Laparoscopic Nephrectomy
by Narendra Narepalem, M.D.
Originally appeared in Urology Update, the patient newsletter of Northwest Suburban Urologists, LTD.

Renal cell carcinoma compromises approximately 3% of all adult malignancies with approximately 30,000 new cases diagnosed each year. It is more common in males with a 2:1 male-to-female raio. With the greater use of CT, ultrasound, and MRI, over 2/3 of all renal masses are now found incidentally. Common treatment options include observation and surgical treatment with either partial or radical nephrectomy.

Laparoscopic nephrectomy is emerging as a preferable alternative to open nephrectomy in appropriately selected patients. Advantages include decreased post-operative pain, decreased hospital stay, and decreased post-operative convalescence.

The procedure is performed through four incisions approximately 1 centimeter in length in the abdomen. After the kidney has been mobilized and the renal hilum trasected, the kidney may be removed en bloc through an additional 5-6 centimeter incision. An alternative removal method involves intra-corporeal morcellation in which the kidney is essentially cut into smaller pieces within the body and eventually removed through one of the existing port sites. There is no difference between efficacy of open versus laparoscopic nephrectomy.

The patient is initiated on clear liquids on post-operative day one and is discharged on post-operative day 2 if a regular diet is tolerated and the patient is ambulating without difficulty.

In conclusion, laparoscopic nephrectomy is a safe alternative to traditional open nephrectomy in appropriately selected patients for both benign and malignant renal disease. The procedure generally results in decreased post-operative morbidity and decreased post-operative convalescence.

Pubovaginal Sling Procedure
by Jeffrey P. Norris, M.D.
Originally appeared in Urology Update, the patient newsletter of Northwest Suburban Urologists, LTD.

The pubovaginal sling procedure is a well-tolerated minimally invasive surgical procedure that is performed for treatment of stress urinary incontinence. This is done through a small vaginal incision. Tiny titanium screws are placed in the pelvic bone on both the sides of the urethra. These screws are attached to sutures that support a rectangular strip of durable tissue that is passed beneath the urethra. This rectangular patch supports the urethra and the bladder, so that the leakage does not occur during coughing, sneezing, laughing or other physical activities. The patients typically do not require more than one day of hospitalization and sometimes can go home on the same day.

Many times, this procedure will be performed in conjunction with cystocele repair surgery. A cystocele is a name for a dropped bladder, and this can be repaired by pulling the pelvic muscles together, so that the bladder can no longer drop and cause bulging or pressure through the vagina.

At the time of the surgery, it is quite common to have a catheter placed in the bladder by making a small puncture in the skin above the pubic bone. This tube allows for drainage of urie from the gladder when the patient cannot urinate normally after the first day of the surgery due to post0operative swelling. Most of the time, the patients are able to urinate on the first post-operative day, and the tube can be removed before the patients are discharged from the hospital.

In conclusion, the pubovaginal sling procedure and cystocele repair surgery are typically well-tolerated minimally invasive surgical procedures that effectively treat female stress urinary incontinence and pelvic floor prolapse.