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Biomedical subjects

Glenn S Gerber

Publications and source records attributed to Glenn S Gerber.

At least 19 recordsLinked to original sources
PubMed2006

Solitary ureteral metastases of renal cell carcinoma.

Metachronous presentation of metastatic renal cell carcinoma (RCC) to the ureter is extremely rare. We report a solitary metachronous metastatic RCC in the contralateral ureter 14 months after right radical nephrectomy for Fuhrman grade 2 pT3a clear cell disease after the patient re-presented with gross hematuria. The proximal left ureteral lesion was excised followed by ileal-ureteral interposition. Pathologic examination confirmed metastatic RCC. To date, only 51 cases of metastatic RCC to the ureter have been reported, with only 6 occurring metachronously in the contralateral ureter. Also, we report the presence of focal extramedullary hematopoiesis occurring within this metastatic lesion.

Carcinoma, Renal Cell↗
PubMed2006

Laparoscopic radical nephrectomy: comparison of clinical Stage T1 and T2 renal tumors.

OBJECTIVES: To compare the outcomes after laparoscopic radical nephrectomy (LRN) at our institution to treat Stage T1 and T2 renal tumors. LRN for Stage T1 renal tumors (less than 7 cm) has become the standard of care at many institutions. The feasibility of performing more complex LRNs on higher stage tumors is continually evolving. METHODS: A retrospective review was performed of a prospective database of patients undergoing LRN at the University of Chicago from October 2002 to January 2006. The data on 141 unilateral LRNs, 98 for clinical Stage T1 tumors and 43 for clinical Stage T2 tumors, were analyzed. The demographic, operative, and postoperative data were compared between the two groups. RESULTS: The demographic data between the two groups was comparable. Operatively, patients with larger tumors had significantly greater blood loss, a longer operative time, and a longer surgical incision. Open conversions (1% versus 12%, P = 0.013) and intraoperative complications (5% versus 19%, P = 0.006) were more likely in patients with clinical Stage T2 tumors. Most intraoperative complications were hemorrhage requiring transfusion. However, the postoperative complication rates (25% versus 21%, P = 0.646) and hospital stay (2.0 versus 2.4 days, P = 0.134) were similar between the two groups. CONCLUSIONS: In experienced centers, clinical Stage T2 renal tumors can be managed efficiently with laparoscopy. LRN for larger tumors demonstrated equivalent perioperative safety compared with LRN for smaller tumors.

Diagnosis, Differential↗
PubMed2006

Case report: laparoscopic resection of ureteral inverted papilloma.

Inverted papilloma of the ureter is a rare entity, often mistaken for malignancy during work-up. As such, many of these patients have been unnecessarily treated with nephroureterectomy. Herein, we describe a novel laparoscopic approach for the treatment of a ureteral inverted papilloma. To our knowledge, this approach is the first application of laparoscopy for the treatment of this lesion.

Humans↗
PubMed2006

Case report: Urothelial hyperplasia causing recurrent obstruction after ureteral metal stent placement in treatment of ureteroenteric anastomotic stricture.

Initial experience utilizing metal stents in the treatment of ureteroenteric anastomotic strictures has yielded promising results. However, the long-term efficacy of metal stent placement remains unknown. Further, there is a paucity of literature to describe the technical considerations associated with the surgical management of obstruction after metal stent failure. We report the case of a 67-year-old man undergoing bilateral ureteral metal stent removal and ileal conduit creation following stent failure and recurrent obstruction.

Aged↗
PubMed2005

A new animal model of hyperoxaluria and nephrolithiasis in rats with small bowel resection.

An association between small bowel resection and stone disease has been noted, which is primarily due to increased gut oxalate absorption and resulting excretion by the kidney. In order to better understand the factors affecting both oxalate absorption and renal excretion, and the resulting renal lesions, we have developed a rodent model of small bowel resection and hyperoxaluria. Using this model, we have studied the renal histology in animals with hyperoxaluria over time spans from 2 weeks to 7 months. The initial lesion appears to be crystal formation along the brush border of the proximal tubule, with eventual crystal deposition in collecting ducts and papillary interstitium, and eventual tubule obstruction, interstitial inflammation and fibrosis. Crystal formation appears to dissociate from urinary supersaturation. We hypothesize that oxalate transporters in the proximal tubule may increase local saturations, leading to crystal formation at this site initially. Further studies are required to better characterize the causes and consequences of hyperoxaluria in this animal model.

Animals↗
PubMed2005

Nephrolithiasis and nephrocalcinosis in rats with small bowel resection.

Intestinal resection (IR) may lead to hyperoxaluria and nephrolithiasis. A rat model of IR was developed, in which kidney stones form. We describe the urine chemistries and histopathologic features. Rats underwent resection of 40-45 cm of distal ileum (n=16) or sham resection (SR) (n=8), and were then fed a 1% Na oxalate, 0.02% Ca diet. After 1 week on the diet, 24 h urine samples were obtained for stone chemistries. At 4-7 months after surgery, kidneys were examined grossly and by light microscopy. The extent and location of crystallization was assessed by polarized light. Histochemistry and infrared spectroscopy were used to determine crystal composition. IR rats had higher urine oxalate excretion (P<0.01) and concentration (P<0.001) than SR rats, and lower urine citrate excretion; only IR rats formed kidney stones (12/15 surviving rats). Tissue calcification was found only in kidneys from IR rats, located in the cortex (83% of kidneys), medulla (73%) and papillary tip (47%). Crystals, composed of CaOx, apatite, and calcium carbonate, filled collecting duct lumens, and were associated with tubular obstruction, and interstitial inflammation. Crystals in the papillary interstitium incited inflammation with tubular destruction and development of progressive papillary erosion. This new rat model of nephrolithiasis and nephrocalcinosis resembles the pattern of urinary abnormalities and tissue calcification that may be seen in humans with small bowel resection. The model allows further studies of the mechanisms of renal crystal formation, and possible therapeutic interventions.

Animals↗
PubMed2005

Use of suspension traction system for renal positioning during laparoscopic partial nephrectomy.

BACKGROUND AND PURPOSE: The technical difficulty of laparoscopic partial nephrectomy (LPN) lies mainly in the steps required during warm ischemia time (WIT), which includes tumor excision and renal reconstruction. We present a renal-suspension traction system to place the tumor in stable optimal view during the critical steps of LPN. PATIENTS AND METHODS: Thirty-three patients underwent LPN from October 2002 through December 2003. Eight had a renal sling placed intraoperatively because of difficult access to the tumor. Perioperative parameters were assessed. The renal hilum was dissected and the tumor exposed. To keep the tumor oriented perfectly toward the camera and the working ports, a 2-0 braided polyglactin (Vicryl) traction suture was passed through Gerota's fascia, catching the renal capsule; brought out through the abdominal wall; and secured to the skin with a clamp. RESULTS: All surgical margins were negative. For the traction and nontraction groups, the mean sizes of the tumor were 2.5 cm and 2.2 cm, respectively (P = 0.426). The estimated blood loss was 125 mL and 246 mL respectively (P = 0.041). The WIT average 27.4 minutes and 30.12 minutes (P = 0.470). The surgical time was 192 minutes and 235 minutes respectively, (P = 0.062). Based on our findings, we have devised a renal suspension traction algorithm for specific tumor locations during LPN. CONCLUSIONS: The renal suspension traction system allows precision in tumor excision and renal reconstruction during the critical steps of LPN. With the renal suspension system we devised, we are able to simplify LPN for tumors located away from optimal port access.

Carcinoma, Renal Cell↗
PubMed2005

Laparoscopy.

Urologists around the world are doing more laparoscopy, with renal surgery being the most common procedure. Almost a third devote more than 20% of their practices to laparoscopy. Among those who do not use laparoscopy, lack of training and equipment are the most common reasons.

Asia↗
PubMed2004

Use of botulinum-A toxin for the treatment of refractory overactive bladder symptoms: an initial experience.

OBJECTIVES: To define the role of botulinum toxin type A (botulinum-A) intradetrusor injections in the treatment of patients with symptoms of bladder overactivity in whom previous anticholinergic therapy has failed. METHODS: Thirty-five patients (29 women and 6 men) with frequency, urgency, and/or urge incontinence received 300 U of botulinum-A toxin injected transurethrally at 30 sites within the bladder. Patients were evaluated at 3 weeks and 6 months after treatment by completion of the short forms of the Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6), as well as questions assessing global response to the treatment. RESULTS: After 3 weeks, the mean IIQ-7 score decreased from 19.4 to 13.9 (P = 0.0006) and the mean UDI-6 score decreased from 16.8 to 12.8 (P = 0.0003). Overall, 21 (60%) of 35 patients reported slight to complete improvement of voiding symptoms after 3 weeks. Among the initial responders followed up for 6 months, the mean IIQ-7 score improved from 20.6 to 15.1 (P = 0.008) and the mean UDI-6 score improved from 16.9 to 13.5 (P = 0.008). Mild hematuria, pelvic pain, and dysuria were seen in 7 patients, lasting for 3 days or less after the procedure. CONCLUSIONS: Botulinum-A toxin injections may provide improvement in symptoms associated with bladder overactivity in a subset of patients. Improvement may be seen for at least 6 months after treatment. The procedure was well tolerated with minimal side effects. Additional study to define the role of injections in a broad group of patients with irritative voiding symptoms is warranted.

Adult↗
PubMed2004

En bloc stapling of renal hilum during laparoscopic nephrectomy and nephroureterectomy.

OBJECTIVES: To evaluate the safety and advisability of en bloc mass stapling of the renal pedicle during difficult laparoscopic nephrectomy to avoid conversion to an open procedure. METHODS: A retrospective chart review was performed of 433 consecutive patients undergoing laparoscopic simple or radical nephrectomy or laparoscopic nephroureterectomy between August 1998 and July 2003 by two surgeons. In all cases of en bloc hilar ligation, a stapler was deployed across the renal hilum without individual dissection of the renal artery and vein. RESULTS: The overall incidence of en bloc ligation was 6.0% (26 of 433 patients). The reasons for en bloc ligation were a difficult hilar dissection and/or the appearance of the renal hilum in 21 cases and urgent ligation secondary to bleeding in 5 cases. No correlation was found between surgeon experience and the frequency of en bloc ligation. No immediate or short-term complications related to this method of hilar division were observed with a mean follow-up of 26 months. CONCLUSIONS: In this study, no cases of arteriovenous fistula development occurred after en bloc stapling of the renal pedicle. Long-term follow-up is needed, because arteriovenous fistula development may be a late complication of nephrectomy. Although we do not advocate the generalized use of en bloc division of the renal pedicle, early data suggest that en bloc stapling can be performed to avoid conversion to an open procedure with no related short-term complications.

Arteriovenous Fistula↗
PubMed2004

Percutaneous placement of permanent metal stents for treatment of ureteroenteric anastomotic strictures.

PURPOSE: To evaluate the efficacy of permanent metal stent placement in the treatment of ureteroenteric anastomotic strictures following failed balloon dilation or laser endoureterotomy. PATIENTS AND METHODS: Metal stents were placed in six ureteroenteric anastomotic strictures in four patients presenting with recurrent obstruction after balloon dilation or laser endoureteromy. Patients were evaluated at 1 week postoperatively with antegrade ureterography and at 3 to 6 months with renal ultrasound or CT scans. Serum creatinine assays and physical examination were performed at serial postoperative clinic visits. RESULTS: At 1-week follow-up, antegrade studies demonstrated a patent anastomosis in all six strictures. With a mean follow-up of 10 months (range 7-12 months), no stricture recurrence has been seen. All patients have been clinically stable, without episodes of pyelonephritis, flank pain, or need for indwelling stents or nephrostomy tube placement. Serum creatinine concentrations have been stable in all patients. CONCLUSIONS: Metal stents offer a useful treatment option in patients who develop ureteroenteric anastomotic strictures after urinary diversion. Further, such stents may be used in patients failing balloon dilation or laser endoureterotomy. Further study to assess the long-term durability of metal stent placement is needed.

Anastomosis, Surgical↗
PubMed2004

Management of caliceal diverticula.

Although most caliceal diverticula are asymptomatic, they can be associated with pain, and concomitant calculi are common. When treatment is indicated, a variety of surgical options are available, although the management is often a challenge even to the most experienced surgeon. We review the indications, surgical options, and outcomes for the treatment of caliceal diverticula.

Diverticulum↗