RESUMO
PURPOSE: To report stoma stenosis rates and efferent channel (EC) complications at long term follow-up for Turin pouch (TP). METHODS: This is a retrospective analysis of the prospectively maintained database of patients who underwent TP between March 2006 and May 2018. The TP is a U-shaped right colon pouch. The EC was conceived by the tubularization of 5 cm of the colon wall with the use of a stapler and sutured to the skin (EC-cutaneostomy). The ureters are sutured separately to the last 10 cm of ileum before the ileocecal valve. In literature, catheterization problems have been described on average in 20.3% of patients and stoma stenosis in 19.5% of the patients with flap valve systems. RESULTS: Thirty-eight consecutive patients underwent a TP procedure. The median age was 55 years (IQR: 52-60). Median operative time was 201 min (IQR: 170-210), median reconstructive time was 61 min (IQR: 55-65) and the blood loss was 244 ml (IQR: 150-300) and 4 patients (10.5%) needed blood transfusions. The median follow-up was 52 months (IQR: 37-92). Complete 24h continence was achieved in 34 (89%) patients. Seven (18.4%) patients reported difficulties in EC catheterization and 4 (10.5%) patients had stoma stenosis. This study is limited by the relatively small number of patients. CONCLUSION: In relation to similar systems, the TP seems to offer comparatively good functional results but EC and stoma complications were lower than other pouch variants in literature.
Assuntos
Bolsas Cólicas , Derivação Urinária , Constrição Patológica/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Estomas Cirúrgicos , Fatores de Tempo , Resultado do TratamentoRESUMO
AIMS AND BACKGROUND: The therapeutic choice in patients with clinically localized prostate cancer depends on preoperative clinical stage. Diagnostic instruments currently available for such an evaluation--considered separately--have not shown enough efficacy. Roach has recently introduced three simple mathematical equations that--on the basis of prostate-specific antigen and the biopsy Gleason score--are aimed at calculating the definitive pathological stage. We retrospectively analyzed our radical prostatectomy data base to assess the accuracy of the equations in predicting the final stage in patients with clinically localized prostate cancer. METHODS STUDY DESIGN: The study included 173 patients who had undergone radical retropubic prostatectomy at our Institution. Patients were divided into 25 groups, depending on preoperative PSA and the biopsy Gleason score. The risk of extracapsular neoplastic growth, seminal vesicle involvement and lymph node involvement was calculated for each group by means of Roach's equations. On the basis of definitive histological examinations, we compared the expected risk to the observed risk. RESULTS: The observed risk fell within the interval of expected risk in 16 of 17 groups (94%) regarding the evaluation of extracapsular growth, in 15 of 17 (88%) regarding the analysis of seminal vesicle involvement, and in 14 of 17 (82%) regarding the evaluation of lymph node involvement. Therefore, the observed event was in agreement with the expected event in 45 of 51 groups (88%). CONCLUSIONS: The equations represent a practical and effective instrument for preoperative clinical staging in patients with localized prostate cancer. By means of these mathematical formulas, one can assess the correct prognosis and--above all--plan the best therapeutic approach.
Assuntos
Modelos Estatísticos , Neoplasias da Próstata/patologia , Idoso , Biópsia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/imunologia , Estudos Retrospectivos , Risco , Índice de Gravidade de DoençaRESUMO
A series of 905 patients suffering from renal calculosis and treated with ESWL is considered and the indications for antibiotic treatment with prophylactic or prolonged aztreonam reviewed: 1) for calculi with sterile urine or occasionally infected with I.S.T. less than 200, monodose prophylaxis is certainly advantageous; 2) for calculi with sterile urine or occasionally infected with I.S.T. between 200 and 500, prolonged antibiotic cover is useful; 3) for calculi with chronic infection or with I.S.T. greater than 500, prolonged target antibiotic therapy is necessary; 4) aztreonam is an effective drug for both monodose prophylaxis and for cover treatment. In more complex cases, an antibiogram indication is necessary.
Assuntos
Aztreonam/uso terapêutico , Litotripsia/efeitos adversos , Infecções Urinárias/prevenção & controle , Aztreonam/administração & dosagem , Avaliação de Medicamentos , Humanos , Infecções Urinárias/etiologia , Infecções Urinárias/terapiaRESUMO
BACKGROUND: Stomach tract used for bladder augmentation decreases urinary pH and produces the syndrome of dysuria and hematuria; gastric mucosa in contact with urine may develop prominent histopathological changes including proliferative lesions. The aim of this study was to investigate in an experimental model the possibility of detecting the factors involved in the mucosal damage. METHODS: Thirty-five Sprague Dawley rats randomly underwent microsurgical gastrocystoplasty or sham operation (5 controls). During operation elliptical gastric patch was isolated with its gastroepiploic vascular pedicle, bladder was opened with midline incision and anastomosis performed. Urine was aspirated from the bladder for culture, pH and electrolytes evaluation; venous blood was samples for electrolytes, BUN and creatinine. Mean follow-up time was 6 months. RESULTS: Of the 30 rats subjected to gastrocystoplasty 23 survived (77%). All of cultures were negative, the urinary pH decreased after operation and increased gradually two months later. Urinary sodium and potassium ions concentrations increased significantly in gastrocystoplasty (p < 0.05). There were no significant changes in serum electrolytes or renal function. CONCLUSIONS: This experimental model was useful to investigate the effects related to the presence of gastric mucosa in the urinary tract.
Assuntos
Mucosa Gástrica/patologia , Microcirurgia/métodos , Complicações Pós-Operatórias/patologia , Estômago/cirurgia , Retalhos Cirúrgicos , Bexiga Urinária/cirurgia , Animais , Nitrogênio da Ureia Sanguínea , Creatinina/sangue , Estudos de Avaliação como Assunto , Concentração de Íons de Hidrogênio , Masculino , Modelos Animais , Potássio/metabolismo , Ratos , Ratos Sprague-Dawley , Sódio/metabolismo , Urina/químicaRESUMO
OBJECTIVE: Ureterointestinal (U-I) anastomotic stricture is one of the most important complications after radical cystectomy, occurring in 4% to 8% of patients. We report our ten years experience in the endourological treatment of this condition. MATERIALS AND METHODS: 32 patients with U-I strictures were endourologically treated at our Institution. The endoscopic procedure provides for a percutaneous nephrostomy, the passage of the stenosis with a guide-wire, the incision and balloon dilation of the stricture and, finally, a ureteral double J stenting. Of the 28 successfully treated patients, 10 underwent balloon dilation alone and 18 both ureteral incision (with cold knife in 11 and hot knife in 7) and dilation. RESULTS: The endourological approach failed in 4/32 (12.5%) patients: 3 failures were due to the inability to pass a guide-wire across the stricture, whilst in the remaining patient a serious intraoperative hemorrhage occurred. In 28/32 (87.5%) patients the endoscopic treatment was successful (a ureteral stent was positioned across the stenosis). However, long term results are less promising: at 6-90 month follow up, only 16 patients (57.1%) are free of strictures without ureteral stent, 10 (35.7%) need a permanent ureteral stent, 2 (7.2%) a percutaneous nephrostomy. CONCLUSION: Due to the low morbidity of endoscopic procedures and to the high risks associated with open surgery, we believe that endourology should represent the first choice in the treatment of U-I strictures, reserving open surgery for endoscopic failures or complications. Moreover, endourological treatment with both incision and dilation is more effective than dilation alone (which should be performed only in very short and recent strictures).
Assuntos
Endoscopia Gastrointestinal , Ureteroscopia , Derivação Urinária/efeitos adversos , Idoso , Cateterismo , Constrição Patológica/terapia , Feminino , Humanos , Intestinos/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapia , Stents , Fatores de TempoRESUMO
Ancient schwannoma is a rare subtype of typical schwannoma, with histological predominance of degenerative findings. We report the second case of retroperitoneal ancient schwannoma (occurred in a 45-year-old female referred to our institution for an unremitting right lumbar pain) and pinpoint clinical, radiological, prognosis and therapeutic aspects of this tumor.
Assuntos
Neurilemoma/patologia , Neoplasias Retroperitoneais/patologia , Dor nas Costas/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Neurilemoma/diagnóstico , Neurilemoma/terapia , Prognóstico , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/terapia , Tomografia Computadorizada por Raios XRESUMO
Eighty-two evaluable patients suffering from UTI were randomly treated with parenteral Aztreonam (1 g OD in cystitis and 1 g BID in pyelonephritis) or oral Norfloxacin (400 mg BID). Predisposing urological conditions were present in 75% and 78.5% respectively. Microbiological cultures at the end of treatment and at a follow-up visit after 4 weeks showed significantly better results among Aztreonam treated patients (microbiological cure: 97.5% vs 71.4%-p less than or equal to 0.005). Clinical cure was achieved in 97.5% and 71.4% respectively (p less than or equal to 0.001). A statistically significant difference was present only in patients treated for pyelonephritis (microbiological cure-AZT: 100%; NOR: 50%-p less than or equal to 0.0005) and not in those with cystitis (AZT: 95.0%; NOR: 83.3%). Side effects were rare in both treatments. Aztreonam seems to offer major advantages, when compared to Norfloxacin, in the treatment of UTI, especially when upper urinary tract is involved.
Assuntos
Aztreonam/uso terapêutico , Norfloxacino/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Administração Oral , Adulto , Idoso , Assistência Ambulatorial , Aztreonam/administração & dosagem , Ensaios Clínicos como Assunto , Cistite/tratamento farmacológico , Feminino , Humanos , Injeções Intramusculares , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Norfloxacino/administração & dosagem , Pielonefrite/tratamento farmacológico , Distribuição Aleatória , RecidivaRESUMO
The Lithoring Multi-One is a lithotripter recently developed in Italy. Its main features are (1) spark gap generator with large ellipsoid, with tunable power for treatments with or without analgesia; (2) localization by fluoroscopy and ultrasounds without moving the patient; (3) isocentric variation of shock wave window, and (4) multifunctional table. It can treat both urinary and biliary stones. The first 50 patients were treated without anesthesia with an average of 1,700 shock waves at 19.2 kV. 37 patients had stones larger than 1 cm. 13 patients had ureteral stones. Two patients had complete staghorn stones. The disintegration rate was 97.9%, the overall stone-free rate at 3 months' follow-up was 83.3%, and the retreatment rate was 1.29 treatments for patients. No complication occurred.
Assuntos
Cálculos Renais/terapia , Litotripsia/instrumentação , Cálculos Ureterais/terapia , Anestesia , Desenho de Equipamento , Seguimentos , HumanosRESUMO
23 cases of flexible retrograde nephroscopy system for undiagnosed hematuria or filling defect are reviewed. The introduction was carried out by combining hydraulic dilation, rigid ureterorenoscopy and a working sheath. The indications were merely diagnostic (filling defects and/or haematuria). The success rate was very high (22 of 23). 9 cases of papillary tumors, 4 cases of small radiolucent stones and 1 case of papillary necrosis were diagnosed. In 8 cases no pathology was found. The complication rate was extremely low and the postoperative course was uneventful. Flexible instruments offer a very good chance to explore the intrarenal collecting system and transureteral nephroscopy through a 10.8 F flexible scope is a feasible and effective procedure.
Assuntos
Endoscopia , Hematúria/diagnóstico , Cálculos Renais/diagnóstico , Neoplasias Renais/diagnóstico , Túbulos Renais Coletores , Adulto , Idoso , Artefatos , Cateterismo , Endoscópios , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Tecnologia de Fibra Óptica , Hematúria/etiologia , Humanos , Cálculos Renais/terapia , Neoplasias Renais/complicações , Neoplasias Renais/cirurgia , Túbulos Renais Coletores/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/cirurgia , Nefrostomia Percutânea , Papiloma/complicações , Papiloma/diagnóstico , Papiloma/cirurgia , Radiografia , Cateterismo UrinárioRESUMO
The Lithoring multi-one is a lithotripter recently developed in Italy. Its main features are: (1) spark gap generator with large ellipsoid with tunable power for treatments with or without analgesia (2) localization by fluoroscopy and ultrasounds without moving the patient (3) isocentric variation of shock wave window (4) multi-functional table. It can treat both urinary and biliary stones. Herein we described (1) the experimental in vitro studies, including those carried out by intentionally changing the direction of the blast path during the treatment (2) the experimental in vivo studies on pigs which demonstrated a rate of side effects favourably comparable with that of other spark gap lithotripters (3) the clinical experience on urinary stones which started in May, 1989. The first 50 patients were treated without anaesthesia with an average of 1700 shock waves at 19.2 Kv. 37 patients had stones larger than 1 cm. 13 patients had ureteral stones. Two patients had complete staghorn stones. The disintegration rate was 97.9 percent, the overall stone-free rate at 3 months follow-up was 83.3 percent and the retreatment rate was 1.29 treatments for patients. No complication occurred.
Assuntos
Cálculos Renais/terapia , Litotripsia/instrumentação , Cálculos Ureterais/terapia , Adulto , Idoso , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
From October 1985 to June 1986 we have treated 82 impotent patients. We related their penis-brachial pressure index (PBPI) with the dosage of papaverine necessary to obtain a full erection as measured by tumistore. We describe the technique and the relationship between the PBPI and the dose of papaverine necessary for the erection; in this way PBPI should be used as guide for the dosage of intracavernous papaverine injection.
Assuntos
Disfunção Erétil/diagnóstico , Papaverina/administração & dosagem , Ereção Peniana/efeitos dos fármacos , Pênis/irrigação sanguínea , Adulto , Idoso , Pressão Sanguínea , Disfunção Erétil/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Papaverina/uso terapêutico , Fluxo Sanguíneo RegionalRESUMO
Priapism can be successfully treated by unilateral or bilateral percutaneous transcatheter occlusion of the internal pudendal arteries. Occlusion should be reversible in order to avoid impotence. Embolization with an autologous clot satisfies this requirement because of clot lysis and consequent vessel recanalization. This treatment is the most specific therapy in 'high-flow' priapism. The authors describe extensively 5 cases which demonstrate the feasibility of the method by which sexual potency is preserved.
Assuntos
Embolização Terapêutica , Priapismo/terapia , Adulto , Idoso , Angiografia , Humanos , Masculino , Pessoa de Meia-Idade , Pênis/irrigação sanguínea , UltrassonografiaRESUMO
A series of 56 percutaneous transcatheter renal angioplasties, carried out in an endourological unit, is reviewed and compared with radiological series. The results were inferior for fibrosclerotic lesions (77 vs. 90%) and nonostial atherosclerosis (67.8 vs. 75%), but slightly superior for ostial lesions (33 vs. 20-30%) in the endourological series as compared with the radiological series. Conversely, morbidity was significantly inferior (8.9 vs. 18.6%). The endourological series compares well with the radiological series in the literature. Percutaneous transcatheter renal angioplasty should be considered a procedure belonging both to interventional radiology and to endourology. Owing to the technical difficulties and the complication rate, it should not be performed in outpatients and a surgical support team should be available in the event of a threatening renal complication.
Assuntos
Angioplastia Coronária com Balão/métodos , Obstrução da Artéria Renal/terapia , Artéria Renal , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/instrumentação , Arteriosclerose/terapia , Feminino , Fibrose , Seguimentos , Humanos , Hipertensão Renovascular/terapia , Cálculos Renais/terapia , Masculino , Recidiva , Artéria Renal/patologia , Obstrução da Artéria Renal/etiologiaRESUMO
50 cases of flexible instrumentation of the intrarenal collecting system are reviewed. 28 were performed by retrograde flexible ureterorenoscopy. The introduction was carried out by combining hydraulic dilation, rigid ureterorenoscopy and a working sheath. 22 cases were performed through a percutaneous route. The indications were both diagnostic (filling defects and/or hematuria) and therapeutic (caliceal stone and/or fragments). The success rate was high in the diagnostic cases (20 of 24), but lower in the therapeutic cases (13 of 26). The complication rate was extremely low and the postoperative course was always uneventful. Flexible instruments offer a very good chance to explore the intrarenal collecting system. Both transureteral and percutaneous flexible nephroscopies are feasible and effective procedures. A laser can be used well in this area.
Assuntos
Endoscópios , Cálculos Renais/terapia , Nefropatias/diagnóstico , Adulto , Idoso , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , UreterRESUMO
Extracorporeal shock wave lithotripsy is becoming the most common procedure for the treatment of renal and ureteral stones. The introduction of a new generator and a new hemi-ellipsoid for the Dornier HM-III lithotripter improves patient comfort and requires no general or peridural anesthesia, thus making it easier to perform this procedure on an outpatient basis.
Assuntos
Assistência Ambulatorial , Cálculos Renais/terapia , Litotripsia/métodos , Cálculos Ureterais/terapia , Adolescente , Adulto , Idoso , Feminino , Humanos , Litotripsia/instrumentação , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Here we describe the clinical, ultrasonographic and histological features of a rare pure adult yolk sac tumor detected in the right testis of a 44-year-old male. Due to the rarity of this neoplasm (less than 10 cases have been reported), there is no unanimous consensus for therapy following inguinal orchiectomy. We believe that nerve-sparing retroperitoneal lymph node dissection could be potentially curative and useful for future interpretations of this tumor's potential evolution.
Assuntos
Tumor do Seio Endodérmico/patologia , Neoplasias Testiculares/patologia , Adulto , Humanos , MasculinoRESUMO
A series of 365 patients with ureteral stones is reviewed. ESWL, ureterorenoscopy, basket extraction and open surgery were alternatively used according to the stone and to the increasing experience in minimally invasive techniques. The overall success rate of in situ ESWL varied between 79 and 90% according to the localization of the stone and no difference was noted between patients treated with the original HM III Dornier lithotriptor and patients treated with the upgraded HM III with low pressure and large ellipsoid for painfree ESWL. Also the retreatment rate did not differ significantly (38 vs 42%). Ureterorenoscopy, carried out as first approach or after ESWL failure, was successful in 80.4% of the cases. Basket extraction was successful only in 32.3% of the cases. In situ ESWL, in one or two sessions, without anaesthesia and without hospital stay, is a good solution for roughly 80% of ureteral stones. Retrograde manipulation with or without ureterorenoscopy, requiring anaesthesia and hospitalization, should be reserved to failures of in situ ESWL.
Assuntos
Cálculos Ureterais/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Endoscopia , Feminino , Humanos , Litotripsia , Masculino , Pessoa de Meia-IdadeRESUMO
Stones situated anteriorly cannot be satisfactorily reached with extracorporeal shock wave lithotripsy (ESWL) in the supine position. By assuming the prone position, patients with stones in horseshoe or ectopic kidneys or in the iliac ureter can be treated by ESWL with the same success rate as patients with posterior stones. This new technique has been used in 30 patients with iliac ureteral stones, 5 patients with caliceal stones in horseshoe kidneys and 1 patient with a pyelic stone in a sacral kidney.
Assuntos
Cálculos Renais/terapia , Rim/anormalidades , Litotripsia/métodos , Postura , Cálculos Ureterais/terapia , Adulto , Idoso , Feminino , Humanos , Cálculos Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cálculos Ureterais/diagnóstico por imagem , UrografiaRESUMO
The results and complications of 122 percutaneous debulking of staghorn stones are carefully reviewed, discriminating between dilated and not dilated kidneys. Percutaneous debulking can be defined as satisfactory in about 70% of the cases. In the remaining 30% of the cases (mostly not dilated kidneys) it has got little or no results. The overall complication rate is quite low and most of the common complications can be prevented. Percutaneous procedures in nondilated kidneys have an overall complication rate highly superior to that in dilated kidneys. It should be preferable to treat as many staghorn stones as possible in nondilated kidneys with staged extracorporeal shockwave lithotripsy (ESWL) monotherapy, stenting the ureter and monitoring the urinary infection. Struvite stones are best suitable for stented ESWL because of their fragility. In case of cystine or oxalate monohydrate staghorn stone open surgery might be preferable in virgin patients, but it is often refused by the patients.
Assuntos
Cálculos Renais/terapia , Litotripsia , Adulto , Idoso , Cateterismo , Humanos , Pessoa de Meia-Idade , Nefrostomia Percutânea , Cateterismo UrinárioRESUMO
Ureteral herniation is a rare, often misdiagnosed event and serious surgical complications are possible. Until 1992, 128 cases of ureteral herniation were reported and in 54 (42%) the inguino-scrotal region was involved. From an anatomical and pathogenic standpoint, two types of uretero-inguinal hernias can be identified: paraperitoneal (more frequent, acquired, always presenting a peritoneal hernia sac, frequently associated with other herniated abdominal structures) and extraperitoneal (very uncommon, congenital, never associated with a true peritoneal sac, always composed only of the ureter). We describe a new case of scrotal extraperitoneal ureteral hernia and review the current urological, surgical and radiological literature to analyze the main clinical characteristics of this pathology and its ideal treatment.