ABSTRACT
OBJECTIVES: To review the cases of atypical squamous cells (ASC), cannot exclude squamous intraepithelial lesion (ASC-H) diagnosed at a single institution and to discuss the interpretation challenges and clinical management of these cases. STUDY DESIGN: The ASC-H cases diagnosed at our institution from 2006 to 2015 were studied retrospectively; of 159,000 Pap smears, there were 959 cases of ASC of undetermined significance (ASC-US) and 148 cases of ASC-H. We have reviewed the clinical records of the ASC-H cases, and data have been analyzed using SPSS 20.0. RESULTS: Median age was 43.1 years; 49.6% of the patients had previous cervical cytologies, and 55.9% of them were negative. Following ASC-H diagnosis, another smear was obtained in 97.1% of the cases and in 67.6% a biopsy was performed. Biopsy revealed low-grade dysplasia in 18.8% of the cases, high-grade dysplasia in 27.8%, and infiltrating carcinoma in 2.3%. Patients with significant lesions in histology were younger than patients with negative results (p = 0.08). A diagnosis of ASC-H/squamous intraepithelial lesion in the repeated cytology had a sensitivity of 74.2%, specificity of 39.6%, positive predictive value of 44.8%, and negative predictive value of 70% for the diagnosis of dysplasia. CONCLUSIONS: ASC-H diagnosis is associated with a high incidence of histological high-grade lesions. A repeat cytology can aid in the selection of high-risk patients, but there may be false-negative results.
Subject(s)
Atypical Squamous Cells of the Cervix/pathology , Uterine Cervical Dysplasia/pathology , Uterine Cervical Neoplasms/pathology , Adult , Biopsy/methods , Colposcopy/methods , Female , Humans , Papanicolaou Test/methods , Retrospective Studies , Tertiary Care Centers , Vaginal Smears/methodsABSTRACT
OBJECTIVES: Laparoscopic pyeloplasty (LP) is the treatment of choice for ureteropelvic junction obstruction (UPJO). We present the 3-trocars LP technique with several considerations and practical advices. METHODS: Several maneuvers to optimize exposure and simplifying the implementation of the operation were showed. A total of thirteen patients with UPJO and criteria for surgical treatment were included, and were operated using the 3 trocars LP technique. Demographic data, perioperative and follow-up were collected retrospectively. RESULTS: Mean operative time was 132 minutes. No conversion to open surgery was registered and additional trocar insertion was not required. Neither perioperative complications nor postoperative complications were reported. Three patients needed ureteral stenting preoperatively for pain. Five patients required flexible nephroscopy with CO2 for extraction of calyceal stones. The pain was controlled in all cases. CONCLUSIONS: The LP is a feasible and safe technique for the surgical correction of UPJO, and maneuvers presented in this study simplify the procedure and may be applied in other laparoscopic procedures.
Subject(s)
Kidney Pelvis/surgery , Laparoscopy/methods , Ureteral Obstruction/surgery , Adolescent , Adult , Female , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
OBJETIVO: La Pieloplastia Laparoscópica (PL) es el tratamiento de elección de la Obstrucción de la Unión Pieloureteral (OUPU). Presentamos la técnica ilustrada de PL con tres trócares con refinamientos y consejos prácticos. MÉTODOS: Se describen varias maniobras paso a paso, para optimizar la exposición y simplificar la ejecución de la cirugía. Un total de trece pacientes con OUPU con criterios para tratamiento quirúrgico fueron incluidos. Todos ellos fueron operados de PL empleando 3 trócares. Los datos demográficos, perioperatorios y de seguimiento fueron recolectados de manera retrospectiva. RESULTADOS: El tiempo operatorio promedio fue de 132 minutos, no hubo conversión a cirugía abierta ni se requirió inserción de trocar adicional en ninguno de los casos. No se reportaron complicaciones perioperatorias ni post-operatorias. Tres casos requirieron inserción de catéter doble J previamente por dolor. Cinco pacientes requirieron nefroscopia flexible con CO2 para la extracción de litiasis caliciales. Todos los casos presentaron desaparición del dolor. Conlcuisones: La PL con tres trocares es una técnica factible y segura en la corrección quirúrgica de la OUPU, y las maniobras presentadas en este estudio simplifican el procedimiento y pueden tener aplicación en otras intervenciones laparoscópicas
OBJECTIVES: Laparoscopic pyeloplasty (LP) is the treatment of choice for ureteropelvic junction obstruction (UPJO). We present the 3-trocars LP technique with several considerations and practical advices. METHODS: Several maneuvers to optimize exposure and simplifying the implementation of the operation were showed. A total of thirteen patients with UPJO and criteria for surgical treatment were included, and were operated using the 3 trocars LP technique. Demographic data, perioperative and follow-up were collected retrospectively. RESULTS: Mean operative time was 132 minutes. No conversion to open surgery was registered and additional trocar insertion was not required. Neither perioperative complications nor postoperative complications were reported. Three patients needed ureteral stenting preoperatively for pain. Five patients required flexible nephroscopy with CO2 for extraction of calyceal stones. The pain was controlled in all cases. CONCLUSIONS: The LP is a feasible and safe technique for the surgical correction of UPJO, and maneuvers presented in this study simplify the procedure and may be applied in other laparoscopic procedures
