Ahmed El-Feel

Objective: To prospectively compare the use of external ureteric stents with internal JJ stenting of the uretero-ileal anastomosis in patients undergoing laparoscopic radical cystectomy (LRC) with a Y-shaped ileal orthotopic neobladder (ON). Patients and methods The study included 69 patients undergoing LRC with ON. Patients were grouped according to the type of uretero-ileal stents used. An external ureteric stent was used in Group A (33 patients) and a JJ stent was used in Group B (36). We prospectively compared the duration of hospital stay, the incidence of short- and intermediate-term complications in the two study groups. Results: The mean (SD) follow-up periods were 29.18 (3.94) and 28.19 (3.37) months for patients in Groups A and B, respectively. Perioperative patient characteristics were comparable in the two study groups. The use of JJ stenting was associated with a shorter hospital stay compared with external stenting, at a mean (SD) of 14.63 (3.74) and 6.8 (3.03) days in Groups A and B, respectively (P < 0.001). The incidence of urinary leakage was comparable in the two study groups, at 6.1% in Group A vs 8.3% in Group B (P = 1.0). Strictures of the uretero-ileal anastomosis occurred in two patients (6%) in Group A and confirmed by intravenous urography. All strictures were treated with antegrade JJ fixation. Conclusion: JJ stents could be used as an effective alternative to external ureteric stents to support the uretero-ileal anastomosis. JJ stenting is associated with a shorter hospital stay and similar complication rates compared with external stenting in patients undergoing LRC with ON.

To assess the feasibility, operative morbidity and oncological outcome of laparoendoscopic single-site (LESS) radical cystectomy.Ten patients with clinical stage T1–T2 bladder cancer underwent a LE...

Objective: The objective of this study was to compare the results of antegrade (AG) ureteral stenting with retrograde (RG) stenting during laparoscopic dismembered pyeloplasty. Materials and Methods: Between October 2003 and April 2007, a case series of 47 laparoscopic dismembered pyeloplasties were done by three surgeons of equal expertise in laparoscopic surgery, where the Double-J ureteral stent was placed by the RG method (RG stenting group) in 15 cases and by the AG method (AG stenting group) in 32 patients. Intraoperative findings and operative data were recorded. Clinical and radiological outcomes were evaluated during the follow-up visits at 3, 6, 12 months and then annually. Results: Differences in patient's age and body mass index were not statistically significant. Laparoscopic pyeloplasty was successfully completed in 45 patients, with two cases of conversion to open (one in each group). A crossing vessel was identified in 42% of RG stenting group versus 45% of AG stenting group. A state of high ureteral insertion was identified in 16% of AG stenting group, a finding that was never seen in RG stenting group. Mean operative time was 271 ± 21 minutes for RG stenting group versus 199 ± 34 minutes for AG stenting group, a difference that was statistically significant ( p ≤ 0.01). Differences in estimated blood loss, hemoglobin decline, time to oral feeding, duration of urethral catheter, and length of hospital stay were not significant. Postoperative complications were seen in two patients: postoperative hematuria belonging to RG stenting group was managed endoscopically and prolonged urine leakage belonging to AG stenting group ceased spontaneously by postoperative day 8. Clinical and radiological improvement was evident in 97%, with a mean follow-up of 30 ± 17 months. Conclusions: AG ureteral stenting is technically feasible and provides better dissection, especially in patients with high ureteral insertion and secondary ureteropelvic junction obstruction, with good long-term outcome in both groups.

In this study we show the outcome of laparoscopic kidney donation for donors and recipients in cases of donors with vascular anomalies. We consider donors to have vascular anomalies if they have multiple arteries or venous abnormalities. Fifty-six cases had double renal arteries (left side n = 52, right side n = 4). Three patients had triple renal arteries. Eighteen cases had venous anomalies (retro-aortic renal vein n = 11, double renal vein n = 4, circum-aortic renal vein n = 2, atrophic proximal renal vein, n = 1). Two donors had multiple abnormalities (double renal arteries, double renal veins, and a retro-aortic renal vein in one case, and double renal artery and double renal vein in one case). Donor surgery was done transperitoneally in all cases, using three trocars on the left side and four on the right side. Outcome in these cases is compared to the outcome in cases with no vascular abnormalities (n = 321) performed in our institution. The total number of patients with vascular anomalies in our series is 79 (19.7%). All cases were completed laparoscopically. The mean operative time was 161 +/- 35 minutes. The mean blood loss was 65 +/- 38 mL, and no donor required blood transfusion. Mean warm ischemia time was 2.6 +/- 0.4 minutes, mean renal artery length was 3.1 +/- 0.4 cm, and mean renal vein length was 3.5 +/- 1.2 cm. Donors were discharged on the second postoperative day, and no donor required readmission. Kidneys were transplanted successfully and mean creatinine of the recipients on discharge was 1.3 +/- 0.3 mg/dL. Five patients had acute tubular necrosis; however, only one of them required dialysis (delayed graft function). Kidney function recovered thereafter in all patients. There were no significant differences in blood loss, warm ischemia time, donor hospital stay, or patient creatinine on discharge, between patients with vascular abnormalities in donors and those without vascular abnormalities in donors. However, operative time was significantly longer in donors with vascular abnormalities. Laparoscopic donor nephrectomy is safe for donors with vascular anomalies. Donors benefit from a less morbid procedure with no effect on functional outcome.