B acille Calmette-Guerin (BCG), for renal cell carcinoma, 83 Balloon dilatation and rupture, for retrograde endopyelotomy, 177 INDEX

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1 INDEX A bdominal wall distention, for video-controlled surgery, 168 Abscesses, perinephric, 194 diagnosis of, 197 treatment of, 198 Acute renal failure, following nephron-sparing surgery, 52 Adenomas, of aldosteronism, 89 Adjuvant therapy, for renal cell carcinoma, Adrenalectomy, laparoscopic, 95 Adrenal glands, Cushing's syndrome and, management of, 91 hormone synthesis and, 88 hyperaldosteronism and, 92 management of, 92 imaging of, of cysts, 90 of malignant tumors, 89 of myelolipoma, 90 of normal glands, 89 incidentally discovered masses of, 94 laparoscopic adrenalectomy and, 95 pheochromocytoma and, magnetic resonance imaging of, 94 management of, 93 physiology of, 88 Adrenal tumors, of medulla, in von Hippei-Lindau syndrome, 36 Aldosterone, factors regulating production of, 88 Aldosteronism, 92 adenomas of, 89 management of, 92 ALT (autolymphocyte therapy), for renal cell carcinoma, AML (angiomyolipoma), computed tomography in, 18 differential diagnosis of, 6 magnetic resonance imaging in, 18 Angiography, in renal cell carcinoma, in renal oncocytoma, 17 in transitional cell carcinoma, 16 Angiomyolipoma (AML), computed tomography in, 18 differential diagnosis of, 6 magnetic resonance imaging in, 18 Arteriography, for preoperative tumor evaluation, 46 in renal cell carcinoma, 10 Arteriovenous malformations (AVMs), 20 Autolymphocyte therapy (ALT), for renal cell carcinoma, AVMs (arteriovenous malformations), 20 B acille Calmette-Guerin (BCG), for renal cell carcinoma, 83 Balloon dilatation and rupture, for retrograde endopyelotomy, Balloon electrocautery incision, for retrograde endopyelotomy, 177 Basket, for stone retrieval, 122 BCG (bacille Calmette-Guerin), for renal cell carcinoma, 83 ( alcium, calcium oxalate stone formation and, 143 Calcium oxalate stones, primary prevention of, high calcium intake and, 143 key determinants of, 142 protein mechanisms of action and, 143 risk factors for developing, 142 sodium mechanisms of action and, 142 Calyceal anatomy, stone clearance after extracorporeal shock-wave lithotripsy and, 105 Cancer genes, 34 Cardiac arrest, with vena caval tumor involvement, 66, 67 Cardiopulmonary bypass, with vena caval tumor involvement, 66, 67 Cavitation bubbles, extracorporeal shock-wave lithotripsy and, 1 01 Chemoimmunotherapy, for renal cell carcinoma, 78 Children, extracorporeal shock-wave lithotripsy in, 103 Coagulopathy, following surgery for vena caval tumor involvement, 69 Colon, reflection of, for laparoscopic nephrectomy, 154 Computed tomography (CT), adrenal masses discovered by, 94 in angiomyolipoma, 18 of arteriovenous malformations, 20 of cystic renal masses, complex, 26 indeterminate, 26 with renal cell carcinoma, 28 simple, 25 for evaluation of renal masses, 4 in lymphoma, 29 of metastatic renal masses, 20, 29 of oncocytoma, 16, 28 of perirenal fluid collections, 196 peri nephric abscesses, 197 pre- and postoperative, with video-controlled surgery, of renal cell carcinoma, 7 differential diagnosis using, 28 hemorrhagic, 27 precontrast, 2 7 staging using, 8, 31 technique for, 8 spiral, for preoperative tumor evaluation. 46 of transitional cell carcinoma, 15 differential diagnosis using, 28 in urinary tract infections, of venal caval tumor involvement, 59 in von Hippei-Lindau syndrome, 35 in xanthogranulomatous pyelonephritis, 19, 27 Conn's syndrome, 92 adenomas of, 89

2 Conn's syndrome, continued management of, 92 Cooling, renal, 48 Crossing vessels, endopyelotomy and, 179 CT. See Computed tomography (CT) Cushing's syndrome, management of, 91 Cyst(s), adrenal, 90 Cystic renal masses, Bosniak classification of, complex, computed tomography of, 26 simple cystic masses versus, 11 on ultrasonography, 12 ultrasonography in, 25 differential diagnosis of, 24 indeterminate, computed tomography of, 26 magnetic resonance imaging of, 26 simple, complex cystic masses versus, 11 computed tomography of, 25 on ultrasonography, 12, 1 i-14 intraoperative, 2 9 Cystine stones, 148 Cytokines, for renal cell carcinoma, 77 with chemotherapy, 78 clinical responses in patients receiving, 80 cytoreductive surgery following, 81 toxicity of, 79 ihydroxyadenine stones, 148 Dismembered pyeloplasty, 188 Distention balloon, for video-controlled surgery, 167 Drainage system, for antegrade endopyelotomy, 176 Ear, inner, malignant tumors of, in von Hippei-Lindau syndrome, 37 Endopyelotomy, antegrade, classic percutaneous technique for, invagination technique for, 1 76 stenting and drainage system for, 176 crossing vessels and, 179 results of, obstruction type and, 1 79 retrograde, 1 77 balloon dilatation and rupture and, 177 balloon electrocautery incision and, 177 ureterorenoscopic approach and, 177 Endoscopic I ithotri psy, comparison of lithotriptors for, 123 ureteroscopic, for difficult cases, 125 for large stones, with percutaneous nephrolithotomy, 123 residual calculi following, 124 treatment success with, 124 ESWL. See Extracorporeal shock-wave lithotripsy (ESWL) Extracorporeal shock-wave lithotripsy (ESWL), with anatomic abnormalities, 104 cavitation bubble formation and collapse and, 1 01 in children, 103 for larger calculi, 102 pressure course of focal zone and, 1 01 shock wave focusing and, 100 for small calculi, 102 for staghorn calculi, 103 steinstrasse following, 105 stone clearance after, calyceal anatomy and, 1 05 stone spallating and, 101 for ureteral stones, 1 04 an retractor, for video-controlled surgery, 166 Fenger-plasty, enes, cancer, 34 Genetics. See Molecular genetics of renal cell carcinoma emangioblastomas, in von Hippei-Lindau syndrome, 36 Hematomas, perirenal, renal trauma causing, 194, 199 spontaneous hemorrhage and, 195 Hematuria, in renal cell carcinoma, 5 Hemorrhage, perirenal, 195 Hemorrhagic renal cell carcinoma, computed tomography of, 2 7 Hemostasis, for laparoscopic nephrectomy, 159 Hereditary papillary renal carcinoma (HPRC), computed tomography in, 42 kindred diagram of, 42 renal tumors in, 43 Histologic classification, of renal masses, 29 HPRC (hereditary papillary renal carcinoma), computed tomography in, 42 kindred diagram of, 42 renal tumors in, 43 Hydronephrosis. See Laparoscopic pyeloplasty; Ureteropelvic junction (U PJ) obstruction Hyperaldosteronism, 92 adenomas of, 89 management of, 92 Hyperinflation, of lungs, for nephron-sparing surgery, 50 Hyperinflation nephropathy, following nephron-sparing surgery, 54 Hypothermia, with vena caval tumor involvement, 66, 67 t-2 (interleukin-2), for renal cell carcinoma, 77, Immunotherapy, for renal cell carcinoma. See Renal cell carcinoma (RCC), immunotherapy for Infections, of urinary tract, computed tomography in, Inflammatory renal masses,

3 Infundibula, ligation of, 49 Inner ear tumors, malignant, in von Hippei-Lindau syndrome, 37 lnterferon-alfa, for renal cell carcinoma, 77, 78-79, 83 lnterleukin-2 (IL-2), for renal cell carcinoma, 77, Intravenous pyelography (IVP), for diagnosis of venal caval tumor involvement, 58 following nephron-sparing surgery, 51 Invagination technique, for antegrade endopyelotomy, 176 IVP (intravenous pyelography), for diagnosis of venal caval tumor involvement, 58 following nephron-sparing surgery, 51 idney, dissection of, for laparoscopic nephrectomy, 155 technique of, entrapment and extraction of, for laparoscopic nephrectomy, technique of, removal of, using video-controlled surgery, 168 Kidney cancer genes, 34 Knot pusher, for laparoscopic pyeloplasty, 191 AK (lymphokine-activated killer) cells, for renal cell carcinoma, Laparoscopic nephrectomy, colon reflection in, 154 complications of, 162 contrai ndications to, 152 final steps in, 158 hemostasis for, 1 59 indications for, 152 kidney dissection in, 155 technique of, kidney entrapment and extraction in, technique of, Mansoura experience with, 163 patient positioning for, 153 pneumoperitoneum creation for, 153 postoperative care for, 162 preoperative preparation for, 153 renal pedicle control for, retroperitoneal space creation for, technique of, 159 surgical anatomy and, for retroperitoneal approach, 153 for transperitoneal approach, 152 surgical port fixation for, 154 technique of, 160 technical variations of, 158 ureter identification and dissection in, 155 Laparoscopic pyeloplasty, postoperative management with, 191 pyeloplasty and, dismembered, 188 Fenger-plasty, retroperitoneoscopic approach for, 183, 188 success and conversion rates for, 192 suturing technique for, knot pusher an~ 191 laparoscopic, 190 laparoscopic suturing device for, 191 transperitoneal approach for, direct, modified, 187 ventral, 183, 184 trocar positions for, 186 Laparoscopy, conventional, video-controlled surgery versus, 1 70 Lithotripsy. See Endoscopic I ithotripsy; Extracorporeal shock-wave lithotripsy (ESWL) Liver, intracaval neoplastic extension at level of, vena caval isolation with, Lungs, hyperinflation of, for nephron-sparing surgery, 50 Lymph node metastasis, by renal cell carcinoma, 8 Lymphokine-activated killer (LAK) cells, for renal cell carcinoma, Lymphoma, computed tomography in, 29 agnesium, in renal calculi prevention, 146 Magnetic resonance imaging (MRI), of angiomyolipoma, 18 of cystic renal masses, 26 for evaluation of renal masses, 4 of neuroendocrine adrenal tumors, 94 of renal cell carcinoma, 9 staging using, 31, 32 of venal caval tumor involvement, Metastasis, lymph node, by renal cell carcinoma, 8 Metastatic renal masses. See also Renal cell carcinoma (RCC), metastatic computed tomography of, 20, 29 MET gene, 34 Molecular genetics of renal cell carcinoma, cancer genes and, 34 clinical applications of, clinical evaluation and, genetic pattern and, kindred studies and, MRI. See Magnetic resonance imaging (MRI) Myelolipomas, adrenal, 90 ~ ephrectomy, laparoscopic. See Laparoscopic nephrectomy for metastatic renal cell carcinoma, 75 partial, surgical techniques for, 49 Nephrolithotomy, anatrophic, incision for, 135 intraoperative radiography and, 136 multiple, radial paravascular, results and complications in patients undergoing, 139 percutaneous. See Percutaneous nephrolithotomy (PNL) renal preservation and, 135 renal vascular supply and, 135 residual stone control and,

4 Nephron-sparing surgery, algorithm of renal cell carcinoma with normal contralateral kidney and, 53 arterial and infundibular ligation in, 49 com pi ications of, acute renal failure as, 52 urinary fistulas as, 51 postoperative surveillance and, 54 results of, 52 surgical procedure for, closure and, 50 exposure of operative field for, 48 hyperinflation of lungs and, 50 indications for, 50 intraoperative ultrasound for, 49 kidney mobilization for, 48 nephropexy and, 50 normal renal arterial blood supply and, 47 for partial nephrectomy, 49 posterior segmental renal artery and, 49 postoperative intravenous pyelogram and, 51 postoperative photograph and, 51 renal cooling and, 48 renal vein mobilization and, 47 for tumors of upper and lower renal poles, 47 tumor characteristics and survival rates following, 52 tumor evaluation for, 46 tumor location and, 53 tumor recurrence after, 53 Nephropexy, 50 Nephroscopy, flexible, 114 secondary, 11 6 rigid, 113 Nephrostomy tubes, placement of, 115 types of, 11 5 Nephrotomography, in renal cell carcinoma, 7 Neuroendocrine tumors, in von Hippei-Lindau syndrome, 35 Nuclear imaging, in renal cell carcinoma, 11 Nuclear scanning, for evaluation of renal masses, 4 0 ncocytoma, renal, angiography in, 17 computed tomography in, 16, 28 Papillary renal carcinoma, hereditary, computed tomography in, 42 kindred diagram of, 42 renal tumors in, 43 Percutaneous nephrolithotomy (PNL), additional access tracts in, 115 balloon dilation in, 113 complications of, 117 contraindications to, 1 08 guidewire placement for, 111 indications for, 108 needle placement for, 109, nephroscopy in, flexible, 114, 116 rigid, 113 nephrostomy tubes for, placement of, 115 types of, 11 5 patient positioning for, postoperative care with, 11 6 preoperative preparation for, 1 08 safety wire for, 112 secondary flexible nephroscopy and, 116 skin access sites for, 110 tract dilation in, 112 ureteroscopic lithotripsy with, 123 Perinephric abscesses, 194 diagnosis of, 197 treatment of, 1 98 Perirenal fluid collections, computed tomography of, 196 hematomas and, renal trauma causing, 194, 199 spontaneous hemorrhage and, 195 percutaneous drainage of, perinephric abscesses and, 194 diagnosis of, 197 treatment of, 1 98 urinomas and, 194, 196 Perirenal hemorrhage, spontaneous, 195 Perirenal space, normal anatomy of, 195 Pheochromocytoma, magnetic resonance imaging of, 94 management of, 93 Planar lift retractor, for video-controlled surgery, 166 Pneumoperitoneum, creation of, for laparoscopic nephrectomy, 153 PNL. See Percutaneous nephrolithotomy (PNL) Protein, calcium oxalate stone formation and, 143 Pyelography, intravenous, for diagnosis of venal caval tumor involvement, 58 following nephron-sparing surgery, 51 Pyelolithotomy, approach to renal sinus for, extended, 134 simple, 133 Pyeloplasty, laparoscopic. See Laparoscopic pyeloplasty Radiation therapy, for renal cell carcinoma, 83 with cytoreductive surgery, 82 RCC. See Renal cell carcinoma (RCC) Renal arteries, ligation of, 49 normal, 47 posterior segmental, 49 Renal calculi, calcium oxalate. See Calcium oxalate stones cystine,

5 dihydroxyadenine, 148 extracorporeal shock-wave lithotripsy for. See Extracorporeal shockwave lithotripsy (ESWL) incisional surgery for. See Surgery, incisional, for renal calculi magnesium in prevention of, 147 percutaneous nephrolithotomy for. See Percutaneous nephrolithotomy (PNL) struvite, acetohydroxamic acid side effects and, 147 formation of, 147 urease inhibitors and, 148 types of, 142 ureteroscopic management of. See Ureteroscopy, for renal calculi uric acid, dissolution of, 146 primary prevention of, 146 recurrence of, prevention of, 147 Renal cell carcinoma (RCC), 5 adjuvant therapy for, combined-modality treatment of, computed tomography of, precontrast, 2 7 with cystic lesions, computed tomography in, 28 diagnosis and differential diagnosis of, computed tomography in, 28 familial form of, in von Hippel-Lindau syndrome, 9 hematuria in, radiologic evaluation of, 5 hemorrhagic, computed tomography of, 27 immunotherapy for, acquired immune dysregulation and, 76 adoptive, Bacille Calmette-Guerin in, 83 with combination cytokine regimens, 77 with cytokines and chemotherapy, 78 cytokines and cytokine regimens used in, 77 cytokine toxicity and, 79 with interferon-alfa, 77, with interleukin-2, 77, rationale for, 76 metastatic, to lymph nodes, radiologic evaluation of, 8 major sites of, 73 percentage rates of, 72 prognostic factors in, 74 risk assessment in, 7 4 surgical treatment of, molecular genetics of. See Molecular genetics of renal cell carcinoma nephron-sparing surgery for. See Nephron-sparing surgery presentation of, 5 prognosis of, 73 radiologic evaluation of, 6-11 angiography in, arteriography in, 10 computed tomography characteristics and, 7 computed tomography staging and, 8 computed tomography technique in, 8 diagnosis using, 7 magnetic resonance imaging in, 9 nephrotomography in, 7 nuclear imaging in, 11 ultrasonography in, 7 sporadic, VHL gene associated with, staging of, 30-32, 72 computed tomography in, 31 magnetic resonance imaging in, 31, 32 for suspected renal cell carcinoma, 30 TNM classification for, 30 ultrasonography in, 32 venography in, 31 suspected, staging of, 30 treatment failure in, 73 with vena caval involvement. See Vena caval tumor involvement in von Hippel-Lindau syndrome, computed tomography in, 28 Renal cooling, 48 Renal cystic masses, renal cell carcinoma with, computed tomography in, 28 Renal masses, cystic. See Cystic renal masses differential diagnosis of, 6 hereditary forms of, 34 histologic classification of, 29 inflammatory, metastatic, 20 radiologic evaluation of, 3-22 computed tomography for, 4 magnetic resonance imaging for, 4 nuclear scanning for, 4 renal cell carcinoma. See Renal cell carcinoma (RCC) solid. See also specific masses ultrasonography in, 25 urography and, 24 Renal oncocytoma, angiography in, 1 7 computed tomography in, 1 6 Renal pedicle, control of, for laparoscopic nephrectomy, Renal vein, intracaval neoplastic extension at level of, vena caval isolation with, 63 mobilization of, 47 Retroperitoneal space, creation of, for laparoscopic nephrectomy, technique of, 159 Shock waves. See Extracorporeal shock-wave lithotripsy (ESWL) Sodium, calcium oxalate stone formation and, 142 Spallating, of renal stones, by extracorporeal shock-wave lithotripsy, 101 Staghorn renal calculi, extracorporeal shock-wave lithotripsy for, 103 Staging, of renal cell carcinoma. See Renal cell carcinoma (RCC), staging of Steinstrasse, following extracorporeal shock-wave lithotripsy, 105 Stenting, for antegrade endopyelotomy, 176 Stones, renal. See Calcium oxalate stones; Extracorporeal shock-wave lithotripsy (ESWL); Percutaneous nephrolithotomy (PNL); Renal calculi; Surgery, incisional, for renal calculi; Ureteroscopy, for renal calculi 205

6 Struvite stones, acetohydroxamic acid side effects and, 147 formation of, 147 urease inhibitors and, 148 Surgery. See also specific procedures adrenal, 95 cytoreductive, for renal cell carcinoma, following cytokine treatment, 81 radiation therapy with, 82 incisional, for renal calculi, dorsal lumbotomy for, 132 incisions for, 129 indications for, 128 nephrolithotomy. See Nephrolithotomy patient positioning for, 129 preoperative workup for, 128 pyelolithotomy. See Pyelolithotomy supracostal approach for, 131 technique for, 130, 131, 132 nephron-sparing. See Nephron-sparing surgery open, video-controlled surgery versus, 170 for vena caval tumor involvement. See Vena caval tumor involvement video-controlled. See Video-controlled surgery Suturing technique, for laparoscopic pyeloplasty, knot pusher and, 191 laparoscopic, 190 laparoscopic suturing device for, 191 CC. See Transitional cell carcinoma (TCC) Thoracoabdominal incision, for venal caval tumor involvement, 62, 67 TIL (tumor-infiltrating lymphocytes), for renal cell carcinoma, TNM classification, for renal cell carcinoma, 30 Transitional cell carcinoma (TCC), angiography in, 16 computed tomography in, 15 differential diagnosis of, 6 computed tomography in, 28 Trauma, classification of, 198 renal, hematoma due to, 194, 199 Trocar, for video-controlled surgery, 167 Tumor-infiltrating lymphocytes (TIL), for renal cell carcinoma, Tumor-sensitized T cells, for renal cell carcinoma, ltrasonography, adrenal masses discovered by, 94 of cystic renal masses, 12, complex, 25 intraoperative, 2 9 simple, 25 intraoperative, in nephron-sparing surgery, 49 in renal cell carcinoma, 7 staging using, 32 UPJ obstruction. See Ureteropelvic junction (UPJ) obstruction Ureter(s), identification and dissection of, for laparoscopic nephrectomy, Ureteral stones, extracorporeal shock-wave lithotripsy for, 104 Ureteropelvic junction (UPJ) obstruction, diagnosis of, retrograde pyelography for, ultrasound for, 185 etiology of, laparoscopic pyeloplasty for. See Laparoscopic pyeloplasty type of, endopyelotomy results and, 179 Ureteroscopy, for renal calculi, advantages of, 126 basket for stone retrieval and, 122 endoscopic lithotripsy and. See Endoscopic lithotripsy flexible ureteroscopes for, machinery positioning for, 122 patient positioning for, 121 rigid ureteroscopes for, 120 wire-pronged grasper for stone retrieval and, 122 Uric acid stones, dissolution of, 147 primary prevention of, 146 recurrence of, prevention of, 147 Urinary fistulas, following nephron-sparing surgery, 51 Urinary tract infections (UTis), computed tomography in, Urinomas, 194, 196 Urography, with renal masses, 24 Urolithiasis. See Calcium oxalate stones; Extracorporeal shock-wave lithotripsy (ESWL); Percutaneous nephrolithotomy (PNL); Renal calculi; Surgery, incisional, for renal calculi; Ureteroscopy, for renal calculi Urothelial tumors, 15 UTis (urinary tract infections), computed tomography in, / ena caval tumor involvement, clinical presentation of, 58 complications of, 69 incisions for, anterior, 63 with neoplastic extension at level of renal vein, 63 with neoplastic extension to liver, thoracoabdominal, 62, 67 venous stages and, 62 intraoperative cardiopulmonary bypass and, 66, 67 operative technique for, 61 postoperative management with, 69 radiologic evaluation of, computed tomography in, 59 goals of staging and, 58 magnetic resonance imaging in, venacavography in, signs and symptoms of caval occlusion and, 58 surgical results with, tumor thrombus extraction and, 68 Venacavography, inferior, of venal caval tumor involvement, Venography, for preoperative tumor evaluation, 46 in renal cell carcinoma, staging using, 31 VHL. See Von Hippel-Lindau (VHL) syndrome

7 VHL gene, 34, associated with sporadic renal cell carcinoma, autosomal dominant inheritance of, 37 clinical applications of identification of, example of, 41 genetic and physical maps and, 38 intragenic mutations and, 38 mutations of, 40, 41 Video-controlled surgery, abdominal wall distention for, 168 conventional laparoscopy versus, 1 70 distention balloon for, 167 failures using, 170 fan retractor for, 1 66 indications for, 169 kidney removal using, 168 open surgery versus, 1 70 patient positioning and preparation for, 167 performance of, 1 68 planar I ift retractor for, 1 66 pre- and postoperative computed tomography scans and, trocar for, 167 Von Hippei-Lindau (VHL) syndrome. See also VHL gene clinical evaluation of, abdominal computed tomography in, 35 adrenal medulla tumors and, 36 hemangioblastomas and, 36 low-grade malignant inner ear tumor and, 37 neuroendocrine tumors and, 35 clinical features of, 34 genetic diagnosis of, 39 genetic pattern of, renal cell carcinoma in, 9 computed tomography of, 28 ire-pronged grasper, for stone retrieval, 122 anthogranulomatous pyelonephritis (XGP), computed tomography in, 19, 27 in renal cell carcinoma, 5 207

8 COLOR PLATES FIGURE 3-19A. FIGURE 3-19B. FIGURE FIGURE4-3. FIGURE4-7. FIGURE 4-lOA. FIGURE FIGURE 4-lOB. FIGURE FIGURE FIGURE FIGURE Colorplates 209

9 FIGURE FIGURE FIGURE 6-20A. FIGURE 7-8. FIGURE FIGURE FIGURE FIGURE FIGURE FIGURE 13-12A. FIGURE 13-12B. FIGURE 13-12C. FIGURE 13-13A. Ill. The Kidneys and Adrenals 21 0 FIGURE 13-13C.

10 FIGURE FIGURE 13-19A. FIGURE 13-19B. FIGURE 13-19C. FIGURE FIGURE FIGURE 15-2A. FIGURE 15-2B. FIGURE 15-2C. FIGURE FIGURE Colorplates 211

11 FIGURE FIGURE FIGURE FIGURE FIGURE FIGURE 16-13B. FIGURE B. FIGURE FIGURE FIGURE FIGU RE Ill. The Kidneys and Adrenals 212