Endourology & laparoscopy

Abstract

could stratify risk of stone recurrence and predict patients at high risk of recurrence. From a review of 204 patients followed for 2 to 5 years with radiographic studies and history, a linear regression model was constructed to determine the importance of each factor in predicting stone recurrence. The factors of positive family history, multiple stones, gouty arthritis and SRPS correlated with stone recurrence rate. At an SRPS cut-off level of ≥ 7, the sensitivity and specificity of calcium oxalate stone recurrence is 62% and 75%, respectively.In this era of limited resources and costly medical care, stratification of risk is critical in order to allow identification of subgroups of patients more likely to suffer a defined event. Metabolic evaluation and indefinite medical therapy is costly. On the other hand, surgery is also costly, but the likelihood of experiencing a stone event requiring surgery is relatively low. As such, prophylactic treatment of patients after their first stone event may not be cost-effective. However if we can identify patients at highest risk of stone recurrence, medical evaluation and treatment in this group would avoid much suffering and expense and would likely justify the cost of treatment. This self-administered questionnaire provides a quick way to stratify patients, and although it will require further retrospective and prospective validation in larger patient groups, it represents a first step towards simple risk stratification. Objectives: To present our experience with the treatment of adult ureteropelvic junction (UPJ) obstruction using a laparoscopic Hellstrom vascular relocation technique. Dr. Margaret S. PearleMethods: Transperitoneal laparoscopy was performed in 35 patients for the management of UPJ obstruction. In 9 cases, we identified crossing lower pole vessels and performed the Hellstrom technique. We discuss our indications, intraoperative techniques, and outcomes when performing only vascular relocation in these patients.Results: All 9 patients presented with long-standing flank pain and were identified as having UPJ obstruction (7 primary, 2 secondary) on radiographic imaging. The intraoperative decision to perform the Hellstrom technique was based on the presence of the crossing vessels, a grossly normal appearance of the ureter and UPJ, and a small renal pelvis. The crossing vessels were completely mobilized, displaced cephalad, and fixed using intracorporeal sutures. The mean operative time and blood loss was 164 minutes and 15 mL, respectively. At a mean follow-up of 19 months (range 14 to 31), the patients were asymptomatic with no evidence of obstruction on Lasix nuclear renography.Conclusions: Traditional treatment of UPJ obstruction, with or without crossing vessels, has been accomplished by pyeloplasty. Dismembered pyeloplasty is a standard method in cases of associated crossing vessels; however, we propose that the Hellstrom technique be considered in cases in which the ureter appears normal and the pelvic anatomy is unfavorable for transection and ant...