RESUMO
Although many ureteral stents are commercially available, the actuality of encrustation is yet to be elucidated in humans. This study compared the Tria Ureteral Stent with PercuShield and the Polaris Ultra Ureteral Stent with HydroPlus Coating for short-term encrustation formation. Eighty-four patients, who required ureteral stent placement after ureteroscopy, were randomized into two stent groups. After stent removal on postoperative day 14, the encrustation volume on the stent surface was measured by micro-computed tomography. The primary outcome was the inner luminal encrustation volume. Secondary outcomes were encrustation volume on the outer or total surfaces and occurrence of adverse events. Clinical factors related to encrustation were also assessed as a post-hoc analysis. Finally, of the 82 patients analyzed, 75 (91.5%) had encrustation in the inner lumen of the stent. The difference in median inner encrustation volume between the Tria and Polaris Ultra stents was comparable (0.56 vs. 0.37 mm3, P = 0.183). There was no difference observed in the encrustation volume on the outer/total surfaces and stent-related adverse events. In both ureteral stents, the shaft body showed significant inner luminal encrustation compared to the proximal or distal loop (all, P < 0.05). Dyslipidemia (P = 0.027), elevated urine pH (P = 0.046), and crystalluria (P = 0.010) were associated with encrustation formation. The Tria and Polaris Ultra stents had similar efficacy for preventing encrustation in the short-term. Further studies are required to compare their long-term patency.
Assuntos
Stents/efeitos adversos , Ureteroscopia/instrumentação , Urolitíase/cirurgia , Idoso , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Stents/estatística & dados numéricos , Ureter/cirurgia , Ureteroscopia/efeitos adversos , Microtomografia por Raio-X/estatística & dados numéricosRESUMO
OBJECTIVE: To investigate whether robot-assisted partial nephrectomy compared with laparoscopic partial nephrectomy is effective for renal hilar tumor removal. METHODS: This was a prospective, multicenter, single-arm, open-label trial with a 2-year enrollment period. A total of 22 academic hospitals in Japan participated in the present study. Comparison with historical control values from reported studies of laparoscopic partial nephrectomy was carried out. The warm ischemia time and positive surgical margin rate were set as primary perioperative and oncological outcomes. In the historical control group, these were 27.7 min and 13%, respectively. RESULTS: The analysis population included 105 participants. The mean warm ischemia time was 20.2 (95% confidence interval 16.7-21.8; P < 0.0001 vs 27.7). Two of 103 participants (1.9%) had a positive surgical margin (95% confidence interval 0.5-6.8%). Both results satisfy the prespecified decision criteria for the superiority of robot-assisted partial nephrectomy over the historical control of laparoscopic partial nephrectomy. Resected weight and preoperative estimated glomerular filtration rate were predictive factors of functional loss of the partially nephrectomized kidney after robot-assisted partial nephrectomy. CONCLUSION: Robot-assisted partial nephrectomy for clinical T1 renal hilar tumors results in shorter warm ischemia time than and comparable positive surgical margin rate to those reported for laparoscopic partial nephrectomy.
Assuntos
Neoplasias Renais , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Robótica , Taxa de Filtração Glomerular , Humanos , Japão , Neoplasias Renais/cirurgia , Nefrectomia/efeitos adversos , Estudos Prospectivos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do TratamentoRESUMO
A 71-year-old man with gross hematuria and urinary retention showed a 7×8 cm polycystic mass compressing the prostate on the right ventral side on pelvic magnetic resonance imaging (MRI). The prostate specific antigen (PSA) level was 6.47 ng/ml. Prostate biopsy histopathology was consistent with prostate ductal carcinoma. Considering the difficulty of surgical therapy, endocrine therapy was undertaken prior to surgery for seven months. Almost all of the cyst disappeared ; robot-assisted laparoscopic radical prostatectomy was then successfully performed. Prostate ductal carcinoma is a relatively rare pathology for which radical prostatectomy plays an important role if the disease is localized. However, when ductal carcinoma involves large cysts, surgical treatment may be difficult. This report discusses the usefulness of neoadjuvant endocrine therapy to reduce the size of the cystic lesions.
Assuntos
Carcinoma Ductal , Cistos , Laparoscopia , Neoplasias da Próstata/cirurgia , Robótica , Idoso , Humanos , Masculino , Terapia Neoadjuvante , Antígeno Prostático Específico , ProstatectomiaRESUMO
BACKGROUND: The host-related risk factors for surgical difficulty of partial nephrectomy include the presence of thick and adherent adipose tissue surrounding the kidney (adherent perinephric fat [APF]). The kidney and perirenal fat must be isolated in donor nephrectomy. Thus, APF is an important surgery-related factor. We analyzed whether the Mayo adhesive probability (MAP) score is related to APF and surgical outcomes in laparoscopic single-site donor nephrectomy (LESS-DN). METHODS: Forty-six donors who underwent LESS-DN were selected. Determination of APF was based on a retrospective review of video-recorded surgical procedures during anterior perinephric fat dissection. The MAP score was evaluated from computed tomography images. Data regarding patient characteristics and operative outcomes were collected. We then examined the MAP score, APF, and related factors. RESULTS: Eleven patients (23.9%) had APF. The patients were divided into 2 groups (MAP score of 0 points and ≥ 1 point). The 2 groups showed significant differences in sex, age, body mass index, history of hypertension, and history of dyslipidemia. The operation time was significantly longer and the estimated blood loss volume was higher in patients with a MAP score of ≥ 1. Eight of 9 patients with a MAP score of ≥ 1 had APF. The only significant differences between patients with and without APF were in the body mass index, history of hypertension, and history of dyslipidemia. The operation time was significantly longer and the estimated blood loss volume was larger in patients with APF. CONCLUSIONS: The MAP score could be useful when predicting surgical difficulty in patients undergoing LESS-DN.
Assuntos
Gordura Intra-Abdominal/diagnóstico por imagem , Nefrectomia/efeitos adversos , Aderências Teciduais/diagnóstico por imagem , Coleta de Tecidos e Órgãos/efeitos adversos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto , Índice de Massa Corporal , Feminino , Humanos , Gordura Intra-Abdominal/patologia , Gordura Intra-Abdominal/cirurgia , Rim/diagnóstico por imagem , Rim/patologia , Rim/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Aderências Teciduais/complicações , Aderências Teciduais/patologia , Coleta de Tecidos e Órgãos/métodosRESUMO
INTRODUCTION: Measuring muscle mass is an important step in detecting sarcopenia. The evaluation of sarcopenia is also important for kidney transplant recipients. Methods for estimating muscle mass have been established using computed tomography or magnetic resonance imaging, which are considered the gold standards. But these methods are invasive and costly, and there is a need for a more practical and simple method using blood samples from kidney transplant recipients. METHODS: The study population was 62 patients who underwent kidney transplantation at Kansai Medical University Hospital, and were evaluated from August to October 2017. Muscle mass was measured using dual-energy X-ray absorptiometry. Serum creatinine and cystatin C levels were measured by immunoassay. RESULTS: We analyzed 62 transplant recipients who met the inclusion criteria (20 females and 42 males, mean age of 45.6 ± 12.7 years). The creatinine/cystatin C ratio in the male group was > 1, whereas the creatinine/cystatin C ratio in the female group was < 1. Muscle mass was significantly larger in the male group than the female group. There was a significant positive correlation between the skeletal muscle index and creatinine/cystatin C ratio in the male (r = 0.553; p < 0.001) and female groups (r = 0.675; p < 0.001). CONCLUSION: The creatinine/cystatin C ratio is appropriate for evaluating muscle mass in kidney transplant recipients.
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Creatinina , Cistatina C , Transplante de Rim , Músculo Esquelético , Complicações Pós-Operatórias , Sarcopenia , Absorciometria de Fóton/métodos , Adulto , Correlação de Dados , Creatinina/análise , Creatinina/sangue , Cistatina C/análise , Cistatina C/sangue , Feminino , Humanos , Imunoensaio/métodos , Japão , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/diagnóstico , Reprodutibilidade dos Testes , Sarcopenia/sangue , Sarcopenia/diagnóstico , Fatores SexuaisRESUMO
The laparoscopic management of urachal remnants has gradually become a common practice. Recently, laparoscopic single-site surgery (LESS), a minimally invasive approach that provides excellent cosmetic results, has been adopted in several surgical procedures for treating urachal remnants. However, when suturing the bladder wall or peritoneal defect during LESS it may be difficult to conduct the procedure manually, and such cases require an additional port for suturing. Our strategy, however, employs a knot pusher to perform the suturing without the need for an additional port. We compared and examined the perioperative parameters of the patients with the additional port and one without it (knot-pusher group). For the additional-port and knot-pusher groups, the average operative time, was 146.8 and 161.7 minutes respectively, pneumoperitoneal surgery time was 90.8 and 88.0 minutes, respectively, suturing time for the bladder wall was 577 and 502 seconds, respectively suturing time for peritoneal defect was 758 vs 779 seconds, respectively, and estimated blood loss was 19 and 9.6 ml, respectively ; there being no significant difference between the two groups. We report our knot-pusher method because it can achieve comparable results without compromising the surgical outcome.
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Laparoscopia/métodos , Doenças da Bexiga Urinária/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Laparoscopia/instrumentação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Úraco , Adulto JovemRESUMO
OBJECTIVE: This study aimed to evaluate the relationship between sexual activity and sexual function using questionnaires distributed to middle-aged Japanese patients with localized prostate cancer. METHODS: A total of 145 patients who underwent radical prostatectomy were enrolled in the survey reported on herein. Sexual activity and sexual function were investigated via the Expanded Prostate Cancer Index Composite (EPIC) and an original self-reported questionnaire. RESULTS: Of participants, 24.1% and 20.7% had sexual activity within a month period as investigated via the EPIC and original questionnaire, respectively. However, 29.7% of all those who reported sexual activity rate reported "about once every 2 months to a year," as shown in the original questionnaire. Regarding sexual function as addressed through EPIC, no results within that questionnaire's measure of sexual function showed significant differences among patients with a rate of actual sexual activity. CONCLUSIONS: The present survey showed that more than quarter of preoperative middle-aged Japanese prostate cancer patients surveyed had actual sexual activity, though not within the preceding 4 weeks. To precisely evaluate sexual function of middle-aged Japanese patients, it is necessary to consider actual sexual activity.