BACKGROUND Renal duplication is a common deformity of the urinary system,with an incidence of approximately 1/125 in children.Symptomatic patients with hydronephrosis,vesicoureteral reflux,or incontinence may require ...BACKGROUND Renal duplication is a common deformity of the urinary system,with an incidence of approximately 1/125 in children.Symptomatic patients with hydronephrosis,vesicoureteral reflux,or incontinence may require surgical interventions.Laparoscopy and retroperitoneoscopy are the two main accesses for partial nephrectomy.CASE SUMMARY A 9-year-old child was admitted to the hospital for hydronephrosis of the left kidney.Ultrasonography showed that the left kidney was larger,approximately 12.6 cm×6.3 cm×5.5 cm in size,with visible separation of the pelvis and an obviously separated lower portion.The upper segment of the left ureter was dilated(approximately 2.6 cm in width),and no significant dilation was observed in the middle and upper segments.The right kidney and ureter were normal.Primary diagnosis was left renal duplication malformation and hydronephrosis.Retroperitoneal laparoscopic nephrectomy and ureterectomy were performed.Intraoperative exploration revealed a dilated pelvis and thin renal parenchyma at the lower pole of the left kidney.The upper left kidney was smaller than normal,and the pelvis and ureter were larger than normal.The renal artery was blocked for 40 min.A hemolock was used to clamp down the kidney ureter,and a drainage tube was retained in the retroperitoneal cavity.The operation was uneventful,and the estimated amount of blood loss was 100 mL.Total abdominal drainage amount was 116 mL.The drainage tube was removed on postoperative day(POD)3 and the patient was discharged on POD6.The pathological diagnosis confirmed the atrophy of the renal parenchyma,the dilation of the renal pelvis,hydronephrosis,and ureteral cystic dilation.CONCLUSION The retroperitoneoscopic approach for partial nephrectomy is feasible and effective in selective pediatric patients with a duplex kidney.展开更多
BACKGROUND A 66-year-old lady was referred to urology for a suspected urinoma after retroperioneoscopy done for debridement of a retroperitoneal abscess that developed following a duodenal perforation.CASE SUMMARY Ser...BACKGROUND A 66-year-old lady was referred to urology for a suspected urinoma after retroperioneoscopy done for debridement of a retroperitoneal abscess that developed following a duodenal perforation.CASE SUMMARY Serous contents of the drain sent for fluid creatinine were elevated confirming this and computed tomography urography findings suggested an upper tract injury with urinoma around the kidney.However,the antegrade nephrostogram suggested otherwise and on flexible cystoscopy and cystogram,an extraperitoneal bladder perforation was instead identified,with tip of retroperitoneal drain sitting inside the bladder.CONCLUSION This case identifies a limitation in the usual diagnostic approach for such injuries and emphasizes the need to exercise caution when managing them especially when they occur after several surgical procedures and in the presence of multiple surgical drains.展开更多
Background:Laparoscopic transperitoneal donor nephrectomy(LTDN)is currently the standard procedure for renal donation from living donors.Only a handful of clinical studies have compared the outcomes of retroperitoneos...Background:Laparoscopic transperitoneal donor nephrectomy(LTDN)is currently the standard procedure for renal donation from living donors.Only a handful of clinical studies have compared the outcomes of retroperitoneoscopic donor nephrectomy(RDN)and LTDN.More robust data and systematic comparative analyses of the outcomes and complications of these 2 techniques are needed.This study aimed to elucidate the noninferiority of RDN to LTDN.Materials and methods:All live renal donors who underwent either RDN or LTDN at our institution during the period of January 2015 to March 2021 were considered subjects,excluding those who refused to participate in the study.This was a bidirectional cohort study.Demographic and clinical data were collected and analyzed using standard statisticalmethods.Statistical significance was set at p<0.05.Results:Our study included 89 subjects:40 in the LTDN group and 49 in the RDN group.The RDN group had significantly shorter warm ischemia time(2.85 vs.6.04 minutes),a lower fall in hemoglobin on postoperative day(POD)-1(1.73 vs.2.24 g/dL),lower estimated blood loss(601.93 vs.797.27 mL),and lower pain on POD-1(0.78 vs.1.28).The improvement in recipient’s estimated glomerular filtration rate on POD-30 was significantly higher in the RDN group(79.98 vs.63.73 mL/min/1.73 m^(2)).There was a significantly higher fall in estimated glomerular filtration rate of donor after nephrectomy in RDN group on POD-30(35.53 vs.30.60 mL/min/1.73 m^(2)).However,there were no significant differences in other parameters.Conclusions:Our study,conducted in India,showed that themajority of RDN outcomes were better than those of LTDN.Hence,RDN is clearly non-inferior to the gold standard LTDN.A well-designed randomized controlled study is required to elucidate the statistical superiority of one approach over another.展开更多
Chyluria is a disease that may severely debilitate a patient＇s health condition. Some investigations have indicated that in patients with chyluria, part of the uptake fat and protein leaks from the urine.Thus, recurr...Chyluria is a disease that may severely debilitate a patient＇s health condition. Some investigations have indicated that in patients with chyluria, part of the uptake fat and protein leaks from the urine.Thus, recurrent chyluria may result in malnutrition. In addition, with nearly one half of the body＇s the urine, depressed regulatory lymphocytes lost through functions of the lymphatic system may cause illnesses following immune deficiency. Therefore, it is imperative to provide effective and active medical care for chyluria patients. The purpose of surgical treatment is to eliminate lymphatic fistula and decrease intralymphatic pressure. We recently performed retroperitoneoscopic renal pedical lymphatic disconnection for 78 cases of chyluria patients in our hospital between April 2003 and June 2007. We herein summarize our experience as follows.展开更多
In the past, living donor nephrectomy required an open flank incision that results in postoperative morbidity and a prolonged hospital stay. Since its introduction in 1995, laparoscopic living donor nephrectomy has be...In the past, living donor nephrectomy required an open flank incision that results in postoperative morbidity and a prolonged hospital stay. Since its introduction in 1995, laparoscopic living donor nephrectomy has been shown to decrease postoperative pain and hospital stay, reduce blood loss, and improve cosmesis while hastening recovery of normal activities of donors. With decreased morbidity and favorable graft function, this procedure as a novel approach has been used to address the increasing disparity between organ need and availability. Better graft function and survival are noted in living-donor kidney transplantation than in cadavefic kidney transplantation.展开更多
Conventional simultaneous bilateral open nephroureterectomy combined with resection of bladder cuffs seems not optimal for bilateral upper tract urothelial carcinoma （UTUC） in renal transplant and dialysis patients ...Conventional simultaneous bilateral open nephroureterectomy combined with resection of bladder cuffs seems not optimal for bilateral upper tract urothelial carcinoma （UTUC） in renal transplant and dialysis patients with enormous invasion related to large morbidity,delayed gastrointestinal function,and late recovery.1 This study reports the largest series of minimally invasive procedures of simultaneous bilateral retroperitoneoscopic nephroureterectomy （SBRNU） via a midline lower abdominal incision in renal recipients.展开更多
文摘BACKGROUND Renal duplication is a common deformity of the urinary system,with an incidence of approximately 1/125 in children.Symptomatic patients with hydronephrosis,vesicoureteral reflux,or incontinence may require surgical interventions.Laparoscopy and retroperitoneoscopy are the two main accesses for partial nephrectomy.CASE SUMMARY A 9-year-old child was admitted to the hospital for hydronephrosis of the left kidney.Ultrasonography showed that the left kidney was larger,approximately 12.6 cm×6.3 cm×5.5 cm in size,with visible separation of the pelvis and an obviously separated lower portion.The upper segment of the left ureter was dilated(approximately 2.6 cm in width),and no significant dilation was observed in the middle and upper segments.The right kidney and ureter were normal.Primary diagnosis was left renal duplication malformation and hydronephrosis.Retroperitoneal laparoscopic nephrectomy and ureterectomy were performed.Intraoperative exploration revealed a dilated pelvis and thin renal parenchyma at the lower pole of the left kidney.The upper left kidney was smaller than normal,and the pelvis and ureter were larger than normal.The renal artery was blocked for 40 min.A hemolock was used to clamp down the kidney ureter,and a drainage tube was retained in the retroperitoneal cavity.The operation was uneventful,and the estimated amount of blood loss was 100 mL.Total abdominal drainage amount was 116 mL.The drainage tube was removed on postoperative day(POD)3 and the patient was discharged on POD6.The pathological diagnosis confirmed the atrophy of the renal parenchyma,the dilation of the renal pelvis,hydronephrosis,and ureteral cystic dilation.CONCLUSION The retroperitoneoscopic approach for partial nephrectomy is feasible and effective in selective pediatric patients with a duplex kidney.
文摘BACKGROUND A 66-year-old lady was referred to urology for a suspected urinoma after retroperioneoscopy done for debridement of a retroperitoneal abscess that developed following a duodenal perforation.CASE SUMMARY Serous contents of the drain sent for fluid creatinine were elevated confirming this and computed tomography urography findings suggested an upper tract injury with urinoma around the kidney.However,the antegrade nephrostogram suggested otherwise and on flexible cystoscopy and cystogram,an extraperitoneal bladder perforation was instead identified,with tip of retroperitoneal drain sitting inside the bladder.CONCLUSION This case identifies a limitation in the usual diagnostic approach for such injuries and emphasizes the need to exercise caution when managing them especially when they occur after several surgical procedures and in the presence of multiple surgical drains.
文摘Background:Laparoscopic transperitoneal donor nephrectomy(LTDN)is currently the standard procedure for renal donation from living donors.Only a handful of clinical studies have compared the outcomes of retroperitoneoscopic donor nephrectomy(RDN)and LTDN.More robust data and systematic comparative analyses of the outcomes and complications of these 2 techniques are needed.This study aimed to elucidate the noninferiority of RDN to LTDN.Materials and methods:All live renal donors who underwent either RDN or LTDN at our institution during the period of January 2015 to March 2021 were considered subjects,excluding those who refused to participate in the study.This was a bidirectional cohort study.Demographic and clinical data were collected and analyzed using standard statisticalmethods.Statistical significance was set at p<0.05.Results:Our study included 89 subjects:40 in the LTDN group and 49 in the RDN group.The RDN group had significantly shorter warm ischemia time(2.85 vs.6.04 minutes),a lower fall in hemoglobin on postoperative day(POD)-1(1.73 vs.2.24 g/dL),lower estimated blood loss(601.93 vs.797.27 mL),and lower pain on POD-1(0.78 vs.1.28).The improvement in recipient’s estimated glomerular filtration rate on POD-30 was significantly higher in the RDN group(79.98 vs.63.73 mL/min/1.73 m^(2)).There was a significantly higher fall in estimated glomerular filtration rate of donor after nephrectomy in RDN group on POD-30(35.53 vs.30.60 mL/min/1.73 m^(2)).However,there were no significant differences in other parameters.Conclusions:Our study,conducted in India,showed that themajority of RDN outcomes were better than those of LTDN.Hence,RDN is clearly non-inferior to the gold standard LTDN.A well-designed randomized controlled study is required to elucidate the statistical superiority of one approach over another.
文摘Chyluria is a disease that may severely debilitate a patient＇s health condition. Some investigations have indicated that in patients with chyluria, part of the uptake fat and protein leaks from the urine.Thus, recurrent chyluria may result in malnutrition. In addition, with nearly one half of the body＇s the urine, depressed regulatory lymphocytes lost through functions of the lymphatic system may cause illnesses following immune deficiency. Therefore, it is imperative to provide effective and active medical care for chyluria patients. The purpose of surgical treatment is to eliminate lymphatic fistula and decrease intralymphatic pressure. We recently performed retroperitoneoscopic renal pedical lymphatic disconnection for 78 cases of chyluria patients in our hospital between April 2003 and June 2007. We herein summarize our experience as follows.
文摘In the past, living donor nephrectomy required an open flank incision that results in postoperative morbidity and a prolonged hospital stay. Since its introduction in 1995, laparoscopic living donor nephrectomy has been shown to decrease postoperative pain and hospital stay, reduce blood loss, and improve cosmesis while hastening recovery of normal activities of donors. With decreased morbidity and favorable graft function, this procedure as a novel approach has been used to address the increasing disparity between organ need and availability. Better graft function and survival are noted in living-donor kidney transplantation than in cadavefic kidney transplantation.
文摘Conventional simultaneous bilateral open nephroureterectomy combined with resection of bladder cuffs seems not optimal for bilateral upper tract urothelial carcinoma （UTUC） in renal transplant and dialysis patients with enormous invasion related to large morbidity,delayed gastrointestinal function,and late recovery.1 This study reports the largest series of minimally invasive procedures of simultaneous bilateral retroperitoneoscopic nephroureterectomy （SBRNU） via a midline lower abdominal incision in renal recipients.
