[Show abstract][Hide abstract] ABSTRACT: Current literature suggests that laparoscopic nephrectomy (LN) in patients with xanthogranulomatous pyelonephritis (XGP) is associated with high conversion and complication rate.
To report contemporary outcome of patients with XGP, managed with either open nephrectomy (ON) or LN.
In this retrospective study, medical records of 37 patients with histopathologically confirmed XGP from January 2001 to October 2009 were reviewed.
The clinical presentation, preoperative course, intraoperative findings, postoperative recovery and complications in ON and LN were analyzed.
Student's t test was used to perform statistical comparison between the LN and ON groups. Values are expressed as mean ± standard deviation.
In 37 patients, 20 underwent ON and 17 underwent LN. One patient in the LN group required conversion. He had ectopic pelvic kidney, and the vascular pedicle could not be identified because of dense adhesions. There were no intraoperative complications. The mean blood loss was 257.5 ± 156.67 ml and 141.18 ± 92.26 ml in ON and LN groups, respectively. Mean hospital stay was 15.45 ± 7.35 days and 9.71 ± 4.55 days in ON and LN groups, respectively. Postoperative complications were classified according to Clavien grading for surgical complications. Grade 2 complications were seen in 40% and 29.4% of patients in ON and LN groups, respectively. One patient in LN required secondary suturing of specimen retrieval site.
LN in patients with XGP is often challenging and requires considerable experience in laparoscopy. In properly selected patients, all benefits of minimally invasive surgery can be availed with LN.
No preview · Article · Oct 2011 · Indian Journal of Urology
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the effect of stone attenuation value on the effectiveness of extracorporeal shockwave lithotripsy (SWL) for upper urinary tract stones.
In this prospective study, 99 patients underwent SWL for solitary renal and upper ureteral stones from January 2007 to March 2009. All patients underwent CT scan before SWL. The mean attenuation value of stones in our study was 1213.3 +/- 314.5 Hounsfield units (HU). Group A consisted of 42 patients with stones of attenuation value <1200 HU and group B had 57 patients with stones of attenuation value >1200 HU. Stone size, location, requirement of number of shockwaves, shock intensities (power), retreatment rate, complication rate, auxiliary procedure rate, and effectiveness quotient (EQ) ratio were studied.
The mean total number of shocks required to fragment the stones in groups A and B were 1317.1 +/- 345.3 and 1646.5 +/- 610.8, respectively (p = 0.001), with a mean shock intensity of 12.2 +/- 0.7 and 12.4 +/- 0.5 kV, respectively (p = 0.03). Retreatment was not required in patients of group A, but 14.03% patients in group B required retreatment (p < 0.0001). Clearance rate in group A was 88.1%, whereas in group B it was 82.5% (p = 0.35). Auxiliary procedure rates were 9.5% and 10.5% in groups A and B (p = 0.22), respectively. EQ was 80.4% and 66.2% in groups A and B (p = 0.03), respectively. Complication rates were similar with 2.4% and 3.5% in groups A and B, respectively (p = 0.37). Significant correlation was recorded for total number and intensity of shocks with stone attenuation value.
The EQ of SWL for upper urinary tract stones was significantly better for stones with lower attenuation value. The number and intensity of shocks required to fragment these stones with lower attenuation value were also significantly lower.
No preview · Article · Jul 2010 · Journal of endourology / Endourological Society
[Show abstract][Hide abstract] ABSTRACT: Hydatid disease is a cyclozoonotic parasitic infestation caused by the cestode Echinococcus granulosus. Isolated renal involvement is extremely rare. A 45-year-old female, working as a farmer, presented with vague abdominal pain and hydatiduria. Ultrasonography of the abdomen revealed hydatid cyst arising from the right kidney. Computerized tomography scan of the abdomen confirmed the findings. Laparoscopic transperitoneal nephrectomy was performed. Isolated right renal hydatid cyst was removed in toto. Microscopic examination confirmed the diagnosis of hydatid cyst. Transperitoneal laparoscopic approach gives a better working space which helped us to remain outside Gerota's fascia and prevent subsequent cyst rupture.
No preview · Article · Oct 2009 · Indian Journal of Urology