RESUMO
Since its introduction in late 1970's, percutaneous nephrolithotomy (PNL) has undergone an evolution in both equipment and technique. This evolution still continues today in the era of minimally invasive treatment options, and is evidenced by the numerous publications. PNL is generally advantageous in the management of large renal stones (>1.5-2 cm) with high stone-free rates and considerable complication rates. However this technique is especially competing with retrograde intrarenal surgery and laparoscopic techniques. Therefore the CROES Global PNL Study Group prospectively collected data of over 5800 patients managed with PNL worldwide and analyzed the data in detail, producing more than 25 scientific papers. And this update focuses on the lessons learned from the CROES PCNL Global Study.
Assuntos
Cálculos Renais/cirurgia , Nefrostomia Percutânea/métodos , Fatores Etários , Análise Custo-Benefício , Bases de Dados Factuais , Remoção de Dispositivo/métodos , Dilatação/instrumentação , Dilatação/métodos , Endoscopia/métodos , Humanos , Cooperação Internacional , Rim/anormalidades , Cálculos Renais/química , Cálculos Renais/patologia , Túbulos Renais Coletores , Nefrostomia Percutânea/efeitos adversos , Nefrostomia Percutânea/tendências , Posicionamento do Paciente/métodos , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Decúbito Dorsal , Resultado do TratamentoRESUMO
The purpose of this study was to evaluate the penile vascular function by color Doppler ultrasonography (CDU) in patients with Peyronie's disease. A total of 136 men with Peyronie's disease were stratified according to their potency by history as Group I consisting of potent patients and Group II consisting of patients with erectile dysfunction. They were all evaluated by penile CDU. Overall, 70.6% had erectile dysfunction by history. CDU revealed penile vascular abnormalities in 76.5%. In Group I, veno-occlusive dysfunction (VOD) was observed in 40% while mixed (arterial + venous) vascular disease was diagnosed in 10%. Penile vascular disease was detected in 87.5% patients in Group II (ie VOD in 28%, arterial disease in 9.3% and mixed vascular disease in 50%). The prevalence of arterial disease on CDU among Peyronie' patients with erectile dysfunction (59.3%) was significantly (P < 0.05) higher then it was among potent patients (10%). The prevalence of pure VOD was almost similar for patients with or without erectile dysfunction (P < 0.05). We conclude that penile vascular abnormalities can be observed in 76.5% on cases with Peyronie's disease by CDU and this ratio significantly increases to 87.5% among cases with erectile dysfunction by history. Our data also indicate that arterial disease, accounts for much of the diminished rigidity in men with Peyronie's disease.