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2.
J Endourol ; 2020 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-32292038

RESUMO

Objective: To report the outcomes of percutaneous nephrolithotomy (PCNL) in horseshoe kidneys (HSK) in 12 institutions worldwide and evaluate the impact of patient position during operation. Methods: We carried out a retrospective analysis of PCNL procedures performed between 2008 and 2018 in patients with HSK. Pre-, peri-, and postoperative data were collected, and a subgroup analysis was performed according to patient position. Success was defined as an absence of >4-mm fragments. Values of p < 0.05 were considered significant. Results: We analyzed 106 procedures. The transfusion, complication, and immediate success rates (ISRs) were 3.8%, 17.5%, and 54.7%, respectively. The final success rate (FSR) increased to 72.4% after a mean of 0.24 secondary procedures. Logistic regression showed that higher body mass index (BMI) and stone size were significantly associated with residual fragments ≥4 mm. Sixty-seven patients (63.2%) were treated in prone and 39 (36.8%) in supine position. The prone group had a significantly higher BMI than the supine group (30.1 vs 27.7, p = 0.024). The transfusion, complication, and ISRs between the prone and supine groups were 4.5% vs 2.6% (p = 0.99), 16.9% vs 18.4% (p = 0.99), and 52.5% vs 69.2% (p = 0.151), respectively. Surgical time was significantly longer in the prone group (126.5 vs 100 minutes, p = 0.04). Upper pole was the preferred access in 80.3% of the prone group and 43.6% of the supine group (p < 0.001). The prone group had significantly more Clavien 2 complications than the supine (p = 0.013). The FSR in the prone and supine groups increased to 66.1% and 82.1% after 0.26 and 0.21 secondary procedures, respectively. No complications higher than Clavien 3 occurred. Conclusion: PCNL in patients with HSK is safe and effective with a low complication rate. Higher BMI and stone size negatively impacted outcomes. Supine PCNL may be an option for treating kidney stones in patients with HSK.

3.
Int Braz J Urol ; 44(5): 1046, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29617078

RESUMO

OBJECTIVE: To show a video of a complete supine Percutaneous Nephrolithotomy (csPCNL) performed for the treatment of a staghorn calculus, from the surgeon's point of view. The procedure was recorded with a GoPro® camera, demonstrating the ten essential steps for a successful procedure. MATERIALS AND METHODS: The patient was a 38 years-old woman with 2.4cm of left kidney lower pole stone burden who presented with 3 months of lumbar pain and recurrent urinary tract infections. She had a previous diagnosis of polycystic kidney disease and chronic renal failure stage 2. CT scan showed two 1.2cm stones in the lower pole (Guy's Stone Score 2). She had a previous ipsilateral double J insertion due to an obstructive pyelonephritis. The csPCNL was uneventful with a single access in the lower pole. The surgeon had a Full HD GoPro Hero 4 Session® camera mounted on his head, controlled by the surgical team with a remote control. All of the mains steps were recorded. Informed consent was obtained prior to the procedure. RESULTS: The surgical time was 90 minutes. Hemoglobin drop was 0.5g/dL. A post-operative CT scan was stone-free. The patient was discharged 36 hours after surgery. The camera worked properly and didn't cause pain or muscle discomfort to the surgeon. The quality of the recorded movie was excellent. CONCLUSION: GoPro® camera proved to be a very interesting tool to document surgeries without interfering with the procedure and with great educational potential. More studies should be conducted to evaluate the role of this equipment.


Assuntos
Falência Renal Crônica/cirurgia , Nefrolitotomia Percutânea/métodos , Doenças Renais Policísticas/cirurgia , Adulto , Feminino , Humanos , Duração da Cirurgia , Cálculos Coraliformes/cirurgia , Resultado do Tratamento
4.
Arq Bras Cardiol ; 82(2): 191-3, 188-90, 2004 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-15042256

RESUMO

We report the case of a 21-year-old female referred to our institution complaining of dizziness when standing up, which improved in the dorsal decubitus position and at rest, after a few minutes. The symptom, which had lasted for years, was not accompanied by vertigo, syncope, or neurological changes, but was gradually getting worse. Transthoracic echocardiogram showed a hyperechoic mass in the middle-apical region of the left ventricular posterior wall and normal pericardium. The cardiac nuclear magnetic resonance allowed the diagnosis of the left ventricular tumor suggestive of lipoma. Surgery was performed and the tumor was resected. The patient recovered well and is currently asymptomatic.


Assuntos
Neoplasias Cardíacas/diagnóstico , Lipoma/diagnóstico , Adulto , Feminino , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração , Humanos , Lipoma/cirurgia
5.
Arq. bras. cardiol ; 82(2): 188-193, fev. 2004. ilus
Artigo em Inglês, Português | LILACS | ID: lil-356072

RESUMO

Mulher de 21 anos encaminhada com piora dos sintomas que vinha apresentando há anos: tontura ao levantar-se, sem sintomas vertiginosos, sem queixas de síncope ou alterações neurológicas, melhora em decúbito dorsal e repouso, após poucos minutos. O ecocardiograma transtorácico mostrava presença de massa hiperecogênica na região médio-apical da parede posterior do ventrículo esquerdo e pericárdio normal. A ressonância nuclear magnética cardíaca permitiu o diagnóstico de tumor de ventrículo esquerdo sugestivo de lipoma. Realizado tratamento cirúrgico e ressecado o tumor, a paciente apresentou boa recuperação e mantém-se assintomática.


Assuntos
Humanos , Feminino , Adulto , Neoplasias Cardíacas/diagnóstico , Lipoma/diagnóstico , Ventrículos do Coração , Neoplasias Cardíacas/cirurgia , Lipoma/cirurgia
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