Jiří Klečka

Charles University in Prague, Praha, Praha, Czech Republic

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Publications (12)6.07 Total impact

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    ABSTRACT: Urine leakage following laparoscopic radical prostatectomy (LRP) is a possible complication that may herald chronic urine incontinence. Intraoperative measures aiming to prevent this is not standardised. Presentation of experience with active suction of the prevesical space in managing postoperative urine leakage. At the Department of Urology, where laparoscopy of the upper abdomen and open RP were performed, a protocol for extraperitoneal LRP was established in 8/2008. Until 5/2011, 154 LRPs have been performed. Urine leakage from a suction drain appeared in 9 cases (5.8%). Permanent active suction (with a machine for Büllae thoracic drainage) of the prevesical space with negative pressure of 7-12 cm of H2O was started immediately. Urine leakage started after a mean of 0.9 (0-2) days postoperatively and stopped after a mean of 8.1 (15-42) days. Leakage stopped with only suctioning in 7 cases. In one case, open re-anastomosis was performed on the 7(th) postoperative day (POD). In another case, ineffective active suction was replaced on the 10(th) POD by needle vented suction without effect and the leakage stopped following gradual shortening of the drain up to the 15(th) POD. Active suction of the prevesical space seems to be an effective intervention to stop postoperative urine leakage after laparoscopic radical prostatectomy.
    Videosurgery and Other Miniinvasive Techniques / Wideochirurgia i Inne Techniki Malo Inwazyjne 03/2013; 8(1):49-54. · 0.76 Impact Factor
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    ABSTRACT: We present a cohort of patients with low-stage pelviureteric neoplastic disease who underwent complete laparoscopic nephroureterectomy (CLNUE) with intravesical lockable clip (IVLC). Due to the absence of a standard technique of NUE, the study was not randomized. From 1/2010 to 1/2012, 21 patients were subjected to CLNUE-IVLC. The first step was transurethral excision of the ureterovesical junction with Collin's knife deep into the paravesical adipose tissue. The ureter was grasped with biopsy forceps and the distal end of the ureter was occluded with lockable clip. The applicator was introduced through a 5 mm port inserted as an epicystostomy. The patients were rotated to flank position and CLNUE followed. The endoscopically introduced clip on the distal ureter is proof of completion of the total ureterectomy. The mean operation time was 161 (115-200) min. In four (19.0%), the application of the clip failed and CLNUE was completed with non-occluded ureter. In three cases, subsequent laparoscopic nephrectomy was converted to open surgery. In two cases, the distal ureterectomy was completed with pluck technique through a lower abdominal incision that was also used for extraction of the specimen. There were four complications (Clavien II 2x, IIIb, V). Follow-up was available for all - mean 10.6 (range: 0-25) months. One died of disease generalization within 11 months. CLNUE-IVLC is fast and safe. If needed, the endoscopic phase can be switched to open NUE. Disadvantages include: the need to change the position of the patient, the risk of inability to apply the clip on the distal ureter, and the risk of an unclosed defect of the urinary bladder.
    Central European journal of urology. 01/2012; 65(2):75-9.
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    ABSTRACT: Tubulocystic renal carcinoma (TCRC) is a recently described neoplastic entity. To date, clinicopathological features on less than hundred cases of these rare tumours have been characterized exclusively in the pathological literature. Herein, we present five additional cases emphasizing clinical aspects on these rare renal neoplasms. Cases diagnosed as TCRC were retrieved and reviewed from the routine and consultation files of the Pilsen tumour registry comprising over 20,000 cases of renal tumours. All patients were men, mean age 56 years (range 29-70). Features on computed tomography (CT) were in two cases Bosniak III, one IV and two were solid tumours. In four patients, nephrectomy was performed, and one patient underwent resection. At the time of surgery, two patients had metastases. In one case, both primary tumour and metastases were active on FDG positron emission tomography (PET)/CT. Both patients with metastatic disease were treated with sunitinib with partial response. One patient died 26 months postoperatively and the other patient is alive 5 months after surgery. Three patients with localized tumours are without evidence of disease 31, 28 and 7 months after surgery. In one case, the resected tumour was histologically combined with a papillary renal cell carcinoma (PRCC). TCRC occurs predominantly in men with a wide age range. TCRC frequently displays a cystic component which may render a radiological classification of Bosniak III or IV. FDG PET/CT is helpful in the detection of metastases. TCRC has definitive malignant potential. Our findings support a possible relationship to PRCC. The tyrosine kinase inhibitor sunitinib may be used a therapeutical agent with partial response and temporary effect.
    World Journal of Urology 11/2010; 29(3):349-54. · 2.89 Impact Factor
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    Central European Journal of Urology 1/2010. 01/2010; 63:77-81.
  • European Urology Supplements - EUR UROL SUPPL. 01/2009; 8(8):692-692.
  • European Urology Supplements - EUR UROL SUPPL. 01/2009; 8(8):691-692.
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    ABSTRACT: Souhrn Cíl: Dát přehled současných poznatků o tkáňových lepidlech obecně a hlavně o jejich využití při resekcích ledvin otevřených i la-paroskopických, které mají nejširší využití v urologii. Výsledky: Na trhu je celá řada lepidel. K resekcím ledvin se používají hlavně lepidla fibrinová (obsahují fibrin, trombin a další kompo-nenty) a trombinová (obsahují v želatině rozpuštěný trombin, který aktivuje pacientův fibrinogen). Lepidla fibrinová vyžadují suchou resekční plochu, čehož nelze zejména u laparoskopických resekcí ledvin dosáhnout a nelze je tedy rutinně využít. Toto platí pro teku-té formy, fibrinová lepidla na kolagenové houbičce našla užití u otevřených resekcí ledvin. Trombinová lepidla ke své aktivaci naopak vyžadují aktivní krvácení, čímž se stávají v současnosti nejlepším lepidlem využitelným u resekcí ledvin. Lepit tkáň však nedokáží, slouží pouze k hemostáze. Firemně vyráběný produkt je želatino-trombinová matrix FloSeal ® , která má využití jak při otevřených, tak zejména při laparoskopických resekcích, kde jsou možnosti hemostázy oproti otevřené operativě omezenější. Tři práce publikovaly úspěšné užití albuminu s glutaraldehydem (Bioglue ®), ale je nutno jej aplikovat na suchou resekční plochu. K vyplnění defektu po resekci při sutuře či k překrytí sutury se užívá oxidovaná celulóza (Surgicel ®). Celulóza se s úspěchem kombinuje s trombinovým lepidlem. Ve studiích na zvířatech se zdají slibné výsledky s cyanoakrylátem a adsorbenty. Jejich klinické užití zatím nebylo publi-kováno. Ostatní tkáňová lepidla nemají u resekcí ledvin v současnosti využití (např. polyetylenglykoly, kolagen). Závěr: Lepidla slouží při resekcích ledvin hlavně ke zlepšení hemostázy. Při otevřených resekcích mají lepidla využití hlavně u slo-žitějších výkonů např. u centrálně uložených tumorů. Využívá se zejména želatino-trombinová matrix FloSeal ® či fibrinové lepidlo aplikované ve formě kolagenové houbičky Tachosil ® . U laparoskopických resekcí se uplatňuje jako součást rutinního postupu FloSeal ® aplikovaný speciálním aplikátorem. Nevýhodou je navýšení ceny výkonu. Klíčová slova: resekce ledvin, lepidla tkáňová, fibrin, trombin, želatina, celulóza. Abstract Objective: To present an overview of recent knowledge of tissue adhesives in general as well as with an emphasis on where they are most widely used in urology, i. e., during both open and laparoscopic kidney resections. Results: A wide variety of tissue adhesives are commercially available. For kidney resection, fibrin (containing fibrin, thrombin, and other components) and thrombin sealants (containing thrombin dissolved in gelatin which activates the patient's fibrinogen) are ma-inly used. Fibrin sealants require a dry resection surface which cannot be achieved particularly in laparoscopic kidney resections; therefore, fibrin sealants cannot be routinely used. This applies to liquid forms; fibrin sealants combined with a collagen sponge have been used in open kidney resections. By contrast, thrombin sealants require active bleeding to be activated which currently makes them most suitable for use in kidney resection. However, they fail to glue tissues and are only intended for haemostasis. The gelatin-thrombin matrix FloSeal ® , a commercial company product, can be used in both open and particularly laparoscopic resections where the possibilities of haemostasis are limited compared to open surgery. There have been three reports of successful use of albumin with glutaraldehyde (Bioglue ®), however, it needs to be applied on a dry resection surface. Oxidized cellulose (Surgicel ®) is used to fill a defect after resection or to cover the suture line. Cellulose has been combined with thrombin sealants with success. Results of animal studies with cyanoacrylate and adsorbents seem promising. Reports of their clinical use have not been published yet. The other tissue adhesives such as polyethylene glycols or collagen are currently not being used in kidney resections. Conclusion: In kidney resection, tissue adhesives are mainly used to improve haemostasis. In open resections, tissue adhesives are used in more complex procedures including centrally located tumours. Commonly used tissue adhesives include gelatin-thrombin matrix FloSeal ® as well as Tachosil ® , a fibrin sealant applied as a collagen sponge. In laparoscopic resections, FloSeal ® delivered by means of a special applicator has routinely been used. A disadvantage is an increase in price of the procedure.
    01/2007; 11(11):147-153.
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    M. Hora, J. Klečka, V. Eret, J. Ferd
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    ABSTRACT: stapleru. Klíčová slova: laparoskopie, nefrektomie, stapler, klipy. HILAR VASCULAR OCCLUSION DURING LAPAROSCOPIC NEPHRECTOMY BY MEANS OF LOCKING CLIPS Summary Aim: The stapler is the standard of care for occlusion of hilar vessels during laparoscopic nephrectomy. This paper aims to evaluate the possibility of replacing the stapler by locking clips. Methods and Results: Between April 2005 and November 2005, a total of 35 hilar vascular occlusions during laparoscopy (24 radical nephrectomies for a tumour, 7 nephrectomies for a benign disease, and 4 nephroureterectomies) were performed. The procedures were done by three operators. Two operators with less experience in laparoscopy used a stapler in all 20 procedures. One more experienced operator carried out 15 hilar occlusions. In 12 (80 %) cases, both the artery and vein were occluded sepa- rately by means of locking clips. In three cases, occlusion was achieved using en bloc hilar stapling (topographically more complex relations of the renal vessels or more prominent vascular anomalies). Conclusion: Renal vein closure by means of locking clips is a safe method. It is more time consuming since it requires preparation of the entire hilum and thus a highly skilled operator. However, this method is significantly cheaper than occlusion with a stapler.
    01/2007;
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    M Hora, J Klečka, T Ürge, J Ferda, O Hes, V Eret
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    ABSTRACT: 1 Urologická klinika LF UK a FN, Plzeň 2 Radiodiagnostická klinika LF UK a FN, Plzeň 3 Šiklův patologicko-anatomický ústav LF UK a FN, Plzeň Souhrn Cíl: Laparoskopická resekce (LR) tumoru ledviny je oproti otevřené (OR) technicky náročnější a má některá omezení. V práci shr-nujeme naše poznatky se zavedením metodiky a srovnáváme metodiku LR a OR. Metodika: Od 9/2004 do 2/2006 bylo chirurgicky řešeno 179 tumorů ledviny. U 58 (32,4 %) byl proveden resekční výkon. Z nich by-lo 21 indikováno k laparoskopickému přístupu (36,2 %). LR provádíme technikou s uzavřením (klampováním) hilových cév cévní svorkou, následuje resekce pomocí nůžek a sutura spodiny a okrajů ledviny intrakorporálním stehem. U jedné pacientky byla pro krvácení po uvolnění hilu provedena konverze. Dvacet dokončených LR je podrobněji zhodnoceno. LR byla porovnána s 20 OR z období 1/2003 až 8/2004 pomocí Studentova testu. Výsledky: Čas operace byl u LR 130,8 ± 20,0 minut, u OR 105,8 ± 18,4 minut, p = 0,000197. Doba uzavření hilu (teplé ischémie) byl u LR 23,3 ± 6,7 minut, u OR 13,3 ± 2,0 minut, p = 0,000002. Délka hospitalizace po operaci byla u LR 8,1 ± 3,3 dne, u OR 8,3 ± 1,8 dne, p = 0,786077. Pooperační krvácení léčené konzervativně se vyskytlo u dvou LR, u OR byla jedna ranná infekce. Závěr: LR je technicky náročný výkon. Lze k němu indikovat asi třetinu resekcí. Vhodné jsou zejména extrarenálně rostoucí tumory dobře dostupné laparoskopickým nástrojům. Oproti OR je vyšší riziko krvácivých komplikací a je zde delší doba teplé ischémie. Klíčová slova: laparoskopie, retroperitoneoskopie, tumor ledviny, parciální nefrektomie, resekce ledviny. LAPAROSCOPIC RESECTION OF RENAL TUMOURS Summary Objective: Laparoscopic resection (LR) of a renal tumour is technically more demanding and has some limitations when compared to open resection (OR). We present our experience with introducing the method and compare LR and OR methodologies. Methods: From September 2004 to February 2006, a total of 179 renal tumours were treated surgically. In 58 (32.4 %) resection was performed. In 21 of these laparoscopic approach was indicated (36.2 %). We perform LR using hilar clamping followed by re-section with scissors and suture of the kidney base and margins with an intracorporeal stitch. In one patient, conversion was per-formed because of bleeding after releasing the hilum. Twenty completed LRs are evaluated in more detail. LR was compared to 20 ORs from between January 2003 and August 2004 using the Student test. Results: The operation time in LR was 130.8 ± 20.0 mins, in OR it was 105.8 ± 18.4 mins, p = 0.000197. The duration of hilar clam-ping (warm ischaemia) in LR was 23.3 ± 6.7 mins, in OR it was 13.3 ± 2.0 mins, p = 0.000002. The length of hospital stay after the surgery was 8.1 ± 3.3 days, in OR it was 8.3 ± 1.8 days, p = 0.786077. Postoperative bleeding which was treated conservatively occurred in two LRs, in OR there was one early infection. Conclusion: LR is a technically demanding procedure. It may be indicated in about a third of resections. Particularly suitable are tumours growing extrarenally which can be accessed well with laparoscopic instruments. Compared to OR, LR poses a higher risk of bleeding complications and is associated with a longer warm ischaemia time.
    Česká urologie. 01/2006; 1:32-39.
  • Article: UP01.23
    Urology 01/2006; 68:229-230. · 2.42 Impact Factor