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3.
Urology ; 129: 126-131, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31009744

RESUMO

OBJECTIVE: To evaluate the histopathologic correlation of recently described subclassification of Bosniak category 3 cysts (3s and 3n). MATERIALS AND METHODS: A total of 106 patients who underwent partial/radical nephrectomy due to a complex renal cyst (≥Bosniak 3) were retrospectively reviewed. All the scans of the patients were reevaluated by 2 experienced uroradiologists. Bosniak 3 cysts were reclassified as 3n (nodularity on the cyst wall/septae) and 3s (septated cysts without nodularity) as described in a recently published paper. Group 1 consisted of patients with Bosniak 3s, Group 2 consisted of patients with Bosniak 3n, and Group 3 consisted of patients with Bosniak 4 cysts. Three groups were compared according to patients' characteristics, radiological findings, histopathologic results, and survival outcomes. RESULTS: There were 52 patients in Bosniak 3 group and 54 patients in Bosniak 4 group. Mean follow-up was 35.3 months. Among Bosniak 3 cysts, 37 lesions were classified in 3s and 15 were classified in 3n. Malignancy was higher in 3n group than 3s (86.7% vs 54.1%, P= .026). Lesion size was significantly lower for malignant cysts compared to benign ones in the patients with Bosniak 3 lesions (44.2 ± 27.5 vs 80 ± 55.9 P= .005). In the subgroups, malignant lesions were significantly smaller than benign lesions in 3s group similar to general Bosniak 3 group. Most of the Bosniak 3 lesions were organ confined and low grade. CONCLUSION: The subclassification of Bosniak 3 cysts as 3s and 3n can help to differentiate highly suspicious malignant lesions from the relatively less suspicious ones.

4.
Turk J Urol ; 2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30978166

RESUMO

OBJECTIVE: The aim of the present study was to evaluate the influence of preoperative hydronephrosis and ureteral orifice involvement (UOI) on survival of patients undergoing radical cystectomy (RC) for bladder cancer (BC). MATERIAL AND METHODS: A total of 162 patients with BC underwent RC between January 2006 and March 2017. Patients were divided into two groups for both presences of preoperative hydronephrosis and orifice involvement at final pathology. Additionally, tumors with orifice involvement were subgrouped histopathologically after RC as those with only UOI and those with invasive to the ureter with an additional concurrent site at final pathology. RESULTS: Preoperative hydronephrosis was detected in 57 patients. Preoperative and postoperative creatinine on month 3 were higher in the preoperative hydronephrosis (+) group (p<0.001). In addition, postoperative T stage, surgical margin positivity, invasion of urethra, and pathological upstaging were higher in this group. Cancer-specific survival (CSS) and overall survival (OS) were better in the hydronephrosis (-) group than in the hydronephrosis (+) group (p=0.001 and p=0.001, respectively). Preoperative hydronephrosis was found to be an independent factor in pathological upstaging. Patients were divided into two groups according to the presence of UOI. Group 1 consisted of patients without UOI, and group 2 with UOI. Preoperative hydronephrosis, hydronephrosis grade, and T stage were statistically higher in tumors with UOI. Moreover, CSS and OS were lower in group 2 than in group 1. CONCLUSION: Preoperative hydronephrosis and UOI are predicting factors on survival of patients undergoing RC for BC. Preoperative hydronephrosis was found to be an independent factor in pathological upstaging.

6.
Arch Ital Urol Androl ; 90(3): 172-175, 2018 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-30362682

RESUMO

OBJECTIVE: To evaluate the effect of variant histology on pathological and survival findings in patients undergoing radical cystectomy due to muscle invasive bladder cancer. MATERIALS AND METHODS: Data from 146 patients with radical cystectomy performed due to muscle-invasive urothelial carcinoma between January 2006 to November 2016 at our clinic were investigated. The preoperative and postoperative data of patients with variant histology were compared with nonvariant urothelial carcinoma patients. Then of patients with variant histology only those with squamous differentiation (SqD) were compared with nonvariant urothelial carcinoma patients in terms of preoperative, postoperative and survival data. RESULTS: Of the 146 patients, 23 had carcinoma with variant histology. Of these, 17 had SqD, 4 had glandular differentiation, 1 patient had plasmocytoid variant and 1 patient had sarcomatoid variant. In patients with variant histology, postoperative T stage and upstaging was higher, with no difference observed in terms of overall and cancer-specific survival compared with nonvariant urothelial cancer patients. SqD patients were observed to have higher postoperative T stage compared to nonvariant urothelial cancer patients, with no significant difference observed in terms of survival. CONCLUSIONS: In cystectomy pathologies, patients with variant histology (especially SqD patients) were observed to have proportionally higher T stage compared to nonvariant urothelial carcinoma; however there were no significant differences for overall survival and cancer-specific survival.

8.
Int Urol Nephrol ; 50(9): 1557-1562, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30054864

RESUMO

PURPOSE: To investigate the utility of attenuation value (Hounsfield unit) of the filled bladder on computed tomography (CT) images and the association of these values with simultaneously obtained urine culture results. METHODS: Between January 2016 and December 2017, retrospective data of 58 patients who were admitted to the emergency department for various symptoms were examined. All patients were evaluated with urine dipstick microscopy, urine culture, and abdominal CT simultaneously. Group 1 consisted of patients with positive urine culture (n = 28) and Group 2 consisted of patients with negative urine culture (n = 30). The attenuation value of urine in the bladder at the level of the bladder trigone was measured inside an elliptical drawing covering all the urine inside the bladder excluding the bladder wall on axial non-contrast CT images. The predictive value of this calculated attenuation value for urine culture positivity was evaluated. RESULTS: The median attenuation value was - 6 (range - 17.8 to + 11) and 12 (range 0-32) in group 1 and group 2 (p < 0.001). According to cut-off value of - 1 attenuation value, sensitivity for predicting urine culture positivity was 92.9%, whereas specificity was 100% (AUC: 0.977 p < 0.001). Urine culture was positive in all of the 26 patients with attenuation value < - 1, whereas only two of the 32 patients with attenuation value > - 1 had urine culture positivity (p < 0.001 OR 14). CONCLUSION: The attenuation value of the urine in the defined area of the bladder may aid in the diagnosis of urinary infection with high sensitivity and specificity and without any additional cost.

9.
Int Urol Nephrol ; 50(8): 1397-1405, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29980924

RESUMO

PURPOSE: The purpose of the study was to investigate the predictive value of stone measurements by including a novel method on non-contrast computed tomography (NCCT) images for stone composition. METHODS: We retrospectively evaluated patients who had stone analysis, NCCT images, and underwent percutaneous nephrolithotomy between 2013 and 2016. Patient characteristics, stone measurements on NCCT images, and stone analysis results were evaluated. Hounsfield unit (HU) values (maximum (HUmax), minimum (HUmin), and average (HUave) of HU values) were investigated on NCCT images. HUdiff was calculated as the difference between the HUmax and the HUmin values. Patients were divided into seven stone groups and data were compared. Then patients were separately divided into two groups according to mineral complexity (mono-mineral and multi-mineral groups) and calcium-based (calcium and other stone groups) evaluation. RESULTS: In the study, 115 patients were evaluated. Age, gender, HUmin, HUmax, and HUave were significantly different between the stone groups. HUdiff and HUave were found to be 341.5 HU (AUC = 0.719, p = 0.017) and 1051.5 HU (AUC = 0.701, p = 0.029) as cut-off, respectively. Seventy of 72 > 341.5 HUdiff patients and 64 of 67 > 1051.5 HUave patients had multi-mineral stones (p = 0.001, OR 9.26, and p = 0.028, OR 4.27), respectively. In multivariate analysis, > 341.5 HUdiff rate was significantly higher in multi-mineral and calcium stone groups; HUave was also significantly higher in the calcium stone group. CONCLUSIONS: HUdiff and HUave were significant predictors of mineral complexity. HUdiff of < 341.5 HU showed 81.8% sensitivity and 67.2% specificity for identification of mono-mineral stones.

10.
Eurasian J Med ; 50(2): 137-138, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30002585

RESUMO

Intrauterine device (IUD) insertion is a long-acting and one of the most effective modes of reversible contraception. Complications that most commonly arise following IUD insertion are failed insertion, pain, vasovagal reactions, infection, menstrual abnormalities, and expulsion. In this paper, we present the case of a woman who experienced hydronephrosis due to the migration of IUD into the ureter after 30 years of insertion. To the best of our knowledge, this is the third such case reported in the literature.

11.
Urolithiasis ; 2018 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-29869167

RESUMO

The residual fragments in patients with preoperative and intraoperative culture positivity may serve as an infection focus. The aim of this study was to assess the importance of residual fragments for developing SIRS in patients with stone culture and/or RPUC positivity. After obtaining institutional review board approval, a total of 729 patients who undergone PCNL for renal stones were included in this study. Residual fragments accepted to be positive if any fragment was detected irrespective of size. All patients were followed-up postoperatively for SIRS criteria. The patients were then followed-up for residual stone-related events and infectious complications. 94 of the 729 patients have developed SIRS postoperatively. SIRS positivity was more common among males and found to be associated with higher stone burden and presence of staghorn stone. Patients with residual fragments after PCNL also had higher rates of SIRS. In the subgroup analysis of 203 patients who had post-PCNL residual fragments, the peroperative stone and/or RPUC positivity was not found to be associated with the development of the SIRS. Although presence of residual fragments after PCNL is associated with SIRS development, stone culture and/or RPUC positivity has no additional risk for development of post-PCNL infectious complications in patients with residual fragments.

14.
Kaohsiung J Med Sci ; 33(10): 516-522, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28962823

RESUMO

The aim of this study was validation and comparison of stone scoring systems (S.T.O.N.E, GUY, CROES, S-ReSC) used to predict postoperative stone-free status and complications after percutaneous nephrolithotomy (PCNL) for staghorn stones. A total of 160 patients who had staghorn renal stones and underwent PCNL between January 2012 and August 2015 were included in the current retrospective study. Guy, S.T.O.N.E., S-ReSC (Seoul National University Renal Stone Complexity) and CROES (Clinical Research Office of the Endourological Society) nephrolithometry scores were calculated for each patient, and their potential association with stone-free status, operative and fluoroscopy time, and length of hospital stay (LOS) were evaluated. Postoperative complications were graded according to the modified Clavien classification, and the correlation of scoring systems with postoperative complications was also investigated. The mean CROES, S.T.O.N.E, Guy and S-ReSC scores were 143.5 ± 33.6, 9.7 ± 1.6, 3.5 ± 0.5 and 6.2 ± 2.0 respectively. The overall stone-free rate was 59%. All scoring systems were significantly correlated with stone-free status in univariate analysis. However, Guy and S-ReSC scores were the only significant independent predictor in multivariate analysis. And all four nomograms failed to predict complication rates. Current study demonstrated that Guy and S-ReSC scoring systems could effectively predict postoperative stone-free status for staghorn stones. However all four scoring systems failed to predict complication rates.


Assuntos
Rim/cirurgia , Nefrolitotomia Percutânea , Cálculos Coraliformes/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Feminino , Hemorragia/diagnóstico , Hemorragia/etiologia , Hemorragia/fisiopatologia , Humanos , Rim/patologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Curva ROC , Projetos de Pesquisa , Estudos Retrospectivos , Cálculos Coraliformes/diagnóstico , Cálculos Coraliformes/patologia , Resultado do Tratamento
15.
J Laparoendosc Adv Surg Tech A ; 27(12): 1284-1289, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28873326

RESUMO

BACKGROUND: To validate and compare the stone scoring systems (stone size [S], tract length [T], obstruction [O], number of involved calices [N], and essence or stone density [E] [S.T.O.N.E.], Guy's Stone Score [GSS], Clinical Research Office of the Endourological Society [CROES], and Seoul National University Renal Stone Complexity [S-ReSC]) used to predict postoperative stone-free status and complications after percutaneous nephrolithotomy (PCNL). METHODS: A total of 567 patients who underwent PCNL for renal stones between January 2012 and August 2015 were included in the recent retrospective study. Sixty-one patients who had not done preoperative CT were excluded from the study. GSS, S.T.O.N.E., S-ReSC, and CROES nephrolithometry scores were calculated for each patient, and their potential association with stone-free status, operative and fluoroscopy time, and length of stay (LOS) was evaluated. Postoperative complications were graded according to the modified Clavien classification, and the correlation of scoring systems with postoperative complications was also investigated. RESULTS: The mean CROES, S.T.O.N.E., GSS, and S-ReSC scores were 203.7 ± 59.8, 7.52 ± 1.8, 2.08 ± 0.9, and 3.35 ± 2.2, respectively. The overall stone-free rate was 77.9%. All scoring systems were significantly correlated with stone-free status and operation time. While GSS, S.T.O.N.E., and CROES systems were significantly correlated with complication rates (CR), S-ReSC score failed to predict CR. All scoring systems except S.T.O.N.E. were significantly correlated with LOS. CROES and S-ReSC scores were predictive of estimated blood loss (EBL), while GSS and S.T.O.N.E. failed to predict EBL. CONCLUSIONS: Recent study demonstrated that S.T.O.N.E., GSS, CROES, and S-ReSC scoring systems could effectively predict postoperative stone-free status. Although S-ReSC scoring system failed to predict CR, the rest three scoring systems were significantly correlated with postoperative CR.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/diagnóstico , Adulto , Idoso , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Curva ROC , Estudos Retrospectivos , Resultado do Tratamento
16.
Int Braz J Urol ; 43(6): 1194, 2017 Nov-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28537693

RESUMO

Paraurethral cysts are usually asymptomatic and frequently detected incidentally during routine pelvic examination however, patients can present with complaints of a palpable cyst or with lower urinary tract symptoms (LUTS) and also dyspareunia. In most cases, diagnosis can be made on physical examination but for more detailed evaluation and to differentiate from malign lesions ultrasonography (US), voiding cystourethrogram (VCUG), computerized tomography (CT), or magnetic resonance imaging (MRI) can also be used. Management of symptomatic paraurethral cyst is surgical excision. In this video our objective is to show the surgical management of female paraurethral cyst with concomitant stress urinary incontinence (SUI). A 37 year-old woman presented with an 8-year history of progressive urinary symptoms, consisting of dysuria, urinary frequency, urgency urinary incontinence, SUI and dyspareunia. Physical examination in the lithotomy position revealed a cystic lesion located in the left anterolateral vaginal wall. Also cough stress test for SUI was positive. Her preoperative ICI-Q, UDI-6, IIQ-7 and SEAPI scores were 16, 8, 9 and 18 respectively. Vaginal US revealed a solitary 2 cm paraurethral cyst, localized in the distal urethra. Pelvic MRI also revealed a benign cystic lesion in the distal urethra. The patient underwent surgical excision of the cyst and anterior colporrhaphy for SUI. At third month visit the patient was very satisfied. The ICI-Q, UDI-6, IIQ-7 and SEAPI scores were 0. Sometimes the LUTS concurring with the parauretral cyst can be dominant. Herein we want to show that extra surgical procedures can be necessary with paraurethral cyst excision for full patient satisfaction.


Assuntos
Cistos/complicações , Doenças Uretrais/complicações , Incontinência Urinária por Estresse/complicações , Adulto , Cistos/diagnóstico por imagem , Cistos/cirurgia , Feminino , Humanos , Achados Incidentais , Satisfação do Paciente , Resultado do Tratamento , Doenças Uretrais/diagnóstico por imagem , Doenças Uretrais/cirurgia , Incontinência Urinária por Estresse/diagnóstico por imagem , Incontinência Urinária por Estresse/cirurgia
17.
Turk J Urol ; 43(1): 55-61, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28270952

RESUMO

OBJECTIVE: We investigated the prognostic value of preoperative neutrophil-to-lymphocyte ratio (NLR) on germ cell testicular tumors (GCT). MATERIAL AND METHODS: The data of 53 patients who underwent inguinal orchiectomy were analyzed retrospectively. NLR was calculated from the preoperative complete blood cell counts. Receiver operating characteristic (ROC) analysis was performed to find the threshold values for NLR. Correlations between cancer-specific survival (CSS) and progression-free survival (PFS) and NLR were evaluated. RESULTS: The mean follow-up time was 23.55±18.06 months. The mean level of NLR was 3.08±1.81. Optimal threshold values of NLR was calculated as 3.55 for PFS (area under curve, AUC: 0.55) and 3.0 for CSS (AUC: 0.66). For patients with a NLR of <3.55 and NLR of ≥3.55, mean times-to-progression were 55.71 months (95% CI, 51.27-60.14) and 51.95 months (95% CI, 38.02-65.87, p=0.152), respectively. As well as, for patients with a NLR of <3.0 and NLR of ≥3.0, mean times-to-cancer specific death were 54.72 months (95% CI, 49.05-60.38) and 49.43 months (95% CI, 37.64-61.22, p=0.119), respectively. CONCLUSION: Preoperative NLR is not a useful tool to predict the prognosis of patients with GCT.

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