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INTRODUCTION: We aimed to evaluate the impact of the resection technique (tumor enucleation (TE) or standard partial nephrectomy (SPN)) on trifecta outcomes in patients having undergone partial nephrectomy (PN). MATERIALS AND METHODS: We retrospectively analyzed the clinical and pathologic parameters in patients with localized renal cell carcinoma (pT1-2N0M0) who had undergone PN between January 2001-December 2018 at one of 15 different tertiary referral centers. Multivariable logistic regression analysis was applied to investigate independent predictors of trifecta failure, decreased postoperative renal functions (decreased estimated glomerular filtration rate (eGFR) > 10%), perioperative complications (Clavien-Dindo > 1), and positive surgical margins. RESULTS: A total of 1070 patients with a mean age 56.11 ± 11.88 years were included in our study. PN was performed with TE in 848 (79.25%) and SPN in 222 (20.75%) patients. Trifecta failure rate was 56.2% for TE and 64.4% for SPN (p = 0.028). On multivariable analysis, TE was associated with less trifecta failure (p = 0.025) and eGFR decrease >10% rates (p = 0.024). On the other hand, there was no statistically significant difference between TE and SPN according to positive surgical margins (p = 0.450) and complication > Clavien-Dindo grade 1 (p = 0.888) rates. The only independent predictive factor for complications > Clavien-Dindo 1 was the Charlson comorbidity index (CCI) (p = 0.001). CONCLUSION: TE is associated with less trifecta failure than SPN. This result is mainly due to better preservation of renal function with TE.
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Neoplasias Renais , Procedimentos Cirúrgicos Robóticos , Urologia , Adulto , Idoso , Feminino , Humanos , Neoplasias Renais/etiologia , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do TratamentoRESUMO
To evaluate the vaccine response of treatment-naive juvenile idiopathic arthritis (JIA) patients who were fully vaccinated against Hepatitis B Virus (HBV) and then compare their antibody status with healthy controls. In this multicenter study, initial visit hepatitis B surface antigen (HbsAg) and anti-hepatitis B surface antibody (anti-Hbs) titers of 262 treatment-naive JIA patients who were followed up regularly between May 2015 and October 2019 were evaluated retrospectively from patients' medical records and compared with 276 healthy peers. Both HbsAg and anti-Hbs antibody titers were tested by the ELISA technique. Anti-HBs titers ≥ 10 IU/L were considered as reactive indicating seroprotection against HBV. In the JIA group, seropositivity rate was 59.1% while 72.9% of the control group were immune against HBV (p = 0.002). The median titer for anti-Hbs was 14 (range: 0-1000) IU/L in the patient group and 43.3 (range: 0-1000) IU/L in the control group (p = 0.01). Neither JIA patients nor healthy controls were positive for HbsAg. Patients with JIA vaccinated according to the national vaccination schedule were evaluated at their first visit in pediatric rheumatology outpatient clinics for anti-Hbs presence and it was found that they have lesser seroprotectivity than their age and sex-matched routinely vaccinated, healthy peers. So, to complete missing vaccines and booster vaccine doses, assessing the immune status of the patients at the time of diagnosis against HBV should be in the check-list of physicians dealing with pediatric rheumatic diseases.
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Artrite Juvenil , Hepatite B , Artrite Juvenil/tratamento farmacológico , Criança , Hepatite B/prevenção & controle , Anticorpos Anti-Hepatite B , Antígenos de Superfície da Hepatite B , Vírus da Hepatite B , Humanos , Estudos Retrospectivos , VacinaçãoRESUMO
Introduction Hydronephrosis (HN) is a common pathology that is with/without obstruction. HN should be promptly addressed; otherwise, it progresses to cause impaired kidney function. This study was conducted to define the diagnosis algorithm and poor prognostic parameters used to evaluate unknown HN. Materials and Methods This study enrolled 100 patients who were over 20 years of age and were admitted to the center between 2001 and 2015 for the diagnosis and treatment of HN. Although initial diagnostic tests were applied, the HN etiology of the patients could not be found in ambulatory conditions; therefore, they were hospitalized to seek the causes for their HN. Patients who had a malignancy or tuberculosis or any previous ureteral injury were excluded. Results Of these cases, 29 were on both sides, whereas 42 were on the left side. Despite further investigations, the etiology was not determined in five patients. The frequency of malignancy in patients with hematuria (5/15) was two times higher than in patients without hematuria (33% vs. 17.6%; p = 0.01). Additionally, the malignancy rate was significantly higher in patients with weight loss (100%) than those without weight loss (OR: 6.25; p < 0.001). Conclusions Further investigation is recommended to define the precise etiology of HN. Hematuria and weight loss should be considered poor predictive factors during diagnosis.
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PURPOSE: To evaluate the prognostic factors affecting the surgical margin and recurrence in patients who underwent partial nephrectomy (PN) for renal masses. MATERIALS AND METHODS: Data of 125 patients who underwent open or laparoscopic PN because of renal mass between January 2006 and January 2019 were analysed retrospectively. Demographic data, habits, additional diseases, clinical and laboratory findings, operational data, the morphology of the tumour in computerised tomography or magnetic-resonance imaging and follow-up data were scanned and acquired via our hospital's system and archive. RESULTS: Average age was 54.4, male-female ratio was 1.55 and average tumour size was 3.31 cm. One hundred and four patients had malignant pathology and 21 were benign. Positive surgical margin (PSM) rate was 5.6% and recurrence rate was 3.2%. Average follow-up was 47.4 months. Pathological size of the tumour was larger (P = .006), warm-ischemia period was lower (P = .003) and PADUA score was higher (P = .015) in open technique. Tumour size and tumour stage were statistically higher in patients with recurrence (P = .009, P < .001, respectively). There was a significantly higher PSM ratio in mandatory indication group than elective indication group (P = .025). No statistically significant difference was observed between surgical margin positivity and tumour size, Fuhrman grades, PADUA scores, RENAL scores and C-index. (P > .05). CONCLUSION: Surgical margin positivity after PN is not significantly associated with tumour characteristics and anatomical scoring systems. Surgical indication for PN has a direct influence on PSM rates. Tumour size and stage after PN are valuable parameters in evaluating the recurrence risk.
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Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Margens de Excisão , Recidiva Local de Neoplasia/patologia , Idoso , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Neoplasias Renais/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Nefrectomia/métodos , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the efficacy of silodosin or mirabegron as a medical expulsive therapy for ureteric stones in adults. PATIENTS-METHOD: This is a prospective, randomized multicentric study. Patients who had ureter stones in size between 4 and 10 mm were assessed prospectively. Patients were divided into three groups with equal randomization. Group 1 was the control group; group 2 took silodosin 8 mg, and group 3 took mirabegron 50 mg once daily. RESULTS: All 169 patients were included in the final analysis. The spontaneous expulsion rate was similar between groups. In patients with distal localization, the stone expulsion interval was shorter in the silodosin group (7.1 ± 4.5 days) than the control (12 ± 8.7) (p = 0.034). In patients with stone size smaller than 6 mm, the stone expulsion interval was shorter in the silodosin group (5.8 ± 4) than the control (12.2 ± 2.8) (p = 0.004); the analgesic requirement was less in the silodosin group (1.4 ± 1.3) than in the control (3.6 ± 2.8) (p = 0.028). Mirabegron had no effect on stone expulsion interval in any analysis. In patients with distal localization or stone size bigger or equal to 6 mm, the need for an analgesic was less in the mirabegron group (1.8 ± 1.9) (1.9 ± 1.8) than in the control (3.6 ± 2.3) (3.2 ± 1.8), respectively (p = 0.004) (p = 0.017). CONCLUSIONS: Silodosin or mirabegron does not improve the stone expulsion rate. Silodosin improves the stone expulsion interval and decreases the need for an analgesic or < 6 mm stones. Mirabegron has no effect on the stone expulsion interval, but decreases the need for an analgesic in patients with distal or sized ≥ 6 mm stones.
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Acetanilidas/uso terapêutico , Indóis/uso terapêutico , Tiazóis/uso terapêutico , Cálculos Ureterais/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: The association between ambient temperature that the mother is exposed to during pregnancy and hypospadias has not been investigated by the studies, although the recent studies showed the correlation between some congenital malformations (congenital heart disease, neural tube defect, etc.) and ambient temperature. OBJECTIVE: The aim was to investigate the relation between hypospadias and the ambient temperatures that the mother is exposed to during her pregnancy. METHODS: The data of patients with hypospadias that had their gestational periods in Ankara and Istanbul regions, and had other urological treatments (circumcision, urinary tract infection, pyeloplasty, nephrolithotomy, etc.) between January 2000 and November 2015 were analyzed retrospectively. The ambient temperature at 8-14 weeks of gestation was investigated for each patient by reviewing the data of the General Directorate of Meteorology, since this period was risky for development of hypospadias. The data including ambient temperature that the pregnant mother was exposed to, maternal age, parity, economical status, gestational age at birth, and birth weight were compared between two groups. The retrospective nature of the study may be a potential source for selection bias. RESULTS: The data of 1,709 children that had hypospadias repair and 4,946 children that had other urological treatments between 2000 and 2015 were retrospectively analyzed. There were no differences between the groups for maternal age, parity, economical status, gestational age at birth, and birth weight (Table). Analysis of exposed maximum and average ambient temperatures at 8-14 weeks of gestation revealed that July and August, hot periods in summer time, were more prevalent in the hypospadias group (p = 0.01). The average and maximum monthly ambient temperatures during summer increased the risk for hypospadias (OR, 1.32; 95% CI, 1.08-1.52; and OR, 1.22; 95% CI, 0.99-1.54, respectively. CONCLUSIONS: In this paper, we evaluated the relation between hypospadias and the ambient temperatures that the mother is exposed during her pregnancy. The results of this study indicated that the high ambient temperatures the mother and fetus are exposed to at 8-14 weeks of gestation increased the risk of hypospadias in the offspring.
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Temperatura Alta/efeitos adversos , Hipospadia/epidemiologia , Hipospadia/etiologia , Exposição Materna/efeitos adversos , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos , Medição de RiscoRESUMO
OBJECTIVES: We aimed to compare ureterolithotripsy and inserting only ureteral-j stent in terms of efficiency, safety and patient comfort in treatment of ureteral calculi in pregnant patients. METHODS: Seventy patients who developed hydronephrosis due to ureteral calculi during pregnancy, and on whom endoscopic intervention was performed were included in the study. In a center, the stones were broken up by ureteroscopy, and then ureteral stents (JJ) were placed if needed. In the other center, nothing was performed on the stones, and only ureteral stents (JJ) was placed. For the statistical analysis, Pearson's chi squared test and the Mann-Whitney U tests were used and the significance level was determined as p < 0.05. RESULTS: The average age of the patients was 26.2 years (18-39) and the average gestational week was 23.4 weeks (8-36). While no significant difference was found between the two groups in terms of the frequency of complications (p=0.381) and post-operative pyelonephritis (p=0.2), the need for additional intervention in the group on whom ureteroscopy was performed was found to be less (9.7% vs. 31%; p=0.032). Moderate or severe LUTS or flank pain during the period between the procedure and the birth was found to be significantly less in the group in which ureterolithotripsy was performed (14% vs. 55%; p=0.036). CONCLUSIONS: Ureterolithotripsy is a safe and more comfortable procedure than only ureteral double-j insertion on pregnant patients with ureterolithiasis.