UP-1.041: Retroperitoneoscopic Drainage of a Psoas Abscess (Two Cases)

UNMODERATED POSTER SESSIONS

liberty of the collecting system was made sure by extraction of hydatid materiel through the fistula. An internal drainage (ureteral stent) of the cavities was performed for large, sloping and pelvic fistula (50%). Nephrectomy was preformed in 5 cases. Only one case of lumbar fistula was treated by internal drainage with good outcome. No cyst recurrence was observed with a mean follow-up of 5 years. Conclusions: Communication with the collecting system is a frequent complication of renal hydatid cyst. Hydaturia is the clinical feature of such complication. It requires conservative treatment with extraction of hydatid materiel from the collecting system and closure of the fistula. An internal drainage should be performed for large, sloping and pelvic fistula. The prognosis remains good.

UP-1.040 Retroperitoneal Laparoscopic Nephrectomy for Pyelonephritic Kidney Rabii R, El-Mhef S, Khelil M, Aboutaib R, Meziane F Urology Department Ibn Rochd Hospital Casablanca, Casablanca, Morocco Introduction and Objective: Retroperitoneal laparoscopic nephrectomy (RLN) is a relatively recent technique whose performance needs to be firmly established. The aim of this study is to assess the results of retroperitoneal laparoscopic nephrectomy for pyelonehretic kidney at a single centre. Materials and Methods: We used a technic with 5 trocars that did not require balloon dilatation of the retroperitoneal space. Results: It was successful in 95% of cases. The average operative times of RLN were 115 minutes. In no instance did the laparoscopic procedure need to be converted to open surgery. There were no peri- or postoperative complications that could be related to the RLN technique. The average length of hospitalization after RLN was 3.8 days. Conclusion: In conclusion, our experience shows that RLN is a safe, reproducible technique that reduces recovery time. It must become the first-line approach for simple nephrectomy.

UP-1.041 Retroperitoneoscopic Drainage of a Psoas Abscess (Two Cases) Rabii R, Aboutaib R, Dakir M, Meziane F Urology Department, Ibn Rochd Hospital, Casablanca, Morocco

Introduction and Objective: Pyogenic psoas abscess is a primary or secondary condition caused mostly by Staphylococcus aureus or tuberculosis. The preferred treatment is percutaneous or surgical drainage under a cover of systemic antibiotics. Laparoscopic drainage scores over open surgery in terms of minimal invasion, shorter hospital stay, better patient comfort, and more complete drainage compared with the percutaneous approach. We report two cases of primary pyogenic psoas abscess that was effectively drained laparoscopically through an extraperitoneal approach. Materials and Methods: Under general anesthesia, the patient was placed in the lateral position. Four trocars were used. A 15 mm incision was made under the 12th rib and the retroperitoneum entered digitally using blunt dissection, pushing the peritoneum forward, aspiring a purulent liquid and allowing the other trocars to be inserted. After washing the retroperitoneum cavity with saline solution, the cavity of psoas abscess was explored, and multiple biopsies specimen were taken. Results: Operative time was less 35 min, the follow-up was good; the patients left hospital after two days without wound infection. The histological results confirmed a psoas abscess tuberculosis in one case, which was treated with antituberculosis drugs for nine months with good results. In the second case, pyogenic psoas abscess was treated by antibiotics for two weeks with good follow-up. Conclusions: The laparoscopic approach of the psoas abscess can avoid the large scars and wound infections happened every time in open surgery with cosmetic results and short hospital stay. The retroperitoneal laparoscopy permits to avoid the contamination of the peritoneal cavity. Retroperitoneal laparoscopy of the psoas abscess reproduces and respects all the principle procedures of conventional surgery: large drainage and biopsy of the psoas which we can not do by percutaneous punction. UP-1.042 Laparoscopic Treatment for Renal Hydatid Cyst Using a Retroperitoneal Approach (An Initial Experience) Rabii R, Aboutaeib R, Dakir M, Meziane F Urology Department, Ibn Rochd Hospital, Casablanca, Morocco Introduction and Objective: Surgery continues to be the mainstay of the treatment for the hydatid cyst. The rapid development of laparoscopy has encouraged surgeons to replicate the principles of

UROLOGY 74 (Supplment 4A), October 2009

conventional hydatid surgery using a minimally invasive approach. We report our experience about five cases between 2005 and 2007. Materials and Methods: Five patients underwent laparoscopic resection of the renal hydatid cyst by retroperitoneal laparoscopic approach. All patients were explored by CT-scan and hydatic serology. CT-scan showed three cases with type III (multivesicular cysts) and two cases type I (univesicular cysts). The hydatic serology was negative in two cases (one type I and one type III). Under general anesthesia and lateral position, five trocars were used. A 15 mm incision was made under the 12th rib and retroperitoneum was entered digitally using blunt dissection, pushing the peritoneum forward and allowing the other trocars to be inserted. The retroperitoneum was created without balloon dilatation. After dissection of the renal hydatic cyst, the endobag was put inside in front of the cavity. A scolicid agent (20% hypertonic saline solution) was injected around the kidney initially and then instilled into the cyst. After that, the cyst content had been evacuated. All the hydatid membranes and hydatic cysts were putted into the endobag. Results: There were no complications nether anaphylactic shocks. The mean operative time was 90 minutes (80 to 130 minutes). The hospital stay was two days after moving up the catheter. The convalescence was short, less than 7 days. No recurrence was observed after an average time of 2 years (1 to 3 years). Conclusion: The retroperitoneal laparoscopic surgery for hydatic cyst is feasible, safe, with good outcome and offers all the laparoscopy surgery advantages: short hospital stay and convalescence, low morbidity and good results. UP-1.043 Evaluation of the Stonebreaker™ for Treatment of Ureteral Stone Disease Leventis A, Leonardopoulos L, Fasoulakis C, Sakelariou G, Drenidis G, Rempelakos A Urology Department Hippokrateion General Hospital, Athens, Greece Introduction and Objective: To evaluate the safety and efficacy of the StonebreakerTM portable, cordless, pneumatic lithotripter for intracorporeal lithotripsy of ureteral stones. Material and Methods: Eighty-one ureteral stone disease patients, six of which were ESWL failures, were prospectively included in this study during a twelve-

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