Laparoscopic Radical Nephrectomy

Laparoscopic Radical Nephrectomy

872 UROLITHIASIS, ENDOUROLOGY AND LAPAROSCOPY 0.08%.1 The fact remains that laparoscopic surgery, despite the minimal access it affords, remains a m...

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0.08%.1 The fact remains that laparoscopic surgery, despite the minimal access it affords, remains a major surgical procedure with all of the attendant risks of complications and mortality. Ralph V. Clayman, M.D. 1. Fahlenkamp, D., Rassweiler, J., Fornara, P., Frede, T. and Loening, S. A.: Complications of laparoscopic procedures in urology: experience with 2,407 procedures at 4 German centers. J Urol, 162: 765, 1999

Indwelling Ureteral Stents: Evaluation of Quality of Life to Aid Outcome Analysis H. B. JOSHI, A. STAINTHORPE, F. X. KEELEY, JR., R. MACDONAGH AND A. G. TIMONEY, Bristol Urological Institute, Southmead Hospital, Bristol and Department of Urology, Taunton and Somerset Hospital, Taunton, United Kingdom J Endourol, 15: 151–154, 2001 Background: Ureteral stents cause various side effects. We have evaluated health-related quality of life (HRQoL) in patients with stents using validated questionnaires and developed a new stent symptom (intervention)-specific questionnaire (SSQ). Patients and Methods: Along with structured literature review and in-depth interviews, prospective substudies were carried out using generic (SF-36 [N ⫽ 30], EuroQol [N ⫽ 40], and Functional Status Questionnaire FSQ [N ⫽ 20]) and symptom-specific (IPSS [N ⫽ 30] and International Continence Society ICS [N ⫽ 30]) questionnaires both with a stent in situ and after removal. The results of these studies formed the foundation for a new SSQ that was pilot tested (N ⫽ 10) and field tested (N ⫽ 20) in order to develop a final draft of the questionnaire that is formally validated. Results: The qualitative research identified a range of problems. Urinary symptoms, pain, work performance, and general health were the most important. Most patients (80%) experienced bothersome urinary symptoms and stent-related pain. Storage symptoms and incontinence were significant urinary symptoms affecting quality of life. As many as 40% of patients experienced sexual dysfunction. The stent had a significant impact on patients’ general health. None of the existing measures evaluated the complete impact. The SSQ includes five sections covering urinary symptoms, pain, sexual matters, general health, and work performance. The preliminary results showed it to be valid, reliable (␣ ⬎0.7) and responsive to the change in scores ( p ⬍0.05) after stent removal. Conclusions: Indwelling ureteral stents are associated with significant morbidity, resulting in a reduced HRQoL in 80% of patients. The SSQ is a reliable intervention-specific instrument that would be useful as an outcome measure to evaluate the impact of stents. Editorial Comment: The development of a validated stent questionnaire is a major step forward in the determination of stent related morbidity. The authors were able to use other validated questionnaires to develop their stent specific questionnaire, thereby reducing the items a patient has to answer from 116 to 42. This instrument provides all urologists interested in stent technology with a means to evaluate the clinical impact of developments in stent materials, stent design and stent configuration. Hopefully, in the near future use of a validated questionnaire will be a prerequisite to publication of any clinical study dealing with patient related quality of life issues. Ralph V. Clayman, M.D. Laparoscopic Radical Nephrectomy A. ZISMAN, A. J. PANTUCK, A. S. BELLDEGRUN AND P. G. SCHULAM, Department of Urology, University of California School of Medicine, Los Angeles, California Semin Urol Oncol, 19: 114 –122, 2001 Permission to Publish Abstract Not Granted Editorial Comment: This is an excellent review of the state of the art of laparoscopic radical nephrectomy. It nicely documents the maturation of the data on laparoscopic radical nephrectomy and makes a cogent argument for the replacement of open radical nephrectomy with a laparoscopic approach in all patients with stage T1 or T2 disease who are candidates for radical nephrectomy. One excellent point in this article is the need for intact extraction of the specimen if the patient has metastatic disease and is a candidate for tumor specific vaccine. Other than for this specific situation, the method of removal (that is intact versus morcellation) really is the decision of the individual surgeon. Ralph V. Clayman, M.D. Radially Expanding Laparoscopic Access for Renal/Adrenal Surgery B. SHEKARRIZ, S. S. GHOLAMI, D. M. RUDNICK, Q.-Y. DUH AND M. L. STOLLER, Departments of Urology and Surgery, University of California, San Francisco, School of Medicine, San Francisco, California Urology, 58: 683– 687, 2001 Objectives. To use a radially expanding system (Step) and a modified port location for intra-abdominal access to decrease the access-related complications in renal and adrenal surgery. Access-related complica-