Urinary Leakages Research Articles

1194 ZERO-ISCHEMIA RADIOFREQUENCY ABLATION ASSISTED TUMOR ENUCLEATION FOR T1B RENAL CELL CARCINOMA

1194 ZERO-ISCHEMIA RADIOFREQUENCY ABLATION ASSISTED TUMOR ENUCLEATION FOR T1B RENAL CELL CARCINOMA

1195 OFF-CLAMP VERSUS COMPLETE HILAR CONTROL LAPAROSCOPIC PARTIAL NEPHRECTOMY: LONG TERM RENAL FUNCTIONAL OUTCOMES

during the enucleation. The mean blood loss was 130.2 iA 56.1 ml (laparoscopic 113.9 iA 44.1 ml vs open 154.2 iA 64.2 ml) and mean operation time was 134.2 iA 32.0 min (laparoscopic 126.6iA27.1 min vs open 145.5iA35.9 min). Overall 8 complications (17.0%) occurred including 4 postoperative fevers (Clavien-Grade II), 1 bleeding need transfusion (Clavien-Grade II) and 3 prolonged urinary leakages (Clavien-Grade III). PADUA score was associated with prolonged urinary leakage (p 0.01) but not overall complications. No patient had positive surgical margins. Glomerular filtration rate differed before and 12 months after surgery with 2.0 mL/min/1.73 m2 decline at the first year after the surgery. One patient with a 5.1cm renal tumor had recurrence near the renal sinus near the ablation zone 9 month after surgery and received laparoscopic radical nephrectomy. CONCLUSIONS: Zero-ischemia, RFA assisted TE is a safe and effective nephron sparing treatment for T1b renal cell carcinoma that may provides excellent oncological and functional outcomes.

Oncological and functional results of extraperitoneal laparoscopic radical prostatectomy

The oncological and functional results of 329 cases in a population treated with extraperitoneal laparoscopic radical prostatectomy (ELRP) were evaluated retrospectively. A total of 329 inconsecutive patients with prostate cancer (PCa) who underwent ELRP were retrospectively analyzed. The median initial prostate-specific antigen (PSA) level was 17.35 ng/ml. The median biopsy Gleason score was 7.77. Patients with a T2 or T3a clinical stage had received preoperative neoadjuvant hormonal therapy (NHT) for 3 to 9 months prior to ELRP. No conversion or re-intervention were observed. The median time for anastomosis, surgery time and postoperative catheterization time were 13.0 min, 90.0 min and 6 days, respectively. The median estimated blood loss was 75 ml. There were 12 temporary urinary leakages requiring prolonged catheterization to 14 days. There was 1 case of deep vein thrombosis, 1 case of alimentary tract hemorrhage and 7 cases of anterior urethral stricture. The median follow-up time was 27 months. A total of 17 patients were lost during the follow-up period. No rectal injury, lymphocele, incision hernia, postoperative persistent urinary leak or anastomotic stricture occurred. Younger patients (≤67 years of age) had a more rapid recovery of continence and a better postoperative potency. The overall positive surgical margin rate was 16.7%, which correlated with the pathological stage and Gleason score, respectively (both P<0.001). A total of 89 (28.6%) patients were diagnosed with biochemical recurrence. The initial PSA value, PSM, pathological stage and Gleason score were identified as independent prognostic factors for biochemical recurrence-free survival using multivariate analysis. Our results demonstrated that preoperative NHT had significant effects on the pathological Gleason score (P<0.001) and surgical margin (P=0.027), but no significant impact on biochemical recurrence (P=0.202). The reproducibility of ELRP has been proven as a reliable curative treatment in Western countries during the last 15 years. Due to the increase in PCa patients, the results of our study may aid surgeons who use ELRP for the first time.

Contrast-material-enhanced MR urography in evaluation of postoperative lower urinary tract fistulae and leakages

Urinary fistulas and leakages of lower urinary tract are serious complications of various surgical procedures. Radiologists need to have enough information about these situations to perform precise diagnosis and treatment. Various techniques [such as intravenous pyelography, ultrasound, computed tomography (CT), CT urography, cystoscopy, cystography and magnetic resonance (MR) imaging] are used for the diagnosis of these conditions. Application of all these techniques reduces the comfort and cooperation of the patients and increases the cost. Here we present four postoperative patients with lower urinary tract fistula or leakage. To the best of our knowledge, there is no report regarding the use of contrast-material-enhanced MR urography (CE-MRU) in the demonstration of postoperative lower urinary tract fistulae and leakages. In conclusion, CE-MRU could show the existence and location of the urinary fistulae and leakages clearly without the need for another investigation technique, as described in our patients. Also, CE-MRU is a safe and relatively inexpensive technique that avoids exposure to radiation as well as nephrotoxic and more allergic contrast-material administration.

The single needle method for urethrovesical anastomosis with strengthened posterior fixation during laparoscopic radical prostatectomy

The single needle method for urethrovesical anastomosis with strengthened posterior fixation during laparoscopic radical prostatectomy was explored. The method was initiated by performing a fixing suture with a knot at 4 o'clock of the posterior lip of bladder neck, and another suture at nearby position was performed to leave the knot outside. From 5 o'clock to 8 o'clock, sutures were performed every one o'clock to secure posterior approximation, then every two o'clock a suture. To avoid a loose anastomosis, lock sutures were performed every 3 sutures. The needle was always driven full-thickness outside-in in the bladder neck and inside-out on the urethra. After completing the full circumference, the needle was drawn near the 4 o'clock and tied at the tail end. Any leakage could be closed with additional interrupted sutures. The clinical data of 89 patients who underwent this method were retrospectively compared with those of 23 patients who underwent the single knot method. The results showed that the anastomosis, operative and catheterization time was 17.6+/-4.7 min, 134.0+/-10.7 min and 6.5+1.6 days respectively. There were 3 temporal urinary leakages identified in 89 cases requiring prolonged catheterization. No urinary leak and anastomotic stricture was confirmed, and 95.2% patients had total urinary control. It was concluded that this method was simple and safe for urethrovesical anastomosis.

Clinical outcome of sacral neuromodulation in incomplete spinal cord injured patients suffering from neurogenic lower urinary tract symptoms

To determine the efficacy and safety of sacral neuromodulation (SNM) in incomplete spinal cord injured (SCI) subjects affected by neurogenic lower urinary tract symptoms (NLUTS). Twenty-four SCI patients were enrolled. The individuals were divided into two groups: 13 individuals in the urinary retention category and 11 suffering from overactive bladder syndrome. All subjects underwent definitive SNM implantation (Medtronic, Inc.). Voiding symptoms were assessed using patient bladder diaries, which recorded both pre-SNM and before each follow-up (1, 3 and 6 months, and then every 6 months). Outcome measures were per 24 h: number of voids and voided volume per void for both groups; number of urinary leakages, pad use and nocturia for patients with overactive bladder syndrome; and volume per catheterization and number of catheterizations for urinary retention subjects only. Final checkups were completed by June 2008. Median follow-up was 61 months. Up to the final visit, all subjects maintained a clinical improvement of more than 50% compared with baseline. Twenty-two side effects were recorded. Four subjects with urinary retention needed a new implant in the controlateral S3 sacral root because of loss of efficacy. One patient with urinary retention developed a wound infection at the implanted pulse generator site. Our study contains the largest series of implanted SCI patients ever published. SNM is a therapy to consider in the treatment of NLUTS for partial SCI patients, even if the loss of clinical benefits for patients with retentive NLUTS must be taken into account. All adverse events were treated effectively.

Effect of Laparoscopic Hysterectomy on the Vascularization of the Lower Urinary Tract

Introduction: The aim of this prospective study was to evaluate the changes in the vascularization of the lower urinary tract following laparoscopic hysterectomy (LH). Methods: Seventy women undergoing LH not under the indication of a uterine myoma were included. All subjects underwent urinalysis, pelvic examination, and introital color Doppler ultrasonography and completed a urinary questionnaire before and 6 months after LH. One-hour pad tests and urodynamic studies were performed in clinically incontinent women pre- and postoperatively. Results: Evaluation of the Doppler velocimetric parameters of bladder neck and periurethral vessels before and after LH, including number of vessels, pulsatility index, systolic peak, and minimum diastole, revealed no statistically significant differences (p > 0.05). In addition, the prevalence of stress urinary incontinence (SUI) decreased significantly from 37.1% (n = 26) preoperatively to 17.1% (n = 12) postoperatively (p < 0.01). A total of 19 patients reported no further SUI following LH. Their urinary leakages on the pad tests had all <10 g before surgery. When we analyzed the data of the women reporting no further SUI (n = 19) and de novo SUI (n = 5) following LH, the changes in the pulsatility index also showed no significant difference from the pre-LH values (p > 0.05). Conclusions: The results of our study suggest that LH has little impact on the blood flow of bladder neck and urethra. Although some women experienced relief of the symptoms of mild or de novo SUI after LH, this being unrelated to changes in the vascularization of the lower urinary tract.

Simple sling resection and a second, intermediate polypropylene mesh for treatment of vaginal tape protrusion concurrent with recurrent urinary stress incontinence after TVT procedure

The tension-free vaginal tape (TVT) procedure is a simple, effective and minimally invasive method for the surgical treatment of urodynamic stress incontinence (USI). Yet, complications such as mesh protrusion and recurrent urinary leakages after TVT have been reported. A case of recurrent USI complicated with vaginal mesh protrusion following a TVT procedure was referred. Video-urodynamics and introital ultrasonography confirmed that the recurrence of USI was secondary to mal-position of the protruded TVT. A simple salvaging procedure was carried out. The mal-positioned distal protruded TVT was resected and a second intermediate piece of polypropylene (Prolene) mesh was replaced at mid-urethra. The operation time was short and blood loss was minimal. The patient was objectively continent at 6 months follow-up with no defect of healing. Considering the cost-effectiveness and invasiveness of the surgeries, the method of inserting an intermediate mesh is clinically useful.

Renal transplantation in children: results of 9 years of renal transplantation in children at our center

ND-STAGE RENAL DISEASE (ESRL) in children is rare. The incidence ranges from one to three new cases yearly per million population. Chronic renal failure in childhood leads to growth retardation, osteodystrophy, and central nervous system morbidity. Renal transplantation (RTx) in children provides a degree of physical and psychological rehabilitation that is unmatched by any dialysis modality. In this article we record the results of RTx performed over a 9-year span on 41 children. PATIENTS AND METHODS From 1989 until 1996, 335 renal transplantations were performed in our center. Forty-one of these patients were children (6 to 18 years.). There were 22 male and 12 female children. The causes of renal failure were reflux nephropathy in eight children, neurogenic bladder in three children, posterior urethral valve in one child, prune belly syndrome in one child, and small kidney with unknown etiology in others. All kidneys were harvested from living donors; there were eight paternal donors, 12 maternal donors, six sibling donors, and 17 were unrelated. Immunosuppression therapy in all children were triple drugs, prednizolonazathioprine-cyclosporin. Acute rejection was treated by intravenous injection of methylprednisolone for 3 days. Antilymphocytic globuline (ALG) was applied for steroid resistance. In two children the grafts were placed intraperitoneally and the vessels were anastomosed to the aorta and vena cava, and in 39 children grafts were transplanted extraperitoneally in the pelvic region. To assess graft and patient survival we constructed the KaplanMeier curve and compared children and adult recipients in our center using the log-rank test. RESULTS Immediate diuresis occurred in all grafts. There were two end ureteral necroses and urinary leakages, which were repaired accordingly. Acute rejection occured in eight children but responded to pulse therapy. Chronic rejection was observed in 14 patients. In three other children, serum creatinine was 2.8 mg/100 mL. The function of grafts in other children was within normal range, and they have a good quality of life. The graft survival was: 2 years following Rtx, 93%; 80% after 5 years, and approximately 60% after 9 years. Patient survival was 100%. DISCUSSION

Application of synchrotron radiation X-ray fluorescence imaging combined with histochemical staining to the renal section of mercury-treated rats

A combination method consisting of synchrotron radiation X-ray fluorescence imaging and histochemical staining was employed to examine the detailed distribution of metal elements and morphological changes in the kidney section of rats exposed simultaneously to mercurial. A single injection of mercuric chloride (5 mg kg (-1)) to rats resulted in significant urinary leakages of the biological markers for acute mercury intoxication. Under this condition (i) a striking damage of brush border, cell loss and a dominant accumulation of mercury in the proximal tubules, (ii) a good correlation between the tubular damage caused by mercury and localization of the toxic metal, and (iii) an obvious distribution difference between zinc and sulfur following mercury exposure, were successfully shown by the present procedure with a 20 micron thick specimen.

Willingness to pay for reduced incontinence symptoms.

To measure the willingness to pay for a reduction in the number of micturitions and urinary leakages for patients with urge incontinence. A self-administered questionnaire with a binary willingness-to-pay question was administered to 541 patients in Sweden with urge or mixed incontinence; 461 questionnaires were returned. The reduction in micturitions and urinary leakages valued in the willingness-to-pay question was varied randomly between 25% and 50% in two different subsamples. Information was also collected about the number of micturitions and urinary leakage, health-related quality of life and socio-economic characteristics of the patients in the study. Quality of life was significantly related to the severity of the symptoms and was worse than that of the sex- and age-matched general Swedish population. The median (mean) willingness to pay per month was 240 (530) Swedish krona (SEK, 1 Pound = SEK 11.50) for a 25% reduction in micturitions and leakages and SEK 470 (1030) for a 50% reduction in micturitions and leakages. As hypothesized, the willingness to pay was significantly related to the size of the reduction in micturitions and leakages, the initial number of micturitions and leakages, and income. Patients with incontinence problems are willing to pay substantial amounts for a reduction in the number of micturitions and leakages.