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1.
Urol Ann ; 11(3): 320-323, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413515

RESUMO

Self-inserted urethral foreign bodies (FBs) are rare. Neither reported case was the self-inflicted FB due to a lack of financial resources nor was either case complicated by Fournier's gangrene. We present a 54-year-old male who inserted a household pipe to relieve his urine retention. Unfortunately, the FB became stuck inside, perforated the urethra, and required perineal exploration. After it was removed, the urethra was closed over a 16F urethral catheter. The wound was complicated by severe infection and resulting Fournier's gangrene. This required an additional surgery for debridement and urine diversion. Retrospectively, it would have been better if the urethra had been left open with SP tube only. We are sharing a clinical lesson learned by the practicing urologist and surgeons. Conclusively, self-inserted FBs in the urethra may lead to a series of complications. Patients with limited financial resources need more attention and care because they may hurt themselves unintentionally.

2.
Int Urol Nephrol ; 51(10): 1709-1713, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31309391

RESUMO

PURPOSE: In view of the differences in early and late management experiences based on Huang and Tseng CT classification of emphysematous pyelonephritis (EP), our study included 34 patients aimed to re-correlate the current management plans with CT classification. METHODS: A retrospective review from January 2009 to December 2018, in patients with primary or final diagnosis of EP. Data included; patients' demographics, routine laboratory and imaging work-up. CT was performed for all, and images were classified based on Huang and Tseng classification. The CT classification was correlated to the laboratory parameters and the final treatment plans. Data were collected and analyzed using SPSS®. RESULTS: Complete data for 34 patients were analyzed. The majority (70%) had positive urine culture, and Carbapenems and Ureidopenicillin were the most commonly used antibiotics. Based on CT classification, 75% (26/34) of the patients were in class I and II, 6 cases with class IIIa, and only two with class IIIb, with no cases of class IV. All patients in class I and II responded well to the medical therapy, and eight required PCN/DJ. Four required nephrectomy in class III, with zero mortality. CONCLUSION: Patients in class I and II comprise the majority of EP patients, and respond well to medical treatment with excellent outcome. Insertion of PCN and DJ are not required routinely, but with urinary obstruction requiring drainage, and a few cases who required nephrectomy-all with class III. Our data show improvement in the overall survival in patients for EP.

3.
Turk J Urol ; 45(3): 177-182, 2019 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-30817281

RESUMO

OBJECTIVE: We aimed to report our 25-year experience on upper tract urothelial carcinoma (UTUC) on a larger number of patients with long-term follow-up at a single tertiary urology institute. MATERIAL AND METHODS: A retrospective study was conducted on 275 patients from 1990 to 2015. Basic patient demographic data with the laboratory and radiologic investigations were collected. We used 1997 TNM classification and the three-tiered WHO grading system. Data were collected using an SPSS® version 21 spreadsheet. RESULTS: The mean age was 59±11 years, and 88% of all the patients were male. Previous and concurrent bladder tumors were found in 16% and 26%, respectively. Computed tomography gave an overall accuracy of 96%. Open nephroureterectomy and bladder cuff excision was performed for 85%, and the remaining by laparoscopy and nephron-sparing surgeries. Tumor was pelvicalyceal, ureteric, and both in 40%, 40%, and 20% respectively. In 97% of the patients, the tumor was transitional cell carcinoma. Nearly two-thirds of the patients were of low grade and non-invasive in stage. Nearly half of the patients (46%) had bladder tumor recurrence after NU. Bladder, urethral, and contralateral recurrence, distant, local metastasis occurred in 46%, 2%, 1%, 7.5%, and 6%, respectively. CONCLUSION: UTUC is a unique disease with synchronous and metachronous urothelial tumor recurrence that requires long-term surveillance. The majority (two-thirds) of the patients are non-invasive in stage of grade II. Tumor stage is of paramount prognostic significance for survival; the five-year survival rate of T1 and T4 is 80% and 0%, respectively.

4.
Urol Ann ; 10(4): 409-412, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30386096

RESUMO

22-year-old male patient with irrelevant medical history presented with bilateral renal stones; multiple stones in right renal pelvis measured 10, 11, and 11mm and another one on the left side measured 12mm. Extra corporeal shock wave lithotripsy (ESWL) was done first on the left side, but after 400 shocks and total energy of 20 Storez Medical Lithotripsy Index only, the stone wasn't visible. Then, the operator switched to the right side and a he completed the session. A day after, the patient presented with bilateral renal colic, gradual rising of renal function and imaging showed bilateral steinstrasse with bilateral hydroureteronephrosis. Patient was managed with insertion of bilateral ureteric stents and had another session of ESWL on the right side. We concluded that bilateral simultaneous ESWL for bilateral renal stones doesn't affect the renal function on the long-term outcome, but still carries the risk of bilateral obstruction and acute renal injury.

5.
Int. braz. j. urol ; 44(4): 726-733, July-Aug. 2018. tab
Artigo em Inglês | LILACS-Express | ID: biblio-954086

RESUMO

ABSTRACT Introduction: Acute kidney injury (AKI) after major surgeries is associated with significant morbidity and mortality. We aim to report incidence, predictors and associated comorbidities of AKI after radical cystectomy in a large cohort of patients. Materials and Methods: We conducted a retrospective analysis of 1000 patients who underwent open radical cystectomy in a tertiary referral center. Perioperative serum creatinine measurements were used to define AKI according to the RIFLE criteria (as Risk, Injury and Failure). The predictors of AKI after surgery were determined using univariate and multivariate analyses. Results: Out of 988 evaluable patients, AKI developed in 46 (4.7%). According to RIFLE criteria; AKI-Risk, AKI-Injury and AKI-Failure occurred in 26 (2.6%), 9 (0.9%) and 11 (1.1%) patients, respectively. Multivariate analysis showed that performing nephroureterectomy with cystectomy (Odds ratio [OR]: 4.3; 95% Confidence interval [CI]: 1.3-13.6; p=0.01) and the development of high grade complications (OR: 3.8; 95% CI 1.9-7.2; p<0.0001) were independently associated with AKI. Conclusions: AKI is a significant morbidity after radical cystectomy and the term should be included during routine cystectomy morbidity assessment.

6.
Int Braz J Urol ; 44(4): 726-733, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29757568

RESUMO

INTRODUCTION: Acute kidney injury (AKI) after major surgeries is associated with significant morbidity and mortality. We aim to report incidence, predictors and associated comorbidities of AKI after radical cystectomy in a large cohort of patients. MATERIALS AND METHODS: We conducted a retrospective analysis of 1000 patients who underwent open radical cystectomy in a tertiary referral center. Perioperative serum creatinine measurements were used to define AKI according to the RIFLE criteria (as Risk, Injury and Failure). The predictors of AKI after surgery were determined using univariate and multivariate analyses. RESULTS: Out of 988 evaluable patients, AKI developed in 46 (4.7%). According to RIFLE criteria; AKI-Risk, AKI-Injury and AKI-Failure occurred in 26 (2.6%), 9 (0.9%) and 11 (1.1%) patients, respectively. Multivariate analysis showed that performing nephroureterectomy with cystectomy (Odds ratio [OR]: 4.3; 95% Confidence interval [CI]: 1.3-13.6; p=0.01) and the development of high grade complications (OR: 3.8; 95% CI 1.9-7.2; p<0.0001) were independently associated with AKI. CONCLUSIONS: AKI is a significant morbidity after radical cystectomy and the term should be included during routine cystectomy morbidity assessment.


Assuntos
Lesão Renal Aguda/etiologia , Cistectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Derivação Urinária/efeitos adversos , Creatinina/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Centros de Atenção Terciária , Resultado do Tratamento
7.
Turk J Urol ; 44(3): 213-220, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29733795

RESUMO

OBJECTIVE: Bladder cancer recurrence after management of upper tract urothelial carcinoma (UTUC) is a common disease. Although the incidence and risk factors for the development of noninvasive bladder tumor have been reported in many series, rare studies have reported on muscle invasive bladder cancer (MIBC) and its urethral recurrence. We aimed to report the incidence, risk factors and survival rate for the development of MIBC and urethral tumors after surgical management of UTUC. MATERIAL AND METHODS: We retrospectively reviewed patients who were surgically treated for UTUC from 1983 to 2013. The tumor was categorized according to the 1997 TNM staging and the 3-tiered WHO grading systems. The primary endpoint of this study was the occurrence of any post-treatment MIBC and its urethral recurrences. We studied the possible risk factors that may contribute to the development of such pathology as well as the prognosis of this pathology. RESULTS: A total of 297 patients were eligible for analysis. Intravesical tumor recurrence was observed in 139 (46.8%) patients and radical cystectomy was warranted for 36 patients (MIBC or multicentric bladder recurrence). Twenty-seven patients were fit for surgery with ileal loop conduit was the urinary diversion for the majority, and others received radiotherapy. Ureteral tumor was the only statistically significant risk factor (p=0.001) and the incidence increased as the ureteral tumors became more distal (p=0.01). Occurrence of invasive or multicenteric bladder recurrence was a predictor for local, urethral recurrence and distant metastasis (p=0.016, 0.0001 and 0.01 respectively). Seven patients had urethral urothelial carcinoma; 5 were diagnosed at the time of cystectomy and 2 were discovered later (1 and 3 years after cystectomy). CONCLUSION: MIBC is a relatively uncommon (6%) post UTUC, and ureteral tumors, especially distal in location, are the independent risk factor. Extended surveillance for those patients is needed. Urethral cancer recurrence is rare (2%); most cases are localized in the posterior urethra, they are noninvasive, and may develop even after cystectomy.

8.
Urol J ; 15(5): 256-260, 2018 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-29687437

RESUMO

PURPOSE: There is a lack of reporting of the bladder cuff pathology in the literature and ongoing debate regarding the role of bladder cuff excision (BCE) in the prognosis in patients with upper tract urothelial carcinoma (UTUC). We aimed to know the risk factors, the survival, and the clinical course of such pathology. MATERIALS AND METHODS: The study was retrospective, from 1983-2013 on 305 patients who had diagnosed with UTUC. Patients were managed by radical open/ laparoscopic nephroureterectomy with bladder cuff excision. The tumor was staged using 1997 TNM classification and the 3-tiered WHO grading system was used for grading. Patients who found to have a malignant bladder cuff on the final pathology were further analyzed for the risk factors for such disease and its effect on survivaltheir outcomes. RESULTS: 13/ 281 (4.6%) cases were found to have malignant bladder cuff. Regarding tumor stage; one case was diagnosed with Tis, eight had T1 and four cases had T2 malignant bladder cuff. All cases were with pure ureteric or multifocalcentric tumors, and none had pure pelvicalyceal tumors (p = .001).Local recurrence at the surgical site and distant metastasis were significantly higher among patients with malignant bladder cuff (p = .001 and .002 respectively), and the last sustained its significance in multivariate analysis. Those patients had a poor prognosis when compared to non-malignant bladder cuff cases (Log Rank test, p = .001)Conclusion: Ureteric tumor is the only independent risk factor for malignant bladder cuff at the final pathology and is associated with increased risks for invasive bladder tumor, distant metastasis and poor survival in comparison with non-malignant bladder cuff. In a clinical implementation, BCE is considered as a mandatory step in management of ureteric tumors, while it could be omitted in pure and low grade renal pelvis tumors.


Assuntos
Carcinoma de Células de Transição , Neoplasias Renais , Nefroureterectomia , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Bexiga Urinária/patologia , Idoso , Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/patologia , Egito/epidemiologia , Feminino , Humanos , Neoplasias Renais/diagnóstico , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Metástase Neoplásica , Estadiamento de Neoplasias , Nefroureterectomia/métodos , Nefroureterectomia/estatística & dados numéricos , Prognóstico , Fatores de Risco , Análise de Sobrevida , Ureter/patologia , Ureter/cirurgia , Neoplasias Ureterais/diagnóstico , Neoplasias Ureterais/mortalidade , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia , Urotélio/patologia
9.
Sultan Qaboos Univ Med J ; 18(4): e557-e559, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30988982

RESUMO

Matrix stones are a rare form of urinary calculi with a low mineral content. We report a 63-year-old female patient who presented to the Sohar Hospital, Sohar, Oman, in 2018 with unexplained left flank pain and constipation. She had a history of chronic renal failure (CRF) and had previously undergone haemodialysis (HD). Non-contrast computed tomography (CT) did not show any renal or urinary stones. However, a left-sided ureteroscopy revealed a yellow-coloured stone that was soft in consistency occupying the proximal 5 cm section of the ureter. Many attempts at forceps extraction were required for complete clearance. A global quantitative composition analysis revealed the extracted stone to be composed entirely of protein-matrix material. Matrix stones require a high index of suspicion as they are sometimes radiolucent and cannot be visualised on CT scans. Risk factors include being female and a history of urinary tract infections, CRF and HD.


Assuntos
Cálculos Ureterais/complicações , Constipação Intestinal/etiologia , Feminino , Dor no Flanco/etiologia , Humanos , Pessoa de Meia-Idade , Omã , Fatores de Risco , Ultrassonografia/métodos , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/diagnóstico por imagem , Ureteroscopia/métodos
10.
Arab J Urol ; 15(3): 216-222, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29071155

RESUMO

OBJECTIVE: To review the incidence, predictors and prognosis of bladder cancer recurrence after management of upper tract urothelial carcinoma (UTUC). PATIENTS AND METHODS: We retrospectively reviewed patients who were surgically treated for UTUC from 1983 to 2013. The tumours were categorised according to the 1997 Tumour-Node-Metastasis (TNM) staging and the three-tiered World Health Organization grading systems. The primary endpoint was the occurrence of any intravesical recurrence after treatment. We studied the possible risk factors that may contribute to development of intravesical recurrence, as well as the prognosis of the patients who had recurrence. RESULTS: In all, 297 patients were eligible for analysis. Recurrent bladder tumours occurred in 139 patients (46.8%). The mean (range) time to recurrence after surgery was 33 (6-300) months. Neither sex, past history of bladder tumours, concomitant bladder tumour, the side of the tumour, UTUC stage, grade, presence of carcinoma in situ or multicentricity at the time of diagnosis of UTUC, were significant predictors of intravesical tumour recurrence. Ureteric tumour was the only identified risk factor (P = 0.02). Post-treatment bladder recurrence was a significant predictor of later urethral recurrence (P = 0.002). CONCLUSIONS: In our present series, bladder cancer recurrence of urothelial malignancy occurred in nearly half of the patients after surgical management of UTUC. Ureteric tumour was the only identifiable risk factor, thus patients with ureteric tumours may benefit from prophylactic intravesical chemoimmunotherapy. Bladder recurrence does not appear to affect the cancer-specific survival after surgical management of UTUC.

11.
Scand J Urol ; 50(6): 433-438, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27589558

RESUMO

OBJECTIVE: The aim of this study was to review different management modalities and outcome of patients presenting with late intestinal obstruction (IO) after radical cystectomy (RC) or palliative cystectomy (PC). MATERIALS AND METHODS: Files of patients who presented with IO between January 1978 and June 2014 were reviewed. Patients who developed IO following either RC or PC more than 30 days after surgery were included. Patients' characteristics and management protocols were evaluated. Predictors for failure of conservative management and unfavorable outcome after surgical explorations were evaluated. Symptom-free and overall survival rates of patients with malignant IO was were recorded. RESULTS: The prevalence of IO was 2.8% after RC (118 out of 4199 patients) and 10% after PC (nine out of 87). Colonic diversions had the highest prevalence (6.2%), followed by ileal loop conduit (2.9%); the lowest prevalences followed Kock pouch and ileal W neobladder (1.7% and 1.6%, respectively). Postoperative urinary leakage from a ureteroenteric anastomosis was the only predictor for surgical intervention (p = 0.039). Nine cases had been explored for malignant obstruction (eight after RC and one after PC). The mean ± SD elapsed time before death was 3.6 ± 2 months (range 0.5-17 months). CONCLUSIONS: Urinary diversion with colonic segments carries more risk for the development of IO in comparison with ileal segments. Postoperative urinary leakage after cystectomy and urinary diversion may be a contributory factor for surgical exploration in cases with late IO.


Assuntos
Cistectomia/efeitos adversos , Obstrução Intestinal/etiologia , Cuidados Paliativos , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/efeitos adversos , Adulto , Idoso , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Colo/cirurgia , Tratamento Conservador , Intervalo Livre de Doença , Feminino , Humanos , Íleo/cirurgia , Obstrução Intestinal/terapia , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Estruturas Criadas Cirurgicamente , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/complicações , Derivação Urinária/métodos
12.
Int J Urol ; 23(10): 861-865, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27545102

RESUMO

OBJECTIVES: To compare treatment-related outcomes of ureteral stenting with an external versus double J stent in patients with orthotopic reservoirs after radical cystectomy. METHODS: Patients undergoing radical cystectomy and orthotopic neobladder were randomized into two groups; group I patients received external stents, whereas group II received double J stents. In both groups, preoperative parameters were recorded, and patients were assessed regarding urinary tract infection, urinary leakage, upper tract deterioration, readmission and hospital stay. RESULTS: A total of 48 and 45 patients were randomized in the external stent group and double J group, respectively. Both groups were comparable in terms of age, sex, associated comorbidity and oncological status. Early urinary leak was observed in two patients (4.2%) in the external stent group, and in two patients (4.4%) in the double J group (P = 0.95). None of our patients developed ureteral strictures in the external stent group, and one patient did in the double J group (P = 0.3). Positive urine culture (58.3%, 51.1%) as well as febrile urinary tract infections (2.1%, 6.7%) were comparable between both groups, respectively (P = 0.43, 0.28). Wound complications (12.5%, 8.9%) and stent-related complications (2.1%, 0%) were comparable between both groups, respectively (P = 0.57, 0.33). The mean hospital stay was 17.5 days (range 14-32 days) and 14.6 days (range 10-42 days) in both groups, respectively (P = 0.001), with comparable re-admission rates (P = 0.95). CONCLUSIONS: Incorporation of double J stents in orthotopic urinary diversion is a safe alternative to the routinely used external stenting.


Assuntos
Cistectomia , Stents , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária , Anastomose Cirúrgica , Drenagem , Humanos
13.
Urology ; 86(3): 593-8, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26126693

RESUMO

OBJECTIVE: To assess the outcome of clinically insignificant residual fragments (CIRFs) after shock wave lithotripsy (SWL) and percutaneous nephrolithotomy (PNL) in children. METHODS: Sixty-one children with CIRFs diagnosed by noncontrast computed tomography (NCCT) 3 months after SWL and 1 month after PNL with documented follow-up ≥6 months were included in the study. Children were evaluated by urinalysis, urine culture, plain abdominal radiography, and urinary ultrasonography or noncontrast computed tomography. Outcomes measured were fragment regrowth, spontaneous fragment passage, and secondary interventions. A clinically significant outcome was defined as the need for secondary intervention for development of complications or regrowth of the residual fragment (RF). RESULTS: The study included 42 boys and 19 girls with mean age of 6.2 years (range 1-14). After a median follow-up of 18 months, 16 children (26.2%) passed RF spontaneously. Regrowth of the RF was observed in 15 children (24.6%), and in 4 children (6.6%) the RF (of the same original size) slipped to the ureter and was treated by ureteroscopy. Therefore, a clinically significant outcome occurred in 31.2% of children with RF. Children with history of stone disease were more likely to develop clinical significance with time (HR, 4.38; 95% CI, 1.37-14; P = .013) CONCLUSION: The term CIRF is not appropriate for all children with post-SWL and -PNL fragments, as one-third of patients have had fragments that became clinically significant. History of stone disease was the only predictor of clinical significance.


Assuntos
Cálculos Renais/terapia , Litotripsia/métodos , Nefrostomia Percutânea/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Cálculos Renais/diagnóstico , Masculino , Recidiva , Retratamento , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ureteroscopia , Urinálise
14.
Int Urol Nephrol ; 47(4): 573-7, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25737073

RESUMO

OBJECTIVES: To define various stone, renal and therapy factors that could affect steinstrasse (SS) formation after extracorporeal shock wave lithotripsy (SWL) for pediatric kidney stones. Thus, SS could be anticipated and prophylactically avoided METHODS: From January 1999 through December 2012, 317 children underwent SWL with Dornier Lithotripter S for the treatment of renal stones. Univariate and multivariate statistical analyses of patients, stones and therapy characteristics in relation to the incidence of SS were performed to detect the factors that had a significant impact on SS formation. RESULTS: The overall incidence of SS was 8.5%. The steinstrasse was in the pelvic ureter in 74.1% of the cases, lumbar ureter in 18.5% and iliac ureter in 7.4%. Steinstrasse incidence significantly correlated with stone size, site and age of child. Steinstrasse was more common with increasing stone length and stones located in renal pelvis or upper calyx with the age below 4 years. A statistical model was constructed to estimate the risk of steinstrasse formation accurately. The equation for logistic regression is Z = -4.758 + B for age + B for size stone X length in mm + B for stone site. CONCLUSIONS: The stone size, site and age are the most important risk factors responsible for SS formation in children. Our regression analysis model can help with prospective identification of children who will be at risk of SS formation. Those children at high risk of SS formation should be closely monitored or treated by endoscopic maneuvers from the start.


Assuntos
Cálculos Renais/terapia , Litotripsia/efeitos adversos , Ureterolitíase/etiologia , Adolescente , Criança , Pré-Escolar , Egito/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Lactente , Masculino , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Ureterolitíase/epidemiologia
15.
BJU Int ; 115(1): 94-100, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24905239

RESUMO

OBJECTIVES: To determine the incidence, risk factors and causes of hospital readmission in a large series of patients who underwent radical cystectomy (RC) and urinary diversion. PATIENTS AND METHODS: We retrospectively analysed the data of 1000 patients who underwent RC and urinary diversion between January 2004 and September 2009 in our tertiary referral centre. Patients stayed in hospital for 21 and 11 days for orthotopic and ileal conduit diversions, respectively. The primary outcome was the development of a complication requiring hospital readmission at ≤3 months (early) and >3 months (late). Causes of hospital readmissions were categorised according to frequency of readmissions. Predictors were determined using univariate and multivariate logistic regression models. RESULTS: In all, 895 patients were analysed excluding 105 patients because of perioperative mortality and loss to follow-up. Early and late readmissions occurred in 8.6% and 11% patients, respectively. The commonest causes of first readmission were upper urinary tract obstruction (UUO, 13%) and pyelonephritis (12.4%) followed by intestinal obstruction (11.9%) and metabolic acidosis (11.3%). The development of postoperative high-grade complications (odds ratio [OR] 1.955; 95% confidence interval [CI] 1.254-3.046; P = 0.003) and orthotopic bladder substitution (OR 1.585; 95% CI 1.095-2.295; P = 0.015) were independent predictors for overall hospital readmission after RC. Postoperative high-grade complications (OR 2.488; 95% CI 1.391-4.450; P = 0.002), orthotopic bladder substitution (OR 2.492; 95% CI 1.423-4.364; P = 0.001) and prolonged hospital stay (OR 1.964; 95% CI:1.166-3.308; P = 0.011) were independent predictors for early readmission while hypertension (OR 1.670; 95% CI 1.007-2.769; P = 0.047) was an independent predictor for late readmission. CONCLUSION: Hospital readmissions are a significant problem after RC. In the present study, UUO, pyelonephritis, metabolic acidosis and intestinal obstruction were the main causes of readmission. Orthotopic bladder substitution and development of postoperative high-grade complications were significant predictors for overall readmission.


Assuntos
Cistectomia/efeitos adversos , Readmissão do Paciente/estatística & dados numéricos , Derivação Urinária/efeitos adversos , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Bexiga Urinária/cirurgia
16.
Arab J Urol ; 12(4): 256-61, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26019959

RESUMO

OBJECTIVE: To determine the use of the prostate specific antigen (PSA) level and digital rectal examination (DRE) findings to estimate the resected tissue weight (RTW) before transurethral resection of the prostate (TURP). PATIENTS AND METHODS: We retrospectively analysed 983 patients who underwent TURP between December 2006 and December 2012. The primary outcome was the RTW required for clinical improvement, and was not associated with re-intervention. Age, PSA level, body mass index (BMI) and DRE findings were correlated and modelled with the RTW. The DRE result was defined as DREa (small vs. large) or DREb (small vs. moderate vs. large) according to the surgeon's report. Equations to calculate RTW were developed and tested using receiver operating characteristic (ROC) curve analyses. RESULTS: There were significant correlations between PSA level (r = 0.4, P < 0.001) and RTW, whilst BMI and age showed weak correlations. The median (range) RTW was 45 (7-60) vs. 15 (6-60) g for small vs. large prostates (DREa) (P < 0.001), respectively. Similarly, the median (range) RTW was 11 (6-59) vs. 26.2 (6-60) vs. 42 (7-60) g in small vs. moderate vs. large prostates (DREb) (P < 0.001), respectively. Using PSA level and DREb (model 3) there was a significantly better ability to estimate RTW than using PSA and DREa (model 2) or PSA alone (model 1) based on ROC curve analyses. The equation developed by model 3 (RTW = 1.2 + (1.13 × PSA) + (DREb × 9.5)) had a sensitivity and specificity of 82% and 71% for estimating a RTW of >30 g, and 84% and 63% for estimating a RTW of >40 g, respectively. CONCLUSIONS: The PSA level and DRE findings can be used to predict the RTW before TURP.

18.
Urology ; 81(3): 508-10, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23332999

RESUMO

OBJECTIVE: To evaluate the effectiveness and safety of shock wave lithotripsy in the management vesical stones in patients with infravesical obstruction. MATERIALS AND METHODS: From March 2007 to April 2010, 59 male patients with infravesical obstruction were treated using the Dornier Compact Delta II Lithotriptor for urinary bladder stones. The indications for shock wave lithotripsy included patients refusing invasive procedures or those with orthopedic malformations hindering the lithotomy position. The mean age was 61.6 ± 8.6 years (range 44-78), and the mean body mass index was 29 ± 5.1 kg/m(2) (range 20.5-45). The mean stone diameter was 26.6 ± 9.8 mm (range 12-50). All patients underwent an initial session and were re-evaluated using ultrasonography and urinary tract plain radiography at 2-week intervals. RESULTS: All patients were treated in the supine position. The number of shocks ranged from 1910 to 9500. Of the 59 patients, 47 and 11 were cleared by 1 or 2 sessions, respectively; 1 patient required a third session to be cleared of stones. All patients develop mild hematuria and started to pass gravel in the first void after the shock wave lithotripsy session. All patients were rendered stone free within 6 weeks. During follow-up, only 2 male patients developed temporary acute urine retention necessitating urethral catheter fixation. Both patients had a neurologic insult. CONCLUSION: Extracorporeal shock wave lithotripsy is an effective, noninvasive approach to disintegrate vesical stones in patients with infravesical obstruction with adequate fragment clearance.


Assuntos
Litotripsia , Cálculos da Bexiga Urinária/terapia , Obstrução do Colo da Bexiga Urinária/terapia , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cálculos da Bexiga Urinária/complicações , Obstrução do Colo da Bexiga Urinária/etiologia
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