Nefrolitotricia percutánea ambulatoria: nuestra experiencia en 156 casos / Ambulatory Percutaneous Nephrolithotomy: Our experience in 156 cases

OBJETIVOS: analizar y presentar nuestros resultados en el tratamiento de la litiasis renal mediante Nefrolitotricia Percutánea (NLP) ambulatoria en un mismo centro. MATERIALES Y MÉTODOS: entre agosto de 2013 y mayo de 2017 se realizó una recolección prospectiva de datos de los pacientes sometidos a NLP ambulatoria tubeless con catéter doble J o totally tubeless por litiasis renal. Se excluyeron aquellos pacientes con score de ASA >3. Se analizaron los datos preoperatorios, intra- y posoperatorios. Se clasificaron las complicaciones de acuerdo con el sistema de Clavien modificado. Se compararon los valores de hematocrito, hemoglobina, creatininemia y uremia pre- y posoperatoria a las 48 horas. RESULTADOS: en total, se operaron 156 pacientes, a los cuales se les dio el alta el mismo día de la cirugía. La suma de los diámetros máximos de las litiasis, en promedio, fue de 26,6 mm, 32 casos de litiasis coraliforme. La posición más utilizada fue la ventral, con un tiempo promedio de cirugía de 50 minutos. Se realizó NLP tubeless en 125 pacientes y totally tubeless en 29 casos. A 40 pacientes se les colocó un tapón de Surgicel en el tracto de acceso percutáneo. La tasa libre de cálculos fue del 84%, y en pacientes con litiasis coraliforme fue del 53%. No hubo complicaciones intraoperatorias y el 80% de los pacientes no presentó complicaciones. La tasa de reinternación fue del 3%. Si bien se hallaron diferencias significativas entre los valores pre- y posoperatorios de hematocrito y hemoglobina (40% y 13,3 g/dl vs. 39% y 12,8 g/dl; p=0,0001 y 0,0001, respectivamente), estas no fueron clínicamente significativas y solamente un paciente requirió de transfusión de sangre (0,6%). CONCLUSIONES: en nuestra experiencia, la NLP ambulatoria fue segura, con tasas libres de cálculos y complicaciones similares a las realizadas con internación.

OBJECTIVES: To assess the safety and feasibility of ambulatory percutaneous nephrolithotomy (PCNL) at a single institution. METHODS: Data collected prospectively of patients submit for ambulatory PCNL tubeless or totally tubeless between August 2013 and May 2017 were review. Exclusion criteria were patients with ASA score >3. Preoperative, intraoperative, and postoperative data were collected. Complications were classified using the Clavien sistem modified for PCNL. Properative and 48hs postoperative value of hematocrit, hemoglobin, creatininemia and uremia were compare. RESULTS: One hundred and fifty five patients underwent ambulatory PCNL. All patients were discharge the same day of surgery. The median of the sum of the maximum stone diameter was 26,6mm, 32 patients had staghorn calculus. We performed the majority of the surgerys in ventral position with a median time of 50 minutes. One hundred and twenty five patients underwent tubeless PCNL and totally tubeless 29 patients. In 40 cases we used Surgicel for sealing the percutaneous tract. Overall stone-free rate was 84% and 53% in staghorn cases. There were no intraoperative complications and 80% of the patients did not have any complications. Readmission rate was 3%. There was a significant decrease in the postoperative hematocrit and hemoglobin level (40% y 13,3 g/dl vs. 39% y 12,8 g/dl; p=0,0001 y 0,0001), this was not clinically significant. Only one patient required blood transfusion (0,6%). CONCLUSION: Ambulatory PCNL is safe with a stone-free rate, readmisions and complications similar to standard PCNL.

Ephrin-B1 Is a Novel Biomarker of Bladder Cancer Aggressiveness. Studies in Murine Models and in Human Samples.

Bladder cancer (BC) is the ninth most common cancer worldwide, but molecular changes are still under study. During tumor progression, Epithelial cadherin (E-cadherin) expression is altered and ß-catenin may be translocated to the nucleus, where it acts as co-transcription factor of tumor invasion associated genes. This investigation further characterizes E-cadherin and ß-catenin associated changes in BC, by combining bioinformatics, an experimental murine cell model (MB49/MB49-I) and human BC samples. In in silico studies, a DisGeNET (gene-disease associations database) analysis identified CDH1 (E-cadherin gene) as one with highest score among 130 BC related-genes. COSMIC mutation analysis revealed CDH1 low mutations rates. Compared to MB49 control BC cells, MB49-I invasive cells showed decreased E-cadherin expression, E- to P-cadherin switch, higher ß-catenin nuclear signal and lower cytoplasmic p-Ser33-ß-catenin signal, higher Ephrin-B1 ligand and EphB2 receptor expression, higher Phospho-Stat3 and Urokinase-type Plasminogen Activator (UPA), and UPA receptor expression. MB49-I cells transfected with Ephrin-B1 siRNA showed lower migratory and invasive capacity than control cells (scramble siRNA). By immunohistochemistry, orthotopic MB49-I tumors had lower E-cadherin, increased nuclear ß-catenin, lower pSer33-ß-catenin cytoplasmic signal, and higher Ephrin-B1 expression than MB49 tumors. Similar changes were found in human BC tumors, and 83% of infiltrating tumors depicted a high Ephrin-B1 stain. An association between higher Ephrin-B1 expression and higher stage and tumor grade was found. No association was found between abnormal E-cadherin signal, Ephrin-B1 expression or clinical-pathological parameter. This study thoroughly analyzed E-cadherin and associated changes in BC, and reports Ephrin-B1 as a new marker of tumor aggressiveness.

Functional and Objective Results of Urinary Undiversions in Oncologic Patients.

OBJECTIVE: To review surgical outcomes in urinary undiversions and describe short and long-term complications. METHODS: Retrospective review of patients who underwent urinary undiversion in our institution between May 2010 and May 2016. Complications were graded according to the Clavien classification. All patients completed the Patient Global Impression of Improvement questionnaire to indicate overall satisfaction with urinary undiversion. RESULTS: Median time from the cystectomy to undiversion was 29 months (range 11-53 months). Five patients (55%) reported significant distress related to the ileal conduit and were undiverted into an orthotopic neobladder. A female patient with an orthotopic neobladder and severe urinary incontinence received neobladder neck closure and catheterizable channel. Another female patient with an orthotopic neobladder was undiverted into an Indiana Pouch. Complications during the first 60 days were mostly minor, Clavien I (1 patient), 5 patients Clavien II, and a patient with Clavien IIIb. Patient Global Impression of Improvement questionnaire scores showed that 6 patients (67%) felt "Very much better" and 3 patients (33%) felt "Much better" after urinary undiversion 60%. CONCLUSION: After urinary undiversions, minor complication rate is high, and major complication rate is considerable. Urinary undiversions are a highly complex, yet feasible procedure, which requires experienced multidisciplinary teams and demands appropriate patient selection. Patients, after undiversions show a high degree of satisfaction with long-term satisfactory outcomes, which points out the need for consideration for these procedures once the oncologic disease is controlled.