Biomedical subjects
Publications and source records attributed to P G Hagood.
Laparoscopic surgery is rapidly being assimilated into the urologic armamentarium. Already many operations commonly done by an open approach are being performed laparoscopically. We report on the laparoscopic performance of a simple cystectomy in a spinal cord-injured male patient suffering from recurrent pyocystis. The procedure proved to be technically feasible, with the patient experiencing a short convalescence period.
We recently treated a number of patients with markedly elevated prostate specific antigen (PSA) levels associated with acute urinary retention in a post-cardiac surgery setting. A controlled study was conducted to determine if this elevation is secondary to trauma from urethral catheterization or more directly associated with the cardiac surgery and extracorporeal bypass. In 68 patients undergoing cardiac surgery serum PSA levels were determined preoperatively and 12 to 18 hours postoperatively (after urethral catheterization). The control patients were 23 men undergoing evaluation for chest pain in the cardiac care unit. The serum PSA level was markedly elevated in 38 patients (56%) after cardiac surgery. In contrast, only 1 control patient (4.3%) had an elevated level after urethral catheterization (p = 0.0001). The mean post-cardiac surgery PSA concentration was 9.14 +/- 16.08 ng./ml. (range 0.1 to 94.8) with a mean elevation of 528% (range -50 to 5,155%). This finding was statistically different from the mean post-catheterization level of 1.86 +/- 2.26 ng./ml. (range 0.2 to 9.1, p = 0.034) and mean elevation of 6% (range -50 to 100%, p = 0.0001) in the control patients. We conclude that cardiac surgery and extracorporeal cardiopulmonary bypass can cause a marked elevation in serum PSA that appears to be unrelated to urethral catheterization. Presently, the etiology of this elevation is unknown, although PSA measurements may eventually find use as a marker for prostatic damage associated with acute urinary retention in the postoperative setting.
A total of 221 patients underwent laparoscopic surgery at our institution. An outcome analysis with regard to type of procedure, success and complications was done. Overall, 216 of 221 procedures (97.7%) were performed as originally planned. One operation was converted to an open procedure. Complications producing morbidity occurred in 33 of 217 patients (15.2%). There was no associated mortality. Most complications occurred early in the participating surgeons experience. Of the complications 11 (5.0%) were considered major and included formation of symptomatic lymphoceles (4 patients), vascular injury (1), ureteral transection (1), bladder perforation (1), bowel obstruction (1), cecal perforation (1) and cerebrovascular accident (1). One patient had an idiopathic reaction to the inhalation anesthetic. Of the 11 major complications 9 occurred among 98 patients undergoing pelvic lymphadenectomy and 7 of these occurred among a subset of 15 patients undergoing an extended dissection. Adjuvant surgical intervention was necessary in 13 patients: celiotomy in 5, laparoscopic techniques in 4 and minor surgical procedures or percutaneous techniques in 4. Our experience suggests that urological laparoscopic surgery is safe and offers a shorter convalescence. However, the technique must be regarded as major surgery, associated with a steep learning curve.
Recent reports have established the feasibility and minimal morbidity of laparoscopic pelvic lymph node dissection in the staging of prostate and bladder cancer. In addition, a prospective study recently published established the completeness and efficacy of this form of endocavitary surgical lymphadenectomy with respect to the standard modified open procedure. The method's utility prior to definitive radiation therapy or radical perineal prostatectomy is obvious. However, clear indications of its utility in identifying men with positive nodes prior to radical retropubic prostatectomy are less clear. A description of the surgical technique as well as a review of the existing literature, and our present indications for its use are presented. In addition, possible future applications of endocavitary node dissection will be put in context.
The advent of laparoscopy has expanded the horizon for endocavitarily approaching urologic disorders, otherwise managed by open surgical procedures. In this article we will review our experience with this new modality as applied to the urinary bladder, and put into perspective future applications.
Laparoscopic techniques have expanded the possibilities of endo-surgically approaching urological abnormalities that would otherwise be managed via an open operation. We report on another useful application of the laparoscope, bladder diverticulectomy. A large bladder diverticulum, responsible for incomplete bladder emptying and recurrent urinary tract infections in an 87-year-old man, was successfully excised endoscopically. The technique and possible future indications are described.
The use of varicocelectomy for the treatment of subfertility seems to be incontrovertible. However, there is a difference of opinion as to the proper surgical method of varicocele ablation. The inguinal and high retroperitoneal approaches are the most commonly accepted methods to date. However, significant postoperative morbidity is common and return to normal activity often is prolonged. Also, bilateral operations are being performed more commonly. These considerations have prompted many to search for alternative techniques. We developed a laparoscopic procedure that is as simple and effective as more traditional methods. In addition, it offers lower morbidity, allows for microscopic dissection with preservation of the spermatic artery and is amenable to bilateral ligation without a second incision. Ten patients 16 to 54 years old underwent laparoscopic ligation of the spermatic veins at the internal inguinal ring. The diagnosis was based on physical examination. Indications for the operation were infertility with a stress sperm pattern in 5 patients, testicular atrophy in 4 and scrotal pain in 1. Four patients underwent bilateral ligation. Preliminary followup showed resolution of the varicocele in all patients and disappearance of pain in the patient treated for this symptom. No morbidity related to this procedure has been encountered and all patients resumed normal activity within 2 days. We believe that this new method is a viable alternative for varicocelectomy.
Lymphocele formation, a common complication of pelvic surgery, can produce considerable morbidity. Treatment is problematic, with no single procedure considered optimal. We recently treated a 67-year-old man with a symptomatic lymphocele by laparoscopic internal marsupialization. Total operative time was 45 min, and the patient was discharged home the same day with minimal need for pain medications. Total resolution of the symptoms occurred within 24 h. In comparison to other methods compiled and analyzed from the literature, this highly effective, minimally invasive procedure offers a significant advantage to the patient.
This report details clinical and pathologic aspects of a patient with small cell undifferentiated carcinoma of the prostate and systemic hyperglucagonemia. A panel of potential serologic markers was evaluated in order to document additional evidence of ectopic hormonal production. Immunocytochemical markers were sought in tissue samples from the primary neoplasm and a lung metastasis. Stains were positive for corticotropin (ACTH) and gastrin in both the prostate and in the lung, but no evidence of excess secretion was documented. These findings are consistent with the notion that neuroendocrine activity is common in undifferentiated small cell carcinomas, regardless of their site of origin.
Although rare, urinary tract infections in children by salmonella species have been associated with a high incidence of structural anomalies. We report on a 5-year-old patient with Salmonella enteritidis urinary tract infection associated with ureteropelvic junction obstruction.