Copyright (c) 2009 Thomas Jefferson University All rights reserved. http://jdc.jefferson.edu/urologyfp Recent documents in Department of Urology Faculty Papers en-us Sat, 14 Nov 2009 23:17:47 PST 3600 http://jdc.jefferson.edu/urologyfp/5 http://jdc.jefferson.edu/urologyfp/5 Fri, 13 Nov 2009 10:31:09 PST BACKGROUND AND OBJECTIVES: We report our institutional experience performing transperitoneal robotic-assisted laparoscopic prostatectomy (RALP) in patients with prior prosthetic mesh herniorrhaphy to assess the feasibility of this procedure in this patient population. METHODS: From October 2005 to January 2008, transperitoneal robotic-assisted laparoscopic prostatectomies were performed and prospectively recorded. We retrospectively reviewed 309 patients. RESULTS: Twenty-seven patients (8.7%) were found to have a history of prior hernia repair with prosthetic mesh placement. The mean age was 55.7, estimated blood loss (EBL) was 228 mL, operative (console) time was 197 minutes, and length of hospital stay (LOS) was 1.62 days. In contrast, patients undergoing RALP with no history of mesh herniorrhaphy had a mean age of 59.3, EBL of 302 mL, console time of 193 minutes, and LOS of 2.2 days. These differences were not statistically significant. The mesh herniorrhaphy cohort had a lower percentage of organ-confined disease, but no difference was seen in margin status, continence, or potency rates after one year. CONCLUSIONS: Transperitoneal RALP is a feasible option for previously operated on patients with prosthetic mesh herniorrhaphy. Two areas that we identified as critical were the initial step of gaining access for pneumoperitoneum and port placement, and meticulous dissection to expose the mesh, which can be subsequently avoided and left intact. As RALP continues to gain popularity, urologists will continue to exploit the advantages of robotic surgery to perform increasingly challenging cases. Costas D. Lallas Feasibility Studies Hernia, Inguinal Humans Laparoscopy Lymph Node Excision Male Middle Aged Prostatectomy Quality of Life Retrospective Studies Robotics Surgical Mesh Treatment Outcome http://jdc.jefferson.edu/urologyfp/4 http://jdc.jefferson.edu/urologyfp/4 Fri, 13 Nov 2009 10:21:13 PST We report our experience performing a robot-assisted dismembered pyeloplasty on a patient with a ureteropelvic junction obstruction in a horseshoe kidney and a prior history of endopyelotomy. We provide 18-month follow-up demonstrating that robotic pyeloplasty is a reasonable second treatment option for patients with horseshoe kidneys with failed prior endourological management. Mark L. Pe Aged, 80 and over Female Humans Kidney Kidney Pelvis Laparoscopy Reoperation Robotics Ureteral Obstruction http://jdc.jefferson.edu/urologyfp/3 http://jdc.jefferson.edu/urologyfp/3 Fri, 13 Nov 2009 10:13:16 PST BACKGROUND AND OBJECTIVES: Laparoscopic renal surgery has become a widely applied technique in recent years. The development of postoperative rhabdomyolysis is a known but rare complication of laparoscopic renal surgery. Herein, 4 cases of rhabdomyolysis and a review of the literature are presented with respect to pathogenesis, treatment, and prevention of this dire complication. METHODS: A retrospective review of over 600 laparoscopic renal operations over the past 8 years was performed. All cases of postoperative rhabdomyolysis were identified. A Medline search was performed to find articles related to the development of postoperative rhabdomyolysis. Cases of rhabdomyolysis developing after laparoscopic renal surgery and common risk factors between cases were identified. RESULTS: The incidence of postoperative rhabdomyolysis in our series is 0.67%. It is similar to the rate reported in other series. Male sex, high body mass index, prolonged operative times, and the lateral decubitus position are all risk factors in its development. CONCLUSION: The prevention and optimal management of postoperative rhabdomyolysis following laparoscopic renal surgery has yet to be defined. The risk factors we identified should be carefully addressed and minimized. A better understanding of the pathogenesis of rhabdomyolysis will also be a key component in its prevention. Deborah T. Glassman Adult Creatinine Humans Kidney Failure, Acute Laparoscopy Male Middle Aged Nephrectomy Postoperative Complications Rhabdomyolysis Risk Factors http://jdc.jefferson.edu/urologyfp/2 http://jdc.jefferson.edu/urologyfp/2 Tue, 28 Oct 2008 14:41:37 PDT PURPOSE: The minimally invasive treatment of ureteropelvic junction obstruction has evolved during the last decade from endoscopic to laparoscopic and robotic. We review our 10-year experience with ureteropelvic junction obstruction, and report on our experience and followup. MATERIALS AND METHODS: We reviewed all patients treated during the last 10 years. There were 294 procedures performed with complete records on 273 patients including 128 retrograde endopyelotomies, 116 laparoscopic pyeloplasties and 29 robotic pyeloplasties. Technique for each procedure is reviewed. Statistical analysis was performed on all results. Variables evaluated were gender, age (younger than 41 vs 41 years or older), side (right or left), presence of crossing vessels, presence of a high insertion, primary or secondary procedure and whether prior endopyelotomy or pyeloplasty had been performed. RESULTS: Mean followup for endopyelotomy, laparoscopic pyeloplasty and robotic pyeloplasty was 20, 20 and 19 months, respectively, with success rates of 60.2%, 88.8% and 100%, respectively. On univariable analysis only the presence of crossing vessels or a high insertion was significant for laparoscopic pyeloplasty. On multivariable analysis age was significant for endopyelotomy and the presence of crossing vessels was significant for pyeloplasty. On Kaplan-Meier analysis failures were noted to occur after 5 years in both groups. CONCLUSIONS: Laparoscopic pyeloplasty and robotic pyeloplasty are superior minimally invasive treatments for ureteropelvic junction obstruction. However, endopyelotomy can be used for select patients. Because of late failures patients who undergo either of these procedures should receive long-term followup. Brent V. Yanke http://jdc.jefferson.edu/urologyfp/1 http://jdc.jefferson.edu/urologyfp/1 Wed, 04 Jun 2008 08:06:16 PDT Metastatic disease to the adrenal glands can occur in a wide array of malignancies. With the increased use of abdominal imaging, these lesions are diagnosed with more frequency. Diagnostic and laboratory evaluation is essential for the differentiation of benign lesions from primary malignant adrenal tumors or extra-adrenal metastasis. Computed tomography (CT) and magnetic resonance imaging (MRI) characteristics, as well as the adjunctive use of immunocytochemical techniques on biopsy specimens, can allow accurate identification of metastatic lesions. Surgical management of metastastic lesions is appropriate in selected patients, primarily when representing the solitary site of metastatic disease. The surgical approach, while debatable, can de done either through open surgery or laparoscopically. Either approach appears comparable in terms of oncologic efficacy in the carefully selected patient, although laparoscopic adrenalectomy is associated with decreased pain and improved convalescence. The surgeon's skill in laparoscopic technique, appropriate patient selection, and the ability to adhere to oncologic principles, including complete excision without tumor spillage, are of utmost importance when deciding the appropriate surgical intervention. Paul R. Gittens Jr.