Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 10 de 10
Filtrar
Mais filtros










Filtros aplicados
Intervalo de ano de publicação
1.
Rev. méd. Chile ; 150(2): 172-177, feb. 2022. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1389638

RESUMO

BACKGROUND: Upper urinary tract urothelial carcinoma (UTUC) represents 5-10% of urothelial carcinomas. It is managed with nephroureterectomy (NUR); however, kidney-sparing techniques are growingly used. AIM: To report the results of a 20-year series of NUR conducted in an academic center. Patients and Methods: Review of clinical and pathological characteristics of patients undergoing NUR between 1999 and 2020. Patients were followed for 63 months. Global survival curves (OS) and mortality predictors were established through Cox regression. RESULTS: We included 90 patients with a median age of 68 years undergoing NUR, of whom 68 (75%) had a pelvic tumor and 22 (25%) had a proximal ureteral tumor. A laparoscopic NUR was performed in 60 patients (66%). Thirty-three patients (37%) had tumors confined to the urothelium (pTa), penetrating the lamina propria (pT1) or carcinoma in situ (CIS), 10 patients (11%) had a tumor spreading to the muscle layer (pT2) and 47 (52%) had a tumor spreading to nearby organs (pT3 / T4). Average tumor size was 3.69 cm, nodal disease (pN) was present 12 patients (13%). Twelve patients (13%) received adjuvant chemotherapy. A higher mortality was observed among smokers (Hazard ratio (HR) 8.79, 95% confidence intervals (CI) 1.5-49.0, p = 0.01), patients with tumors classfied as pT≥ 2 (HR 1.09, 95% CI 0.01-1.0, p = 0.04) and those with tumors larger than 2 cm (HR 14.79, CI 95% 1.5-272, p = 0.01). CONCLUSIONS: Smoking patients, those with invasive tumors (T2-T4) and greater than 2 cm have higher mortality. Therefore, they should not be candidates for conservative management.


Assuntos
Humanos , Idoso , Neoplasias Ureterais/cirurgia , Neoplasias Ureterais/patologia , Neoplasias da Bexiga Urinária/cirurgia , Carcinoma de Células de Transição/cirurgia , Carcinoma de Células de Transição/patologia , Neoplasias Renais/cirurgia , Prognóstico , Estudos Retrospectivos , Nefroureterectomia
2.
Int. braz. j. urol ; 47(5): 1072-1073, Sept.-Oct. 2021.
Artigo em Inglês | LILACS | ID: biblio-1286814

RESUMO

ABSTRACT Introduction: One of the most remarkable characteristics of urothelial carcinomas is multifocality. However, occurrence of synchronous bladder cancer and upper urinary tract urothelial cancer (UTUC) is exceptional. Minimally invasive approach for these synchronous tumors was just occasionally reported (1-4). The aim of this video article is to describe step-by-step the technique for simultaneous laparoscopic nephroureterectomy and robot-assisted anterior pelvic exenteration with intracorporeal ileal conduit urinary diversion (ICUD). Patients and methods: A 66-year-old female presented with synchronous BCG refractory non-muscle invasive bladder cancer and a right-side UTUC. She was a former smoker and had previously been submitted to multiple transurethral resections of bladder tumor, BCG and right distal ureterectomy with ureteral reimplant. We performed a simultaneous laparoscopic right nephroureterectomy and robot-assisted anterior pelvic exenteration with totally intracorporeal ICUD. Combination of robot-assisted and pure laparoscopic approaches was proposed focusing on optimization of total operative time (TOT). Results: Surgery was uneventful. TOT was of 330 minutes. Operative time for nephroureterectomy, anterior pelvic exenteration and ICUD were 48, 135, 87 minutes, respectively. Estimated blood loss was 150mL. Postoperative course was unremarkable and patient was discharged after 7 days. Histopathological evaluation showed a pT1 high grade urothelial carcinoma plus carcinoma in situ both in proximal right ureter and bladder, with negative margins. Twelve lymph nodes were excised, all of them negative. Conclusion: In our preliminary experience, totally minimally invasive simultaneous nephroureterectomy and cystectomy with intracorporeal ICUD is feasible. Pure laparoscopic approach to upper urinary tract may be a useful tactic to reduce total operative time.


Assuntos
Humanos , Exenteração Pélvica , Derivação Urinária , Neoplasias da Bexiga Urinária/cirurgia , Robótica , Laparoscopia , Cistectomia , Nefroureterectomia
3.
Int. braz. j. urol ; 46(5): 778-785, Sept.-Oct. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1134213

RESUMO

ABSTRACT Purpose: To investigate the association between preoperative retrograde pyelography (RGP), conducted to evaluate upper tract urothelial carcinoma (UTUC), and intravesical recurrence (IVR) after radical nephroureterectomy (RNU). Materials and Methods: Of 114 patients that underwent RNU, 72 patients without preoperative ureteroscopy and a history of bladder tumor were selectively enrolled. Variables associated with IVR were identified. Results: RGP was performed at a mean duration of 24.9 days prior to RNU in 41 (56.1%) of study subjects. During the mean follow-up period of 64.5 months, IVRs were identified in 32 (44.4%) patients at 22.3±18.8 (mean±SD) months after RNU. Despite similar tumor characteristics in the RGP and non-RGP groups, the incidence of IVR was considerably higher in the RGP group (63.4%) than in the non-RGP group (19.4%, p <0.001). The following variables differed significantly between the IVR and non-IVR groups: age (64.6±8.51 vs. 59.6±9.65 years), tumor location (lower or upper; 53.1% vs. 20%), tumor invasiveness (> pT2; 53.1% vs. 17.5%), preoperative hemoglobin (12.8±1.36 vs. 13.9±1.65), preoperative creatinine (1.29±0.32 vs. 1.11±0.22), and preoperative RGP (81.3% vs. 37.5%), respectively. Multivariate Cox regression model showed that tumor location (p=0.020, HR=2.742), preoperative creatinine level (p=0.004, HR=6.351), and preoperative RGP (p=0.045, HR=3.134) independently predicted IVR. Conclusion: Given the limitations of retrospective single-center series, performance of RGP before RNU was shown to have a negative effect on IVR after surgery.


Assuntos
Humanos , Carcinoma de Células de Transição/cirurgia , Carcinoma de Células de Transição/diagnóstico por imagem , Neoplasias Urológicas/diagnóstico por imagem , Nefroureterectomia , Urografia , Estudos Retrospectivos , Recidiva Local de Neoplasia/diagnóstico por imagem , Nefrectomia
6.
Int. braz. j. urol ; 44(6): 1174-1181, Nov.-Dec. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-975656

RESUMO

ABSTRACT Objective: To evaluate the safety and feasibility of total retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection for a tuberculous nonfunctional kidney. Materials and Methods: A total of 27 individuals diagnosed with unilateral nonfunctional kidney secondary to tuberculosis were treated between June 2011 and June 2015. All patients had normal renal function on the contralateral side and underwent the standard four-drug anti-tuberculosis treatment for at least four weeks before surgery. Total retroperitoneal laparoscopic nephroureterectomy was performed in all patients, and the urinary-bladder junction of distal ureter was managed using different auto-suture techniques. Results: Nineteen male and 8 female patients with an average age of 47.3 years (range, 36-64 years) underwent surgery. All the operations were successfully performed without conversion. The median operative time was 109.3 min (range, 75-138 min), the median blood loss was 157.5 mL (range, 70-250 mL), and the median hospitalization time was 3.7 days (range, 3-6 days). No serious perioperative complications occurred. Anti-tuberculosis chemotherapy was prescribed to all patients, with the entire course of treatment lasting six months. No recurrence of tuberculosis of the bladder or the contralateral kidney was observed during the median follow-up period of 26.7 months (range, 6-54 months). Conclusion: Retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection is a safe and feasible approach for the treatment of tuberculous non-functional kidneys.


Assuntos
Humanos , Masculino , Feminino , Adulto , Tuberculose Renal/cirurgia , Laparoscopia/métodos , Nefroureterectomia/métodos , Espaço Retroperitoneal/cirurgia , Resultado do Tratamento , Duração da Cirurgia , Pessoa de Meia-Idade
7.
Int. braz. j. urol ; 44(1): 22-37, Jan.-Feb. 2018. tab
Artigo em Inglês | LILACS | ID: biblio-892953

RESUMO

ABSTRACT Upper tract urothelial carcinoma (UTUC) is a rare and aggressive disease that is associated with high rates of recurrence and death. Radical nephroureterectomy (RNU) with excision of the bladder cuff is considered the standard of care for high-risk UTUC, whereas kidney-sparing techniques can be indicated for select patients with low-risk disease. There is a significant lack of clinical and pathological prognostic factors for stratifying patients with regard to making treatment decisions. Incorporation of tissue-based molecular markers into prognostic tools could help accurately stratify patients for clinical decision-making in this heterogeneous disease. Although the number of studies on tissue-based markers in UTUC has risen dramatically in the past several years—many of which are based on single centers and small cohorts, with a low level of evidence—many discrepancies remain between their results. Nevertheless, certain biomarkers are promising tools, necessitating prospective multi-institution studies to validate their function.


Assuntos
Humanos , Biomarcadores Tumorais/análise , Neoplasias Urológicas/diagnóstico , Prognóstico , Sensibilidade e Especificidade , Neoplasias Urológicas , Nefroureterectomia , Recidiva Local de Neoplasia/diagnóstico
9.
Rev. chil. urol ; 82(4): 70-77, 2017. tab
Artigo em Espanhol | LILACS | ID: biblio-906211

RESUMO

Introducción: La simulación en medicina está cobrando cada vez mayor importancia, principalmente en el área quirúrgica, ya que nos otorga la posibilidad de lograr el aprendizaje de forma segura, bajo ambiente controlado y reproducible. Nuestro objetivo es establecer una pauta estructurada de realización de ureteroscopía flexible para un procedimiento simulado de nefro-ureterolitotomía endoscópica.Material y métodos. Se utilizó el método de Delphi modificado. Se contactó vía correo electrónico a cinco urólogos a los cuales se les envió un checklist para la evaluación de la técnica del procedimiento de 1 a 7, agregando comentarios. Basado en esto, se modifica el checklist en 2 oportunidades, hasta lograr el consenso.Resultados. Se obtiene una la versión definitiva del checklist. Esta consta de 20 puntos, con una media que fluctúa entre 5,6 y 7, y una mediana entre 6 y 7. El coeficiente de Cronbach para establecer su consistencia interna es de 0,86.Conclusión. Se establece un listado estándar para la realización de nefro-ureterolitotomíaendoscópica flexible utilizando el método de Delphi modificado.(AU)


Introduction: The simulation in medicine is becoming increasingly important, mainly in the surgical area, because it gives us the possibility to achieve learning safely, in a controlled and reproducible environment. Our objective is to establish a structured guideline of flexible ureteroscopy for a simulated endoscopic nephro ureterolithotomy procedure.Material y Methods. The modified Delphi method was used. Five urologists were contacted via email, a checklist was sent for the evaluation of the procedure technique from 1 to 7, adding comments. Based on this, the checklist is modified 2 times, until consensus is reached.Results. A final version of the checklist is obtained. It consists in 20 points, with a mean that fluctuates between 5.6 and 7, and a median between 6 and 7. The Cronbach coefficient to establish its internal consistency is 0, 86.Conclusion. A standard list is established using the modified Delphi method for the performance of flexible endoscopic nephro-ureterolithotomy.(AU)


Assuntos
Nefroureterectomia , Ureteroscopia , Endoscopia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...