Ultrasound guided endoscopic combined Intrarenal surgery - 10 steps for the success

ABSTRACT Background: Endoscopic combined intrarenal surgery (ECIRS) has been used to treat complex kidney stones (1). The combined use of ultrasound (US) has the potential to improve safety and reduce radiation exposure, however, it is still underutilized (2). Objectives: Our objective is to describe, in a step-by-step manner, the ultrasound-guided ECIRS (USG ECIRS) technique, in order to facilitate learning by urologists. Materials and Methods: We describe the 10 standardized steps that we recommend to achieve a good outcome, based on our previous experience on a high-volume kidney stone center. We recorded a case of a 37-year-old female patient with complex bilateral kidney stones that underwent a left simultaneous combined retrograde and antegrade approach. The 10 described steps are: 1 - case evaluation with CT scan (3); 2 - preoperative care with antibiotics and tranexamic acid; 3 - warm-up and training with phantoms; 4 - patient positioning in Barts flank free position; 5 - retrograde nephroscopy with flexible ureteroscope; 6 - US and endoscopic guided puncture; 7 - tract dilation under endoscopic view; 8 - stone fragmentation; 9 - status free checking and 10, kidney drainage. Images were captured by external and internal cameras, promoting a complete understanding of the procedure. The patient has signed a written informed consent form. Results: Puncture was achieved under US guidance with one attempt. Another puncture was necessary in the lower pole, parallel to the initial puncture, due to a large fragment. Surgical time was 140 min. Stone-free status was verified by retrograde and antegrade view. Kidney drainage was done with ureteral stent on string, removed after 7 days. Hb drop was 1.1 Hb/dL. The first postoperative day CT scan showed no residual stones and no complications. The patient was discharged after the CT and urethral catheter removal. Conclusion: The USG ECIRS seems to be a very efficient and reproducible technique for the treatment of complex kidney stones. Its use should be widespread.

Predictive factors for success after supine percutaneous nephrolithotomy: an analysis of 961 patients.

OBJECTIVE: The aim of this study was to evaluate the predictive factors for success following percutaneous nephrolithotomy in the supine position. METHODS: Patients who underwent percutaneous nephrolithotomy in the supine position from June 2011 to October 2018 were evaluated. Age, sex, body mass index, the American Society of Anesthesiologists physical status classification, hemoglobin level, number of previous surgeries, stone size, and the Guy's Stone Score were analyzed. Success was considered if no fragments were observed on the computed tomography scan on the first postoperative day. Univariate and multivariate analyses were performed to determine significant parameters. RESULTS: We evaluated 961 patients; of them, 483 (50.2%) underwent previous stone-related surgery, and 499 (51.9%) had Guy's Stone Score 3 or 4. The overall success rate in a single procedure was 40.7%, and complication rate was 13.7%. The univariate analysis showed that the maximum diameter of the stone (25.10±10 mm; p<0.001), previous percutaneous nephrolithotomy (OR 0.52; p<0.001), number of previous percutaneous nephrolithotomy (OR 0.15; p<0.001), the Guy's Stone Score (OR 0.28; p<0.001), and the number of tracts (OR 0.32; p<0.001) were significant. In the multivariate analysis, the number of previous percutaneous nephrolithotomy (OR 0.54; p<0.001) and the Guy's Stone Score (OR 0.25; p<0.001) were statically significant. CONCLUSIONS: Guy's Stone Score and the number of previous percutaneous nephrolithotomy are predictors of success with the supine position. Complex cases and with previous percutaneous interventions may require technical improvements to achieve higher stone-free rates.

Predictive factors for success after supine percutaneous nephrolithotomy: an analysis of 961 patients

SUMMARY OBJECTIVE: The aim of this study was to evaluate the predictive factors for success following percutaneous nephrolithotomy in the supine position. METHODS: Patients who underwent percutaneous nephrolithotomy in the supine position from June 2011 to October 2018 were evaluated. Age, sex, body mass index, the American Society of Anesthesiologists physical status classification, hemoglobin level, number of previous surgeries, stone size, and the Guy's Stone Score were analyzed. Success was considered if no fragments were observed on the computed tomography scan on the first postoperative day. Univariate and multivariate analyses were performed to determine significant parameters. RESULTS: We evaluated 961 patients; of them, 483 (50.2%) underwent previous stone-related surgery, and 499 (51.9%) had Guy's Stone Score 3 or 4. The overall success rate in a single procedure was 40.7%, and complication rate was 13.7%. The univariate analysis showed that the maximum diameter of the stone (25.10±10 mm; p<0.001), previous percutaneous nephrolithotomy (OR 0.52; p<0.001), number of previous percutaneous nephrolithotomy (OR 0.15; p<0.001), the Guy's Stone Score (OR 0.28; p<0.001), and the number of tracts (OR 0.32; p<0.001) were significant. In the multivariate analysis, the number of previous percutaneous nephrolithotomy (OR 0.54; p<0.001) and the Guy's Stone Score (OR 0.25; p<0.001) were statically significant. CONCLUSIONS: Guy's Stone Score and the number of previous percutaneous nephrolithotomy are predictors of success with the supine position. Complex cases and with previous percutaneous interventions may require technical improvements to achieve higher stone-free rates.

Ultrasound guided endoscopic combined Intrarenal surgery - 10 steps for the success.

BACKGROUND: Endoscopic combined intrarenal surgery (ECIRS) has been used to treat complex kidney stones (1). The combined use of ultrasound (US) has the potential to improve safety and reduce radiation exposure, however, it is still underutilized (2). OBJECTIVES: Our objective is to describe, in a step-by-step manner, the ultrasound-guided ECIRS (USG ECIRS) technique, in order to facilitate learning by urologists. MATERIALS AND METHODS: We describe the 10 standardized steps that we recommend to achieve a good outcome, based on our previous experience on a high-volume kidney stone center. We recorded a case of a 37-year-old female patient with complex bilateral kidney stones that underwent a left simultaneous combined retrograde and antegrade approach. The 10 described steps are: 1 - case evaluation with CT scan (3); 2 - preoperative care with antibiotics and tranexamic acid; 3 - warm-up and training with phantoms; 4 - patient positioning in Barts flank free position; 5 - retrograde nephroscopy with flexible ureteroscope; 6 - US and endoscopic guided puncture; 7 - tract dilation under endoscopic view; 8 - stone fragmentation; 9 - status free checking and 10, kidney drainage. Images were captured by external and internal cameras, promoting a complete understanding of the procedure. The patient has signed a written informed consent form. RESULTS: Puncture was achieved under US guidance with one attempt. Another puncture was necessary in the lower pole, parallel to the initial puncture, due to a large fragment. Surgical time was 140 min. Stone-free status was verified by retrograde and antegrade view. Kidney drainage was done with ureteral stent on string, removed after 7 days. Hb drop was 1.1 Hb/dL. The first postoperative day CT scan showed no residual stones and no complications. The patient was discharged after the CT and urethral catheter removal. CONCLUSION: The USG ECIRS seems to be a very efficient and reproducible technique for the treatment of complex kidney stones. Its use should be widespread.

High CD39 expression is associated with the non-muscle-invasive phenotype of human bladder cancer.

BACKGROUND: An accurate prediction of progression is critical to define the management of bladder cancer (BC). The ectonucleotidases CD39 and CD73 play strategic roles in calibrating purinergic signals via an extracellular balance between ATP and adenosine. The altered expression of these enzymes plays a potential role in tumor invasion and metastasis, therefore, has been proposed to be used for prognosis of solid tumor. In BC this is not yet clear. OBJECTIVE: This study aimed to evaluate CD39 and CD73 expression in a cohort of patients with non-muscle-invasive (NMI) and muscle-invasive (MI) BC regard to its association with clinicopathological features. MATERIALS AND METHODS: Retrospective clinical follow-up data and primary urothelial BC specimens of 162 patients were used (87 from patients who underwent transurethral resection and 75 from cystectomized patients). Tissue microarrays were constructed, and immunohistochemistry for CD39 and CD73 was performed to make associations with clinicopathological data. RESULTS: Overall, 96 were NMI (59.3%) and 66 MI (40.7%). CD39 immunoreactivity in BC cells was found in 72% of the cases, while CD73 was found in 97%. High CD39 expression alone was more frequent in NMI BC (p < 0.001), while CD73 expression was not powerful to predict the stage of BC. The association of both markers confirmed that only CD39 has potential in BC prognosis. CONCLUSIONS: The altered expression of CD39 presented herein supports the idea that this ectonucleotidase may be involved in bladder tumorigenesis. High expression of CD39 in tumor cells is correlated with the early stage of BC.

Patients with encrusted ureteral stents can be treated by a single session combined endourological approach

ABSTRACT Purpose: To describe our experience in the management of retained encrusted ureteral stents using a single session combined endourological approach. Materials and Methods: Patients with retained encrusted ureteral stents who had been submitted to a single session combined endourological approach from June 2010 to June 2018 were prospectively evaluated. Patients were divided according to the Forgotten-Encrusted-Calcified (FECal) classification. The stone burden, surgical intervention, number of interventions until stone free status, operation time, hospital stay, complications, stone analysis, and stone-free rate were compared between groups. ANOVA was used to compare numerical variables, and the Mann-Whitney or Chi-square test to compare categorical variables between groups. Results: We evaluated 50 patients with a mean follow-up of 2.9±1.4 years (mean±SD). The groups were comparable in terms of age, sex, laterality, BMI, comorbidities, ASA, reason for stent passage, and indwelling time. The stone burden was higher for grades IV and V (p=0.027). Percutaneous nephrolithotomy was the most common procedure (p=0.004) for grades IV and V. The number of procedures until the patients were stone-free was 1.92±1.40, and the hospital stay (4.2±2.5 days), complications (22%), and stone analysis (66% calcium oxalate) were similar between groups. The stone-free rate was lower in grades III to V (60%, 54.5%, and 50%). Conclusions: The endoscopic combined approach in the supine position is a safe and feasible technique that allows removal of retained and encrusted stents in a single procedure. The FECal classification seems to be useful for surgical planning.

Early Effects of High-intensity Focused Ultrasound (HIFU) Treatment for Prostate Cancer on Fecal Continence and Anorectal Physiology.

OBJECTIVE: To evaluate high-intensity focused ultrasound (HIFU) effects on anorectal physiology and fecal continence or constipation, and on quality of life (QoL). METHODS: We prospectively evaluated 26 patients with localized prostate cancer who underwent HIFU. The Rome III criteria for functional constipation, the Cleveland Clinic Florida Fecal Incontinence Score, and the Fecal Incontinence QoL Score questionnaires were answered before and after treatment. Anorectal manometry was used to evaluate resting and squeezing pressures, sustained contraction, paradoxical puborectalis contraction, rectal sensation, and rectal capacity. RESULTS: Thirteen patients underwent hemiablation and 13 underwent whole-gland ablation. There was no difference between groups regarding the Rome III criteria for functional constipation results. The Cleveland Clinic Florida Fecal Incontinence Score results showed that 3 (11.5%) of patients had mild fecal incontinence before HIFU and 5 (19.2%) had it afterward (P = .625). No patients reported poor QoL due to fecal incontinence in the Fecal Incontinence QoL Score. Anorectal manometry demonstrated no decrease in resting pressure after treatment (P = .299), while squeezing pressure significantly increased from 151.87 to 167.91 mm Hg (P = .034). The number of patients with normal sustained contraction remained the same (20 [77%]). Paradoxical puborectalis contraction was seen in 12 (46%) of the patients before the procedure and in 13 (50%) after (P = .713). Improvement in sensory parameters was not significant: first sense changed from 73.46 to 49.71 mL (P = .542) and first urge from 98.27 to 82.88 mL (P = .106). Rectal capacity had a nonsignificant decrease from 166.15 to 141.15mL (P = .073). CONCLUSION: HIFU did not cause significant changes in anorectal physiology. Fecal incontinence or constipation after HIFU was not observed via validated questionnaires.

Hemorrhagic complications after percutaneous nephrolithotomy: angiographic diagnosis and management by transcatheter arterial embolization / Complicações hemorrágicas após nefrolitotripsia percutânea: diagnóstico angiográfico e tratamento por embolização arterial transcateter

Abstract Objective: To identify the main hemorrhagic complications after percutaneous nephrolithotomy, as well as the results obtained with transcatheter arterial embolization (TAE) at an interventional radiology center. Materials and Methods: This was a retrospective analysis of patients undergoing TAE for the treatment of hemorrhagic complications after percutaneous nephrolithotomy. All patients underwent computed tomography angiography (CTA). Results: We evaluated a total of nine patients. At emergency department readmission, the most common symptom was macroscopic hematuria, which was seen in five patients. Three patients had an isolated pseudoaneurysm, two had a pseudoaneurysm together with active bleeding (perirenal hematoma), and one had a pseudoaneurysm together with arteriocalyceal fistula. Arteriovenous fistula was diagnosed in three patients and was not seen in combination with other vascular lesions. We did not identify arteriocalyceal fistula in isolation. Five patients underwent TAE with 6 × 15 mm and 6 × 20 mm microcoils. Four patients underwent TAE with n-butyl-2-cyanoacrylate and ethiodized oil. Follow-up CTAs revealed no complications. Conclusion: Because of its high diagnostic accuracy, CTA provides the interventional radiologist with valuable data for individualized therapeutic planning. The TAE procedure is safe and effective. It can therefore be used as a first-line treatment for hemorrhagic complications resulting from percutaneous renal procedures.

Resumo Objetivo: Demonstrar as principais complicações hemorrágicas após nefrolitotripsia percutânea, bem como os resultados após o tratamento por embolização arterial transcateter (EAT) em um centro de radiologia intervencionista. Materiais e Métodos: Coleta e análise de dados retrospectivos de pacientes submetidos a EAT por complicações hemorrágicas após nefrolitotripsia percutânea. Resultados: O sintoma mais comum foi hematúria macroscópica, presente em cinco pacientes no momento da readmissão ao pronto-socorro, e nestes pacientes identificamos três pseudoaneurismas isolados, dois casos de combinação de pseudoaneurisma e sangramento ativo (hematoma perirrenal) e um caso de associação de pseudoaneurisma e fístula arteriocalicinal. Fístula arteriovenosa foi diagnosticada em três pacientes, não sendo observada em associação com outras lesões vasculares. Não identificamos fístula arteriocalicinal isolada, somente associada a pseudoaneurisma. Cinco pacientes foram submetidos a embolização por micromolas 6 × 15 mm e 6 × 20 mm. Quatro pacientes foram submetidos a embolização por Histoacryl e Lipiodol. Não observamos complicações pela angiotomografia computadorizada de controle. Conclusão: A angiotomografia computadorizada apresenta alta acurácia diagnóstica e guarnece o radiologista intervencionista de dados para um planejamento terapêutico individualizado. EAT é um procedimento seguro e eficaz e pode ser utilizado como primeira linha para o tratamento de complicações hemorrágicas resultantes de procedimentos percutâneos renais.

Comparative study of percutaneous nephrolithotomy performed in the traditional prone position and in three different supine positions

ABSTRACT Purpose: To compare the outcomes of percutaneous nephrolithotomy (PCNL) performed in the prone position (PRON) and in three variations of the supine position. Materials and Methods: We performed a retrospective analysis of patients that underwent PCNL at our institution from June 2011 to October 2016 in PRON and in three variations of the supine position: complete supine (COMPSUP), original Valdivia (VALD), and Galdakao - modified Valdivia (GALD). All patients had a complete pre - operative evaluation, including computed tomography (CT). Success was defined as the absence of residual fragments larger than 4 mm on the first post - operative day CT. Results: We analyzed 393 PCNLs: 100 in COMPSUP, 94 in VALD, 100 in GALD, and 99 in PRON. The overall success rate was 50.9% and was similar among groups (p = 0.428). There were no differences between groups in the number of punctures, stone - free rate, frequency of blood transfusions, drop in hemoglobin level, length of hospital stay, and severe complications (Clavien ≥ 3). COMPSUP had a significantly lower operative time than the other positions. COMPSUP had lower fluoroscopy time than VALD. Conclusion: Patient positioning in PCNL does not seem to impact the rates of success or severe complications. However, COMPSUP is associated with a shorter surgical time than the other positions.

Comparative study of percutaneous nephrolithotomy performed in the traditional prone position and in three different supine positions.

PURPOSE: To compare the outcomes of percutaneous nephrolithotomy (PCNL) performed in the prone position (PRON) and in three variations of the supine position. MATERIALS AND METHODS: We performed a retrospective analysis of patients that underwent PCNL at our institution from June 2011 to October 2016 in PRON and in three variations of the supine position: complete supine (COMPSUP), original Valdivia (VALD), and Galdakao - modified Valdivia (GALD). All patients had a complete pre - operative evaluation, including computed tomography (CT). Success was defined as the absence of residual fragments larger than 4 mm on the first post - operative day CT. RESULTS: We analyzed 393 PCNLs: 100 in COMPSUP, 94 in VALD, 100 in GALD, and 99 in PRON. The overall success rate was 50.9% and was similar among groups (p = 0.428). There were no differences between groups in the number of punctures, stone - free rate, frequency of blood transfusions, drop in hemoglobin level, length of hospital stay, and severe complications (Clavien ≥ 3). COMPSUP had a significantly lower operative time than the other positions. COMPSUP had lower fluoroscopy time than VALD. CONCLUSION: Patient positioning in PCNL does not seem to impact the rates of success or severe complications. However, COMPSUP is associated with a shorter surgical time than the other positions.

Impact of patient position on the outcomes of percutaneous neprolithotomy for complex kidney stones

ABSTRACT Purpose: To evaluate the impact of the patient position on the outcomes of PCNL among patients with complex renal stones. Material and Methods: From July 2011 to July 2014, we collected prospective data of consecutive patients who underwent PCNL. We included all patients with complex stones (Guy's Stone Score 3 or 4 (GSS) based on a CT scan) and divided them based on the position used during PCNL (prone or supine). The variables analyzed were gender, age, body mass index, ASA score, stone diameter, GSS, number of punctures, calyx puncture site, intercostal access and patient positioning. Complications were graded according to the modified-Clavien Classification. Success was considered if fragments ≤ 4mm were observed on the first postoperative day CT scan. Results: We analyzed 240 (46.4%) of 517 PCNL performed during the study period that were classified as GGS 3-4. Regarding patient positions, 21.2% were prone and 79.8% were supine. Both groups were comparable, although intercostal access was more common in prone cases (25.5% vs 10.5%; p=0.01). The success rates, complications, blood transfusions and surgical times were similar for both groups; however, there were significantly more visceral injuries (10.3% vs 2.6%; p=0.046) and sepsis (7.8% vs 2.1%; p=0.042) in prone cases. Conclusion: Supine or prone position were equally suitable for PCNL with complex stones and did not impact the success rates. However, supine position was associated with fewer sepsis cases and visceral injuries.

Giant Perineal Solitary Fibrous Tumor: A Rare Case Report.

Background. Solitary fibrous tumor (SFT) is a fibroblastic mesenchymal tumor that was initially described from the pleura but currently arises at almost every anatomic site. It is usually benign, and surgical resection is curative. SFT involving the perineum is extremely rare. This is the third case report of a perineal SFT in the literature. Case Presentation. We reported an uncommon case of a 64-year-old man presenting with a huge perineal mass that started growing 3 years before his arrival in our service. He was asymptomatic. A contrast-enhanced CT scan revealed a heterogeneous well-circumscribed perineal mass with soft-tissue density. Invasion of the surrounding organs, distal metastasis, and lymph node swelling were absent. The complete resection of mass was done successfully. The specimen was a 23.0 × 14.0 × 8.0 cm encapsulated tumor. Mass weight was 1,170 g. After pathological analysis, we confirmed that the mass was a solitary fibrous tumor. The diagnosis was based on clinical findings and histological morphology and immunohistochemistry study. Conclusion. SFTs are usually indolent tumors with a favorable prognosis. The perineal location is extremely rare. Complete resection of the mass is the treatment of choice.

Cavernous nerve reconstitution with the use of bone marrow stem cells and erectile function evaluation: an experimental animal study / Avaliação da função erétil após a reconstituição do nervo cavernoso com o uso de células-tronco de medula-óssea: estudo experimental em ratos

Objective: To assess the influence of adult stem cells from bone marrow of rats in the regeneration of cavernous nerve, taking the return of erectile function as a parameter in animals subjected to the apomorphine-induced test of erection. Methods: Forty-eight male Wistar-EPM rats, aged between nine and ten weeks, and weighing approximately 250 g were used. They were randomly divided into four study Groups containing 12 animals each, as follows: Group I: surgical exposure of the cavernous nerves bilaterally without injury; Group II: bilateral surgical injury of the cavernous nerve of approximately 3 mm, without reconstruction; Group III: bilateral surgical injury of the cavernous nerves of approximately 3 mm, and bilateral reconstruction with silicone guiding tubes containing saline solution inside; Group IV: bilateral surgical injury of the cavernous nerves of approximately 3 mm, and bilateral reconstruction with silicone guiding tubes filled with adult stem cells. Four weeks after surgery, the animals were injected with apomorphine for induction of erection. Results: In Group I there was complete erectile response in all animals (100% ? 12 out of 12). On the other hand, none of the animals in Group II presented erection after the use of apomorphine. Five of the twelve animals of Group III (41.7%) and nine of the 12 animals of Group IV (75%) had erections after the stimulus. When we compared the frequency of restoration of erection in the four Groups, Group IV was shown to have a similar performance to Group I (p = 0.217), while Group III animals had a frequency of erections inferior to those in Group I (p = 0.005). Moreover, comparison of results of Groups III and IV versus Group II showed that the frequency of erections was statistically higher in the first two Groups (p = 0.037 and p < 0.001, respectively). Finally, Group IV presented a tendency to a larger number of erections when compared to Group III (75 versus 41.7%) but this difference was not statistically significant (p = 0.098). Conclusion: This study shows that adult stem cells from bone marrow, filling silicone guiding tubes, may promote the regeneration of cavernous nerves and restore erectile function in an animal model.

Objetivo: Avaliar a influência de células-tronco adultas da medula óssea de ratos na regeneração do nervo cavernosos lesado, tomando-se como parâmetro o retorno da função erétil nos animais submetidos ao teste de ereção induzido pela apomorfina. Métodos: Quarenta e oito ratos Wistar-EPM machos, com idades entre nove e dez semanas, pesando aproximadamente 250 g, foram usados e randomicamente subdivididos em quatro grupos de estudo contendo 12 animais cada. Os grupos experimentais foram divididos em: Grupo I: exposição cirúrgica bilateral do nervo cavernoso sem lesão do mesmo. Grupo II: lesão cirúrgica bilateral do nervo cavernoso de aproximadamente 3 mm, sem reconstrução. Grupo III: lesão cirúrgica bilateral dos nervos cavernosos de aproximadamente 3 mm, e reconstrução bilateral com sondas-guia de silicone contendo solução salina em seu interior. Grupo IV: lesão cirúrgica bilateral dos nervos cavernosos de aproximadamente 3 mm, e reconstrução bilateral com sondas-guia de silicone semeadas com células-tronco adultas em seu interior. Quatro semanas após a cirurgia, os animais foram injetados com apomorfina para indução da ereção. Resultados: No grupo I observou-se resposta erétil completa em todos os animais (100% ? 12 em 12). Por outro lado, nenhum dos animais do grupo II apresentou ereções após a administração de apomorfina. Cinco dos doze animais do grupo III (41,7%) apresentaram ereções, enquanto nove dos 12 animais do grupo IV (75%) evidenciaram ereções após o estímulo. Quando foram comparadas as frequências de restauro de ereção nos quatro grupos, demonstrou-se que Grupo IV teve um comportamento semelhante ao Grupo I (p = 0,217), ao passo que os animais do Grupo III apresentaram frequência de ereções inferiores aos do Grupo I (p = 0,005). Por outro lado, a comparação dos resultados entre os Grupos III e IV versus o Grupo II demostrou que a frequência de ereções foi estatisticamente superior nos dois primeiros Grupos (p = 0,037 e p < 0,001, respectivamente). Finalmente, o Grupo IV apresentou tendência a maior número de ereções quando comparado ao Grupo III (75 versus 41,7%), mas essa diferença não foi estatisticamente significante (p = 0,098). Conclusão: O presente estudo demonstra que células-tronco adultas da medula óssea, semeadas em sondas-guia de silicone, favorecem a regeneração dos nervos cavernosos e promovem o restabelecimento da função erétil em um modelo animal.

Mini-incisions by lombotomy or subcostal access in living kidney donors: a randomized trial comparing pain, safety, and quality of life.

OBJECTIVES: The aim of this study was to compare two mini-incision techniques and judge the impact on the quality of life, pain, and safety of living kidney donors. PATIENTS AND METHODS: From March through September 2003, a prospective randomized study with 60 donors had nephrectomy performed - 30 through a lombotomy and another 30 patients underwent subcostal mini-incisions. The same anesthetic procedure was used for both groups. All patients were evaluated from baseline (T0) to day 90 after surgery. Pain evaluation included visual analog scale (VAS) and drug usage. To assess quality of life (QOL), the questionnaire SF-36 was used and surgical outcomes were also checked. RESULTS: Sixty patients (41.6 +/- 8.9 yr old) were included in the protocol. Regarding incision length and blood loss, no statistical difference was observed. However, irrespective to the site of the mini-incision, patients with body mass index (BMI) higher than 25 kg/m(2) had significantly longer incision length as well as higher blood loss. There were no complications. No significant difference in tramadol or in pain perception was observed between groups. QOL was also not different between groups, however, there was a significant loss with subsequent return to baseline levels. CONCLUSION: The position of the mini-incision (lombotomy or subcostal) has no significant impact on surgical outcomes, pain perception, and QOL of living kidney donors. Mini-incision techniques represent fast and safe approaches to perform nephrectomy in the healthy population. Special care must be taken in obese patients in order to minimize surgical complications.

Cirurgia venosa peniana no tratamento da impotência / Penile venous surgery in impotence treatment

A drenagem venosa anormal dos corpos cavernosos é uma causa importante de impotência. Até recentemente a melhor forma de tratamento para a disfunçäo oclusiva era a cirurgia venosa. Dentre 740 pacientes com disfunçäo erétil, 21 foram submetidos à cirurgia venosa devido à disfunçäo venoclusiva dos corpos cavernosos. A idade desses pacientes variou de 27 a 69 anos (mediana de 53 anos). Catorze casos foram avaliados com seguimento de 13 meses e apresentaram índice de sucesso de 64 por cento. Considerou-se como sucesso o paciente que passou a ter relaçäo sexual normal, sem nenhum tratamento adjuvante. Os 21 pacientes avaliados com um seguimento mediano de 25 meses apresentaram índice de sucesso que caiu para 38 por cento.

Cirurgia venosa peniana no tratamento da impotência / The penile venous surgery in the treatment of impotence

A drenagem venosa anormal dos corpos cavernosos é uma causa importante de impotência. Até recentemente, a melhor forma de tratamento para a disfunçäo oclusiva era a cirurgia venosa. Dentre 740 pacientes com disfunçäo erétil, 21 foram submetidos à cirurgia venosa devido à disfunçäo veno-oclusiva dos corpos cavernosos. A idade desses pacientes variou de 27 a 69 anos (mediana de 53 anos). Catorze foram avaliados com seguimento de 13 meses e apresentaram índice de sucesso de 64 por cento. Considerou-se como sucesso o paciente que passou a ter relaçäo sexual normal, sem nenhum tratamento adjuvante. Os 21 pacientes avaliados com um seguimento mediano de 25 meses apresentaram índice de sucesso que caiu para 38 por cento

Cálculo coraliforme: nefrolitotomia anatrófica versus percutânea / Staghorn calculi: percutaneous versus anathrophic nephrolithotomy

Retrospectivamente, foram analisados os resultados do tratamento de 85 doentes portadores de litíase renal coraliforme. De acordo com o tratamento instituído, foram estabelecidos dois grupos: grupo 1- 29 pacientes submetidos à nefrolitotomia anatrófica; grupo 2- 56 pacientes tratados por via percutânea, cinco por litíases bilaterais, representando 61 unidades renais. Os pacientes foram estudados quanto ao tempo cirúrgico, índice de sucesso, complicaçöes, período de recuperaçäo às atividades habituais e quantidade de analgésicos necessários no pós-operatório. Cinco doentes, tratados durante o período de aprendizagem, näo foram incluídos no estudo, independentemente ao tipo de cirurgia, aberta ou percutânea. A remoçäo completa dos cálculos foi obtida em 82,1% na cirurgia anatrófica e 84,2% na percutânea. O grupo tratado por via percutânea apresentou estatisticamente menor tempo cirúrgico (mediana 147 versus 210 minutos), menor período de hospitalizaçäo (quatro versus sete dias), menor necessidade de analgésicos (mediana 1,03 versus 4,7 doses por paciente) e recuperaçäo mais rápida, com volta às atividades físicas normais (nove versus 43 dias). Dentre os pacientes submetidos à cirurgia anatrófica, 14 (50 por cento) necessitaram cuidados adicionais no tratamento das complicaçöes. Na cirurgia percutânea, apesar de 22,8 por cento dos casos serem submetidos de um ato cirúrgico, o total de complicaçöes näo foi significativamente maior, näo requerendo cirurgia aberta. Os resultados obtidos mostram menor índice de complicaçöes e maior taxa de bons resultados com a cirurgia percutânea. Recomendamos assim nefrolitotomia percutânea como primeira opçäo no tratamento da litíase coraliforme

Rotura espontânea do trato urinário superior / Spontaneous rupture of the upper urinary tract

Paciente com cólica renal esquerda miccional foi submetido à urografia excretora que demonstrou cálculo ureteral, extravasamento renal retardo na eliminaçäo do contraste do lado esquerdo. A tomografia axial computadorizada revelou grande coleçäo retroperitoneal. O tratamento foi conservador. Quatro dias após o estudo radiológico o paciente eliminou o cálculo

Tumor de ureter: descriçäo de um caso; papel da ureteroscopia no diagnóstico e tratamento / Ureteral tumor: a case report; function of ureteroscopy in diagnostic and treatment

Paciente de 60 anos foi submetido à ureteroscopia por suspeita de tumor do ureter, confirmado pela biópsia que revelou carcinoma papilífero de células transicionais. O tratamento consistiu na eletrocauterizaçäo endoscópica do tumor. Onze dias após, foi ressecada a porçäo acometida do ureter e o exame anatomopatológico revelou ausência de neoplasia