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UP-1.037: Retroperitoneoscopic Versus Open Radical Nephrectomy in Patients with Larger Tumors (Average Diameter ≥7cm)
UNMODERATED POSTER SESSIONS
scopic manipulation are associated with bizarre shaped stones with filling defects as seen on intravenous urography, with stone sizes averaging 12mm x 7mm. 3. The IVU shows ureteral kinking of the ureter distal to the stone. 4. The complications during the difficult endoscopic procedure ranges from mucosal tear, ureteral perforation bleeding and post op fever. 5. All of our failed ureteroscopic procedures were managed w/ temporary percutaneous nephrostomy and were salvaged successfully by repeat URS-L with a 95.8% stone free rate. 6. No patient required open surgery due to failed ureterscopy in our institution due to impacted ureteral stones. 7. Hence, we are proposing that temporary percutaneous nephrostomy, whenever possible, can be a helpful treatment option for failed ureteroscopic. UP-1.037 Retroperitoneoscopic Versus Open Radical Nephrectomy in Patients with Larger Tumors (Average Diameter >7cm) Zhou L, He Z, Li N, Wu S, Zhang X Dept. of Urology, Peking University First Hospital, Beijing, China Introduction and Objective: To report our experience with retroperitoneoscopic radical nephrectomy (RRN) and compare it with a contemporary cohort of patients who underwent open radical nephrectomy (ORN) for renal cell carcinoma (RCC) with average diameter ⱖ7cm. Materials and Methods: From January of 2002 to July of 2006, 36 patients underwent RRN for such RCC. Clinical data is reviewed and compared it to a contemporary group of 46 patients who underwent ORN. Results: For patients with tumor mass 4 –10cm (average diameter ⱖ7cm), the RRN group had significantly reduced estimated blood loss (210⫾30 vs 410⫾100ml, P⬍0.01), quicker recovery of intestinal function (3.9⫾1.0 vs 7.4⫾2.0 days, P⬍0.01) and shorter postoperative hospital stay (7⫾1.3 vs 8.5⫾1.8days, P⬍0.01). The operating time in the RRN group is similar with the ORN group (172⫾35 vs 165⫾40 mins, P⬎0.01). The average follow-up was 27 months (range 9 to 50) for all patients. By the time of the last followup, there have been no cases of tumor seeding in both trocar pathway and open incision. Conclusions: Although technically demanding, RRN is a valuable alternative for managing localized renal tumors 4 to 10
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cm (average diameter ⱖ7cm ) in size. It affords patients with an improved postoperative course, a quicker recovery and a similar efficacy to compare with ORN within 3-year follow-up. UP-1.038 The Anatomical Retroperitoneoscopic Nephrectomy: Radical or Non-Radical Zhou L, Song G, He Z, Li N, Song Y Dept. of Urology, Peking University First Hospital, Beijing, China Introduction and Objective: To study the anatomy of retroperitoneal cavity under amplified view of retroperitoneoscopy and introduce the concept of the anatomical retroperitoneoscopic nephrectomy (ARN), radical or non-radical and compare the efficacy of ARN with that of non-ARN. Materials and Methods: Fasciae around kidney are studied and summarized as follows: the anterior fasciae include colon fusion fascia, pre-renal fusion fascia and anterior lamella of Gerota’s fascia and the posterior fasciae include transverse abdominal fascia, lateral conal fascia and posterior lamella of Gerota’s fascia, both from outer to inner layers. For radical ARN, dissociate and separate between 2 avascular planes of pre-renal fascia and anterior lamella of Gerota’s fascia, and lateral conal fascia and posterior lamella of Gerota’s fascia. For non-radical ARN, cut the posterior lamella of Gerota’s fascia open and separate inside it. From January 2002 to June 2008, 405 cases of ARN and 149 cases of non-ARN were done in our department and the mean age of patients was 56.4⫾15.1 years. These patients suffered from renal cell carcinoma, carcinoma of renal pelvis and ureter, and benign diseases of kidney with no function. Results: All results were summarized in table 1 and there were statistical differences between groups of ARN and nonARN for those with asterisks. For complications, there were 4 cases (1.0%, 4/405) to convert to open surgery due to 2 severe tissue adhesions, 1 renal helium
hardly exposed and 1 bleeding for group ARN. For group non-ARN, there were 3 cases (2.0%, 3/149) to convert to open surgery due to 2 kidney ruptures and 1 bleeding. Conclusions: The ARN has shorter operative time, less blood loss, less drainage volume postoperatively than the non-ARN and should be done as a routine procedure. UP-1.039 Renal Hydatid Cysts: Communicating with Collecting System About 30 Cases Sallami S, Ben Rhouma S, Chelif M, Hmidi M, Nouira Y, Horchani A Urology Department La Rabta Hospita, Tunis, Tunisia Introduction and Objectives: Echinococcosis is an endemic parasitic infestation in Tunisia involving the kidneys in 4% of the cases. Communication of renal hydatid cyst (RHC) with the collecting system requires a specific treatment. We present our experience in the management of this entity. Material and Methods: Between 1992 and 2008, 67 patients were operated for RHC, a communication with the collecting system was noted in 30 patients (44,7%). They were 13 males and 17 females with a media age of 43,2 years (19-76). We reviewed the clinical and therapeutic particularities of these cases. Results: History of hydatid disease was reported in only 5 cases. The diagnosis was established on clinical features in 26 patients (87%): hydatiduria (debris resembling grape skins in the urine) with or without hematuria. It was established per-operatively in only 4 cases. The cysto-urinary fistula was usually unique (90%), communicating with a calyx or the pelvis respectively in 80% and 20%. The fistula was large (greater than 2 cm) in 20% of the cases. The RHC was type III, type IV and type V (according to the Gharbi’s classification) respectively in 18, 9 and 3 patients. The main treatment was conservative (83%) consisting on a cysto-pericystectomy. The
UP-1.038, Table 1. Results Compared Between Groups of ARN and Non-ARN
Mean operative time (min)* Medium estimated blood loss (ml)* Medium drainage volume (ml)* Blood transfusion (ml) Drainage time (d) Time to oral intake post-op (d) Post-operative hospital stay (d)
Group ARN (n ⴝ 405) 174⫾64 100 (10-2500) 150 (0-1152) 400 (3.7% ,15) (400-1650) 3.9⫾1.8 2.7⫾1.2 8.6⫾3.8
Group NonARN (n ⴝ 149) 204⫾62 200 (10-1500) 198 (5-1144) 400 (5.4%, 8) (400-900) 3.9⫾1.3 2.4⫾1.1 9.3⫾2.9
UROLOGY 74 (Supplment 4A), October 2009
scopic manipulation are associated with bizarre shaped stones with filling defects as seen on intravenous urography, with stone sizes averaging 12mm x 7mm. 3. The IVU shows ureteral kinking of the ureter distal to the stone. 4. The complications during the difficult endoscopic procedure ranges from mucosal tear, ureteral perforation bleeding and post op fever. 5. All of our failed ureteroscopic procedures were managed w/ temporary percutaneous nephrostomy and were salvaged successfully by repeat URS-L with a 95.8% stone free rate. 6. No patient required open surgery due to failed ureterscopy in our institution due to impacted ureteral stones. 7. Hence, we are proposing that temporary percutaneous nephrostomy, whenever possible, can be a helpful treatment option for failed ureteroscopic. UP-1.037 Retroperitoneoscopic Versus Open Radical Nephrectomy in Patients with Larger Tumors (Average Diameter >7cm) Zhou L, He Z, Li N, Wu S, Zhang X Dept. of Urology, Peking University First Hospital, Beijing, China Introduction and Objective: To report our experience with retroperitoneoscopic radical nephrectomy (RRN) and compare it with a contemporary cohort of patients who underwent open radical nephrectomy (ORN) for renal cell carcinoma (RCC) with average diameter ⱖ7cm. Materials and Methods: From January of 2002 to July of 2006, 36 patients underwent RRN for such RCC. Clinical data is reviewed and compared it to a contemporary group of 46 patients who underwent ORN. Results: For patients with tumor mass 4 –10cm (average diameter ⱖ7cm), the RRN group had significantly reduced estimated blood loss (210⫾30 vs 410⫾100ml, P⬍0.01), quicker recovery of intestinal function (3.9⫾1.0 vs 7.4⫾2.0 days, P⬍0.01) and shorter postoperative hospital stay (7⫾1.3 vs 8.5⫾1.8days, P⬍0.01). The operating time in the RRN group is similar with the ORN group (172⫾35 vs 165⫾40 mins, P⬎0.01). The average follow-up was 27 months (range 9 to 50) for all patients. By the time of the last followup, there have been no cases of tumor seeding in both trocar pathway and open incision. Conclusions: Although technically demanding, RRN is a valuable alternative for managing localized renal tumors 4 to 10
S182
cm (average diameter ⱖ7cm ) in size. It affords patients with an improved postoperative course, a quicker recovery and a similar efficacy to compare with ORN within 3-year follow-up. UP-1.038 The Anatomical Retroperitoneoscopic Nephrectomy: Radical or Non-Radical Zhou L, Song G, He Z, Li N, Song Y Dept. of Urology, Peking University First Hospital, Beijing, China Introduction and Objective: To study the anatomy of retroperitoneal cavity under amplified view of retroperitoneoscopy and introduce the concept of the anatomical retroperitoneoscopic nephrectomy (ARN), radical or non-radical and compare the efficacy of ARN with that of non-ARN. Materials and Methods: Fasciae around kidney are studied and summarized as follows: the anterior fasciae include colon fusion fascia, pre-renal fusion fascia and anterior lamella of Gerota’s fascia and the posterior fasciae include transverse abdominal fascia, lateral conal fascia and posterior lamella of Gerota’s fascia, both from outer to inner layers. For radical ARN, dissociate and separate between 2 avascular planes of pre-renal fascia and anterior lamella of Gerota’s fascia, and lateral conal fascia and posterior lamella of Gerota’s fascia. For non-radical ARN, cut the posterior lamella of Gerota’s fascia open and separate inside it. From January 2002 to June 2008, 405 cases of ARN and 149 cases of non-ARN were done in our department and the mean age of patients was 56.4⫾15.1 years. These patients suffered from renal cell carcinoma, carcinoma of renal pelvis and ureter, and benign diseases of kidney with no function. Results: All results were summarized in table 1 and there were statistical differences between groups of ARN and nonARN for those with asterisks. For complications, there were 4 cases (1.0%, 4/405) to convert to open surgery due to 2 severe tissue adhesions, 1 renal helium
hardly exposed and 1 bleeding for group ARN. For group non-ARN, there were 3 cases (2.0%, 3/149) to convert to open surgery due to 2 kidney ruptures and 1 bleeding. Conclusions: The ARN has shorter operative time, less blood loss, less drainage volume postoperatively than the non-ARN and should be done as a routine procedure. UP-1.039 Renal Hydatid Cysts: Communicating with Collecting System About 30 Cases Sallami S, Ben Rhouma S, Chelif M, Hmidi M, Nouira Y, Horchani A Urology Department La Rabta Hospita, Tunis, Tunisia Introduction and Objectives: Echinococcosis is an endemic parasitic infestation in Tunisia involving the kidneys in 4% of the cases. Communication of renal hydatid cyst (RHC) with the collecting system requires a specific treatment. We present our experience in the management of this entity. Material and Methods: Between 1992 and 2008, 67 patients were operated for RHC, a communication with the collecting system was noted in 30 patients (44,7%). They were 13 males and 17 females with a media age of 43,2 years (19-76). We reviewed the clinical and therapeutic particularities of these cases. Results: History of hydatid disease was reported in only 5 cases. The diagnosis was established on clinical features in 26 patients (87%): hydatiduria (debris resembling grape skins in the urine) with or without hematuria. It was established per-operatively in only 4 cases. The cysto-urinary fistula was usually unique (90%), communicating with a calyx or the pelvis respectively in 80% and 20%. The fistula was large (greater than 2 cm) in 20% of the cases. The RHC was type III, type IV and type V (according to the Gharbi’s classification) respectively in 18, 9 and 3 patients. The main treatment was conservative (83%) consisting on a cysto-pericystectomy. The
UP-1.038, Table 1. Results Compared Between Groups of ARN and Non-ARN
Mean operative time (min)* Medium estimated blood loss (ml)* Medium drainage volume (ml)* Blood transfusion (ml) Drainage time (d) Time to oral intake post-op (d) Post-operative hospital stay (d)
Group ARN (n ⴝ 405) 174⫾64 100 (10-2500) 150 (0-1152) 400 (3.7% ,15) (400-1650) 3.9⫾1.8 2.7⫾1.2 8.6⫾3.8
Group NonARN (n ⴝ 149) 204⫾62 200 (10-1500) 198 (5-1144) 400 (5.4%, 8) (400-900) 3.9⫾1.3 2.4⫾1.1 9.3⫾2.9
UROLOGY 74 (Supplment 4A), October 2009