HOW I DO IT

• How I do it: laparoscopic renal cryoablation (LRC)

  da Silva Donalisi Rodrigo, Jaworski Paulo, Gustafson Diedra, Nogueira Leticia, Kang Francis, Molina Wilson, Kim J. Fernando, MD Division of Urology, Denver Health Medical Center, Denver, Colorado, USA

  ---

  

  Recently, diagnoses of small renal masses and renal cell carcinoma (RCC) have increased due to the widespread use of radiographic imaging studies (computerized tomography, magnetic resonance imaging). It appears that biological factors such as obesity and tobacco use increase the risk for RCC. In general, small malignant renal masses are low stage and low grade. The management of asymptomatic renal masses is a surgical challenge since overtreatment of benign masses is not desired, especially for patients with complex medical comorbidities, elderly patients, and those with impaired renal function. Partial nephrectomy has been considered the gold standard when treating small renal masses. However, technical challenges and possible irreversible ischemia-reperfusion injury should be considered when treating these lesions. Preservation of renal function without compromising oncological control is the foundation for nephron-sparing surgery. Laparoscopic renal cryoablation (LRC) emerges as an option to treat small renal masses due to the less invasive procedure with low intraoperative complications rates, with no renal ischemia-reperfusion injury and comparable medium term follow up. It is our objective to demonstrate our technique to perform an effective small renal tumor cryoablation using the laparoscopic approach.

  Keywords: renal cancer, renal cryoablation, laparoscopic cryoablation,

  Dec 2014 (Vol. 21, Issue 6 , Page 7574)
  Full Text   |  PDF (532.6KB)Free
• Sacral nerve stimulation for neuromodulation of the lower urinary tract

  Hubsher P. Chad , Jansen Robert , Riggs R. Dale , Jackson J. Barbara , Zaslau Stanley, MD Division of Urology, Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA

  ---

  Sacral neuromodulation (SNM) has become a standard treatment option for patients suffering from urinary urge incontinence, urgency-frequency, and/or nonobstructive urinary retention refractory to conservative and pharmacologic treatment. Since its initial development, the manufacturer of InterStim therapy (Medtronic, Inc., Minneapolis, MN, USA), has introduced technical modifications, while surgeons and researchers have adapted and published various innovations and alterations of the implantation technique. In this article, we feature our SNM technique including patient selection, comprehensive dialogue/evaluation, procedure details, and appropriate follow up. Although there is often great variability in patients with lower urinary tract dysfunction, we maintain that great success can be achieved with a systematic and methodical approach to SNM.

  Keywords: bovine pericardium, renal cancer, partial nephrectomy,

  Oct 2012 (Vol. 19, Issue 5 , Page 6480)
  Full Text   |  PDF (211.7KB)Free