Objective: The aim was to assess the place of endourologic intervention in our practice and compare it to open surgery in the management of upper urinary tract calculi in Senegal. Patients and Methods: This was a retr...Objective: The aim was to assess the place of endourologic intervention in our practice and compare it to open surgery in the management of upper urinary tract calculi in Senegal. Patients and Methods: This was a retrospective study conducted at both the Principal and Grand Yoff Hospitals of Dakar from January 2009 to December 2013 in which 89 patients with upper urinary tract calculi were mobilized. All patients with symptomatic upper urinary tract colic symptoms were included. Results: Eighty-nine were followed up during the study period, 63 men and 36 women (sex of ratio 1.2). The average age was 44 years with extremes 22 - 75 years. Forty two patients, including 28 men and 14 women (sex ratio 1: 2) were treated with open surgery. The mean age was 42.75 years (4 - 75 years). The average duration of hospitalization after open surgery was 8 days (4 - 60 days). The mean stone size in open surgery was 23 mm (5 mm - 45 mm). Complications noted were: 2 cases of urinomas (4.76%), 1 case of lower back fistula (2.38%), 1 case of renal pelvis fistula (2.38%) and 1 case (2.38%) of infection. Forty seven patients including 35 men (55.6%) and 12 women (46.2%) were treated by endourology. The average length of hospital stay was 2 days (2 d - 3 d). The average stone size treated by endourology was 13 mm (5 mm - 40 mm). No complications were observed in this group. The cost of open surgery was a third of that of endourology. Conclusion: Endoscopic surgery, as is observed from industrialized countries occupies a prominent place in the treatment of upper urinary tract calculi in Senegal;however, the only limiting factor encountered is the cost which remains out of reach for patients and burdening the budgets of our hospitals with limited means.展开更多
Upper urinary tract urothelial carcinomas(UTUCs)are uncommon and account for only 5%e10%of urothelial carcinomas.Pyelocaliceal tumors are about twice as common as ureteral tumors.Sixty percent of UTUCs are invasive at...Upper urinary tract urothelial carcinomas(UTUCs)are uncommon and account for only 5%e10%of urothelial carcinomas.Pyelocaliceal tumors are about twice as common as ureteral tumors.Sixty percent of UTUCs are invasive at diagnosis.Radical nephroureterectomy,including the excision of the distal ureter and bladder cuff is standard of care for treatment of localized UTUCs,because of the high potential for recurrence,multifocality,and progression.Since first laparoscopic nephroureterectomy(LNU)was introduced by Clayman et al.in 1991 and improvement of laparoscopic technique and equipment,LNU has been reported to be equivalent to conventional open method.We reviewed the current literature of patients with UTUCs treated by LNU focusing on technical aspects,peri-operative and oncological outcomes.Laparoscopic radical nephroureterectomy offers the advantages of minimally invasive surgery without deteriorating the oncological outcome for treatment of UTUCs.Indications tend to increase as operator skills increase.Indications for laparoscopic or open nephroureterectomy are in principle the same.The basic requirement for laparoscopic surgery in UTUCs is to achieve benefits of minimal invasive surgery and maintain oncologic principles.展开更多
文摘Objective: The aim was to assess the place of endourologic intervention in our practice and compare it to open surgery in the management of upper urinary tract calculi in Senegal. Patients and Methods: This was a retrospective study conducted at both the Principal and Grand Yoff Hospitals of Dakar from January 2009 to December 2013 in which 89 patients with upper urinary tract calculi were mobilized. All patients with symptomatic upper urinary tract colic symptoms were included. Results: Eighty-nine were followed up during the study period, 63 men and 36 women (sex of ratio 1.2). The average age was 44 years with extremes 22 - 75 years. Forty two patients, including 28 men and 14 women (sex ratio 1: 2) were treated with open surgery. The mean age was 42.75 years (4 - 75 years). The average duration of hospitalization after open surgery was 8 days (4 - 60 days). The mean stone size in open surgery was 23 mm (5 mm - 45 mm). Complications noted were: 2 cases of urinomas (4.76%), 1 case of lower back fistula (2.38%), 1 case of renal pelvis fistula (2.38%) and 1 case (2.38%) of infection. Forty seven patients including 35 men (55.6%) and 12 women (46.2%) were treated by endourology. The average length of hospital stay was 2 days (2 d - 3 d). The average stone size treated by endourology was 13 mm (5 mm - 40 mm). No complications were observed in this group. The cost of open surgery was a third of that of endourology. Conclusion: Endoscopic surgery, as is observed from industrialized countries occupies a prominent place in the treatment of upper urinary tract calculi in Senegal;however, the only limiting factor encountered is the cost which remains out of reach for patients and burdening the budgets of our hospitals with limited means.
文摘Upper urinary tract urothelial carcinomas(UTUCs)are uncommon and account for only 5%e10%of urothelial carcinomas.Pyelocaliceal tumors are about twice as common as ureteral tumors.Sixty percent of UTUCs are invasive at diagnosis.Radical nephroureterectomy,including the excision of the distal ureter and bladder cuff is standard of care for treatment of localized UTUCs,because of the high potential for recurrence,multifocality,and progression.Since first laparoscopic nephroureterectomy(LNU)was introduced by Clayman et al.in 1991 and improvement of laparoscopic technique and equipment,LNU has been reported to be equivalent to conventional open method.We reviewed the current literature of patients with UTUCs treated by LNU focusing on technical aspects,peri-operative and oncological outcomes.Laparoscopic radical nephroureterectomy offers the advantages of minimally invasive surgery without deteriorating the oncological outcome for treatment of UTUCs.Indications tend to increase as operator skills increase.Indications for laparoscopic or open nephroureterectomy are in principle the same.The basic requirement for laparoscopic surgery in UTUCs is to achieve benefits of minimal invasive surgery and maintain oncologic principles.
