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Biomedical subjects

L R Kavoussi

Publications and source records attributed to L R Kavoussi.

At least 19 recordsLinked to original sources
PubMed1992

Percutaneous management of urolithiasis during pregnancy.

A total of 6 pregnant women with obstructing urinary calculi was managed by percutaneous nephrostomy drainage placed under ultrasound guidance with the patient under local anesthesia. All patients initially had relief of acute obstruction. However, occlusion of the percutaneous nephrostomy tubes with debris necessitated tube changes in 5 of 6 patients. In 2 patients recurrent nephrostomy tube obstruction, fever and pain led to percutaneous stone removal during pregnancy. In the remaining 4 patients the nephrostomy tubes were left indwelling through delivery. During the postpartum period 3 patients successfully underwent ureteroscopic stone extraction and 1 passed the stone spontaneously. Bacteriuria developed in each patient despite the use of preventive antibiotics. All 6 women had uncomplicated vaginal deliveries of healthy newborns and are currently asymptomatic with no evidence of obstruction. Percutaneous drainage of an acutely obstructed kidney in a pregnant woman is an effective temporizing alternative to ureteral stent placement until definitive treatment can be performed.

Adolescent↗
PubMed1992

Endoscopic hydrocele ablation.

A new technique for the treatment of hydroceles by percutaneous drainage and endoscopic ablation under direct vision is described. The possible benefits and drawbacks of this treatment modality for symptomatic hydroceles are discussed.

Catheter Ablation↗
PubMed1992

Laparoscopic ureterolysis.

We report a case of an obstructed right kidney due to retroperitoneal fibrosis. Ureterolysis, biopsy of the retroperitoneal tissue and intraperitonealization of the ureter were accomplished laparoscopically.

Adolescent↗
PubMed1992

Organ entrapment system for removing nodal tissue during laparoscopic pelvic lymphadenectomy.

When performing a laparoscopic pelvic lymph node dissection, the tissue specimen may be too large to remove through the laparoscopic trocar. An organ entrapment system has been developed that allows en bloc retrieval of nodal tissue via an 11 mm. trocar site. This system facilitates tissue removal, and minimizes the risk of tissue loss and possible peritoneal or wound contamination.

Humans↗
PubMed1992

Caveat emptor: caliceal stones and the missing calix.

The failure of a stone-containing calix to visualize on an imaging study (that is a missing calix) is often the initial and only sign of an associated pyocalix, since the patient may present without fever and with sterile urine. Extracorporeal shock wave lithotripsy (ESWL*) in these patients may lead to life-threatening systemic sepsis. Therefore, the treatment of choice for the stone-laden missing calix is percutaneous drainage of the affected calix followed by percutaneous stone removal and, when necessary, an endoinfundibulotomy to reestablish communication between the obstructed calix and the renal pelvis.

Adult↗
PubMed1992

Endoureterotomy for treatment of ureteral strictures.

Advances in endosurgical technology have provided the urological surgeon with an alternative to open surgery for the treatment of ureteral strictures. We report the use of an endoscopic intraureteral incision (endoureterotomy) followed by balloon calibration to treat benign ureteral strictures in 13 patients. With an average subjective and objective followup among successful endoureterotomies of 20 months (all cases 12 months or greater), the overall success rate for this procedure is 62%. Of these patients 5 also received triamcinolone injections into the stricture bed following incision and dilation. This method appeared to influence favorably subsequent ureteral patency. The only operative complication was a urinoma, which resolved without intervention. Endoureterotomy appears to be a safe and reasonably effective modality for the treatment of ureteral stricture disease.

Adult↗
PubMed1992

Laparoscopic nephrectomy: a review of 16 cases.

Laparoscopic nephrectomy is a new procedure in which the entire kidney is removed via an endoscopic technique using a surgical sack entrapment method in combination with a recently developed high-speed 10-mm electrical tissue morcellator. Since June 25, 1990, this procedure has been successfully accomplished in 16 consecutive patients. The average operating room time was 5.6 h. Two patients received a blood transfusion (one and three units, respectively). The average hospital stay was 4.6 days, and convalescence was completed within an average of 12 days. We believe the methods developed for laparoscopic nephrectomy will allow surgeons in other disciplines to broaden their indications for laparoscopic surgery as the entrapment sack and morcellator can potentially be applied to the removal of many other solid intraabdominal and pelvic tissues.

Adolescent↗
PubMed1991

Bilateral renal cell carcinoma with metastasis to thyroid.

A case of bilateral synchronous renal cell carcinomas with metastases to the regional lymph nodes and later to the thyroid gland was treated with aggressive surgical extirpation and adjuvant gamma interferon. The patient continues to have an excellent performance status sixteen months after initial diagnosis despite a large tumor burden at presentation.

Carcinoma, Renal Cell↗
PubMed1991

Laparoscopic nephrectomy: initial case report.

A tumor-bearing right kidney was completely excised from an 85-year-old woman using a laparoscopic approach. A newly devised method for intra-abdominal organ entrapment and a recently developed laparoscopic tissue morcellator made it possible to deliver the 190 gm. kidney through an 11 mm. incision.

Adenoma↗
PubMed1991

Effect of temporary occlusion of hypogastric arteries on blood loss during radical retropubic prostatectomy.

We report on a prospective, partially randomized study of 130 patients, examining the effect of temporary occlusion of the hypogastric arteries on intraoperative blood loss, perioperative blood replacement and change in preoperative to postoperative hematocrit. We observed no significant difference in any of these parameters when comparing patients who did and did not undergo intraoperative occlusion of the hypogastric arteries. These findings suggest that temporary occlusion of the hypogastric arteries during radical prostatectomy does not have a major effect on the blood loss associated with this operation. Extensive collateral circulation to the prostate and a substantial venous component of blood loss may explain these findings. Banking of 3 units of autologous blood preoperatively would have decreased the need for homologous transfusions in the majority of patients.

Adenocarcinoma↗
PubMed1991

Ureteronephroscopic marsupialization of obstructing peripelvic renal cyst.

Flexible ureteronephroscopy has been used for numerous therapeutic applications in the upper urinary tract. We report a case of a large peripelvic renal cyst causing obstruction to the ureteropelvic junction, which was treated by incising the wall of the cyst into the renal pelvis with the ureteronephroscope.

Endoscopes↗
PubMed1991

Endopyelotomy for secondary ureteropelvic junction obstruction in children.

Percutaneous endopyelotomy has been shown to be successful in treating ureteropelvic junction obstruction in adults. Little data have been published regarding this procedure in children. We describe 4 patients 6.5 weeks to 5.5 years old who underwent percutaneous endopyelotomy to treat ureteropelvic junction obstruction following failed open dismembered pyeloplasty. Preoperative obstruction was demonstrated by a nephrostogram, diuretic renogram and/or ultrasonography. Percutaneous endopyelotomy was successful in relieving the obstruction in all 4 patients, although 2 required secondary endoscopic procedures. One patient had persistent obstruction 40 days after endopyelotomy at the ureteropelvic junction and, subsequently, required percutaneous resection of a persistent flap of obstructing tissue. In another patient a ureterovesical stricture was noted at the time of stent removal, which was treated by endoscopic incision. All patients have been followed from 1.5 to 3 years postoperatively. Followup diuretic renograms, ultrasound and/or excretory urography demonstrated a patent ureteropelvic junction in all patients and all have remained asymptomatic. Endopyelotomy appears to be safe and effective in treating secondary ureteropelvic junction obstruction in children.

Child, Preschool↗
PubMed1991

Endourological treatment of ureteroenteric anastomotic strictures: long-term followup.

In 1987 we reported our initial experience with an endosurgical incisional approach to ureteroenteric anastomotic strictures (that is endoureterotomy). We have extended that initial report to encompass 15 patients with 19 ureteroenteric strictures followed for an average of 2.5 years. In all cases an endosurgical approach was well tolerated, blood loss was less than 50 cc and hospital stay averaged 3.5 days. A 16 to 22F external stent was left in place for 4 to 6 weeks postoperatively in 14 strictures. A permanent external 12F catheter was left in 5 strictures due to the presence of metastatic disease (4) and a complete dense stricture (1). The only major complication was a ureteroenteric fistula that healed over a ureteral stent without any open surgical intervention. Among 14 ureteroenteric strictures in which the stent was removed, the ureteroenteric area has remained patent in 8 (57%) with an average followup of 28.6 months (range 9 to 57 months). Failures were associated with metastatic disease in 2 cases, generalized debility in 2 and unexplained in 2. In this series an endosurgical approach to ureteroenteric strictures provided long-term satisfactory management of the problem in the majority of patients with benign and malignant disease. By current standards, only 1 patient (7%) would have been considered a candidate for open surgical repair.

Adolescent↗
PubMed1991

Laparoscopic nephroureterectomy: initial clinical case report.

Using a 12-mm GIA laparoscopic stapling device, a method of organ entrapment, and a recently developed high-speed electrical tissue morcellator, laparoscopic nephroureterectomy was accomplished in an 82-year-old male with a low-grade transitional cell cancer of the renal pelvis.

Aged↗
PubMed1990

Role of nerve-sparing radical prostatectomy for clinical stage B2 prostate cancer.

To examine the role of nerve-sparing radical prostatectomy in patients with clinical stage B2 prostate cancer we reviewed the first 77 such patients in our series since we adopted the nerve-sparing technique. A total of 47 patients (61%) underwent bilateral and 26 (34%) underwent unilateral nerve-sparing prostatectomy, while in 4 (5%) both neurovascular bundles were resected. Among the patients followed for 12 months 27 of 41 (66%) treated with bilateral and 7 of 19 (37%) treated with unilateral nerve-sparing prostatectomy had potency preserved. With the strict clinicopathological criteria of organ-confined tumor, that is intracapsular tumor with negative surgical margins and undetectable postoperative prostate specific antigen levels, complete tumor excision was achieved in 17 patients (36%) treated with bilateral and 7 of 26 (27%) treated with unilateral nerve-sparing prostatectomy. All patients in whom both neurovascular bundles were resected had pathological stage C or D1 disease. Of the 24 patients who had complete tumor excision by the strict criteria only 15 (19.5% of the 77 preoperatively potent patients) had potency preserved. Of these patients 19 had microscopically positive margins without seminal vesicle invasion (pathological stage C1) with undetectable postoperative prostate specific antigen levels. In addition, 4 patients had seminal vesicle involvement with negative surgical margins and undetectable postoperative prostate specific antigen levels. If these patients also are considered as having complete tumor excision, there was an over-all complete tumor excision rate of 61% (47 of 77), of whom 25 (32% of the 77 patients) had preservation of potency. Ten patients with clinical stage B2 tumor whose potency was preserved had histological and serological evidence of incomplete tumor excision. Of 53 patients with pathological stage C1 disease 9 (17%) had margins positive only in the regions of the neurovascular bundles. Preoperative prostate specific antigen and acid phosphatase levels, and findings on transrectal ultrasonography failed to predict accurately which patients had extracapsular tumor extension. Patients with poorly differentiated tumors and/or bulky disease on rectal examination had a higher incidence of extracapsular extension and positive margins. We conclude that in the majority of potent patients with clinical stage B2 prostate cancer not all of the goals of nerve-sparing radical prostatectomy are realized.(ABSTRACT TRUNCATED AT 400 WORDS)

Acid Phosphatase↗
PubMed1990

Fibronectin-mediated Calmette-Guerin bacillus attachment to murine bladder mucosa. Requirement for the expression of an antitumor response.

Adjuvant intravesical Calmette-Guerin bacillus (BCG) is an effective treatment for superficial bladder cancer. The mechanisms by which BCG mediates antitumor activity are not known. We investigated the initial interaction of BCG with the bladder mucosa to determine whether binding was essential for the development of antitumor activity. Herein, we show that bladder urothelial disruption induced by acrolein, adriamycin, or electrocautery resulted in BCG binding in areas of urothelial damage. Binding induced by each method was inhibited by anti-fibronectin (FN) antibodies but not by antibodies to the basement membrane component laminin. Intravesical BCG binding also was inhibited by pretreating BCG with soluble FN. Inhibition of intravesical FN-mediated BCG attachment prevented immunization via the intravesical route. Moreover, the expression of both delayed hypersensitivity in the bladder of BCG-immunized mice and antitumor activity was inhibited by blocking FN-mediated intravesical BCG attachment. These data suggest that intralumenal attachment of BCG appears to be mediated by FN. Moreover, these data suggest that intravesical FN mediated attachment of BCG is a requisite step in BCG-mediated antitumor activity in the murine bladder tumor model.

Acrolein↗