Renal cyst treatment (Table 3.16)

The laparoscopic treatment of renal cysts represents a minimal invasive procedure which is easy to perform compared to the alternative of percutaneous sclerotherapy. Only one comparative study exists (246), in which laparoscopic deroofing of renal cysts demonstrated a 5% recurrence rate compared with an 82% recurrence rate for sclerotherapy. In three papers (247-249), the various experiences of laparoscopic treatment of renal cysts are reviewed, mainly with a few patients. Both cortical and peripyelic cysts have been treated. The indications for treatment were pain and infection. The operative time ranged from between 50 and 390 minutes, and the success rate ranged between 50% and 100%, with a follow up of between 6 and 40 months. The main complications reported were bleeding and haematomas. It is recommended that the surgeon performs a biopsy of the base of complex cysts and fills the unroofed cavity with perirenal fat.

Table 3.16 Renal cyst treatment: guideline recommendations

Ureterolithotomy (Table 3.17)

Laparoscopic ureterolithotomy is seldom indicated in the era of Shockwave lithotrypsy (SWL) and endo-urology. The few reported cases in the literature are very small series, without randomized, controlled or comparative studies. Only one review paper (247) considers the possible indications: failure of SWL or endo-urological

methods; large stone requiring multiple SWL or endo-urological interventions; longstanding impacted stone; multiple ureteric calculi. Because of the risk of urinary leakage, a post-procedure ureteral stent is recommended. The success rate is between 90% and 100%, whereas the conversion rate is up to 15%.

Table 3.17 Ureterolithotomy: guideline recommendations

Varicocelectomy (Table 3.18)

Laparoscopic spermatic vein ligation is reported in the early series of urological laparoscopy (250-260). It is a procedure that is easy to perform and has a low rate of complications (2-12%). In controlled studies, similar results were obtained with laparoscopic spermatic vein ligation compared with open surgery (261-265), including a pregnancy rate of 26-47%, an improvement in sperm density of 27-80%, and a recurrence rate of 1-20%. The mean operative time is longer than for open surgery (10-170 minutes). Although it provides an alternative to the Palomo technique, it carries costs and is more invasive, and is therefore considered appropriate only for bilateral varicocele.

Table 3.18 Varicocelectomy: guideline recommendations

References

Date: 2016-06-13; view: 7