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1.
Int Urogynecol J ; 2024 Sep 14.
Artículo en Inglés | MEDLINE | ID: mdl-39276281

RESUMEN

INTRODUCTION AND HYPOTHESIS: Urodynamics (UDS) assesses voiding dysfunction using intravesical, vaginal, or rectal catheters, which can be distressing. This study was aimed at utilizing mindfulness to reduce anxiety and pain in patients undergoing UDS. METHODS: A single-institution randomized controlled trial was conducted on 60 patients who underwent UDS. Patients were assigned to a mindfulness group (n = 30) or a control group (n = 30). Before UDS testing, all patients completed validated questionnaires assessing lower urinary tract symptoms (Urogenital Distress Inventory 6, UDI-6), anxiety (State-Trait Anxiety Inventory 6, STAI-6), and pain (Visual Analog Scale, VAS). The mindfulness group listened to a mindfulness audio prompt before UDS. All patients received standardized UDS education before UDS testing in a calm environment. After UDS testing, all patients completed validated UDS-perception questionnaires, STAI-6, Likert scale, and VAS surveys. Statistical analysis was performed using paired t tests, independent t tests, Wilcoxon, and Chi-squared tests. RESULTS: Both groups had similar demographics, history of prior UDS, anxiety, and baseline UDI-6 and STAI-6. Post-UDS, anxiety scores decreased in both groups, with the mindfulness group reporting significant improvement in "calmness" (mean 1.7, SD = 0.84) compared with the control group (mean 2.3, SD = 1.0, p < 0.05). The mindfulness group reported increased relaxation whereas the control group reported decreased relaxation post-UDS. Patients in both groups without a history of UDS had a significant improvement in total anxiety compared with those with a history of UDS. CONCLUSION: Mindfulness meditation may improve calmness and relaxation for patients undergoing UDS.

2.
Am J Physiol Renal Physiol ; 310(7): F628-F636, 2016 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-26697981

RESUMEN

Psychological stress exacerbates interstitial cystitis/bladder pain syndrome (IC/BPS), a lower urinary tract pain disorder characterized by increased urinary frequency and bladder pain. Glutamate (Glu) is the primary excitatory neurotransmitter modulating nociceptive networks. Glt1, an astrocytic transporter responsible for Glu clearance, is critical in pain signaling termination. We sought to examine the role of Glt1 in stress-induced bladder hyperalgesia and urinary frequency. In a model of stress-induced bladder hyperalgesia with high construct validity to human IC/BPS, female Wistar-Kyoto (WKY) rats were subjected to 10-day water avoidance stress (WAS). Referred hyperalgesia and tactile allodynia were assessed after WAS with von Frey filaments. After behavioral testing, we assessed Glt1 expression in the spinal cord by immunoblotting. We also examined the influence of dihydrokainate (DHK) and ceftriaxone (CTX), which downregulate and upregulate Glt1, respectively, on pain development. Rats exposed to WAS demonstrated increased voiding frequency, increased colonic motility, anxiety-like behaviors, and enhanced visceral hyperalgesia and tactile allodynia. This behavioral phenotype correlated with decreases in spinal Glt1 expression. Exogenous Glt1 downregulation by DHK resulted in hyperalgesia similar to that following WAS. Exogenous Glt1 upregulation via intraperitoneal CTX injection inhibited the development of and reversed preexisting pain and voiding dysfunction induced by WAS. Repeated psychological stress results in voiding dysfunction and hyperalgesia that correlate with altered central nervous system glutamate processing. Manipulation of Glu handling altered the allodynia developing after psychological stress, implicating Glu neurotransmission in the pathophysiology of bladder hyperalgesia in the WAS model of IC/BPS.


Asunto(s)
Transportador 2 de Aminoácidos Excitadores/metabolismo , Hiperalgesia/metabolismo , Médula Espinal/metabolismo , Estrés Fisiológico/fisiología , Vejiga Urinaria/fisiopatología , Dolor Visceral/metabolismo , Animales , Conducta Animal/efectos de los fármacos , Conducta Animal/fisiología , Ceftriaxona/farmacología , Modelos Animales de Enfermedad , Agonistas de Aminoácidos Excitadores/farmacología , Antagonistas de Aminoácidos Excitadores/farmacología , Femenino , Motilidad Gastrointestinal/efectos de los fármacos , Motilidad Gastrointestinal/fisiología , Hiperalgesia/fisiopatología , Ácido Kaínico/análogos & derivados , Ácido Kaínico/farmacología , Ratas , Ratas Endogámicas WKY , Médula Espinal/efectos de los fármacos , Dolor Visceral/fisiopatología
3.
Int Urogynecol J ; 27(1): 77-83, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26231233

RESUMEN

INTRODUCTION AND HYPOTHESIS: In interstitial cystitis/bladder pain syndrome (IC/BPS), pelvic floor dysfunction may contribute significantly to pelvic pain. To determine if pelvic floor hypertonicity manifests alterations on magnetic resonance imaging (MRI) in patients with IC/BPS, we retrospectively compared pelvic measurements between patients and controls. METHODS: Fifteen women with IC/BPS and 15 age-matched controls underwent pelvic MRI. Two blinded radiologists measured the pelvic musculature, including the H- and M lines, vaginal length, urethral length and cross-sectional area, levator width and length, and posterior puborectalis angle. MRI measures and clinical factors, such as age, parity, and duration of symptoms, were compared using a paired, two-tailed t test. RESULTS: There were no significant differences in age, parity, or symptom duration between groups. Patients with IC/BPS exhibited shorter levator muscles (right: 5.0 ± 0.7 vs. 5.6 ± 0.8, left: 5.0 ± 0.8 vs. 5.7 ± 0.8 cm, P < 0.002) and a wider posterior puborectalis angle (35.0 ± 8.6 vs. 26.7 ± 7.9°, P < 0.01) compared with controls. The H line was shorter in patients with IC/BPS (7.8 ± 0.8 vs. 8.6 ± 0.9 cm, P < 0.02), while M line did not differ. Total urethral length was similar, but vaginal cuff and bladder neck distances to the H line were longer in patients with IC/BPS (5.7 ± 0.6 vs. 5.1 ± 0.9 cm, P < 0.02; 1.9 ± 0.4 vs. 1.4 ± 0.2 cm, P < 0.001, respectively). CONCLUSIONS: Patients with IC/BPS have pelvic floor hypertonicity on MRI, which manifests as shortened levator, increased posterior puborectalis angles, and decreased puborectal distances. We identified evidence of pelvic floor hypertonicity in patients with IC/BPS, which may contribute to or amplify pelvic pain. Future studies are necessary to determine the MRI utility in understanding pelvic floor hypertonicity in patients with IC/BPS.


Asunto(s)
Cistitis Intersticial/fisiopatología , Imagen por Resonancia Magnética , Tono Muscular , Diafragma Pélvico/fisiopatología , Dolor Pélvico/fisiopatología , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
4.
Abdom Radiol (NY) ; 48(3): 1011-1019, 2023 03.
Artículo en Inglés | MEDLINE | ID: mdl-36592198

RESUMEN

OBJECTIVE: To evaluate whether microscopic hematuria (MH) patients with a negative initial evaluation have an elevated risk for urinary carcinoma. METHODS: This is a population-based retrospective study with a matched control identified 8465 adults with an MH ICD code, an initial negative urinary malignancy work-up of cystoscopy and CT urography, and at least 35 months of clinical care. 8465 hematuria naïve controls were age, gender, and smoking status matched. Subsequent coding of non-prostatic urinary cancer, or any following hematuria codes: additional microscopic unspecified or unspecified hematuria, and gross hematuria was obtained. Χ2 tests were performed. RESULTS: There was no statistically significant difference in urinary malignancy rates (p > 0.05). Any urinary cancer: cases 0.74% (63/8465; 95% CI 0.58-0.95%)/controls 0.83% (71/8465; 95% CI 0.66-1.04%%) (p = 0.54); bladder: 0.45%/0.47% (p = 0.82); renal: 0.31%/0.38% (p = 0.43); ureteral: 0.01%/0.02% (p = 0.56). Subsequent gross hematuria in both males and females increased the odds of cancer: males 2.35 (p = 0.001; CI 1.42-3.91); females 4.25 (p < 0.001; CI 1.94-9.34). Males without additional hematuria had decreased odds ratio: 0.32 (p = 0.001; CI 0.16-0.64). Females without additional hematuria 0.58 (p = 0.19; CI 0.26-1.30) and both genders with additional unspecified hematuria/microscopic hematuria males 1.02 (p = 0.97; CI 0.50-2.08) and females 1.00 (p = 0.99; CI 0.38-2.66) did not have increased odds ratios (p > 0.05). CONCLUSION: MH patients with initial negative evaluation have a subsequent urologic malignancy rate of less than 1% and likely do not need further urinary evaluation unless they develop gross hematuria.


Asunto(s)
Hematuria , Neoplasias Urológicas , Adulto , Humanos , Masculino , Femenino , Estudios Retrospectivos , Riesgo , Tomografía Computarizada por Rayos X , Urografía
5.
Urol Pract ; 8(1): 155-159, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37145442

RESUMEN

INTRODUCTION: Patient perpetrated sexual harassment has been studied with family physicians, surgical residents and dermatologists with the prevalence ranging from 27% to 77%. To our knowledge this phenomenon has not yet been studied in urology. METHODS: We surveyed urologists in the United States about their age, employment/training status and their experiences of patient perpetrated sexual harassment. Surveys were anonymous and hosted on a web based platform. Pearson chi-square analysis was used to assess risk factors and descriptive statistics were used to describe prevalence. RESULTS: A total of 190 urologists completed the survey. Patient perpetrated sexual harassment was reported by 49.5% of respondents. Women were more likely to report patient perpetrated sexual harassment when compared with men, at 69% and 23%, respectively (p <0.0001). Being a resident/fellow portended higher rates of patient perpetrated sexual harassment compared to staff/attendings, at 69% and 44%, respectively (p=0.004). Respondents 40 years or younger were more likely to have reported patient perpetrated sexual harassment when compared to those 41 years old or older, at 65% and 39%, respectively (p=0.001). CONCLUSIONS: The results of this survey study suggest that the prevalence of patient perpetrated sexual harassment in the field of urology may be high. Professional societies should perform further investigation into this matter. We suggest proactive development of guidelines and protocols to address patient perpetrated sexual harassment in urology.

6.
Turk J Urol ; 47(1): 58-65, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33112732

RESUMEN

OBJECTIVE: Sacral neuromodulation (SNM) is an advanced treatment option for patients with refractory overactive bladder (OAB) symptoms, urinary retention, and bowel disorders; it is usually performed in 2 separate procedures. This study aims to determine a cohort's progression rate from stage 1 to 2 and predict factors for progression and unplanned device removal or revision. MATERIAL AND METHODS: A retrospective review was conducted in patients who underwent SNM at a single institution between June 2012 and May 2019. Progression rates from stage 1 to 2, patient characteristics, and indications for unplanned SNM removal or revision were recorded. Chi-square, Mann-Whitney U, and Fisher's exact tests were used for data analysis. RESULTS: A total of 128 patients underwent SNM for 1 or more of the following diagnoses: OAB (n=103), urinary retention (n=15), neurogenic bladder dysfunction (n=4), fecal incontinence (n=2), and constipation (n=4). The progression rate to stage 2 was 92.2% (118/128). Patients who failed to progress to stage 2 had additional diagnoses other than OAB, such as urinary retention or bowel disorders (p=0.007). Fifteen patients (12.7%) required SNM removal or revision within 4 years of surgery. Among these patients, the body mass index was significantly lower (p=0.036). CONCLUSION: Most patients (92.2%) progressed to stage 2. Patients with only OAB symptoms had a higher progression rate to stage 2. Single full-stage procedures may be considered in select patients to reduce morbidity, time, and costs.

7.
J Urol ; 182(6): 2762-7, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19837431

RESUMEN

PURPOSE: Unenhanced multidetector computerized tomography is the imaging modality of choice for urinary calculi but exposes patients to substantial radiation doses with a subsequent risk of radiation induced secondary malignancy. We compared ultra low dose and conventional computerized tomography protocols for detecting distal ureteral calculi in a cadaveric model. MATERIALS AND METHODS: A total of 85 calcium oxalate stones 3 to 7 mm long were prospectively placed in 14 human cadaveric distal ureters in 56 random configurations. The intact kidneys, ureters and bladders were placed in a human cadaveric vehicle and computerized tomography was performed at 140, 100, 60, 30, 15 and 7.5 mA seconds while keeping other imaging parameters constant. Images were independently reviewed in random order by 2 blinded radiologists to determine the sensitivity and specificity of each mA second setting. RESULTS: Overall sensitivity and specificity were 98% and 83%, respectively. Imaging using 140, 100, 60, 30, 15 and 7.5 mA second settings resulted in 98%, 97%, 97%, 96%, 98% and 97% sensitivity, and 83%, 83%, 83%, 86%, 80% and 84% specificity, respectively. Interobserver agreement was excellent (kappa >0.87). There was no significant difference in sensitivity or specificity at any mA second settings. All false-negative results were noted for 3 mm calculi at a similar frequency at each mA second setting. CONCLUSIONS: Ultra low dose computerized tomography protocols detected distal ureteral calculi in a fashion similar to that of conventional computerized tomography protocols in a cadaveric model. These protocols may decrease the radiation dose up to 95%, reducing the risk of secondary malignancies.


Asunto(s)
Oxalato de Calcio , Protocolos Clínicos , Dosis de Radiación , Tomografía Computarizada por Rayos X/normas , Cálculos Ureterales/diagnóstico por imagen , Cadáver , Oxalato de Calcio/análisis , Femenino , Humanos , Sensibilidad y Especificidad , Cálculos Ureterales/química
8.
Case Rep Urol ; 2019: 4732356, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31139489

RESUMEN

Midurethral slings are the most common treatment for female stress urinary incontinence. Perioperative vascular injuries during placement of a retropubic midurethral sling (RMUS) are uncommon but have been described. The objective of this case report is to describe a complication of delayed presentation from a vascular injury at the time of retropubic sling arm removal not previously documented in the literature. This life-threating complication should be considered and precautions should be taken at retropubic sling arm removal. Prevention is accomplished by proper visualization of pelvic vasculature and/or eliminating tension on sling before excision.

9.
Urol Pract ; 11(2): 264-265, 2024 03.
Artículo en Inglés | MEDLINE | ID: mdl-38214939
10.
J Endourol ; 22(5): 973-7, 2008 May.
Artículo en Inglés | MEDLINE | ID: mdl-18393647

RESUMEN

PURPOSE: A variety of techniques have been used to secure the renal artery and vein during laparoscopic donor nephrectomy. The purpose of this study is to compare the amount of vessel length lost when the artery and vein are secured with four different techniques. METHODS: A model was constructed to simulate a left laparoscopic donor nephrectomy. In this model vessel length lost was determined when veins were secured using polymer locking (PL) clips, the endo-GIA stapling device, and the endo-TA stapling device. Arterial length lost was determined for the same three techniques, as well as securing the artery with titanium (Ti) clips. RESULTS: The mean arterial length lost for the PL clips, Ti clips, endo-TA, and endo-GIA stapling devices was 6.2, 6.3, 9.8, and 10.0 mm, respectively. Both clip types produced less loss of arterial length than both types of stapling devices (P<0.001), and there was no difference between the two types of stapling devices (P=0.73) or clips (P=0.85). The mean venous length lost for the PL clip, endo-GIA, and endo-TA stapling devices was 5.7, 10.1, and 9.4 mm, respectively. The PL clips resulted in significantly less vessel loss compared to both stapling devices (P<0.001), and there was no difference between the two stapling devices (P=0.40). CONCLUSIONS: Both types of clips resulted in longer graft arterial lengths compared to both stapling devices. PL clips resulted in longer graft vein length compared to the two stapling devices. The endo-TA stapling device was limited in this model by its inability to articulate.


Asunto(s)
Hemostasis Quirúrgica/instrumentación , Laparoscopía , Modelos Biológicos , Nefrectomía , Arteria Renal/cirugía , Venas Renales/cirugía , Animales , Humanos , Trasplante de Riñón , Ligadura/métodos , Arteria Renal/patología , Venas Renales/patología , Instrumentos Quirúrgicos , Engrapadoras Quirúrgicas , Trasplante Homólogo
11.
J Endourol ; 21(9): 985-92, 2007 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-17941773

RESUMEN

BACKGROUND AND PURPOSE: The effects of commonly used reprocessing methods on flexible ureteroscope longevity have never been examined. We prospectively studied the effects of Steris 1 sterilization and Cidex ortho-phthalaldehyde (OPA) high-level disinfection (HLD) on the image quality, physical structure, and deflective properties of two new flexible ureteroscopes. MATERIALS AND METHODS: Two identical "out-of-the-box" Storz 11278AU1 flexible ureteroscopes (Karl Storz Endoscopy, Tuttlingen, Germany) were sterilized individually using the Steris 1 system (Steris Mentor, Ohio) or disinfected with Cidex OPA (Advanced Sterilization Products, J&J, Irvine, CA) for 100 trials followed by a crossover to the other method for another 100 trials over a period of 1 year. After every five trials, optical quality, angle of deflection, and fiber damage were analyzed in the laboratory. Throughout the study, neither of these ureteroscopes was used clinically. RESULTS: After 100 trials, ureteroscope 1, which was sterilized initially in the Steris system, had a 12-mm tear on its shaft (noted after the 17th trial), 297 damaged fibers, and a 37% drop in resolution (loss of 3.75 lines/mm). There was no change in deflection from baseline. In contrast, after 100 cycles, ureteroscope 2, which was subjected to HLD with Cidex OPA, had no visible external damage, a 0% change in resolution, 10 damaged fibers, and no change in deflection. After the crossover, ureteroscope 2 developed a semilunar defect that obscured the endoscopic view, whereas there was no further significant damage to ureteroscope 1. CONCLUSION: After 100 cycles, the Steris 1 system rendered the flexible ureteroscope unusable, whereas HLD with Cidex OPA had minimal adverse impact.


Asunto(s)
Desinfectantes/farmacología , Desinfección/métodos , Ureteroscopios , o-Ftalaldehído/farmacología , Estudios Cruzados , Diagnóstico por Imagen/métodos , Endoscopios , Endoscopía/métodos , Contaminación de Equipos/prevención & control , Diseño de Equipo , Falla de Equipo , Equipo Reutilizado , Tecnología de Fibra Óptica , Humanos , Estudios Prospectivos , Factores de Tiempo
12.
J Endourol ; 19(7): 889-93, 2005 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-16190852

RESUMEN

PURPOSE: To compare the efficacy of nonabsorbable polymer ligating (NPL) and titanium clips applied with and without a 1-mm vascular cuff at physiologic and supraphysiologic pressures. MATERIALS AND METHODS: An in vitro equine-vessel model was created to test clip occlusion strength. Ten-millimeter NPL and standard Ti clips were applied to veins (10 mm) and arteries (10, 6, and 5 mm) with and without a 1-mm cuff and tested until they held a pressure of 300 mm Hg (veins) or 760 mm Hg (arteries) for 2 minutes or leaked. RESULTS: The NPL clip was statistically more secure on 10-mm veins with and without a cuff, 10-mm arteries with and without a cuff, and 6-mm arteries with a cuff than was the Ti clip. Leaving a 1-mm cuff resulted in a statistically higher leak point in all vessels tested except the 6-mm arteries secured with the Ti clip. CONCLUSIONS: The NPL clip was more secure than the Ti clip on larger arteries and veins. A 1-mm vascular cuff enhances the security of both NPL and Ti clips in vessels of all sizes. The NPL clip is secure and reliable in securing both arteries and veins.


Asunto(s)
Hemostasis Quirúrgica/instrumentación , Polímeros , Titanio , Animales , Caballos , Ligadura/instrumentación , Ensayo de Materiales , Modelos Animales , Estrés Mecánico
14.
Neurosurg Clin N Am ; 25(1): 33-46, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24262898

RESUMEN

Various pelvic floor conditions, including overactive bladder syndrome and chronic pelvic pain, have been successfully managed with the neuromodulation of sacral nerves. Sacral neuromodulation is a minimally invasive procedure involving the implantation of a programmable pulse generator that delivers low-amplitude electrical current via quadripolar tined leads through the S3 foramen. Durable efficacy has been demonstrated in retrospective studies, but questions regarding ideal patient candidacy and optimal technical considerations remain unanswered.


Asunto(s)
Cistitis Intersticial/terapia , Terapia por Estimulación Eléctrica/métodos , Vejiga Urinaria Hiperactiva/terapia , Cistitis Intersticial/fisiopatología , Humanos , Región Sacrococcígea/fisiología , Vejiga Urinaria Hiperactiva/fisiopatología
15.
J Endourol ; 28(7): 881-6, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24641687

RESUMEN

BACKGROUND AND PURPOSE: The effect of oral anxiolytics in diminishing patient discomfort and pain perception has been demonstrated in GI endoscopy, percutaneous coronary interventions, and various procedures in the emergency department setting, but has not been prospectively studied in the setting of prostate biopsy. The purpose of this study was to investigate the effect of diazepam on pain perception during and after prostate biopsy. PATIENTS AND METHODS: Sixty patients undergoing prostate biopsy at a single academic institution were enrolled into a prospective, randomized, placebo-controlled study. A questionnaire was administered prebiopsy to determine baseline discomfort and pain history. A visual analog pain scale was used to determine pain associated with each step of the transrectal Ultrasonography-guided prostate biopsy and was administered 20 minutes after biopsy and 1 week later. Responses were compared between groups using the Mann-Whitney U test, Fisher exact test, and Wilcoxon signed rank test as appropriate. RESULTS: A total of 60 patients (29 diazepam, 31 placebo) completed pre- and postbiopsy surveys for analysis. The number of cores sampled during biopsy was controlled during analysis and was found to have no correlation with total pain measured. There were no differences between diazepam and placebo groups in age, prebiopsy survey results, immediate and 1 week postbiopsy survey results. There was no difference in the patients' willingness to undergo a repeated procedure in the control and treatment groups. Complications of taking diazepam prebiopsy included drowsiness, chills, and ankle injury. CONCLUSIONS: Diazepam does not improve patient pain perception immediately after or at 1-week recall after prostate biopsy. Omitting diazepam simplifies the biopsy regimen and allows the patient to drive himself home. Based on these results, routine use of diazepam in prostate biopsy is not recommended.


Asunto(s)
Ansiolíticos/uso terapéutico , Diazepam/uso terapéutico , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/efectos adversos , Percepción del Dolor/efectos de los fármacos , Dolor/psicología , Próstata/patología , Anciano , Método Doble Ciego , Humanos , Masculino , Persona de Mediana Edad , Dolor/tratamiento farmacológico , Dolor/etiología , Dimensión del Dolor , Estudios Prospectivos , Estadísticas no Paramétricas , Encuestas y Cuestionarios
16.
Urology ; 77(1): 92-6, 2011 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-20573378

RESUMEN

OBJECTIVES: To compare the incidence of ocular complications (OC) and corneal abrasion (CA) after hand-assisted laparoscopic donor nephrectomy (HALDN) and open donor nephrectomy (ODN). METHODS: A retrospective review was conducted of 241 consecutive patients (141 HALDN and 100 ODN) over a 9-year period. OC were strictly defined as ocular complaints requiring any treatment or ophthalmologic consultation. Chi-square tests were used to compare the incidence of OC and CA by type of surgery. RESULTS: OC were observed in 9 HALDN patients (6.4%) and no ODN patients (0%; P = .01). All OC in HALDN patients involved the dependent eye (P <.001). CA occurred in 2 HALDN patients (1.4%) compared with no ODN patients (0%; P = .23). HALDN patients had significantly higher net fluid intake than the ODN patients (P <.01). CONCLUSIONS: The increased OC and CA seen in HALDN patients may result from the increased fluid intake, flank positioning, and potential increased venous compression resulting from the effects of the pneumoperitoneum. The fact that the dependent eye was involved in all patients suggests conjunctival edema as a potential common pathway. The high frequency of OC suggests the importance of techniques to minimize OC after HALDN.


Asunto(s)
Oftalmopatías/epidemiología , Oftalmopatías/etiología , Laparoscopía/efectos adversos , Nefrectomía/efectos adversos , Nefrectomía/métodos , Donantes de Tejidos , Adulto , Enfermedades de la Córnea/epidemiología , Enfermedades de la Córnea/etiología , Humanos , Incidencia , Estudios Retrospectivos
17.
J Endourol ; 25(10): 1643-7, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-21819222

RESUMEN

PURPOSE: To evaluate the outcomes of robot-assisted radical prostatectomy (RARP) in patients with previous renal transplantation. PATIENTS AND METHODS: We retrospectively identified all patients who had undergone RARP for localized prostate cancer between 2005 and 2008 at a single institution (N=228). Of these, three patients were renal transplant recipients. A four-arm robotic configuration was used in all patients. Port placement was modified in two of the three renal transplant recipients to avoid trauma to the renal allograft. Preoperative demographics, perioperative parameters, and postoperative outcomes were reviewed. RESULTS: RARP was completed successfully in all three renal transplant recipients. As expected, the American Society of Anesthesiologists score (3.3 vs 2.4) and Charlson weighted index of comorbidity (4.7 vs 2.4) were greater in previous transplant patients. There were no major differences in mean age, Gleason score, body mass index, estimated blood loss, operative time, complications, or oncologic outcomes between the two groups. Each of the patients with renal allografts had an undetectable prostate-specific antigen level and was continent (needing no pads) at 13 months of follow-up. CONCLUSIONS: RARP is feasible in patients with a previous renal transplant. Although technically more challenging, RARP can be performed in previous transplant patients with acceptable morbidity and oncologic outcomes similar to those of other prostate cancer patients.


Asunto(s)
Trasplante de Riñón , Prostatectomía/métodos , Robótica , Estudios de Casos y Controles , Demografía , Humanos , Cuidados Intraoperatorios , Masculino , Cuidados Posoperatorios , Cuidados Preoperatorios
18.
J Endourol ; 25(7): 1175-80, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-21612432

RESUMEN

BACKGROUND AND PURPOSE: Patients with end-stage renal disease (ESRD) have multiple comorbidities that place them at increased risk for surgical complications. Consequently, patients with both ESRD and prostate cancer (PCa) have rarely been considered candidates for radical prostatectomy. The objective of this study is to compare ESRD patients who are undergoing robot-assisted laparoscopic prostatectomy (RALP) with a cohort of patients with no history of dialysis. PATIENTS AND METHODS: A retrospective review was conducted of 430 patients who were undergoing RALP, including 12 receiving dialysis at the time of surgery. Preoperative demographics, perioperative parameters, and postoperative outcomes were compared using a two-tailed Student t test and a chi-square test, with significance at P<0.05. RESULTS: Patient demographics including body mass index, Gleason score, and prostate-specific antigen (PSA) value were similar between the two groups. Patients with ESRD had younger age (55.5 vs 62.9 years; P<0.01), higher American Society of Anesthesiologists scores (3.7 vs 2.5; P<0.01), and higher age-adjusted Charlson Comorbidity Index scores (6.2 vs 4.2; P<0.01). Patient outcomes including operative time, estimated blood loss, complication rate, postoperative stay, and positive margins did not differ significantly between groups. No ESRD patients needed pads or had a detectable PSA level using an ultrasensitive assay. CONCLUSIONS: This series represents the largest series of patients with ESRD undergoing RALP. These patients experienced similar outcomes compared with patients with no history of dialysis despite greater preoperative comorbidity. RALP produces minimal fluid shifts, low blood loss, and excellent cancer control, making it an ideal treatment option to prepare patients with both ESRD and PCa for renal transplantation.


Asunto(s)
Fallo Renal Crónico/cirugía , Laparoscopía , Prostatectomía/métodos , Robótica/métodos , Adulto , Anciano , Estudios de Cohortes , Demografía , Humanos , Cuidados Intraoperatorios , Masculino , Persona de Mediana Edad
19.
J Endourol ; 25(7): 1187-91, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-21631303

RESUMEN

BACKGROUND AND PURPOSE: Laparoendoscopic single-site (LESS) surgery produces virtually no scar but is technically challenging because of the loss of triangulation. The objective of this study is to compare classic transumbilical LESS nephrectomy with needlescopic-assisted laparoscopy (NAL) surgery. In doing so, we evaluated whether the addition of a single 2-mm subcostal port could restore triangulation while not jeopardizing recovery or cosmetic outcome in the porcine model. MATERIALS AND METHODS: Ten female farm pigs were randomized to laparoscopic nephrectomy with either LESS or NAL. In LESS, a TriPort was placed through a single 2.5-cm umbilical incision. In NAL, 5- and 10-mm ports were placed in the umbilicus and a 2-mm port was placed in the midclavicular line. Preoperative, perioperative, and postoperative parameters were compared. Variables were analyzed with the Wilcoxon signed-rank test and two-tailed Fisher exact test. Cosmesis was evaluated objectively using the Vancouver Scar Scale and subjectively by a blinded dermatologist. A cost analysis was performed. RESULTS: Estimated blood loss was minimal in both groups (28.8 mL in LESS and 9.4 mL in NAL). Operative time was significantly shorter in NAL (103 vs 150 min; P<0.001). There was no difference in complications (2 vs 1; P=0.500), objective cosmesis (3.9 vs 3.8; P>0.2), or subjective cosmesis (2 vs 3; P=0.500). The NAL protocol had significantly lower disposable equipment costs ($363 vs $1696). CONCLUSIONS: The addition of a 2-mm subcostal port and the restoration of triangulation in the NAL protocol enable shorter operative times, increased surgeon comfort, improved technical ease, and lower costs while maintaining the scarless cosmesis of the traditional LESS protocol.


Asunto(s)
Laparoscopía/instrumentación , Laparoscopía/métodos , Modelos Animales , Nefrectomía/instrumentación , Nefrectomía/métodos , Sus scrofa/cirugía , Animales , Equipos Desechables/economía , Femenino , Laparoscopía/economía , Nefrectomía/economía , Estudios Prospectivos , Distribución Aleatoria , Factores de Tiempo , Resultado del Tratamiento
20.
J Endourol ; 24(9): 1415-9, 2010 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-20804434

RESUMEN

BACKGROUND AND PURPOSE: Significant bleeding necessitating use of a tamponade balloon, embolization, or renal exploration is a rare but catastrophic complication after percutaneous nephrolithotomy (PCNL). The purpose of this study is to review the success of a novel, minimally invasive technique for controlling percutaneous tract bleeding that is refractory to conventional measures. MATERIALS AND METHODS: A retrospective review was performed on four patients with refractory tract hemorrhage that was managed with a novel gelatin matrix hemostatic sandwich technique. In this technique, a 5F angiographic reentry catheter was placed through the kidney into the bladder and a 22F Councill-tip catheter balloon was passed over this catheter and positioned so that the inflated balloon would occlude the inner surface of the nephrostomy tract. Next, a 16F Councill-tip catheter was placed over a second wire so that the uninflated balloon was just underneath the skin surface. Gelatin matrix hemostatic sealant was then injected to fill the tract. Inflation of the outer balloon completely sealed the tract, completing the hemostatic sandwich. RESULTS: This technique was successfully applied to four patients with tract bleeding that would not stop with pressure or a conventional nephrostomy tube alone. The average estimated blood loss was 562 mL, and three of four patients avoided transfusion. All postoperative hemoglobin values stabilized within 2 days of surgery. There were no major or minor complications after use of this technique. No patients needed angioembolization or renal exploration. CONCLUSIONS: This novel hemostatic sandwich technique should be considered as an option for the control of refractory tract hemorrhage after PCNL.


Asunto(s)
Pérdida de Sangre Quirúrgica/prevención & control , Técnicas Hemostáticas , Nefrostomía Percutánea/efectos adversos , Adulto , Creatinina/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad
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