfavorable disease features, and significant higher risk for early progression (multivariate Cox: HR = 2.368; p = 0.033) and poor survival (multivariate Cox: HR = 2.151; p = 0.032) of NMIBC and MIBC patients, respectively. Multivariate models integrating 5&prime;-tRF-LysCTT with disease established markers resulted in superior risk-stratification specificity and positive prediction of patients&rsquo; progression. In conclusion, increased 5&prime;-tRF-LysCTT levels were strongly associated with adverse disease outcome and improved BlCa patients&rsquo; prognostication