7 research outputs found
Novel Management of Anastomotic Disruption and Persistent Hematuria Following Robotic Prostatectomy: Case Report and Review of the Literature
Vesicourethral anastomosis leaks are not uncommon following radical prostatectomy. We present a case of a 59-year-old male who presented to our ED with hematuria, abdominal pain, and clot retention 17 days after a robotic-assisted laparoscopic prostatectomy. A 50% vesicourethral disruption was ultimately managed endoscopically and with hemostatic agents. At 9-month follow-up he is fully continent with normal erectile function. Vesicourethral leaks can typically be managed conservatively with gentle traction and prolonged catheterization. Persistent hematuria can complicate management, and hemostatic agents may allow for completely endoscopic management with minimal morbidity as seen in this case
Treatment of renal angiomyolipoma. Pooled analysis of individual patient data endourology and technology
Background: This study was performed to evaluate the impact of baseline characteristics and treatment methods
on the outcome of sporadic renal angiomyolipoma (AML).
Methods: This was a pooled analysis of individual data of 441 patients with AML retrieved from 58 studies and 3
institutional series.
Results: Ninety-three patients underwent nephrectomy, 163 partial nephrectomy/enucleation, 128 embolisation,
19 cryoablation, 6 radiofrequency ablation, and 32 conservative treatment. Their mean follow-up period was
44.5 months. Patients who experienced major bleeding at presentation had significantly larger tumours than
did those without bleeding (mean diameter, 10.1 vs. 5.9 cm, respectively; p < 0.0001). A total of 9.4 % and
26.4 % of bleeding tumours had a diameter of <4 and <6 cm, respectively. A tumour diameter of ≥8.0 cm
(hazard ratio, 2.07; 95 % confidence interval, 1.20–4.77) and the treatment method (p = 0.001) were independent
predictors of re-intervention. The risk of re-intervention was significantly higher after embolisation, particularly
for large tumours (5-year rate of freedom from re-intervention: diameter of ≥8.0 cm, 49.2 %; diameter of <8.0 cm,
74.8 %; p = 0.018). Conservatively treated AMLs had a mean baseline diameter of 3.2 ± 2.7 cm; after 41 months, their
mean diameter was 3.7 ± 3.1 cm (p = 0.109).
Conclusions: The prevalence of major bleeding is high in sporadic AMLs with a diameter of >6 cm. These
results suggest that conservative treatment can be considered in AMLs of <6 cm in diameter. Among current
treatment methods, embolisation was associated with a significantly higher risk of re-intervention. Further studies
are needed to define risk factors for bleeding and assess the relative benefits of different treatment modalities.
Keywords: Angiomyolipoma, Bleeding, Radiofrequency ablation, Surgery, Embolisation, Re-interventio