A case report of the first laparoscopic radical nephrectomy done at the Clinic of urology, Clinical centre of Serbia

Laparoscopic interventions are at the very beginning of its evolution in the Clinic of Urology. The first steps have been made primarily to cope with problem of varicocele. We continued to gain laparoscopic experience by switching to solving some demanding intervention, primarily kidney cyst. The only logical next step lead to laparoscopic renal surgery. So, after a few successful primary simple nephrectomy, the next step was to perform a laparoscopic radical nephrectomy. Today, at the Clinic of Urology, Clinical Center of Serbia we successfully perform much more demanding interventions, such as extraperitoneal laparoscopic radical prostatectomy. In this paper we present our experience with the first laparoscopic radical nephrectomy, which was done at the Clinic of Urology, Clinical Center of Serbia.</jats:p

Laparoscopic ligature of spermatic veins as a method of surgical management of varicocele

Objective: To present the surgical technique of laparoscopic ligation spermatic vein in the treatment of varicocele as well as the results of this procedure. Material and methods: The study was conducted at the Clinic of Urology, Clinical Centre of Serbia, during the seventeen months, from November 2012 till March of 2014. During this time, the thirteen patients underwent laparoscopic ligation of spermatic vein. Including factors for this type of surgical treatment were clinically manifest varicocele and/or bad finding of semen. Results: During the seventeen months, thirteen patients underwent laparoscopic spermatic vein ligature. The youngest patient was 21 years old, while the oldest patient was 38 years old. The median was 28.46 years. 6 patients had varicocele Gr III, and with 7 patients we verified varicocele Gr II. The duration of surgery ranged from 15 to 70 minutes, with a median of 35.46 minutes. The amount of gas that was insufflated during surgery ranged from 14.1 l to 45 l, with a median of 23:32 litters. Three patients underwent laparoscopic ligature of spermatic vein with preservation of spermatic artery. Interventions in which underwent preservation of artery lasted longer (median 60 minutes) than it was the case in the group of patients without preservation (the median 28.1 minutes). Conclusion: Laparoscopic ligation of spermatic veins is a safe, minimally invasive, rapid and effective procedures. The level of postoperative complications is minimal learning curve fast and patient discomfort is minimized. The procedure is the financial cost effective, especially compared with the open surgical procedure.</jats:p

Comparison of two Wallace’s technique of implantation of the ureter to the ileal conduit: Five year experience

At the Clinic of Urology, at the Clinical Centre of Serbia, within the formation of ileal conduit as a form of urinary diversion, we apply three techniques of implantation of the ureter. A technique Nesbit-Bricker is the oldest technique described, and it sovereign occupies deserved place as a form of implantation of the ureter into an isolated segment of the intestinal tract. Technique by Wallace is the second technique which is applied at the Clinic of Urology, and has undergone some changes during the time, so that in the current practice we offer two modes of this technique. This paper present the postoperative results these two techniques, trying to answer the question which one of these two techniques is superior.</jats:p

Procena stepena bubrezne insuficijencije kod pacijenata podvrgnutih ilealnom konduitu kao vidu derivacije urina u odnosu na vrstu insercije uretera

Ileal conduit as a form supravesical derivaton, is still one of most popular method of urinary diversion, in daily urological practice. Bearing in mind this fact, this type of diversion, rightfully so, is also called the "gold standard" in the derivation of urine. Considering the fact of unnatural route of elimination of urine from the upper urinary tract that occurs during creation of ileal conduit, it is reasonable to expect that, in time, this type of diversion lead to some degree of renal insufficiency. Some authors, this effect on renal function, attribute to specific type of ureterointestinal anastomosis during formation of ileal conduit1,2. A very important part of the surgical technique of creating ileal conduit is precisely a step of implantation ureters into the intestinal segment. The ultimate goal is to enable a more natural way of evacuation of urine from the upper urinary tract in terms of maintaining the quality of renal function. Numerous authors describes a quite number of techniques of ureteral implantation into the intestinal segment (Wallace A, Wallace B, Nesbit-Bricker, Le Duc ...)3,4. Each of these techniques has its own strengths and weaknesses, and the decision witch technique will be applied is still in the hand of urologist - operator, individually. Bearing in mind the fact of unnatural route of elimination of urine from the upper urinary tract that occurs during creation of ileal conduit, it is reasonable to expect that the renal function over the time will start to show signs of incipient or advanced failure 5,6,7,8. Objective: To determine the most appropriate type ureterointestinal anastomosis in forming ileal conduit, as a form of supravesical urinary diversion, to ensure adequate renal function postoperatively as an important parameter of quality of life. Methods and patients: This is a retrospective study, which covered a population of 193 patients treated at the Department of Urology, Clinical Center of Serbia, who underwent creation of ileal conduit as a form of urinary diversion. The study was conducted 2007. - 2011. Postoperative follow-up lasts up to 48 months. The assess of the level of renal insufficiency were analyzed by monitoring parameters which determine the degree of anemia, and biochemical parameters of renal function. We have investigated three techniques of insertion of the ureters into the ileal conduit, which are used in the daily practice (Wallace A, Wallace B, Nesbit-Bricker). Conclusion: Kidney failure occurs equally often in all patients who underwent urinary diversion by ileal conduit, ignoring the type of insertion of the ureters to the intestinal segment.</jats:p

Procena stepena zastojnih promena na gornjim urinarnim putevima kod pacijenata podvrgnutih ilealnom konduitu kao vidu derivacije urina u odnosu na vrstu insercije uretera

Substitution of the bladder with segment of the digestive tract, within the radical treatment of bladder cancer, as well as treatment of the other bladder abnormality, is extremely demanding surgical procedure, that aims adequate treatment of the underlying disease and provide patient?s renal function within physiological level. Surgical implantation of the ureter into the intestinal segment are an important part of the surgical technique, the formation of ileal conduit, with the ultimate aim of providing a more natural way of evacuation of urine from the upper urinary tract in terms of maintaining the adequate quality of renal function. Which of the existing surgical method of implantation of ureter in the intestinal segment will be applied, it is for urologist to decided, according to his affinity and/or his operating school of origin. The literature describes many procedures of this technique (Wallace A, B Wallace, Nesbit-Bricker, Le Duc). Bearing in mind that the ileal conduit, as a form of supravesical derivation, is still one of most widely used method of urinary diversion, with a very large number of patients during the follow-up period were recorded certain complications of renal function disorders, which by some authors attributed to a type of ureterointestinal anastomoses, during the creation of ileal conduit. Having in mind the fact of unnatural route of elimination of urine from the upper urinary tract that occurs during creation of ileal conduit, it is reasonable to expect some degree of renal deterioration. These complications require prompt resolution. Bearing in mind the fact of unnatural route of elimination of urine from the upper urinary tract that occurs during creation of ileal conduit, it is reasonable to expect that the renal function over the time will start to show signs of incipient or advanced failure7. Objective: The main objective is to show the degree of renal deterioration, postoperatively, according to the type of insertion of the ureters to the ileal conduit. Methods and patients: The study was conducted retrospectively on material of Urological Clinic, Clinical Center of Serbia and on material of Faculty of Medicine, University of Belgrade, on 193 patients, for a period of five years (2007 to 2011), with a time of postoperative follow-up of patients up to 48 months (four years). Assessment of the level of renal deteriorisation was performed by ultrasound examination during regular audits of patients during follow-up. Conclusion: It was found that all three examed techniques in an insertion of ureter into ileal conduit were equally satisfactorily, with the similar degree of postoperative complications. Based on these facts, we can conclude, that the quality of life of patients in all three analyzed groups of ureteral insertion in the ileal conduit, approximately the same.</jats:p

Diagnostic and therapeutic protocol in the treatment of hypo functional kidney

Laparoscopic nephrectomy is indicated in the treatment of many benign conditions of the kidneys. Hydronephrosis caused by obstruction of the ureter, either internal, or external, is one of the main indications for laparoscopic reconstruction. If an obstruction is prolonged, consequently, it leads to chronic inflammatory process accompanied by persistent and recurrent pain with fever, which eventually become resistant to therapy. If not operated sufficiently fast to resolve the causes, as a consequence it leads to hypofunction and ultimately afunction of affected kidney. In such a situation, the only therapeutic option is surgical treatment. By analyzing the case, we will try to illustrate the diagnostic algorithm and therapeutic treatment modality.</jats:p