Publications by authors named "Gheorghe Nita"

4 Publications

  • Page 1 of 1

Retroperitoneal Laparoscopic Radical Prostatectomy.

Chirurgia (Bucur) 2018 Jul-Aug;113(4):542-550

Retroperitoneal Laparoscopic Radical Prostatectomy (RLRP) has been introduced in our department as the first line treatment for patients with localized prostatic cancer and life expectancy over 10 years. At the time, the surgical team had already extensive experience in minimally invasive urologic surgery. Our aim is to describe the laparoscopic technique we currently use and to analyze our oncologic and functional results. Patients and All the patients who underwent RLRP in our institution (PONDERAS ACADEMIC HOSPITAL) from January 2015 to March 2017 were included into a prospective study. The standard preoperative protocol included blood tests, prostate biopsy, pelvis MRI and bone scintigraphy, while the particular therapy was discussed and approved by the Institutional Multidisciplinary Tumor Board. In all the 45 cases, RLRP was indicated for localized prostate cancer. The average patient’s age was 68 years (range 45 â€" 74 years), mean preoperative prostate specific antigen (PSAi) level was 8 ng/mL (range 3â€"15 ng/mL) and prostatic volume between 26 and 52 cc. The laparoscopic approach was completed in all 45 cases â€" no conversions to open surgery. Bilateral nerve sparing was performed in 7 cases (16%) and unilateral in 23 cases (51%). The mean operative time was 165 minutes (range 120 - 240 min), while the average blood loss was 255 mL (range 20â€"800) and two patients received blood transfusions. The mean catheterization time was 10 days (range 7â€"14 days). Positive surgical margins were observed in 8 cases (17.7%). Overall, 86% and respectively, 93% of the patients were continent during the following 3 and 6 months. 51% of the patients had erectile disfunction 6 month after the intervention. Four complications were encountered: intraoperatively - rectal injury (1 case) and postoperatively - bleeding (2 cases) and stenosis at the vesicourethral anastomosis (1 case). No mortality or late morbidity encountered. The radical laparoscopic prostatectomy is a safe and efficient procedure for localized prostate cancer with minimal complications and short hospitalization time, but it requires an experienced team of laparoscopic surgeons. The functional and oncological outcomes of LRP are expected to be improved as the medical team experience is extended.
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http://dx.doi.org/10.21614/chirurgia.113.4.542DOI Listing
June 2019

Ureteroscopic laser approach in recurrent ureteropelvic junction stenosis.

Eur Urol 2007 Jun 8;51(6):1542-8. Epub 2006 Sep 8.

Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania.

Objectives: Endourological procedures are widely used for treating ureteropelvic junction (UPJ) obstruction. Our aim was to establish the value of using laser retrograde endopyelotomy (REP) in cases with recurrence.

Materials And Methods: Between November 2000 and June 2005 we performed 30 REPs in recurrent UPJ obstruction with grades 3 and 4 hydronephrosis (failed pyeloplasty, 17 cases; failed endopyelotomy, 13 cases). Our series was characterized by absence of renal calculi, stenosis length<2 cm, and absence of massive hydronephrosis. We used semirigid and flexible endoscopic equipment (Wolf and Storz) and holmium:YAG laser. In 11 cases, an indwelling double J was placed for 2 wk. An indwelling pyelostent 8/12 F was postoperatively placed for 8 wk.

Results: All cases were evaluated at 6, 12, and 18 mo. Ultrasonography and urography were the main follow-up investigations. At 6 mo, we found normal UPJ and pyelocaliceal system in 9 cases (30%); a reduction of the hydronephrosis degree with normal UPJ in 4 cases (13.3%); and no changes of the hydronephrosis degree in 17 cases (56.6%), but with large UPJ passage in 13 of the 17 cases (76.5%). REP success did not correlate with the degree of hydronephrosis. The success rate after 18 mo was 83.3%. Patients experienced minor complications. The mean follow-up period was 31 mo (range: 18-52 mo).

Conclusions: REP may represent an efficient minimally invasive technique in recurrent UPJ stenosis, with a reduced rate of complications, short period of hospitalization, and good anatomical and functional results.
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http://dx.doi.org/10.1016/j.eururo.2006.08.035DOI Listing
June 2007

Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience.

J Endourol 2006 Mar;20(3):179-85

Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania.

Background And Purpose: Ureteroscopy is nowadays one of the techniques most widely used for upper urinary- tract pathology. Our goal is to describe its complications in a large series of patients.

Patients And Methods: Between June 1994 and February 2005, 2436 patients aged 5 to 87 years underwent retrograde ureteroscopy (2735 procedures) under video and fluoroscopic assistance. We used semirigid ureteroscopes (8/9.8F Wolf, 6.5F Olympus, 8F and 10F Storz) for 384 diagnostic and 2351 therapeutic procedures. Upper urinary-tract lithiasis (2041 cases), ureteropelvic junction stenosis (95 cases), benign ureteral stenosis (29 cases), tumoral extrinsic ureteral stenosis (84 cases), iatrogenic trauma (35 cases), superficial ureteral tumors (16 cases), superficial pelvic tumors (7 cases), and ascending displaced stents (44 cases) were the indications. The mean follow-up period was 56 months (range 4-112 months).

Results: The rate of intraoperative incidents was 5.9% (162 cases). Intraoperative incidents consisted of the impossibility of accessing calculi (3.7%), trapped stone extractors (0.7%), equipment damage (0.7%), and double- J stent malpositioning (0.76%). In addition, migration of calculi or stone fragments during lithotripsy was apparent in 116 cases (4.24%). The general rate of intraoperative complications was 3.6% (98 cases). We also saw mucosal injury (abrasion [1.5%] or false passage [1%]), ureteral perforation (0.65%), extraureteral stone migration (0.18%), bleeding (0.1%), and ureteral avulsions (0.11%). Early complications were described in 10.64%: fever or sepsis (1.13%), persistent hematuria (2.04%), renal colic (2.23%), migrated double-J stent (0.66%), and transitory vesicoureteral reflux (4.58%, especially in cases with indwelling double-J stents). We also found late complications such as ureteral stenosis (3 cases) and persistent vesicoureteral reflux (2 cases). Most (87%) of the complications followed ureteroscopic therapy for stones. Three fourths (76%) of the complications occurred in the first 5 years of the series.

Conclusions: According to our experience, mastery of ureteroscopic technique allows the urologist to proceed endourologically with minimum morbidity. Despite the new smaller semirigid instruments, this minimally invasive maneuver may sometimes be aggressive, and adequate training is imperative.
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http://dx.doi.org/10.1089/end.2006.20.179DOI Listing
March 2006

Value of duplex Doppler ultrasonography in renal colic.

Eur Urol 2002 Jan;41(1):71-8

Department of Urology, Saint John Emergency Hospital, Bucharest, Romania.

Objectives: The aim of our study was to determine the value of duplex Doppler ultrasonography (DDU) in the patients' evolution with renal colic. The study of the resistive index (RI), difference of the RI (ARI) associated with a DDU intravesical recording (ureteral jets) were compared with renographic findings in renal colic.

Patients And Methods: Between October 1998 and January 2001 we studied 377 cases with suspected renal colic by intravenous pyelography (IVP), grey-scale ultrasonography and DDU with determination of the RI, the difference between the RI of ipsilateral and contralateral kidneys (ARI) and the amplitude (maximum length of the intravesical ureteral jet), velocity and frequency of the urine bolus. We considered normal values RI < or = 0.70 and ARI < or = 0.06. VP was used as a referee investigation and the ureteral intravesical jets were determined in standard conditions. All patients came to the hospital between 4 and 12 h after the onset of the renal colic.

Results: We found four series of patients: 1, acute (complete) obstructed kidney (IVP nonfunctional) and dilatation at normal grey-scale, with normal contralateral kidney (n = 153). In this series we found RI > 0.70 in 87%, RI > 0.06 in 90% and absent ureteral intravesical jet of the obstructed kidney site in 89%; 2, acute (complete) obstructed kidney (IVP nonfunctional) without abnormalities at normal grey-scale, with normal contralateral kidney (n = 57). In this series we found RI > or = 0.70 in 73.5%, deltaRI > 0.06 in 82.5% of patients, absent or asymmetric ureteral intravesical jet in 80.7% of cases; 3, incomplete obstructed kidney (IVP with various degree of ureterohydronephrosis) with normal contralateral kidney (n = 96). In this series we found RI > or = 0.70 in 58.3% and deltaRI > 0.06 in 64.5% of patients, asymmetric ureteral intravesical jets in 74% of cases; 4, normal both kidneys normal IVP) were found in 71 cases (18.8%). In this series we found RI < 0.70 in 80.2%, deltaRI < or = 0.06 in 89% of cases, normal ureteral intravesical jets in 93% of cases. The mean RI was 0.76 (0.05) in 306 obstructed kidneys, significantly higher than the mean RI of 0.62 (0.05) in 448 normal kidneys (P < 0.001). The ARI in patients with obstruction was significantly higher than in patients with normal both kidneys, at 0.08 (0.05) and -0.001 (0.03), respectively (P < 0.001). The RI was sensitive in 75.5% and specific in 92.5% and ARI was sensitive in 80.7% and specific in 95.7% (versus IVP, considered the referee value). The presence of the intravesical ureteral jets of the renal colic side, associated with the values of RI (RI < or = 0.70) and deltaRI (deltaRI < or = 0.06), was followed by spontaneous passage of the stones in 71% of cases.

Conclusions: Renal DDU and consecutively, intravesical evaluation of ureteral jets could detect acute renal obstruction and, as a functional investigation, could have a predictive value regarding the ureteral stones passage. It could replace the IVP, being a sensitive and highly specific test.
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http://dx.doi.org/10.1016/s0302-2838(01)00005-7DOI Listing
January 2002