No abstract

No abstract

Aim:In the present study, we discuss the surgical management, complications and clinical outcomes of patients with renal cell carcinoma (RCC) extending into the inferior vena cava (IVC), who were treated with surgical resection at a teaching hospital from 1997 to 2011. Patients and Methods: Twelve patients diagnosed with RCC and IVC tumour thrombus underwent radical nephrectomy and IVC tumour thrombectomy during the study period. Results: Of the 12 patients (male : female: 1:1), the mean age was 65 years (range: 48-82 years). All had good premorbid performance status and no distant metastasis at the time of operation. Employing the Mayo Clinic classification, the tumour thrombus extension was level I in four cases (33 per cent), level II in four cases (33 per cent), level III in two cases (17 per cent) and level IV in two cases (17 per cent). In one patient, the renal tumour extended into the right atrium and had a solitary right pulmonary artery tumour embolus, which subsequently underwent a simultaneous right pulmonary artery tumour embolectomy. In our series, the mean blood loss in levels I-IV tumour thrombus were 1050 mL, 2075 mL, 4152 mL and 11 500 mL, respectively. Complications occurred in three cases (25 per cent), and one (8.3 per cent) required re-laparotomy for haemostasis. There was no hospital mortality. The median follow up was 45.5 months (range: 6-125 months). Median disease-free and overall survivals were 29 and 76 months, respectively. Five-year disease-free and overall survivals were 35.5 per cent and 62.5 per cent, respectively. Conclusion: Radical nephrectomy and IVC tumour thrombectomy remain a challenging procedure. With detailed perioperative planning and multidisciplinary efforts, surgical resection is the definitive treatment of choice for patients with RCC and IVC tumour thrombus. The perioperative and survival outcomes of the present series were comparable to contemporary series. Fig. 2. (a) Right atrium and ascending aorta were cannulated during cardiopulmonary bypass. (b) Surgical specimen of left renal cell carcinoma with inferior vena caval tumour thrombus. MH Cheung et al. 4

Background: Rectourethral fistula is a rare complication of radical prostatectomy. Risk factors include history of pelvic irradiation, cryotherapy, intraoperative rectal injury or transurethral resection of the prostate. Diagnosis of rectourethral fistula requires a high index of suspicion, and complete work-up with endoscopy and imaging studies. The majority of patients require operative intervention, with approaches ranging from transabdominal, transrectal, transanal, and transperineal routes. Method: We report two patients with rectourethral fistula after radical prostatectomy. The first patient was a 59-year-old man who underwent an uncomplicated laparoscopic radical prostatectomy for early prostate cancer in another hospital. The second patient was a 64-year-old man who had local recurrence after cryotherapy for prostate cancer. He underwent salvage radical prostatectomy in a private hospital, which was complicated by intraoperative rectal injury. Results: In both patients, the rectourethral fistulae were successfully repaired with a transperineal approach in the prone jack-knife position. Conclusion: We found that the transperineal approach in the prone jack-knife position offered excellent exposure, allowed versatile surgical manoeuvres and produced successful repair with good continence outcomes.