Læknablaðið : fylgirit - 01.06.2009, Blaðsíða 27

2 7 T H CONGR SCAND ASSOC UROL
F Y L G I R I T 6 1
term oncological outcome of renal cryoablation procedures
performed in our department.
Materials and methods: 58 patients underwent cryoablation of
63 renal tumors. 27 patients were ablated percutaneously and
31 laparoscopically. Positioning of the cryoneedles and freezing
of the tumor was monitored peroperatively by percutaneous
or laparoscopic ultrasonography. Ablation was considered
successful when tumors gradually shrunk and showed no sign
of contrast enhancement assessed by CT or MR scan.
Results: Median tumor size was 2,2 cm [1,0-4,4] ([min-max]).
We used 4 [1-9] cryoneedles. Cryotherapy was feasible in all
patients. One patient had a nephrostomy for two days because
of haematuria and hydronephrosis. No patients had blood
transfusion. One patient developed hydronephrosis, probably
because of a thermal ureteric lesion. Median follow-up time was
14 months (range 1-39). The cancer specific survival was 100%.
Residual tumor was suspected in three patients, histology at re-
ablation showed carcinoma (lpt) and necrosis (1 pt). The third
patient will be operated within weeks. No successfully ablated
patients have had recurrence so far.
Conclusion: Cryoablation of small renal tumors offers a safe
alternative to renal resection or nephrectomy in terms of
complications. Care must be taken to identify patients with
primary incomplete ablation. Long- term follow-up is needed.
53 Our experiences in laparoscopic simple and radical
nephrectomy
S Sozen, B Kupeli, I Ure, S Gurocak, I Bozkirli
Gazi University School ofMedicine, Department ofUrology, Ankara Turkey
borakupeli@yahoo.com
Aim: To assess our experiences in laparoscopic simple (LSN)
and radical nephrectomy (LRN).
Methods: Between July 2006 - July 2008, we performed LSN
for non-functioning kidney in 15 (37,5%) patients and LRN for
localised kidney tumors in 25 (62,5%) patients. All procedures
were performed transperitoneally. Demographic features,
operation datas and hospitalization times of the patients were
compared.
Results: Mean age of patients were 51,8±14,8 years. The
operation time of LSN were significantly shorter than LRN
(p=0.001). Mean blood loss during the LRN were 184,7±229,5
ml which was statistically higher than LSN (p=0,002). The mean
tumor size and skin incision length for extracting the specimen
were 5,43±3,17 cm and 13,4±4 cm respectively in LRN. The
drain catheter removal time and hospitalization were shorter
in LSN (p=0,003). There were no major complication, however
temporary renal function deterioration and bleeding requiring
blood transfusion were seen in 2(10.5%) and 1(5.2%) patients,
respectively, in LRN group. One LRN patient was converted to
open surgery because of insufficient exposure.
Conclusions: With the increasing experience in laparoscopic
surgery, all open nephrectomies can be replaced with
laparoscopic procedures with the advantage of minimal
complications and short hospitalization times. LRN now
became the first treatment option in all Tlb renal cell carcinoma
patients in our clinic.
54 Retrograde endopyelotomy in a selected population
with ureteropelvic junction obstruction
NM Stilling, HU Jung, B Norby, SS Osther, PJS Osther
Department ofUrology, Fredericia Hospital, Fredericia, Denmark
palle.joeni.osther@slb.regionsyddaimiark.dk
Objective: Controversy remains regarding the best way to treat
ureteropelvic junction obstruction (UPJO). This study evaluated
subjective and objective outcome of retrograde endopyelotomy
in a selected population with UPJO.
Material and methods: 47 patients above 18 years of age with
UPJO in which a very large pelvis, a high insertion of the ureter,
a renal split function below 20% or a long (>2 cm) stenosed
ureteropelvic segment were excluded. Renal function was
estimated on renal diuretic scan before and after surgery with
a mean renographic follow-up of 35 weeks. Subjective results
were based on questionnaires (mean follow-up 110 weeks).
Success criteria were defined as symptom relief and improved
or preserved renal function.
Results: Twenty-nine patients (66%) experienced complete
symptom resolution and 10 patients (23%) had significant
symptom improvement (i.e. no need for pain-killing medication).
Five patients (11%) had unchanged symptoms. No difference in
postoperative renal function was observed between these three
groups of patients. No major complications were observed.
Retrograde ureteroscopic endopyelotomy is a safe and effective
treatment option in patients with primary and secondary UPJO
when selected properly.
55 A case of robotic retroperitoneoscopic pyeloplasty in
a duplex kidney
YF Rawashdeh, LH Olsen, TM Jorgensen
Department of Urology, Aarhus University Hospital - Skejby, Aarhus, Denmark
yazan@ki.au.dk
Aim: To present a case of robotic retroperitoneoscopic
pyeloplasty in a duplex kidney.
Methods: Ten Year old girl presented with a history of left sided
flank pain and recurring episodes of pyelonephritis. Imaging
revealed a left sided incomplete duplex system with severe
dilatation of the lower moiety. Ureteropelvic junction (UPJ)
obstruction of the lower moiety was confirmed by retrograde
pyelography.
The patient was operated in the right lateral position. Access
to the retroperitoneal space was obtained by a muscle splitting
incision below the XII rib, and the space was developed by
balloon dissection. Two 8 mm working ports and an accessory 5
mm port were established maintaining adequate triangulation.
The collecting systems of the duplex kidney were identified,
with obvious stenosis of the lower moiety UPJ. The ureter was
incised in a "U" shaped fashion along the confluence of the
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